bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of EEG monitoring on intraoperative stapedius reflex threshold values in cochlear implantation in children
Authors: Schultz B. , Beger F.A. , Weber B.P. , Niclaus O. , Lüllwitz E. , Grouven U. , Schultz A. 
Published: November 2003

SummaryBackground Cochlear implantation is a widely used means of treating deafness and severe hearing disorders. The surgical procedure includes inserting the cochlear implant electrode array into the cochlea and embedding the corresponding signal receiver in the mastoid bone behind the ear. Postoperative fitting of the externally worn speech processor is very important for successful use of the cochlear implant. For this purpose, electrically elicited stapedius reflex threshold values can be used. However, stapedius reflex threshold values measured intraoperatively are influenced by anaesthetics. The goal of this retrospective study was to find out whether electroencephalogram (EEG) control of anaesthesia produces more reliable reflex threshold values as a basis for the fitting of the speech processor.Methods Three groups of children, after surgery for cochlear implantation, were analysed with regard to the magnitude of intraoperative electrically elicited stapedius reflex threshold values and their deviations from postoperatively determined maximum comfortable levels (group 1: methohexital/remifentanil with EEG monitoring, n = 10; group 2: isoflurane/fentanyl with EEG monitoring, n = 9; group 3: isoflurane/fentanyl without EEG monitoring, n = 11).Results Children with EEG monitoring had significantly lower electrically elicited stapedius reflex threshold values and also significantly lower differences between intraoperative stapedius reflex threshold values and postoperatively determined maximum comfortable levels.Conclusions Electroencephalogram monitoring in cochlear implantation is of considerable value in controlling anaesthesia and improving speech processor fitting based on more reliable intraoperative neurophysiological data.
Comparison of perioperative blood salvage and postoperative reinfusion of drained blood during surgical correction of craniosynostosis in infants
Authors: Orliaguet Gilles A. , Bruyere Marie , Meyer Philippe G. , Blanot Stéphane , Renier Dominique , Carli Pierre A. 
Published: November 2003

SummaryBackground The surgical correction of craniosynostosis may be associated with extensive blood loss and transfusion. The aim of this study was to compare the efficacy of the perioperative use of the continuous autotransfusion system (CATS group) and of the postoperative use of the CBCII ConstaVac® system (CV group) to reduce homologous transfusion in infants during repair of craniosynostosis.Methods Two groups of consecutive infants, weighing <10 kg, and scheduled for the surgical correction of craniosynostosis, were compared retrospectively according to the blood salvaging system used: CATS group and CV group. The primary endpoint was the comparison of the total volume of homologous blood transfused.Results There was no significant difference between the CV (n = 69) and the CATS (n = 135) groups with regard to physical, preoperative and postoperative data, except for the type of craniosysnostosis with more scaphocephaly in the CV group (P = 0.03). No significant difference in blood loss and homologous transfusion was observed between the two groups during the perioperative period. Two subgroups of patients were also compared: a subgroup including patients operated on with a linear craniectomy for scaphocephaly, and a subgroup including all other patients. There was also no significant difference in blood loss and homologous transfusion between the CV and the CATS groups for these two subgroups of patients.Conclusion Our results suggest that the postoperative use of the CBCII ConstaVac® system is as efficient as the perioperative use of the CATS® system for reducing homologous blood transfusion during repair of craniosynostosis in infants weighing <10 kg.
Anaesthesia in a child with Sotos syndrome
Authors: Adhami Eftim J. , Cancio‐Babu Consolacion V. 
Published: November 2003

SummarySotos syndrome is a rare condition characterized by typical facies, early accelerated growth, large body size, developmental delay and congenital heart defects. Reports of anaesthetic management of these children are very rare. We report a case of general anaesthesia in a 2½‐year‐old boy with this condition, undergoing inguinal hernia repair. The child had a marked developmental delay, hypotonia and mitral regurgitation. The key points in the management of anaesthesia in Sotos syndrome are discussed.
Anaesthesia for magnetoencephalography in children with intractable seizures
Authors: Szmuk Peter , Kee Spencer , Pivalizza Evan G. , Warters Robert D. , Abramson David C. , Ezri Tiberiu 
Published: November 2003

SummaryBackground Magnetoencephalography (MEG), a noninvasive technique for evaluation of epileptic patients, records magnetic fields during neuronal electrical activity within the brain. Anaesthesia experience for MEG has not yet been reported.Methods We retrospectively reviewed records of 48 paediatric patients undergoing MEG under anaesthesia. Thirty‐one patients (nonprotocol group) were managed according to the anaesthesiologist's discretion. Premedication included oral midazolam, chloral hydrate or fentanyl oralet, intravenous midazolam or inhalational anaesthesia with sevoflurane. Anaesthesia was maintained with propofol, midazolam, fentanyl, alone or in combination. A subsequent protocol group (17 patients) received chloral hydrate as premedication and propofol for maintenance of anaesthesia.Results There was an overall 25% failure of interictal activity and localization on the MEG scan. In the nonprotocol group, 11 scans failed (35.5%). Of these, eight (72.7%) received midazolam orally. Only one failure (5.8%) was recorded in the protocol group in a patient who received chloral hydrate as sedation supplemented by sevoflurane.Conclusions In our experience, midazolam premedication resulted in a high MEG failure rate (73%). Chloral hydrate premedication and propofol maintenance resulted in a lower incidence of MEG failure (5.8%). General anaesthesia with a continuous infusion of propofol or sevoflurane appears acceptable, although, lighter levels of anaesthesia might be required to avoid interference with interictal activity of the brain.
Prolonged cannulation of the left internal mammary artery (LIMA) for blood pressure monitoring in a child after cardiopulmonary bypass
Authors: Verghese Susan T. , Sell Jeff E. , Midgley Frank M. , Margolis Mark , Martin Gerard R. 
Published: November 2003

SummaryCannulation of the radial artery percutaneously or by cut down is frequently used to monitor blood pressure in infants and children undergoing cardiopulmonary bypass. When radial artery cannulation is difficult because of previous cannulation attempts, and/or surgical cut downs, posterior tibial artery cannulation is sometimes undertaken. We describe a child in whom the left internal mammary artery (LIMA) was chosen for monitoring arterial blood pressure because of malfunction of the existing posterior tibial arterial pressure line after cardiopulmonary bypass. This line was used for more than 3 weeks postoperatively in the intensive care unit for monitoring and for sampling. There were no complications with the placement and/or the removal of this arterial line on the 25th postoperative day. When standard arterial monitoring sites are not accessible, internal mammary artery cannulation can provide reliable access for prolonged arterial blood pressure monitoring in the postoperative period in children.
Epidural analgesia in children. A survey of current opinions and practices amongst UK paediatric anaesthetists
Authors: Williams D.G. , Howard R.F. 
Published: November 2003

SummaryBackground Despite the widespread use of epidural analgesia in children its place in paediatric pain management has not been clearly established. In order to investigate the current practice of paediatric epidural analgesia in the UK paediatric anaesthetists and paediatric pain management teams were surveyed.Methods Questionnaires were sent to the members of the Association of Paediatric Anaesthetists (APA) working within the UK and to lead clinicians and clinical nurse specialists for acute pain in the 26 designated major paediatric centres.Results The response rate was 72%. There was little consensus regarding drugs and drug combinations used for epidural analgesia. A total of 36% of paediatric centres did not audit their epidural practice, and of those that did the reported incidences of side‐effects showed wide variation. Important differences in practice were also identified in the areas of patient selection, informed consent, the use of epidural test doses, drug delivery systems, monitoring and the management of side‐effects. Twelve per cent of specialist paediatric hospitals did not have an acute pain team and elsewhere the provision was often limited to staff with few or no specialist skills.Conclusion There is wide variation in the practice of paediatric epidural analgesia in the UK. Inconsistencies are likely to be related to the poor evidence base available to guide clinical decision making and the lack of a specialized paediatric acute pain service in some centres. More research is required to determine the optimal management of epidural analgesia, and suitable clinical support for paediatric pain control should be more widely available.
Tariff Policy and the Foreign Entry Decision in the Presence of a Cost‐Based Informational Asymmetry
Authors: Herander Mark G. , Kamp Brad 
Published: November 2003

AbstractThe paper demonstrates that the standard prediction on the relation between tariff rates and the mode of foreign entry—exports or direct investment—may not hold in the presence of incomplete information. A foreign firm lacks full information on the cost structure of an informed incumbent firm located in the domestic (potential) host country. Within a two‐period model, the local incumbent may behave in a manner which keeps the potential foreign entrant uninformed of its cost structure. In such a pooling equilibrium, the uninformed foreign firm either refrains from entering altogether or serves the host country via exports at tariff rates which would, otherwise under complete information, induce entry via direct investment. When entry mode is altered, other standard full‐information effects of trade policy may also no longer hold.
Mitochondrial dynamics
Authors: Logan David C. 
Published: November 2003

SummaryMitochondria cannot be createdde novobut instead must arise from the fission (division) of a parental organelle. In addition to fission, mitochondria also fuse with one another and it is thought that a co‐ordinated balance of these two processes controls mitochondrial shape, size and number. In the past 5–7 yr, molecular genetics coupled to state‐of‐the‐art cell biology, in particular the use of mitochondrial‐targeted green fluorescent protein (GFP), has enabled identification of proteins controlling mitochondrial shape, size and number in yeast and mammalian cells. Little is known about higher plant mitochondrial dynamics. Recently, however, several genes involved in the control of plant mitochondrial dynamics have been identified. The aim of this article is to bring together what is known about mitochondrial dynamics in any organisms and to relate this to our recent knowledge of the underlying processes in higher plants.ContentsSummary463I.Introduction464II.Mitochondrial evolution464III.Mitochondria and the cytoskeleton465IV.Mitochondrial morphology, biogenesis, proliferation and inheritance466V.Mitochondrial fission and fusion468VI.Mitochondrial distribution470VII.Plant specific proteins playing a role in mitochondrial dynamics470VIII.Conclusions471Acknowledgements475References475
Becoming professional: exploring the complexities of professional socialization in health and social care
Authors: Clouder Lynn 
Published: November 2003

AbstractA search of the literature, focusing on professional socialization of health and social care professionals, indicates little contemporary research and therefore a paucity of current debate around what the process involves. Most of the research, including perspectives dating back to the 1950s and 1960s, portrays professional socialization as a deterministic process of moulding essentially passive recipients. A social constructionist perspective, however, encourages a more sceptical view of the ways in which student professionals identify with professional norms and discourses within the context of health and social care. While acknowledging the power of the professions to regulate professional practice and entry into practice, the scope for individuals to exercise personal agency within the professional socialization process is made explicit.
Developing ‘the good healthcare practitioner’: clues from a study in medical education
Authors: Duncan Peter , Cribb Alan , Stephenson Anne 
Published: November 2003

AbstractThis article explores perspectives on the idea of ‘the good healthcare practitioner’, through active consideration of virtue theory and how virtue could be embedded and developed in the lives of healthcare practitioners. It draws particularly on exploratory work with a small number of medical students and general practitioners, in which these participants were asked to reflect on what, for them, constituted ‘the good doctor’. Three key themes emerged from this empirical work: the idea of medicine as a ‘lived experience’ and the potential of this to contribute to developing the lives of ‘good doctors’; the importance of relationships with patients in understanding who is a ‘good doctor’; and the essential need to attempt the marrying of technical medical knowledge with humanistic skills and intuitive sympathy in ‘good medical lives’. The article reflects on the implications of these themes for medical education and training in particular, and more generally for the wider healthcare field. Some methodological difficulties in the relationship between theoretical conceptions and these empirical investigations are discussed, as are those connected to using the experience of medicine as an exemplar for how the ‘good lives’ of healthcare practitioners, in general, might be developed.
Oxidative stress in Caenorhabditis elegans: protective effects of superoxide dismutase/catalase mimetics
Authors: Sampayo James N. , Olsen Anders , Lithgow Gordon J. 
Published: November 2003

SummaryThe lifespan of Caenorhabditis elegans can be extended by the administration of synthetic superoxide dismutase/catalase mimetics (SCMs) without any effects on development or fertility. Here we demonstrate that the mimetics, Euk‐134 and Euk‐8, confer resistance to the oxidative stress‐inducing agent, paraquat and to thermal stress. The protective effects of the compounds are apparent with treatments either during development or during adulthood and are independent of an insulin/IGF‐I‐like signalling pathway also known to affect thermal and oxidative stress resistance. Worms exposed to the compounds do not induce a cellular stress response and no detrimental effects are observed.
Juvenile diet restriction and the aging and reproduction of adult Drosophila melanogaster
Authors: Tu Meng‐Ping , Tatar Marc 
Published: November 2003

SummaryMutations of the insulin signal pathway in Drosophila melanogaster produce long‐lived adults with many correlated phenotypes. Homozygotes of insulin‐like receptor (InR) and insulin‐like receptor substrate (chico) delay time to eclosion, reduce body size, decrease reproduction and increase life span. Because these mutations are expressed through all life stages it is unclear when insulin signals must be reduced to increase life span. As a first analysis of this problem in D. melanogaster we have manipulated the larval diet to determine if changes in metabolic regulation at this stage are sufficient to slow aging. We controlled the dietary yeast fed to third instar larvae and studied the size, mortality, fecundity and hormones of the resulting adults, which were fed a normal, yeast‐replete diet. Adults from yeast‐deprived larvae phenocopied many traits of InR and chico mutants: small body size, delayed eclosion, reduced ovariole number and reduced age‐specific fecundity. But unlike constitutive mutants of the insulin/IGF system, adults from yeast‐deprived larvae had normal patterns of demographic senescence, and this was accompanied by normal insulin‐like peptide and juvenile hormone syntheses. Surprisingly, the normal aging in these adults was also associated with greatly reduced fecundity. Although nutritional conditions of the larvae can affect the subsequent body size and fecundity of adults, these are not sufficient to slow aging.
Real‐time imaging of transcriptional activation in live cells reveals rapid up‐regulation of the cyclin‐dependent kinase inhibitor gene CDKN1A in replicative cellular senescence
Authors: Herbig Utz , Wei Wenyi , Dutriaux Annie , Jobling Wendy A. , Sedivy John M. 
Published: November 2003

SummaryCellular replicative senescence is a permanent growth arrest state that can be triggered by telomere shortening. The cyclin‐dependent kinase (Cdk) inhibitor p21CIP1/WAF1 (p21), encoded by the CDKN1A gene, is a critical cell cycle regulator whose expression increases as cells approach senescence. Although the pathways responsible for its up‐regulation are not well understood, compelling evidence indicates that the upstream triggering event is telomere dysfunction. Studies of replicative senescence have been complicated by the asynchrony of its onset, which is caused by the continuous and stochastic variability in individual cell lifespans. In fact, the actual entry into senescence has never been observed in a single unperturbed cell. We report here a new in vitro human model system that allows entry into senescence to be monitored in real‐time in individual viable cells. We used homologous recombination to generate non‐immortalized fibroblast cells with the enhanced yellow fluorescence protein (EYFP) gene knocked into one CDKN1A gene copy, allowing promoter activity to be visualized as fluorescence intensity. Gamma irradiation, DNA‐damaging drugs, expression of p14ARF or oncogenic Ras, and replicative exhaustion all resulted in elevated EYFP expression, demonstrating its proper control by physiological signalling circuits. Analysis by time‐lapse microscopy of cultures approaching replicative senescence revealed that p21 levels rise abruptly in individual aging cells and remain elevated for extended periods of time.
Fast anterograde transport of Herpes Simplex Virus: Role for the amyloid precursor protein of Alzheimer's disease
Authors: Satpute‐Krishnan Prasanna , DeGiorgis Joseph A. , Bearer Elaine L. 
Published: November 2003

SummaryAnterograde transport of herpes simplex virus (HSV) from its site of synthesis in the neuronal cell body out the neuronal process to the mucosal membrane is crucial for transmission of the virus from one person to another, yet the molecular mechanism is not known. By injecting GFP‐labeled HSV into the giant axon of the squid, we reconstitute fast anterograde transport of human HSV and use this as an assay to uncover the underlying molecular mechanism. HSV travels by fast axonal transport at velocities four‐fold faster (0.9 µm/sec average, 1.2 µm/sec maximal) than that of mitochondria moving in the same axon (0.2 µm/sec) and ten‐fold faster than negatively charged beads (0.08 µm/sec). Transport of HSV utilizes cellular transport mechanisms because it appears to be driven from inside cellular membranes as revealed by negative stain electron microscopy and by the association of TGN46, a component of the cellular secretory pathway, with GFP‐labeled viral particles. Finally, we show that amyloid precursor protein (APP), a putative receptor for the microtubule motor, kinesin, is a major component of viral particles, at least as abundant as any viral encoded protein, while another putative motor receptor, JIP 1/2, is not detected. Conventional kinesin is also associated with viral particles. This work links fast anterograde transport of the common pathogen, HSV, with the neurodegenerative Alzheimer"s disease. This novel connection should prompt new ideas for treatment and prevention strategies.
RENAL RESEARCH INSTITUTE SYMPOSIUM: Disablement and Rehabilitation in End‐Stage Renal Disease
Authors: Tawney Katherine W. , Tawney Paul J. W. , Kovach Jim 
Published: November 2003

AbstractPatients with end‐stage renal disease (ESRD) are encumbered by disabilities in spite of advances in medical treatments. Research shows that exercise training is one way to improve physical work capacity and reduce functional limitations that impede role behaviors, such as shopping, personal care, homemaking, and yard maintenance. However, exercise training does not ameliorate some of the psychosocial and environmental factors that exacerbate disabilities for patients with ESRD. A disability process model described in this review illustrates that disability prevention may be more effective if exercise rehabilitation is integrated with self‐management education. Research is needed to delineate which disabilities in patients with ESRD are a product of psychosocial factors and physical environments. Once identified, those disability risk factors that are amenable to change can guide the development of tailored rehabilitation interventions.
RENAL RESEARCH INSTITUTE SYMPOSIUM: The Practical Problem of Improving Quality in Multicenter Dialysis Facilities
Authors: Balter Paul 
Published: November 2003

AbstractMultifacility dialysis groups are frequently interested in improving overall quality and find that there are major differences between individual units. Upper management must consider what strategy is needed for the whole company and what strategy must be formulated by individual facilities. To make substantive changes, management must decide to adopt a new culture of true teamwork, drive out fear, and emphasize leadership and education both at the management level and in the individual unit. Both at the corporate and unit levels, leaders must be chosen who are able to recognize people who have the ability, the educational background, the enthusiasm, and the time to direct change. Empowering the individual units and individual employees to make changes and be enthusiastic about improvement is the key to success.
RENAL RESEARCH INSTITUTE SYMPOSIUM: Cellular Mechanisms of Bone Resorption Induced by Metabolic Acidosis
Authors: Krieger Nancy S. , Bushinsky David A. , Frick Kevin K. 
Published: November 2003

AbstractMetabolic acidosis increases urine calcium excretion without an increase in intestinal calcium absorption, resulting in a net loss of bone mineral. In vitro metabolic acidosis induces bone calcium efflux initially by physicochemical dissolution and subsequently by cell‐mediated mechanisms involving inhibition of osteoblasts and stimulation of osteoclasts. In bone, prostaglandins (PGs) are important mediators of bone resorption and we have recently determined that acid‐induced bone resorption is mediated by PGs. Utilizing neonatal mouse calvariae in culture, we found that decreasing pH by a reduction in bicarbonate concentration, a model of metabolic acidosis, induced an increase in net calcium efflux and in medium prostaglandin E2 (PGE2) levels, both of which were inhibited in the presence of indomethacin. There was a direct correlation between calcium flux and medium PGE2. If pH is lowered to a comparable degree by an increase in pCO2 to model respiratory acidosis, there was no significant stimulation of net calcium efflux from the calvariae and no stimulation of PGE2 production. We have also shown that metabolic acidosis alters osteoblastic expression of a specific osteoclastogenic factor, RANKL, and this response is also PG dependent. Incubation of calvariae in acid medium stimulated expression of RANKL RNA in parallel with the increased calcium flux. Both responses were inhibited in the presence of indomethacin. Thus metabolic, but not respiratory, acidosis induces production of bone PGE2, which mediates acid‐induced bone resorption.