bluuebunny/crossref_metadata_2025_split huggingface dataset:
Childhood invasive pneumococcal disease: A hospital‐based study from Malaysia
Authors: Lim Li Han , Lee Way Seah , Parasakthi Navaratnam 
Published: May 2007

Aim:  New conjugate vaccine for Streptococcus pneumoniae has been introduced in Malaysia recently. Information on infection due to S. pneumoniae in Malaysian children is scarce. We conducted a retrospective chart review of childhood invasive pneumococcal disease (IPD) presented to a single centre in Malaysia.Methods:  A retrospective review of 5 years and 4 months of all cases of IPD in children younger than 14 years of age (May 1999–August 2004) seen at the University of Malaya Medical Centre (UMMC), Kuala Lumpur, was conducted. Cases were identified from the record of Department of Medical Microbiology, UMMC.Results:  IPD was identified in 50 children (median age 1.1 years, range 2 weeks−14 years) during the study period. Seventy‐six per cent of the cases were younger than 2 years of age. Pattern of infections noted include definite pneumonia (n = 8), probable pneumonia (n = 33), meningitis (n = 4), bacteraemia without focus (n = 4) and septic arthritis (n = 1 each). Pre‐morbid diseases were present in 28% of all cases. Complications (n = 12, 24%) due to IPD were seizures (n = 5), pleural effusion/empyema (n = 4), cerebral palsy (n = 2) and deafness (n = 1). No deaths were attributed to IPD. Sixty‐two per cent of the pneumococcal isolates were penicillin non‐susceptible and were detected throughout the study period.Conclusions:  IPD is associated with high morbidity, particularly among young children. Majority of the isolates were penicillin‐non‐susceptible strains. Additional information on the serotype of S. pneumoniae isolated is necessary to assess the potential impact of immunisation on preventing pneumococcal infection in Malaysia.
Infant care practices associated with sudden infant death syndrome: Findings from the Pacific Islands Families study
Authors: Schluter Philip J , Paterson Janis , Percival Teuila 
Published: May 2007

Aim:  To report infant care practice prevalence for known modifiable sudden infant death syndrome (SIDS) risk factors among a generally disadvantaged yet low‐SIDS rate population of mothers with Pacific infants.Methods:  The Pacific Islands Families study follows a cohort of Pacific infants born at a large tertiary hospital in South Auckland, between 15 March and 17 December 2000. Maternal self‐report of infant care practices was undertaken at interview 6 weeks post‐partum.Results:  Overall, 1376 mothers self‐reported upon their care practices for infants with median age of 7 weeks. Current maternal smoking was reported by 29%. Of infants: 50% were fully breastfed; 1% were placed prone to sleep; 50% usually bed‐shared with their mother and 12% usually bed‐shared with a mother who smoked; and 94% usually and 1% occasionally slept in the same room as their mother. Except for room sharing (P = 0.09), there were significant differences in these practices between the three major Pacific Island ethnic subgroups (all P < 0.001).Conclusion:  Adoption of bed‐sharing and room‐sharing practices appears to be saving Pacific infants’ lives, even though the New Zealand Cot Death Association has discouraged bed‐sharing and not actively promoted room sharing. Mothers need to receive adequate information antenatally about the risks and benefits of room‐sharing, bed‐sharing and safe‐sleeping practices and environments should they decide or have no option but to bed‐share.
Association of endothelial nitric oxide synthase gene intron 4 polymorphism with end‐stage renal disease
Authors: BELLINI MARIA H , FIGUEIRA MÁRCIA N , PICCOLI MICHELLY F , MARUMO JÚLIO T , CENDOROGLO MAYSA S , NETO MIGUEL C , DALBONI MARIA A , BATISTA MARCELO C , GOES MIGUEL Â , SCHOR NESTOR 
Published: May 2007

SUMMARY:Background:  Nitric oxide (NO) released from endothelial cells is related to the maintenance of physiological vascular tone. The impairment of endothelial NO generation brought about by gene polymorphism is considered one of the deterioration factors in progressive renal disease. In the endothelial nitric oxide synthase (eNOS) intron 4 polymorphism, the presence of the aa genotype has been associated with cardiovascular and renal disease. The aim of this study was to investigate the presence of eNOS gene intron 4 polymorphism in patients with end‐stage renal disease (ESRD).Methods:  A total of 114 patients and 94 controls were studied. DNA specimens were extracted from blood and amplified by polymerase chain reaction. The alleles were separated by agarose gel electrophoresis. Genotype distribution and allele frequencies were compared between groups using the chi‐squared test.Results:  Statistical analysis revealed that the frequency of the eNOS4 genotype aa was significantly different in ESRD patients and in controls (P = 0.016, OR = 2.07, CI 95%: 1.14–3.74). There was also a statistically significant difference between ESRD patients and controls regarding allele carriers (P = 0.004; OR = 2.26; CI 95%: 1.29–3.96). When the frequencies of allele carriers in the diabetic nephropathy group and in the control group were compared, a significant difference was found (P = 0.034, OR = 2.28; CI 95%: 1.04–5.00).Conclusion:  This study showed a strong correlation between eNOS4a polymorphism and end‐stage renal disease.
The differential regulation of Smad7 in kidney tubule cells by connective tissue growth factor and transforming growth factor‐beta1
Authors: QI WEIER , CHEN XINMING , TWIGG STEPHEN , ZHANG YUAN , GILBERT RICHARD E , KELLY DARREN J , POLLOCK CAROL A 
Published: May 2007

Summary:Aims:  Smad7 is an inhibitory Smad that regulates transforming growth factor‐β (TGF‐β) signaling. Connective tissue growth factor (CTGF) is recognized as a potent downstream mediator of the fibrogenic effects of TGF‐β1. SMAD binding sites have been identified in both TGF‐β and CTGF promoters. The effect of CTGF on Smad7 expression and its role in the regulation of Smad7 induced by TGF‐β1 in renal tubular cells is unknown.Methods:  Human model of proximal tubular cells (HK‐2 cells) was used and confirmed using a diabetic rat model. RT‐PCR was performed to measure Smad7, TGF‐β1 and Smad2 and ELISA was performed to measure active TGF‐β1. CTGF or TGF‐β1 was silenced in HK‐2 cells using siRNA methodology.Results:  TGF‐β1 induced Smad7 in a time‐dependent manner, peaking at 30 min (P < 0.0005) but sustained up to 24 hrs (p < 0.005). Conversely, CTGF reduced Smad7, which was maximal at 24 hrs (p < 0.05). This was supported by our in vivo data demonstrating that CTGF protein significantly increased while Smad7 mRNA level was reduced in a diabetic rat model. The basal expression level of Smad7 decreased in TGF‐β1 silenced cells compared to cells transfected with non‐specific siRNA (p < 0.0005). The basal expression level of Smad7 increased in CTGF silenced cells (p < 0.05), which was increased by TGF‐β1 (p < 0.005). Both mRNA and protein levels of TGF‐β1 decreased in CTGF silenced cells (p < 0.05 and p < 0.005 respectively) accompanied by reduction in Smad2 mRNA level in CTGF silenced cells.Conclusions:  Smad7 is induced rapidly by TGF‐β1 limiting the response to TGF‐β1. CTGF likely plays a key role in promoting TGF‐β1 activity by decreasing the availability of Smad7 and increasing Smad2.
DISCREPANCIES IN GLEASON SCORING OF PROSTATE BIOPSIES AND RADICAL PROSTATECTOMY SPECIMENS AND THE EFFECTS OF MULTIPLE NEEDLE BIOPSIES ON SCORING ACCURACY. A REGIONAL EXPERIENCE IN TAMWORTH, AUSTRALIA
Authors: Ooi Kevin , Samali Ramin 
Published: May 2007

Background:  The aim of this study was to review the discrepancies in Gleason scores (GS) of prostate biopsies and radical prostatectomy specimens and the effects of multiple‐needle biopsies on scoring accuracy.Methods:  One hundred patients who had undergone consecutive radical prostatectomies (RP) between January 2004 and May 2006 were reviewed retrospectively. Patient information including age, prebiopsy prostate‐specific antigen levels, biopsy GS, RP GS and pathology details were recorded and compared.Results:  The concordance rate of biopsy GS and RP GS was found to be at 43%, with 46% of biopsy specimens being undergraded. Eleven per cent of the specimens were overgraded. The accuracy was fairly similar when specimens were reported by the same or different pathologists, at 42 and 44%, respectively. The accuracy of biopsy GS improved with increasing number of biopsies taken.Conclusion:  There are significant discrepancies in Gleason scoring of biopsy and RP specimens, with a concordance rate of 43% and undergrading rate of 46%. Increasing the number of biopsies helps improve scoring accuracy. Clinicians and patients need to be mindful when deciding cancer treatment options, in view of these discrepancies.
VASCULAR SURGERY CONSULTS: A SIGNIFICANT WORKLOAD
Authors: Koh Cherry E. , Walker Stuart R. 
Published: May 2007

Background:  Patients with vascular disease typically suffer from widespread atherosclerosis and complex multisystem pathologies. As a result, it may be expected that significant portion of a vascular surgeon’s inpatient workload is derived from consultations from other inpatient specialist units. This aspect of the workload of vascular surgeons is poorly documented.Methods:  A prospective audit on inpatient vascular consultations was carried out. All vascular admissions to the Vascular Surgery unit at the Royal Hobart Hospital as well as inpatient referrals by other units over a 6‐month period were recorded on a database. The data were analysed to evaluate the number of inpatient consultations, the reason for the consultation and its outcome.Results:  Most inpatient referrals were derived from internal medicine (32%), renal, endocrinology and plastic surgery units (26, 13 and 9%, respectively). Sixty‐four per cent of all referrals required intervention with most of these patients having been referred from renal and endocrinology units.Conclusion:  In our experience, 50% of the vascular surgeon’s inpatient workload is derived from inpatient referrals. Sixty‐four per cent of referrals required some form of vascular intervention. This aspect of vascular workload is significant and has not been previously documented. It is time‐consuming and also resource consuming and this needs to be taken into consideration when allocating theatre resources and during rostering.
GALL BLADDER POLYPS IN SCLEROSING CHOLANGITIS: DOES THE 1‐CM RULE APPLY?
Authors: Leung Universe C , Wong Phillip Y , Roberts Ross H , Koea Jonathan B 
Published: May 2007

Introduction:  Polyps of the gall bladder (PLG) are common findings in radiological investigations of the gall bladder and most are benign although carcinoma of the gall bladder can arise in PLG. In the general population PLG less than 1 cm in diameter are thought to have a low risk of malignancy and can be cautiously observed.Methods:  All patients undergoing surgical resection for gall bladder cancer were entered into a prospective database. Four patients with primary sclerosing cholangitis (PSC) presenting with gall bladder cancer in a PLG are studied.Results:  Four patients (two men; median age 46.5 years, range 37–71 years) presented with PLG and known histories of PSC. All patients were shown to have PLG of size between 7 mm × 8 mm and 25 mm × 14 mm on imaging with no radiological evidence of carcinoma. Tumour markers carcinoembryonic antigen and CA19‐9 were within the normal range in all patients. All patients were managed with cholecystectomy. Two patients with T1 tumours remain alive and well at 2 and 4 years post‐cholecystectomy. Of the remaining two patients with T2 tumours, one underwent re‐resection of the liver bed and portal lymph nodes and remains alive and well at 12 months. The remaining patient developed an abdominal wall recurrence 12 months after cholecystectomy. She has also undergone resection with postoperative radiation therapy and remains well after 12 months of clinical follow up.Conclusion:  Gall bladder polyps, which are common and are usually benign in the general population, are often malignant in PSC. Regardless of size, any PLG in a patient with PSC should be considered for cholecystectomy.
TREATMENT OF DUODENAL ADENOMAS WITH ENDOSCOPIC ARGON PLASMA COAGULATION
Authors: Lienert Andrew , Bagshaw Philip F 
Published: May 2007

Background:  Surgical resection has been the standard treatment for duodenal adenomas. It has a high associated morbidity rate and a significant recurrence rate. The aim of this study was to evaluate endoscopic treatment of these lesions with argon plasma coagulation.Methods:  We retrospectively identified patients with non‐ampullary duodenal adenomas without a polyposis syndrome and who were treated endoscopically between 1st January 1999 and 31st December 2003. Their management, follow up and outcomes were reviewed.Results:  Fifteen patients were included, with mean age 72 years (range 46–85 years). All were treated with at least one session of argon plasma coagulation. Initially, 13 adenomas were macroscopically cleared. Of these, eight (61%) had no recurrence during mean follow up of 40 months (26–68 months). The mean time to recurrence was 14 months (6–30 months). Eradication was possible a second time in four of five recurrent adenomas. There was one complication, of haemorrhage, from 37 sessions of argon plasma coagulation. No patient developed duodenal adenocarcinoma during the study period.Conclusion:  Argon plasma coagulation may be safe and effective for the treatment of duodenal adenomas, but further research is required. Progression of adenomas is slow and perhaps no treatment is required.
NERVE STIMULATION IN THYROID SURGERY: IS IT REALLY USEFUL?
Authors: Loch‐Wilkinson Thorbjorn J , Stalberg Peter L. H , Sidhu Stan B , Sywak Mark S , Wilkinson James F , Delbridge Leigh W 
Published: May 2007

Background:  Monitoring of the recurrent laryngeal nerve (RLN) has been claimed in some studies to reduce rates of nerve injury during thyroid surgery compared with anatomical dissection and visual identification of the RLN alone, whereas other studies have found no benefit. Continuous monitoring with endotracheal electrodes is expensive whereas discontinuous monitoring by laryngeal palpation with nerve stimulation is a simple and inexpensive technique. This study aimed to assess the value of nerve stimulation with laryngeal palpation as a means of identifying and assessing the function of the RLN and external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery.Methods:  This was a prospective case series comprising 50 consecutive patients undergoing total thyroidectomy providing 100 RLN and 100 EBSLN for examination. All patients underwent preoperative and postoperative vocal cord and voice assessment by an independent ear, nose and throat surgeon, laryngeal examination at extubation and all were asked to complete a postoperative dysphagia score sheet. Dysphagia scores in the study group were compared with a control group (n = 20) undergoing total thyroidectomy without nerve stimulation.Results:  One hundred of 100 (100%) RLN were located without the use of the nerve stimulator. A negative twitch response occurred in seven (7%) RLN stimulated (two bilateral, three unilateral). Postoperative testing, however, only showed one true unilateral RLN palsy postoperatively (1%), which recovered in 7 weeks giving six false‐positive and one true‐positive results. Eighty‐six of 100 (86%) EBSLN were located without the nerve stimulator. Thirteen of 100 (13%) EBSLN could not be identified and 1 of 100 (1%) was located with the use of the nerve stimulator. Fourteen per cent of EBSLN showed no cricothyroid twitch on EBSLN stimulation. Postoperative vocal function in these patients was normal. There were no instances of equipment malfunction. Dysphagia scores did not differ significantly between the study and control groups.Conclusion:  Use of a nerve stimulator did not aid in anatomical dissection of the RLN and was useful in identifying only one EBSLN. Discontinuous nerve monitoring by stimulation during total thyroidectomy confers no obvious benefit for the experienced surgeon in nerve identification, functional testing or injury prevention.
The National Pediatric Epidural Audit
Authors: LLEWELLYN N , MORIARTY A. 
Published: May 2007

SummaryBackground:  This paper describes a prospective audit of children receiving epidural infusion analgesia (EIA) in Great Britain and Ireland. The aim was to quantify the risks associated with this technique.Methods:  In order to obtain sufficient data on the number of pediatric epidurals performed and the incidence of unwanted events, a decision was taken, at an Annual Meeting of Great Britain and Ireland Paediatric Pain Services, to establish a national audit of EIA practice in these centers. Each site sent a monthly return of the numbers of EIA performed to the coordinating center. If an incident occurred then the referring site completed a more detailed form and the child was followed up for 1 year if possible. Incidents were graded by severity 1–3, serious to minor.These data were collected over the 5‐year period (2001–2005).Results:

Ninety six incidents were reported in 10 633 epidurals performed.
Fifty six were associated with the insertion or maintenance of EIA; most were of low severity (1 : 189).
Five incidents were graded as 1 (serious) (approximately 1 : 2000).
Nine incidents were graded as 2 (approximately 1 : 1100).
Only one child has residual effects from a grade 1 incident 12 months after surgery (approximately 1 : 10 000).
Forty incidents were also reported that were felt to be associated with the use of EIA; 33 of these incidents were the development of pressures sores. Four incidents of compartment syndrome were reported, in each of these cases the presence of EIA did not mask the condition.

Conclusions:  Epidural infusion analgesia in children does have risks associated with the technique. The occurrence of compartment syndrome does not appear to be masked by the presence of working EIA.As a result of this audit we can now provide parents with better information, thereby improving the process of informed consent.
Percutaneous transtracheal emergency ventilation with a self‐made device in an animal model
Authors: SCHAEFER RAIK , HUETER LARS , PREUSSLER NIELS‐PETER , SCHREIBER TORSTEN , SCHWARZKOPF KONRAD 
Published: May 2007

SummaryBackground:  Special equipment for emergency percutaneous transtracheal ventilation is often not immediately available. We used a self‐made device consisting of a three‐way stopcock connected between a G‐15 transtracheal airway catheter and an oxygen supply in a simulated ’cannot intubate, cannot ventilate’ scenario and tested the hypothesis that the effectiveness of the device depends on the body weight of the experimental animals.Methods:  With approval of the local animal protection committee, two groups of six pigs each with a body weight of 21 ± 2 and 36 ± 6 kg, respectively, were tracheally intubated and mechanically ventilated after induction of anesthesia. Hemodynamic monitoring included cardiac output and arterial, central venous and pulmonary artery pressures. An emergency transtracheal airway catheter was inserted into the trachea and a situation of partial expiratory airway obstruction was created. Each animal was ventilated for 15 min via the transtracheal airway catheter with the self‐made device (FiO2 1.0 at an oxygen flow of 15 l·min−1; respiratory rate of 60 min−1; I/E ratio approximately 1 : 1).Results:  Whereas satisfactory oxygenation was achieved in all animals, sufficient ventilation was obtained only in the lightweight animals.Conclusions:  Adequate oxygenation could be provided by jet‐like transtracheal ventilation with a simple self‐made device using easily available materials. Sufficient ventilation depends on the body weight of the animals.
Clonidine disposition in children; a population analysis
Authors: POTTS AMANDA L , LARSSON PETER , EKSBORG STAFFAN , WARMAN GUY , LÖNNQVIST PER‐ARNE , ANDERSON BRIAN J 
Published: May 2007

SummaryBackground:  There are few data describing clonidine population pharmacokinetics in children (0–15 years) despite common use. Current pediatric data, described in terms of elimination half‐life or Cmax and Tmax, poorly explain variability in drug responses among individuals representative of those in whom the drug will be used clinically.Methods:  Published data from four studies investigating clonidine PK after intravenous (i.v.), rectal and epidural administration (n = 42) were combined with an open‐label study undertaken to examine the pharmacokinetics of i.v. clonidine 1–2 μg·kg−1 bolus in children after cardiac surgery (n = 41). A population pharmacokinetic analysis of clonidine time–concentration profiles (380 observations) was undertaken using nonlinear mixed effects modeling. Estimates were standardized to a 70‐kg adult using allometric size models.Results:  Children had a mean age of 4 (sd 3.6 years, range 1 week–14 years) years and weight 17.8 (sd 12.6, range 2.8–60) kg. A two compartment disposition model with first‐order elimination was superior to a one compartment model. Population parameter estimates (between subject variability) were clearance (CL) 14.6 (CV 35.1%) l·h−1 70 kg−1, central volume of distribution (V1) 62.5 (71.1%) l 70 kg−1, intercompartment clearance (Q) 157 (77.3%) l·h−1 70 kg−1 and peripheral volume of distribution (V2) 119 (22.9%) l 70 kg−1. Clearance at birth was 3.8 l·h−1 70 kg−1 and matured with a half‐time of 25.7 weeks to reach 82% adult rate by 1 year of age. The volumes of distribution, but not clearance, were increased after cardiac surgery (V1 123%, V2 126%). There was a lag time of 2.3 (CV 73.2%) min before absorption began in the rectum. The absorption half‐life from the epidural space was slower than that from the rectum (0.98 CV 24.5% h vs 0.26 CV 32.3% h). The relative bioavailability of epidural and rectal clonidine was unity (F = 1).Conclusions:  Clearance in neonates is approximately one‐third that described in adults, consistent with immature elimination pathways. Maintenance dosing, which is a function of clearance, should be reduced in neonates and infants when using a target concentration approach.