bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prone equals prone? – impact of different techniques of body positioning on functional residual capacity and ventilation distribution in anaesthetised, paralysed preschool children
Authors: Von Ungern‐Sternberg B.S. , Frei F.J. , Hammer J. , Erb T.O. 
Published: November 2006

Introduction:  In children undergoing anesthesia or sedation, optimizing functional residual capacity (FRC) is of special importance, because they have smaller elastic retraction forces compared with adults and a lower relaxation volume that makes them more prone to airway collapse. Moreover, children are particularly vulnerable to hypoxaemia because of their higher oxygen demand per kilo body weight. Although the prone position is effectively used to improve oxygenation, its impact on FRC is controversial. Thus, additional confounding factors such as changes in ventilation distribution or differences in positioning techniques might be of importance. In fact, positioning techniques such as flat versus augmented prone position could exert different degrees of pressure on the abdominal contents and thus differences in the cephalic displacement of the diaphragm. The aim of this study was to determine the impact of two different prone positioning techniques on FRC and ventilation distribution in anesthetized, paralyzed preschool‐aged children. We hypothesized that augmented prone positioning improves FRC and ventilation distribution compared with the supine or flat prone position.Methods:  Following local Ethics Committee approval, 30 preschool children without cardiopulmonary disease undergoing elective surgery were studied. FRC and lung clearance index (LCI), a measure of ventilation distribution, were calculated using a sulfur‐hexafluoride gas (SF6) multibreath washout technique. After intubation, the measurements were taken in the supine position and in random order in the flat prone and augmented prone position (gel pads supporting the pelvis and the upper thorax to ensure free movement of the abdomen). The position of the arms was kept constant and the head was turned to the side for all assessments. Measurements were taken 5 min after each positioning. Results:  Mean (range) age was 48.5 (24–80) months, weight = 17.2 (10.5–26.9) kg. FRC (mean ± SD) was 22.9 ± 6.2 ml·kg‐1 in the supine position and 23.3 ± 5.6 ml·kg‐1 in the flat prone position while LCI was 8.1 ± 2.3 vs 7.9 ± 2.3 in these two positions, respectively. In contrast, FRC increased to 27.6 ± 6.5 ml·kg‐1 (P < 0.001) in the augmented prone position while at the same time the LCI decreased to 6.7 ± 0.9 (P < 0.001).Conclusions:  FRC and ventilation distribution were similar in the supine and flat prone positions, while these parameters improved significantly in the augmented prone position suggesting that the technique of prone positioning could have a major impact on respiratory function in anaesthetized, mechanically ventilated preschool children.Acknowledgement:  The study was funded by the Department of Anaesthesia, University of Basel, Switzerland.
Epidural analgesia for tracheo‐oesophageal fistula repair
Authors: Krishnan K. , Marcus R. 
Published: November 2006

Introduction:  Traditionally neonates undergoing surgical repair of tracheo‐oesophageal fistula (TOF) would receive opioid analgesia and be returned ventilated to a neonatal intensive care unit (ICU). It has been shown that the use of epidural analgesia can reduce the need for postoperative ventilation (1). In recent years it has been the practice in our institution to use epidural analgesia for these neonates where possible. This is an audit of our recent experience.Methods:  We retrospectively identified cases of TOF repair at our institution from January 2002 to September 2005. The notes of these neonates were reviewed for the following information: birth weight, gestational age, co‐existing congenital anomalies, preoperative respiratory function, operation duration, postoperative analgesia, ICU admission and duration of stay in ICU.Results:  Thirty‐five TOF repairs were identified. One neonate was excluded as he had concomitant abdominal surgery. Of the 34 remaining, 30 sets of notes were reviewed. The outcome for these neonates is shown in the diagram. Of the 10 neonates who did not receive an epidural, a reason was found in eight cases: three were already ventilated, two had abnormal coagulation, two had coexisting congenital heart disease and one had recurrent apnoeas. Only three of the 20 neonates with an epidural required postoperative ventilation, one for metabolic acidosis, one for lung collapse and one for inadequate respiratory effort. All three remained on ICU for <24 h. The median PICU stay for those neonates who did not receive an epidural was 4 days (range 2–11 days). The group who received epidural analgesia was more mature (38.7 weeks c.f. 35.3 weeks gestational age) and heavier (2.9 kg c.f. 2.3 kg) than the group who did not. The mean operative time (including bronchoscopy and surgery) was 2.8 h in the epidural group and 3.3 h in the nonepidural group. Conclusion:  Mature neonates presenting for TOF repair can be managed with epidural analgesia, usually removing the need for postoperative ventilation and an ICU bed. There is a group of smaller, less mature neonates that did not receive epidural analgesia, we cannot determine from this audit whether any of these would have benefited from epidural analgesia.Reference  1 Bosenberg AT, Wiersma R, Hadley GP. Esophageal atresia: caudo‐thoracic epidural anesthesia reduces the need for post‐operative ventilatory support. Pediatr Surg Int 1992; 7: 289–291.
Serial measurement of leak conductance around uncuffed endotracheal tubes in children after cardiopulmonary bypass
Authors: Murphy T.W.G. , Reay C.A. , Sims A.J. , Smith J.H. 
Published: November 2006

Introduction:  Judging the correctness of the fit of an uncuffed tube in the trachea is an imprecise process that may rely on detecting a just‐audible leak (1). An optimal fit would allow adequate ventilation whilst minimising trauma to the subglottis. If ventilation is prolonged, the fit of the tube in the trachea might vary. We believe that the leak of gas around an uncuffed tube may be evaluated to give an indication of the ‘goodness’ of fit.Methods:  In the laboratory we developed a technique for quantifying the leak around the tracheal (TT) tube in ventilated children from continuous measurements of airway pressure and inspiratory and expiratory flow acquired from a ventilator. We obtained ethical approval to study 20 children who were ventilated on our PICU after undergoing cardiac surgery on cardiopulmonary bypass. Recordings were made for sequences of 100 breaths at intervals of approximately 4 h during the time that the child was ventilated. Audible leak was graded as ‘none’, ‘minute’, ‘moderate’ or ‘large’ by the anaesthetist responsible for each patient. We calculated the leak conductance (in l.s.–1 cmH2O–1) for each recording and plotted it against time for each patient. We calculated the average leak conductance from the normalised area under this curve to account for irregular sampling, and used this quantity (2) to compare patients who were grouped according to grade of audible leak.Results:  A total of 286 recordings were collected from 20 patients (age range 5–1356 days, mean age 193 days, weight range 3.0–12.4 kg, mean weight 5.5 kg). Eleven recordings were rejected due to failure or artefact, and two patients were excluded due to insufficient data (two or fewer recordings). Five patients were graded with moderate or large audible leak and the mean leak conductance for this group (mean 360 l.s –1 cmH2O–1) significantly exceeded the leak conductance for the remaining 13 patients with no leak or minute leak (mean 125 l.s –1 cmH2O–1)) with P < 0.05.Discussion:  We have demonstrated that the physical characteristics of a leak around an uncuffed ET tube can be quantified (3) and that, in this small study, serial measurement of leak conductance is consistent with qualitative audible assessment of leak.Conclusion:  Leak conductance may provide an objective method for analysing the leak around an uncuffed TT tube and thereby the fit of the tube in the subglottis. We believe that this technique, if adapted, may be useful in the clinical setting.References  1 Fine GF, Borland LM. The future of the cuffed endotracheal tube. Pediatr Anesth 2004; 14: 38–42.2 Matthews JNS et al. Analysis of serial measurements in medical research. BMJ 1990; 300: 230–235.3 Smith JH et al. Leak resistance around uncuffed endotracheal tubes. Pediatr Anesth 2005; 15: 805–806.
Saving the sphincter in rectal cancer: are we prepared to change practice?
Authors: Wallace M. H. , Glynne‐Jones R. 
Published: November 2006

AbstractTotal mesorectal excision and preoperative radiation with or without chemotherapy has led to a reduction in local recurrence rates in patients with rectal cancer. This article examines the effect such treatment has on the rate of sphincter preservation in patients with rectal cancers close to the anal sphincter mechanism and looks at the evidence for changing clinical practice.
THE CONFESSING ANIMAL IN FOUCAULT AND WITTGENSTEIN
Authors: Plant Bob 
Published: November 2006

ABSTRACTIn The History of Sexuality, Foucault maintains that “Western man has become a confessing animal” (1990, 59), thus implying that “man” was not always such a creature. On a related point, Wittgenstein suggests that “man is a ceremonial animal” (1996, 67); here the suggestion is that human beings are, by their very nature, ritualistically inclined. In this paper I examine this crucial difference in emphasis, first by reconstructing Foucault's “genealogy” of confession, and subsequently by exploring relevant facets of Wittgenstein's later thinking. While there are significant correlations between Foucault and Wittgenstein, an important disparity emerges in relation to the question of the “natural.” By critically analyzing this, I show how Wittgenstein's minimal naturalism provides an important corrective to Foucault's more extravagant claims. By implication, we see why any radical relativist, historicist, and/or constructivist position becomes untenable on Wittgensteinian grounds, even though Wittgenstein himself is often read as promoting such views.
“NOT ETHICS, NOT ETHICS ALONE, BUT THE HOLY”
Authors: Caruana John 
Published: November 2006

ABSTRACTWhile much has been written about Levinas's conception of ethics, very little has been said about the connection between ethics and holiness in his work. Yet, throughout much of his corpus, Levinas consistently links the two. The first part of my article addresses the important distinction that Levinas establishes between the sacred (le sacré) and holiness (la sainteté). According to Levinas, several influential thinkers conflate these two categories. Holiness, Levinas suggests, represents a kind of antidote to the sacred. The second part examines the various ways that holiness is manifest in ethicality. The key, I suggest, for properly understanding the link between ethical regard and sanctification revolves around an appreciation of Levinas's frequent appeal to the notion of straightforwardness (droiture). For Levinas, the complex relations that bind the self, Other, and God, involve essential conditions of rectitude and uprightness.
THE RELIGIOUS ETHICS IMPLICIT IN SCHLEIERMACHER'S DOCTRINE OF CREATION
Authors: Crossley John P. 
Published: November 2006

ABSTRACTThere is a religious ethics implicit in Schleiermacher's doctrine of creation based on the universal feeling of absolute dependence “prior to” its being informed by any historical tradition. The “highest good” which fundamentally characterizes his religious ethics is found at the intersection of God and the World. The “original perfection of man” and the “original perfection of the world” come together when human life in the world is fully informed by the feeling of absolute dependence. Although Schleiermacher did not develop his religious ethics to the same extent as his philosophical and Christian ethics, it should still be of interest to ethicists in many religious traditions, as it establishes contours and sets limits for the ethics of any monotheistic religious tradition.
RELIGIONIS CAUSA
Authors: Van Eijnatten Joris 
Published: November 2006

ABSTRACTThe claim is widespread that the preservation, or reintroduction, of Western traditions of holy war in the post‐Reformation period was due mostly to Protestantism, especially in its Calvinist variety. This paper makes a case for examining the thought of a much broader selection of minor intellectuals on just and holy war than is usually done, and to do so in other national contexts than exclusively the English Puritan one. To test the apparently widespread view that, historically, Calvinism has had a particular proclivity for holy war, the article treats theological justifications of war in seventeenth‐ and eighteenth‐century Dutch moral theology. Showing that a full‐blown concept of “holy war” was largely absent from Dutch theological thought, it falsifies the assumption that historical Calvinism (or Protestantism in general) is inherently belligerent. The paper demonstrates that justifications of violencereligionis causaand ideological motives for war have always been contingent, not on religions, but on the historical contexts in which those religions operate.
AN ENGAGED BUDDHIST RESPONSE TO JOHN RAWLS'S THE LAW OF PEOPLES
Authors: King Sallie B. 
Published: November 2006

ABSTRACTIn The Law of Peoples, John Rawls proposes a set of principles for international relations, his “Law of Peoples.” He calls this Law a “realistic utopia,” and invites consideration of this Law from the perspectives of non‐Western cultures. This paper considers Rawls's Law from the perspective of Engaged Buddhism, the contemporary form of socially and politically activist Buddhism. We find that Engaged Buddhists would be largely in sympathy with Rawls's proposals. There are differences, however: Rawls builds his view from the idea of independent nation–states, while the Buddhists see the world more in terms of a single humankind, the members being highly interdependent with one another, and also with the physical world. The Buddhists would also push harder than Rawls for global structures building multilateralism, restrict more severely justifications for war and behavior in war, stress economic justice more heavily, and insist on all the human rights in the Universal Declaration of Human Rights.
Lupus erythematosus and other autoimmune diseases related to statin therapy: a systematic review
Authors: Noël B 
Published: November 2006

AbstractBackground  Statins have been increasingly associated with drug‐induced autoimmune reactions, including lupus erythematosus.Objective  To identify and determine the clinical and biological characteristics of statin‐induced autoimmune reactions.Material and methods  The MEDLINE database (1966 to September 2005) was used to identify all reported cases of statin‐induced autoimmune diseases. The keywords used were statins, 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors, adverse effects, autoimmune disease, lupus erythematosus, dermatomyositis and polymyositis.Results  Twenty‐eight cases of statin‐induced autoimmune diseases have been published so far. Systemic lupus erythematosus was reported in 10 cases, subacute cutaneous lupus erythematosus in three cases, dermatomyositis and polymyositis in 14 cases and lichen planus pemphigoides in one case. Autoimmune hepatitis was observed in two patients with systemic lupus erythematosus. The mean time of exposure before disease onset was 12.8 ± 18 months; range 1 month−6 years. Systemic immunosuppressive therapy was required in the majority of cases. In many patients, antinuclear antibodies were still positive many months after clinical recovery. A lethal outcome has been recorded in two patients despite aggressive immunosuppressive therapy.Conclusion  Long‐term exposure to statins may be associated with drug‐induced lupus erythematosus and other autoimmune disorders. Fatal cases have been reported despite early drug discontinuation and aggressive systemic immunosuppressive therapy.
The autologous serum skin test in a cohort of chronic idiopathic urticaria patients compared to respiratory allergy patients and healthy individuals
Authors: Guttman‐Yassky Emma , Bergman Reuven , Maor Carcom , Mamorsky Merav , Pollack Shimon , Shahar Eduardo 
Published: November 2006

AbstractBackground  A positive autologous serum skin test (ASST) is considered to reflect the presence of anti‐FceRI and/or anti‐IgE autoantibodies that are capable of activating mast and basophil cell degranulation. The ASST is regarded as a reliable in vivo test in chronic idiopathic urticaria (CIU) patients, with diagnostic, therapeutic and prognostic implications. However, positive ASST results have also occasionally been demonstrated in patients with other diseases and in healthy subjects.Objective  To evaluate the specificity and sensitivity of the ASST in a cohort of CIU patients compared to a cohort of respiratory‐allergic patients and a group of normal individuals.Methods  ASST was performed in a cohort of 116 subjects, 47 subjects with seasonal allergic rhinitis, 32 respiratory‐symptom‐free CIU patients, and 37 healthy individuals.Results  The results were compared statistically to those of the CIU patients. The intradermal injection of autologous serum induced a weal and flare reaction in 17/32 (53.1%) CIU patients; 14/47 (29.8%) patients with seasonal allergic rhinitis (P = 0.06) and in 15/37 (40.5%) of the healthy controls (P = 0.34). The sensitivity and specificity of the ASST in the CIU patients and the seasonal allergic rhinitis patients was 53 and 28%, respectively. When comparing the CIU patients with the healthy controls the sensitivity and specificity was 55 and 31%, respectively. The positive and negative predictive values of the ASST when comparing CIU patients with healthy controls were 53 and 59.5%, respectively. The positive and negative predictive values of the ASST in the CIU patients compared to seasonal allergic rhinitis patients were 53 and 70%, respectively.Conclusion  The relatively low sensitivity and specificity of the ASST in the CIU patients compared to the seasonal allergic rhinitis patients and healthy controls warrants a more critical interpretation of the ASST in chronic idiopathic urticaria.
Digital computer analysis of dermatoscopical images of 260 melanocytic skin lesions; perimeter/area ratio for the differentiation between malignant melanomas and melanocytic nevi
Authors: Fikrle T , Pizinger K 
Published: November 2006

AbstractBackground  Digital computer analysis of dermatoscopical images has been reported to facilitate the differential diagnosis of pigmented skin lesions in recent years.Objective  The aim of our study was to perform digital computer analysis of a set of different melanocytic lesions and compare the objective results.Methods  The set of 260 melanocytic lesions (150 excised difficult cases (46 melanomas, 47 atypical nevi, 57 common nevi and 110 unexcised common nevi) was automatically analysed by the digital dermatoscopical system microDERM. We searched for differences in asymmetry, size, compactness and colour distribution. Perimeter/area ratio was calculated.Results  The perimeter/area ratio was detected as the most important criterion for differentiation between malignant and benign melanocytic lesions (sensitivity 91.3% and specificity 90.7% for malignant melanomas vs. all benign nevi; sensitivity 91.3% and specificity 80.8% for melanomas vs. clinically atypical nevi). Differences in size of the lesion, shape and asymmetry of colour were found and statistically verified. Using step‐wise logistic regression the formula for calculation of probability of malignant nature of every analysed lesion was constructed.Conclusion  The perimeter/area ratio is a simple parameter for the differential diagnosis of melanocytic skin lesions.
Vascular adhesion protein‐1 (VAP‐1) is overexpressed in psoriatic patients
Authors: Madej A , Reich A , Orda A , Szepietowski JC 
Published: November 2006

AbstractBackground  Vascular adhesion protein (VAP)‐1 is an adhesion molecule with an enzymatic activity that partakes in the migration process of lymphocytes.Objectives  The aim of this study was to investigate the expression of VAP‐1 in the skin and serum of psoriatic patients.Material and methods  Seventy‐one patients suffering from psoriasis aged between 23 and 89 years were included in the study. The mean psoriasis severity assessed according to the psoriasis area and severity index was 14.2 ± 9.6 points. The soluble VAP‐1 serum concentration was evaluated by ELISA and VAP‐1 expression in the skin (nine patients) immunohistochemically.Results  The serum concentration of soluble VAP‐1 was significantly higher in psoriatic patients than in healthy controls (403.4 ± 130.8 ng/mL vs. 246.4 ± 68.0 ng/mL; P < 0.0001). No significant relationships were found between sVAP‐1 concentration and studied clinical parameters, except the presence of pruritus. Mean number of VAP‐1 positive vessels in psoriatic skin, both lesional (19.8 ± 1.4) and non‐lesional (9.4 ± 1.4), was significantly higher than in healthy skin (5.4 ± 1.5; P < 0.005). Lesional psoriatic skin demonstrated significantly more VAP‐1 positive vessels than non‐lesional skin (P < 0.01).Conclusions  Significant overexpression of VAP‐1 in both lesional and non‐lesional psoriatic skin and higher serum level of soluble VAP‐1 in psoriatic patients may indicate the role of VAP‐1 in chronic inflammation occurring in psoriasis. However, because of lack of correlation between soluble VAP‐1 serum levels and psoriasis severity this hypothesis needs further investigation.
Dual alteration of limbic dopamine D1 receptor‐mediated signalling and the Akt/GSK3 pathway in dopamine D3 receptor mutants during the development of methamphetamine sensitization
Authors: Chen Pei‐Chun , Lao Chu‐Lan , Chen Jin‐Chung 
Published: November 2006

AbstractThe central dopamine system plays significant roles in motor activity and drug‐induced behavioural sensitization. Our goal was to determine the significance of dopamine D3 receptors in the development of behavioural sensitization to methamphetamine, assessed with D3 receptor mutant mice. The absence of D3 receptors significantly increased the behavioural responses to acute methamphetamine and evoked a faster rate of behavioural sensitization to chronic methamphetamine. In addition, both D3 receptor protein and mRNA levels in the limbic forebrain decreased in sensitized wild‐type mice. Further analyses indicated that D1‐dependent behavioural sensitization and the number of limbic D1 receptors increased in sensitized D3 mutants as compared with sensitized wild‐type mice. Consistent with this finding, we observed higher levels of D1 receptor‐evoked cAMP accumulation and basal phosphoDARPP‐32/Thr34 in the limbic forebrain of D3 mutants than wild‐type mice and the difference was more pronounced after chronic methamphetamine treatment. We also observed an increase in phospho‐extracellular signal‐regulated kinase 2 but a decrease in phosphoAkt/Ser473 and phosphoglycogen synthase kinase 3 (GSK3)‐α/β in the limbic forebrain of D3 mutants compared with wild‐type mice after methamphetamine treatment. The convergent results implicate D3 receptors as a negative regulator of the development of methamphetamine sensitization. A compensatory up‐regulation of D1 receptor‐mediated signals, in addition to an altered Akt/GSK3 pathway, could contribute to the accelerated development of behavioural sensitization.