bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retention of general practitioners in rural Nepal: A qualitative study
Authors: Butterworth Katrina , Hayes Bruce , Neupane Bhusan 
Published: July 2008

AbstractObjectives:  To explore the key issues that influence GP retention in rural areas of Nepal. Design:  A qualitative study using triangulation of data from one postal questionnaire, one hand‐delivered questionnaire with semistructured interview and focus group discussions. Data from a small community survey from 13 rural districts also included. Participants:  Sixty‐two Nepali GPs, 25 doctors in General Practice training programs, 11 individuals involved in policy development and rural health care. Results:  The key issues identified by this study as critical to the retention of Nepali GPs in rural areas were: • Career/promotion prospects• Status/recognition• Financial incentives• Working conditions• Education for children• Continuing medical education• Political stability and securityConclusions:  The strongest theme was that of career development. This must be addressed by the Government of Nepal if there is to be any hope of improving retention of GPs in rural areas. GPs need to have a clear career ladder, with recognition of the value of service in rural areas. There is, however, no one single answer to the complex interacting factors that impact on GP retention in rural Nepal. A multifaceted, holistic response is necessary. From the level of community awareness, a career structure and financial remuneration to adequately set up hospitals, functional teams, family support, continuing professional development and a secure working environment – each area must be addressed for the whole to function.
Quality of life in Hepatitis C virus infection: Assessment of rural patients living in north‐western New South Wales
Authors: Gunasekera Sanjeevani , Fraser John , Alexander Christian 
Published: July 2008

AbstractObjective:  To measure the health‐related quality of life (HRQOL) of rural Australian Hepatitis C virus (HCV)‐infected patients living in north‐western New South Wales. Design:  A cross‐sectional survey, including the Short Form 36 (SF36) questionnaire as well as topics concerning demographic data and items relating to the perceived mode and duration of HCV infection. Subjects:  A total of 80 patients with HCV infection were identified, using non‐random, convenience sampling, during October 2004 to June 2005. These patients attended either the Hepatitis C clinic, the Alcohol and Other Drugs clinic or general practitioner surgeries in rural north‐western New South Wales. Of the 80 patients selected, 65 completed the survey instrument, yielding a response rate of 81%. Measurements:  HRQOL in terms of the standard eight SF36 subscores as well as aggregate physical and Mental Component Summary (MCS) scores based on the SF36. Results:  Patients attending the Alcohol and Other Drugs clinic had a significantly (P = 0.024) lower vitality score than patients attending either the Hepatitis C clinic or the general practice surgeries. Otherwise, the three groups had similar scores in respect of the remaining seven SF36 dimensions. Most participants (86%) stated that their families are aware of their HCV status and 74% of participants mentioned that their families are supporting them in respect of their HCV status. Conclusion:  Our rural HCV‐infected patients have comparable HRQOL measures to their counterparts selected from patients attending the Liver Diseases Clinic or the Infectious Diseases Clinic in Adelaide. Both groups have reduced HRQOL compared with the Australian population norm.
Glycine N‐methyltransferase is a favorable prognostic marker for human cholangiocarcinoma
Authors: Huang Yu‐Chuen , Chen Marcelo , Shyr Yi‐Ming , Su Cheng‐Hsi , Chen Chi‐Kuan , Li Anna Fen‐Yau , Ho Donald Ming‐Tak , Chen Yi‐Ming Arthur 
Published: July 2008

AbstractBackground and Aim:  Glycine N‐methyltransferase (GNMT) is a susceptibility gene for human hepatocellular carcinoma (HCC). We previously reported that GNMT expression is diminished in HCC. Here we report our examination of GNMT expression patterns in cholangiocarcinoma and the relationship between its expression and prognosis.Methods:  We analyzed GNMT expression in tumor tissues from 33 cholangiocarcinoma patients (19 male) using immunohistochemistry (IHC) procedures with a GNMT monoclonal antibody (mAb 4–17). GNMT expression intensity and percentages were scored on a scale of 0 to 6. The association between GNMT expression and survival was analyzed using the Kaplan–Meier method, and prognostic factors were evaluated with a multivariate Cox proportional hazards regression model.Results:  High GNMT expression was found in epithelial cells of normal bile ducts. Six of 33 (18.2%) cholangiocarcinoma tissues had no GNMT expression. A statistically significant difference was noted in GNMT expression between male and female patients (68.4% vs 100%, P < 0.05). Compared to patients with GNMT expression scores > 3, the death hazard ratio for patients with GNMT scores ≤ 3 was 3.68 (95% confidence interval = 1.17–11.59, P < 0.05).Conclusions:  GNMT expression is a favorable prognosis predictor for cholangiocarcinoma.
Rapid hepatic fate specification of adipose‐derived stem cells and their therapeutic potential for liver failure
Authors: Banas Agnieszka , Teratani Takumi , Yamamoto Yusuke , Tokuhara Makoto , Takeshita Fumitaka , Osaki Mitsuhiko , Kato Takashi , Okochi Hitoshi , Ochiya Takahiro 
Published: July 2008

AbstractBackground and Aim:  Multipotential mesenchymal stem cells (MSC), present in many organs and tissues, represent an attractive tool for the establishment of a successful stem cell‐based therapy in the field of regeneration medicine. Adipose tissue mesenchymal stem cells (AT‐MSC), known as adipose‐derived stem cells (ASC) are especially attractive in the context of future clinical applications because of their high accessibility and minimal invasiveness during the procedure to obtain them. The goal of the present study was to induce human ASC into functional hepatocytes in vitro within a very short period of time and to check their therapeutic potential in vivo.Methods:  In vitro generated ASC‐derived hepatocytes were checked for hepatocyte‐specific markers and functions. Afterwards, they were transplanted into nude mice with liver injury. Twenty‐four hours after transplantation, biochemical parameters were evaluated in blood serum.Results:  We have shown here that ASC can be differentiated into hepatocytes within 13 days and can reach the functional properties of primary human hepatocytes. After transplantation into mice with acute liver failure, ASC‐derived hepatocytes can restore such liver functions as ammonia and purine metabolism. Markers of liver injury, alanine aminotransferase, aspartate aminotransferase, as well as ammonia, were decreased after ASC‐derived hepatocyte transplantation.Conclusions:  Our data highlight the properties of ASC as having a special affinity for hepatocyte differentiation in vitro and liver regeneration in vivo. Thus, ASC may be a superior choice for the establishment of a therapy for injured liver.
Platelets contribute to the reduction of liver fibrosis in mice
Authors: Watanabe Motonobu , Murata Soichiro , Hashimoto Ikuka , Nakano Yoritaka , Ikeda Osamu , Aoyagi Yasuyuki , Matsuo Ryota , Fukunaga Kiyoshi , Yasue Hiroshi , Ohkohchi Nobuhiro 
Published: July 2008

AbstractBackground and Aim:  Several recent studies have reported that liver cirrhosis (LC) can be ameliorated, but few adequate strategies are available against liver fibrosis. Although LC clinically shows thrombocytopenia and hypersplenism, the correlation with liver fibrosis and platelets remains unclear. The aim of the present study was to investigate the effect of platelets on liver fibrosis in mouse models.Methods:  To induce liver fibrosis, C57BL6 female mice were injected i.p. with 1 mL/kg carbon tetrachloride (CCl4) twice a week for 8 weeks. Thrombocytosis was achieved by giving thrombopoietin or splenectomy in addition to CCl4 intoxication. At 8 weeks, whole blood and liver specimens were obtained for studies as follows: peripheral platelet counts, histopathological examination, hydroxyproline assay, immunostaining, quantification of mRNA expression, and microarray analysis.Results:  Thrombocytosis significantly reduced liver fibrosis and hydroxyproline content of liver tissues compared to mice with CCl4 administration alone. Platelets suppressed increments in mRNA expression for transforming growth factor‐β, and increased matrix metalloproteinase‐9 expression in the liver. Microarray analysis of the liver revealed that platelets upregulated gene expressions involved in cell proliferation compared to expression in mice with CCl4 intoxication alone. Platelets also increased liver volume, proliferative cell nuclear antigen labeling index, and mitotic index in fibrotic mice.Conclusion:  These results clearly show that platelets reduce liver fibrosis and promote liver regeneration, even under cirrhotic conditions. We, therefore, propose that platelets could offer a potent tool in the treatment of liver cirrhosis.
Discussing withdrawing and withholding of life‐sustaining medical treatment in a tertiary paediatric hospital: A survey of clinician attitudes and practices
Authors: Forbes Tom , Goeman Emma , Stark Zornitza , Hynson Jenny , Forrester Mike 
Published: July 2008

Aim:  To better understand current attitudes and practices relating to discussions concerning the withholding and withdrawing of life‐sustaining medical treatment (WWLSMT) among medical staff in the paediatric setting.Methods:  An anonymous online survey of paediatricians (senior medical staff – SMS) and paediatric trainees (junior medical staff – JMS) likely to be involved in the care of children with life limiting illness.Results:  A total of 162 responses were obtained (response rate 42%). SMS indicated feeling more comfortable with their abilities to discuss WWLSMT than JMS. Barriers to discussing WWLSMT were numerous and included clinician concerns about family readiness for the discussion, prognostic uncertainty, family disagreement with the treating team regarding the child's prognosis/diagnosis and concerns about how to manage family requests for treatments that are not perceived to be in the child's best interests. Fifty‐eight per cent of JMS and 35.8% of SMS reported receiving no specific communication training regarding WWLSMT. Most learned through experience and by observing more senior colleagues. There was a high level of support for additional training in this area and for the provision of resources such as discussion guidelines and a structured form for documenting the outcomes WWLSMT discussions.Conclusion:  The majority of JMS feel less comfortable with their abilities to facilitate these discussions than their senior colleagues. The results of this study suggest that although confidence correlates with experience, junior and senior clinicians are eager to improve their skills through ongoing professional development and the provision of resources. The education needs of JMS and SMS appear to be different.
Erythropoietin pharmacokinetic/pharmacodynamic analysis suggests higher doses in treating neonatal anemia
Authors: Neelakantan Srividya , Widness John A. , Schmidt Robert L. , Veng‐Pedersen Peter 
Published: July 2008

AbstractBackground: The establishment of effective treatment of neonatal anemia using recombinant human erythropoietin (r‐HuEPO) requires a thorough understanding of the physiology and mechanism of EPO’s pharmacologic effect. The purpose of the present preclinical study in sheep was to elucidate the stimulatory effect of EPO on erythroid progenitors and their differentiation into reticulocytes useful in predicting optimal r‐HuEPO dosing.Methods: Five young adult sheep each underwent two phlebotomies spaced 4–6 weeks apart in which their hemoglobin levels were reduced from 12 g/dL to 3–4 g/dL. Endogenous EPO levels and reticulocyte counts produced in response to anemia were sampled throughout the study and analyzed using a pharmacokinetic/pharmacodynamic (PK/PD) model.Results: The phlebotomy‐induced drop in hemoglobin resulted in a increase in EPO levels, which reached a maximum of 764 ± 55 mU/mL (mean ± %CV) in 0.5–2.6 days. The reticulocyte counts increased from baseline values of 76.9 × 103 ± 67/μL to 619 × 103 ± 30/μL in 8 days. The PK/PD analysis indicated an increased maturation time for the reticulocytes (4.88 ± 35 days) and demonstrated that the Emaxmodel for EPO’s activation of the progenitors did not show significant effect saturation at the endogenous EPO levels reached.Conclusions: In extrapolating from the animal pilot experiment, the present study provides a case for the use of higher r‐HuEPO doses in human studies to determine if higher doses are more effective in treatment of neonatal anemia to reduce, and in some less severe cases, eliminate, the need for blood transfusions.
Growth of infants with osteogenesis imperfecta treated with bisphosphonate
Authors: Hasegawa Kosei , Inoue Masaru , Seino Yoshiki , Morishima Tsuneo , Tanaka Hiroyuki 
Published: July 2008

AbstractBackground:  Osteogenesis imperfecta (OI) is a heritable bone disease characterized by bone brittleness and various degrees of growth disorder. Cyclic pamidronate therapy is reportedly useful to prevent bone fracture in OI and in infants with OI, but, it remains unclear how infants with OI grow during bisphosphonate therapy.Methods:  Height and weight measurements of OI infants treated with cyclic pamidronate therapy were taken before and every 6 months during therapy until 18 months. Vertebral morphometry and the concavity index were analyzed using X‐ray films taken simultaneously.Results:  Among OI patients, those in the group for which the height z‐score decreased tended to have more femur fractures than those of the group for which the height z‐score increased. Morphometry of the lumbar spine showed that compression fractures occurred less during cyclic pamidronate therapy, by which the lumbar bone mineral density increased.Conclusions:  Bisphosphonate preserved vertebral morphometry during 18 months after starting therapy in infants. Prevention of femur fracture during the infantile period might help prevent short stature; therapeutic strategies during infancy must better emphasize prevention of long bone fracture before the beginning of gait.
Time‐course changes in the liver of biliary atresia patients on magnetic resonance imaging
Authors: Takahashi Atsushi , Hatakeyama Shin‐itsu , Kuroiwa Minoru , Suzuki Norio , Toki Fumiaki , Suzuki Makoto , Suehiro Taketoshi , Shimura Tatsuo , Kuwano Hiroyuki 
Published: July 2008

AbstractBackground:  Using magnetic resonance imaging (MRI), changes in the livers of postoperative biliary atresia (BA) patients were investigated.Methods:  Periodic MRI was performed in 32 postoperative BA patients. The findings were evaluated by calculating the near‐normal liver tissue area that corresponded with normal‐ or high‐signal regions on T1‐weighted imaging. The patients were divided into three groups based on the extent of near‐normal liver tissue on the final MRI: group A, n = 14; group B, n = 13; and group C, n = 5, included patients with >40%, 20–40%, and <20% area of near‐normal liver tissue, respectively. The relationship among the macroscopic and histological findings in the liver at orthotopic living donor liver transplantation (OLDLT), patient outcomes, and MRI findings were investigated.Results:  In group A, 11 patients had no evidence of liver dysfunction. In group B, six patients either had undergone or were awaiting OLDLT. In group C, all patients had undergone OLDLT. All patients had either adequate or impaired bile drainage in each liver segment. The segmental changes corresponded with the liver architecture at OLDLT. The changes could be evaluated on MRI at 1–2 years after surgery.Conclusions:  Adequate and restricted areas of liver tissue with near‐normal structure were indicative of good and poor prognoses, respectively. Shortly after portoenterostomy, these segmental changes occurred and/or developed in each liver segment and could be detected on MRI. It is emphasized that patients with >40% area of near‐normal liver architecture at the initial stages did not require OLDLT, while those with <20% area did require OLDLT.
Management of an unusual pediatric difficult airway using ketamine as a sole agent
Authors: PATERSON NEIL A. 
Published: July 2008

SummaryWe present the case of a 9‐year‐old boy who suffered a fall while brushing his teeth. This resulted in impalement of the lateral pharyngeal wall by the toothbrush with its head becoming firmly lodged adjacent to the internal carotid artery as demonstrated by CT scan. The length of the toothbrush protruding from the mouth and the inability to adequately assess the airway prior to any intervention gave rise to a unique set of surgical and anesthetic airway management problems. These were compounded by the possibility of damage to the carotid artery and potential catastrophic hemorrhage with manipulation of the toothbrush at any point. We detail the problems and outline our management.
Dexmedetomidine disposition in children: a population analysis
Authors: POTTS AMANDA L. , WARMAN GUY R. , ANDERSON BRIAN J. 
Published: July 2008

SummaryBackground: There are few data describing dexmedetomidine population pharmacokinetics (PK) in children (0–15 years) despite increasing use.Methods: An open‐label study was undertaken to examine the PK of i.v. dexmedetomidine 1–4 μg·kg−1bolus in children after cardiac surgery (n = 45). A population PK analysis of dexmedetomidine time–concentration profiles (148 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 3.38 years (range 4 days to 14 years) and weight 15.1 kg (range 3.1–58.9 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) 39.2 (CV 30.36%) l·h−1per 70 kg, central volume of distribution (V1) 36.9 (69.49%) l per 70 kg, inter‐compartment clearance (Q) 68.2 (37.6%) l·h−1per 70 kg and peripheral volume of distribution (V2) 69.9 (48.6%) l per 70 kg. Clearance at birth was 15.55 l·h−1per 70 kg and matured with a half‐time of 46.5 weeks to reach 87% adult rate by 1 year of age. Simulation of an infusion of 1 μg·kg−1over 10 min followed by an infusion of 0.7 μg·kg−1·h−1for 50 min suggested that children arouse from sedation at a plasma concentration of 0.304 μg·l−1.Conclusions: Clearance in neonates is approximately one‐third of 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.
The FLACC behavioral scale for procedural pain assessment in children aged 5–16 years
Authors: NILSSON STEFAN , FINNSTRÖM BERIT , KOKINSKY EVA 
Published: July 2008

SummaryObjectives:  To evaluate the concurrent and construct validity and the interrater reliability of the Face, Legs, Activity, Cry and Consolability (FLACC) scale during procedural pain in children aged 5–16 years.Background:  Self‐reporting of pain is considered to be the primary source of information on pain intensity for older children but a validated observational tool will provide augment information to self‐reports during painful procedures.Methods:  Eighty children scheduled for peripheral venous cannulation or percutaneous puncture of a venous port were included. In 40 cases two nurses simultaneously and independently assessed pain by using the FLACC scale and in 40 cases one of these nurses assessed the child. All children scored the intensity of pain by using the Coloured Analogue Scale (CAS) and distress by the Facial Affective Scale (FAS).Results:  Concurrent validity was supported by the correlation between FLACC scores and the children’s self‐reported CAS scores during the procedure (r = 0.59, P < 0.05). A weaker correlation was found between the FLACC scores and children’s self‐reported FAS (r = 0.35, P < 0.05). Construct validity was demonstrated by the increase in median FLACC score to 1 during the procedure compared with 0 before and after the procedure (P < 0.001). Interrater reliability during the procedure was supported by adequate kappa statistics for all items and for the total FLACC scores (κ = 0.85, P < 0.001).Conclusions:  The findings of this study support the use of FLACC as a valid and reliable tool for assessing procedural pain in children aged 5–16 years.
Anaesthetic management of gastrochisis – a review of our practice over the past 5 years
Authors: RAGHAVAN MURALI , MONTGOMERIE JAMES 
Published: July 2008

SummaryBackground:  Surgical closure of gastrochisis has traditionally been performed under general anesthesia followed by admission to intensive care and postoperative ventilation. We reviewed the management of these neonates in our hospital over the past 5 years to identify the changes in practice and possible factors which affect the peri‐operative course.Methods:  We retrospectively identified cases of gastrochisis undergoing repair from June 2002 to May 2007. Details of the demographic data, preoperative factors, intra‐operative anesthetic and surgical management, and postoperative care were collected from the anesthetic chart, operative record, and patient notes.Results:  Forty‐eight self‐ventilating neonates underwent operative repair in theatre. A neuraxial local anesthetic block was performed as part of the anesthetic technique in 22 patients. There was a significant difference in the need for postoperative ventilation in this group (23%) when compared with a traditional opioid‐based method of providing analgesia (88%, P < 0.05). This difference was seen in both term and preterm babies.Conclusion:  Conclusions are difficult to make when analyzing retrospective data in patients with a heterogeneous variety of factors. The results suggest that anesthesia which includes a regional technique is a valid method in these cases. Traditional opioid analgesia when compared with regional techniques may be associated with increased need for postoperative ventilation.
Diversity and disease: community structure drives parasite transmission and host fitness
Authors: Johnson Pieter T. J. , Hartson Richard B. , Larson Donald J. , Sutherland Daniel R. 
Published: July 2008

AbstractChanges in host diversity and community structure have been linked to disease, but the mechanisms underlying such relationships and their applicability to non‐vector‐borne disease systems remain conjectural. Here we experimentally investigated how changes in host community structure affected the transmission and pathology of the multi‐host parasite Ribeiroia ondatrae, which is a widespread cause of amphibian limb deformities. We exposed larval amphibians to parasites in monospecific or heterospecific communities, and varied host number to differentiate between density‐ and diversity‐mediated effects on transmission. In monospecific communities, exposure to Ribeiroia significantly increased mortality (15%), malformations (40%) and time‐to‐metamorphosis in toads. However, the presence of tree frogs significantly reduced infection in toads, leading to fewer malformations and higher survival than observed in monospecific communities, providing evidence of parasite‐mediated facilitation. Our results suggest that interspecific variation in parasite resistance can inhibit parasite transmission in multi‐species communities, reducing infection and pathology in sensitive hosts.