bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors affecting the spread of bupivacaine in the adult thoracic paravertebral space
Authors: Cheema S. , Richardson J. , McGurgan P. 
Published: June 2003

SummaryFactors affecting the spread of bupivacaine in the paravertebral space were investigated in patients undergoing paravertebral nerve blocks for the treatment of chronically painful conditions. Injections of bupivacaine 0.5%, 10–15 ml mixed with depomedrone up to 80 mg were repeated at 2‐wk intervals up to a maximum of four times. A blinded observer mapped out the subsequent distribution of sensory loss to cold on both sides of the torso at 5‐min intervals after each injection. Age, sex, height and weight did not correlate with the block; nor did injectate volume, mass of bupivacaine, previous posterolateral thoractomy and spread of radiocontrast. Injections repeated at 2‐wk intervals in the same patient resulted in different degrees of spread that were unrelated to one another. Time to peak onset of blockade was 40 min in 95% of patients. A single bolus of bupivacaine produces a safe but unpredictable block. Yet to be defined physical properties and anatomical factors are probably key determinants of the spread of bupivacaine in the paravertebral space. This single bolus technique may be better supplanted by a reversion to the older multiple level injection technique.
Day of surgery cancellations after nurse‐led pre‐assessment in an elective surgical centre: the first 2 years
Authors: Rai M. R. , Pandit J. J. 
Published: June 2003

SummaryWe describe a nurse‐led pre‐assessment system at an elective surgical centre. A targeted referral system was used by trained nurses to direct referrals to a supervising consultant anaesthetist or to the surgical team. Of 2726 patients pre‐assessed in the first 2 years, 105 patients (3.9%) were cancelled or postponed for medical optimisation after pre‐assessment. There were 137 cancellations (5.0%) on the day of surgery, despite pre‐assessment, but only 36 were for anaesthetic or medical reasons. Only eight of these 36 were considered a ‘failure’ of the pre‐assessment system. These results are much better than the cancellation rate of about 11% in the Trust as a whole. There were 18 transfers of patients postoperatively from the elective centre to another hospital. A review suggested that four of these transfers could have been reasonably predictable from the patients' medical history. We conclude that a pre‐assessment clinic has an important role to play in minimizing cancellations on the day of surgery and also in reducing the number of patients transferred to other hospitals. This last conclusion has an important implication for the planning of systems in hospitals that perform only elective surgery.
New aspects of ventilation in acute lung injury
Authors: Malarkkan N. , Snook N. J. , Lumb A. B. 
Published: June 2003

SummaryRecent recognition that artificial ventilation may cause damage to the acutely injured lung has caused renewed interest in ventilation techniques that minimise this potential harm. Many ventilation techniques have proved beneficial in small trials of very specific patient groups, but most have subsequently failed to translate into improved patient outcome in larger trials. An exception to this is ‘protective ventilation’ using reduced tidal volumes (to lower airway pressure) and increased PEEP (to reduce pulmonary collapse). Results of trials of protective ventilation have been encouraging, and the technique should now be adopted more widely. High frequency ventilation, inverse ratio ventilation, prone positioning and inhaled nitric oxide are all techniques that may be considered when, in spite of optimal artificial ventilation, the patient's gas exchange remains dangerously poor. Under these circumstances, the choice of technique is dependent on their availability, local expertise and individual patient needs.
Prognostic significance of soluble interleukin‐2 receptor levels in patients with dilated cardiomyopathy
Authors: Limas C. J. , Hasikidis C. , Iakovou J. , Kroupis C. , Haidaroglou A. , Cokkinos D. V. 
Published: June 2003

AbstractBackground Activation of T lymphocytes is thought to mediate myocardial dysfunction in dilated cardiomyopathy (CMP), probably through cytotoxic cytokines, but its value as a prognostic factor has not been evaluated.Methods For 2 years we prospectively followed 76 patients (65 males, 11 females, age 49 ± 7 years) with CMP and New York Heart Association(NYHA) Class II–III heart failure; left ventricular (LV) function was assessed echocardiographically. Thirty‐three patients (28 males, five females, age 52 ± 6 years) with ischaemic heart disease (IHD) and similar NYHA and LV function characteristics were used as controls. Serum sIL‐2R levels, peripheral blood lymphocyte proliferation (basal, + concanavalin A) and HLA‐DQB1 genotyping was carried out in all patients.Results The CMP patients had increased sIL‐2R levels (1259 ± 130 pg mL−1) compared with the IHD patients (703 ± 80 pg mL−1, P < 0·01, only 3 > 800 pg mL−1). In the CMP patients, there was a significant (r = +0·45, P= 0·04) correlation between sIL‐2R and the LV end‐diastolic diameter but not with the LV ejection fraction or NYHA Class. During the 24‐month follow up, 17 of the CMP patients had an adverse clinical course (death, need for cardiac transplantation, or worsening heart failure). Of these, 14 (75%) had elevated (≥ 800 pg mL−1) sIL‐2R levels (Group I) compared with only five (6%) with a stable clinical course (Group II). Neither [3H] thymidine incorporation into the peripheral blood lymphocytes nor the excess of HLA‐DQB1‐30 histidine homozygotes in the Group I patients (38% vs. 17%, P < 0·05) could predict the clinical outcome.Conclusion Increased sIL‐2R levels in CMP patients are an independent predictor of a more aggressive clinical course.
Broad identification of bacterial type from pus by 1H MR spectroscopy
Authors: Garg M. , Misra M. K. , Chawla S. , Prasad K. N. , Roy R. , Gupta R. K. 
Published: June 2003

AbstractBackground  Abscess formation is a common bacterial infection and requires an immediate antimicrobial approach for apposite treatment. Delay in patient treatment is usually a common feature, as the bacterial identification of clinical samples is based on the culture, which is a time‐consuming exercise. The current study was aimed at developing an alternative technique with the potential for rapid bacterial group identification.Materials and methods  In the present study we performed ex vivo proton magnetic resonance spectroscopy of 40 pus samples collected from abscesses in different locations and the results have been retrospectively compared with the microorganism identified in the pus culture. In addition, the microbes obtained from the culture have been further subcultured and studied with magnetic resonance spectroscopy to identify the bacterial fingerprint in the pus sample seen on spectroscopy.Results  On reviewing the spectra obtained from the various abscesses, they were found to be qualitatively similar for a particular bacterium. The similar spectral pattern of the pus with obligate aerobes/anaerobes and pure cultures of the same bacteria suggests its strict metabolism under in vivo and in vitro conditions, respectively.Conclusions  The characteristic metabolite pattern of obligate anaerobes may be used as a prototype for its rapid identification. This information may be of value for more appropriate clinical management of such cases.
Urinary excretion of complement C3d in patients with renal diseases
Authors: Branten A. J. , Kock‐Jansen M. , Klasen I. S. , Wetzels J. F. 
Published: June 2003

AbstractIntroduction  Complement‐mediated tubular injury may play an important role in the progression of renal diseases. C3d is a presumed marker of complement activation. Its precursor C3dg has been detected in the urine of patients with membranous nephropathy. However, little is known of the renal handling of C3d or its excretion in other renal diseases.Methods  We measured the urinary excretion of albumin, IgG, β2‐microglobulin (β2m), and of complement C3d in patients with tubulo‐interstitial nephritis (TIN; n= 8), in patients with membranous nephropathy (n = 35) and in patients with nonmembranous glomerular diseases (23 nonproliferative and 21 proliferative). Fractional excretions (FE) were calculated using creatinine clearance as marker of GFR.Results  C3d was not measurable in the urine of the healthy controls, but was detectable in seven out of eight of the TIN patients (median excretion 0·11 mU min−1, range 0·006–2·4 mU min−1). In these patients the urinary excretion of β2m was clearly elevated (median 26·6 µg min−1, range 1·0–103 µg min−1). The FE of C3d correlated with the FE of β2microglobulin (r = 0·83, P = 0·01), and their ratio amounted to 0·03 (range 0·003–0·06), a value in agreement with the expected sieving coefficient. Urine C3d was detectable in all but three of the patients with glomerular diseases (median excretion 0·36 mU min−1, range 0·004–7·9 mU min−1); C3d‐excretion did not differ between the three subgroups of patients with glomerular diseases. FEC3d correlated with FEIgG (r = 0·88, P < 0·01). The ratio FEC3d/FEβ2m was 0·78 (range 0·04–9·99). Selected patients with membranous nephropathy were re‐analyzed after (partial) remission of proteinuria. Reduction of proteinuria resulted in a decrease of C3d excretion.Conclusion  Urinary excretion of C3d is elevated in patients with TIN, most likely as a mere consequence of decreased tubular reabsorption. In patients with glomerular diseases urinary excretion of C3d is increased and related to proteinuria, independent of the underlying glomerular disease. In these patients there is evidence of increased local formation of C3d.
Variable expression of CYP and Pgp genes in the human small intestine
Authors: Lindell M. , Karlsson M. O. , Lennernäs H. , Påhlman L. , Lang M. A. 
Published: June 2003

AbstractBackground  The small intestine is receiving increased attention for its importance in drug metabolism. However, knowledge of the intervariability and regulation of the enzymes involved, cytochrome P450 and P‐Glycoproteins (CYP and Pgp), is poor when compared with the corresponding hepatic enzymes.Methods  The expression of eight different CYP genes and the Pgp were determined by reverse transcription polymerase chain reaction (RT‐PCR) in 51 human duodenum biopsies. And the variability and correlation of expression was analyzed.Results  Extensive interindividual variability was found in the expression of most of the genes. Only CYP2C9, CYP3A4 and Pgp were found in all samples. CYP1A2, CYP2A6 and CYP2E1 exhibited the highest interindividual variability. No strong correlation of expression existed between the genes. But a highly significant correlation was found between CYP2D6/1A2, 2D6/2E1, 1A2/2E1 and 2B6/2C9. Acetylsalicylic acid and omeprazole significantly increased the expression of CYPs 2A6, 2E1 and 3A4, respectively.Conclusions  Extensive interindividual variability is characteristic for the expression of drug‐metabolizing CYP and Pgp genes in human duodenum, and external factors such as drugs may further increase the variability. It is possible that the large interindividual variability may lead to variable bioavailability of orally used drugs and hence complicate optimal drug therapy, especially for drugs with a small therapeutic window. Elucidation of factors contributing to clinically important variances warrants further investigation.
Nesidioblastosis in adults: a challenging cause of organic hyperinsulinism
Authors: Kaczirek K. , Soleiman A. , Schindl M. , Passler C. , Scheuba C. , Prager G. , Kaserer K. , Niederle B. 
Published: June 2003

AbstractBackground Nesidioblastosis in adults has been reintroduced into the differential diagnosis of organic hyperinsulinism by the description of ‘noninsulinoma pancreatogenous hypoglycaemia syndrome (NIPHS)’.Materials and methods Pathologic specimens of all adult patients (n = 66) operated on for organic hyperinsulinism were re‐examined. Five patients fulfilled the histomorphological criteria of nesidioblastosis. Retrospective review of clinical presentation, results of 72‐h fasts, intravenous tolbutamide tolerance tests, pre‐ and intraoperative localization studies and surgical therapy was performed.Results In contrast to NIPHS, fasting tests became positive after 8–14 h. Tolbutamide tests were positive and preoperative imaging showed negative results in all patients. At first operation distal pancreatic resections were performed in three patients, resection of the pancreatic body in one patient and biopsy of the pancreatic tail in one patient. Two of three patients with recurrent disease had to be reoperated. One patient showed a coexistence of nesidioblastosis and multiple small insulinomas and is part of a kindred with autosomal dominantly inherited ‘familial islet‐cell adenomatosis’.Conclusions Surgical exploration is indicated only after thorough biochemical diagnosis. An aggressive strategy for preoperative localization including selective arterial calcium stimulation testing seems justified. There may be a combination of nesidioblastosis and islet cell tumours. A link between β‐cell hyperplasia and progression to insulinoma based on not yet known genetic causes can be suspected.
Cyclooxygenase expression in splanchnic hyposensitivity to glypressin of bleeding portal hypertensive rats
Authors: Huang H.‐C. , Wang S.‐S. , Chen Y.‐C. , Lee F.‐Y. , Chang F.‐Y. , Lin H.‐C. , Hou M.‐C. , Chan C.‐C. , Chen C.‐T. , Wu S.‐L. , Lee S.‐D. 
Published: June 2003

AbstractBackground Prostacyclin mediates, at least partly, the splanchnic vascular hyporesponsiveness to glypressin in bleeding portal hypertensive rats. This study investigated the relative contribution of cyclooxygenase‐1 (COX‐1) and cyclooxygenase‐2 (COX‐2) in the splanchnic hyposensitivity to glypressin in rats with portal hypertension induced by partial portal vein ligation (PVL).Methods Fourteen days after the operation, the rats were divided into without‐ and with‐bleeding groups. Three series of PVL rats were used to investigate (i) the haemodynamic effects of glypressin (0·07 mg kg−1 intravenously), (ii) COX‐1/COX‐2 mRNA expression over abdominal aorta and superior mesenteric artery and (iii) plasma levels of 6‐keto‐prostaglandin‐F1α. In rats with a hypotensive haemorrhage, 4·5 mL of blood was withdrawn and 50% of the withdrawn blood was re‐infused before blood and vessel sampling or the administration of glypressin.Results Splanchnic hyposensitivity to glypressin was demonstrated in the haemorrhage‐transfused PVL rats with enhanced COX‐1 expression of superior mesenteric artery and increased plasma levels of 6‐keto‐prostaglandin‐F1α. There were no differences in the COX‐2 expression of superior mesenteric artery and COX‐1 and COX‐2 expressions of abdominal aorta between without‐ and with‐bleeding groups.Conclusion In portal hypertensive rats with acute haemorrhage, COX‐1 over‐expression in the superior mesenteric artery plays a role in mediating the splanchnic hyposensitivity to glypressin.
Fatty acids modulate the effect of darglitazone on macrophage CD36 expression
Authors: Svensson L. , Camejo G. , Cabré A. , Vallvé J.‐C. , Pedreño J. , Norén K. , Wiklund O. , Hultén L. M. 
Published: June 2003

AbstractBackground Scavenger receptor‐mediated uptake of cholesterol by macrophages in the arterial wall is believed to be proatherogenic. Thiazolidinediones are peroxisome proliferator‐activated receptor γ (PPARγ)‐agonists, which are used in the treatment of type II diabetes. They reduce atherogenesis in LDL receptor deficient and ApoE knockout mice, but up‐regulate CD36, which may contribute to foam cell formation. The dyslipidaemia in type II diabetes is characterized by high levels of nonesterified fatty acids. Therefore we tested the effect of fatty acids and how fatty acids and the thiazolidinedione darglitazone interact in their effect on CD36 expression in human monocytes and macrophages.Materials and methods Flow cytometry and reverse transcription‐polymerase chain reaction were used to study CD36 expression. Cellular lipids were analyzed with high performance liquid chromatography.Results Darglitazone increased CD36 mRNA and protein expression in human macrophage cells. In the presence of 5% human serum, darglitazone increased the accumulation of triglycerides, but did not affect cholesterol ester levels. In the presence of albumin‐bound oleic or linoleic acid, darglitazone did not increase CD36 mRNA, cell‐surface CD36 protein or triglyceride content. Fatty acids per se increased CD36 mRNA and protein.Discussion The increase in CD36 in macrophages suggests a role for fatty acids in the regulation of foam cell formation. The results also suggest that the potentially proatherogenic CD36 up‐regulating effect of thiazolidinediones in macrophages might not be present when the cells have access to physiological levels of albumin‐bound fatty acids.
Natural killer receptor repertoires in transplantation
Authors: Jones D. C. , Young N. T. 
Published: June 2003

SummaryNatural killer (NK) lymphocytes are potent effector cells that are controlled by the expression of a variety of cell surface receptors with either inhibitory or activating functions. The genetic and functional diversity of this receptor repertoire and the role of HLA class I molecules as a major group of NK receptor ligands create an innate alloreactive capacity in this cell type. Both animal models and in vitro studies have implicated NK cells as contributors to the pathology of clinical transplantation. However, recent clinical studies have indicated the potential benefit of exploiting NK cell alloreactivity in mismatched haematopoietic stem cell transplantation. Further investigations of NK cell alloreactivity will undoubtedly reveal additional applications of this fundamental cell type in clinical transplantation.
Association of ABO histo‐blood group B allele with myocardial infarction
Authors: Nydegger U. E. , Wuillemin W. A. , Julmy F. , Meyer B. J. , Carrel T. P. 
Published: June 2003

SummaryTo investigate a possible association of ABO blood group alleles with myocardial infarction, a case–control study comprising 177 patients (median age 57.0 years; range 32–72 years) and 89 controls was performed. The distributions of the ABO blood‐genotype O1, O2, A1, A2 and B alleles were assessed by analysis of genomic DNA, using the sequence‐specific primer–polymerase chain reaction (PCR‐SSP) technique to investigate exons VI and VII on chromosome 9. The prevalence of the B allele was 2.5 times higher amongst patients with a history of myocardial infarction than amongst controls (16.3 vs. 6.7%; P = 0.034, Fisher's exact test). There was an association between patients carrying the B allele and myocardial infarction, with an odds ratio (OR) of 2.7 (95% confidence interval 1.1–6.8). The B allele remained an independent risk factor for myocardial infarction (P = 0.038) when classical risk factors were adjusted for by unconditional logistic regression. In conclusion, the ABO blood group B allele was found to be an independent risk factor for myocardial infarction.
Different roles of proteolipids and 70‐kDa subunits of V‐ATPase in growth and death of cultured human cells
Authors: Zhan Hong , Yokoyama Ken , Otani Hajime , Tanigaki Keiji , Shirota Naomi , Takano Syuichi , Ohkuma Shoji 
Published: June 2003

AbstractBackground: The vacuolar‐type proton‐translocating adenosine triphosphatase (V‐ATPase) plays important roles in cell growth and tumour progression. V‐ATPase is composed of two distinct structures, a hydrophilic catalytic cytosolic sector (V1) and a hydrophobic transmembrane sector (V0). The V1 sector is composed of 5–8 different subunits with the structure A3B3C1D1E1F1G1H1. The V0 sector is composed of 5 different subunits with the structure 1161381191166. The over‐expression of 16‐kDa proteolipid subunit of V‐ATPase in the perinuclear region of the human adventitial fibroblasts promotes phenotypic modulation that contributes to neointimal formation and medial thickening. A relationship between oncogenicity and the expression of the 16‐kDa proteolipid has also been suggested in human pancreatic carcinoma tissue.Results: We found that the mRNA levels of the 16‐kDa proteolipid but not of the 70‐kDa subunit of V‐ATPase in human myofibroblasts were more abundant in serum‐containing medium (MF(+) cells) than serum‐free medium (MF(–) cells). In HeLa cells, the levels of mRNA and protein of the 16‐kDa, 21‐kDa or 70‐kDa were clearly suppressed when the corresponding anti‐sense oligonucleotides were administered to the culture medium. The growth rate and viability (mostly due to necrosis) of HeLa cells were reduced markedly by the 16‐kDa and 21‐kDa anti‐sense, but little by the 70‐kDa anti‐sense, and not at all by any sense oligonucleotides. The localization of 16‐kDa/21‐kDa proteolipid subunits was different from that of the 70‐kDa subunit in HeLa cells.Conclusion: These results suggest that the 16‐kDa and 21‐kDa proteolipid subunits of the V0 sector play crucial roles in growth and death of cultured human cells. Our results may provide new insights into the mechanism and therapeutic implications for vessel wall hyperplasia and tumorigenesis.
Transmembrane topology of sphingoid long‐chain base‐1‐phosphate phosphatase, Lcb3p
Authors: Kihara Akio , Sano Takamitsu , Iwaki Soichiro , Igarashi Yasuyuki 
Published: June 2003

AbstractBackground: Sphingoid long‐chain base‐1‐phosphates (LCBPs) are thought to act as intracellular signalling molecules in yeast. Lcb3p is a member of the LCBPs‐specific phosphatase family (SPP family). Other yeast phosphatases, Lpp1p and Dpp1p, are members of a different lipid phosphatase family (LPP family) known to exhibit broader substrate specificities. Until now, only the membrane topology of mammalian LPP family members has been reported, whereas that of the SPP family has remained unclear.Results: In our in vitro system, Lcb3p displayed major phosphatase activity against dihydrosphingosine‐1‐phosphate, while Dpp1p and Lpp1p also exhibited activities. Here, we determined that Lpp1p and Dpp1p exhibit the topology common to the LPP family. Moreover, we examined the transmembrane topology of Lcb3p using a C‐terminal reporter approach. From our results we deduced a structural model illustrating that Lcb3p has eight membrane‐spanning domains with its highly conserved phosphatase motifs positioned within the endoplasmic reticulum (ER) lumen. Consistent with this result, Lcb3p collected in low speed pellet fractions was highly resistant to exogenous proteinase K unless the membrane was disrupted.Conclusion: Our results suggest that the active site of Lcb3p is located in the ER lumen and, thus, the phosphate group of the LCBP is hydrolysed on the lumenal side.