bluuebunny/crossref_metadata_2025_split huggingface dataset:
A role for glycine in the gating of plant NMDA‐like receptors
Authors: Dubos Christian , Huggins David , Grant Guy H. , Knight Marc R. , Campbell Malcolm M. 
Published: September 2003

SummaryThe amino acid glycine has a well‐established role in signalling in the mammalian central nervous system. For example, glycine acts synergistically with the major excitatory neurotransmitter, glutamate, to regulate the influx of ions such as calcium, through N‐methyl‐d‐aspartate (NMDA) receptors. Plants possess NMDA‐like receptors, generically referred to as glutamate receptors (GLRs), named on the basis of their presumed ligand, glutamate. Previously, glycine has not been implicated in plant GLR activity or any other aspect of plant signalling. Using transgenic Arabidopsis seedlings expressing aequorin to monitor ligand‐mediated changes in the cytosolic concentration of Ca2+ ([Ca2+]cyt), the data presented herein show that glutamate and glycine act synergistically to control ligand‐mediated gating of calcium in plants. Glutamate and glycine synergism also regulates hypocotyl elongation. Transient increases in [Ca2+]cyt mediated by glutamate and glycine, as well as hypocotyl elongation, were inhibited by 6,7‐dinitroquinoxaline‐2,3 dione (DNQX), a competitive inhibitor of animal GLRs. Using a multiscale docking algorithm in combination with a molecular model of the ligand‐binding domain of plant GLRs, evidence is provided indicating that glycine, and not glutamate, is likely to be the natural ligand for most plant GLR subunits. These findings uncover a hitherto unconsidered role for glycine signalling in plants, and suggest that the synergistic action of glutamate and glycine at NMDA‐like receptors predates the divergence of plants and animals.
Metastatic cutaneous squamous cell carcinoma to the parotid: the role of surgery and adjuvant radiotherapy to achieve best outcome
Authors: Dona Eddy , Veness Michael J. , Cakir Burcu , Morgan Gary J 
Published: September 2003

Background:  Australia has the highest incidence of cutaneous squamous cell carcinoma in the world. The majority of lesions occur in the head and neck with metastases to the parotid gland lymph nodes reflecting an uncommon, but aggressive, manifestation. Parotidectomy ± neck dissection followed by adjuvant radiotherapy should be considered as best practice.Methods:  Between 1983 and 2000, seventy‐four patients were treated for metastatic cutaneous squamous cell carcinoma to the parotid with surgery and adjuvant radiotherapy at Westmead Hospital, Sydney. Relevant data were extracted from patient files and a prospectively maintained database. Patterns of relapse and outcome were analysed.Results:  Median age at diagnosis was 65 years (34−93 years) in 63 men and 11 women. Median follow‐up duration was 41 months (12−188 months). All patients underwent parotidectomy with 52 undergoing a simultaneous neck dissection. Twelve patients required sacrifice of the facial nerve (4) or one or more branches (8). All received adjuvant radiotherapy to the parotid region with 56 also receiving radiotherapy to the ipsilateral neck. Despite treatment, 24% developed locoregional recurrence, with a median time to relapse of 7.5 months. The most common site for recurrence was the treated parotid region and upper neck. Most relapsed patients died. No variable independently predicted for locoregional recurrence on multivariate analysis. The 5‐year absolute and cause‐specific survival rates were 58% and 72%, respectively.Conclusion:  Parotid gland lymph node metastases from cutaneous squamous cell carcinoma are associated with a high rate of recurrence and cause‐specific mortality despite current best practice (surgery and high dose adjuvant radiotherapy). The role of more aggressive surgery, altered fractionation or chemotherapy to enhance locoregional control remains unclear.
Chemoprevention of gastrointestinal malignancies
Authors: Garcea Giuseppe , Dennison Ashley R. , Steward Will P. , Berry David P. 
Published: September 2003

Background:  There has been considerable interest in the use of chemical or dietary agents to suppress or inhibit the development of tumours in the early stages of carcinogenesis. This concept is known as chemoprevention and although the potential for such agents is tremendous, evaluating their clinical benefit is beset with difficulties.Aims:  Using selected agents, such as curcumin and indole‐3‐carbinol, as examples, the present review will discuss the possible mechanisms of chemoprevention and the problems encountered in developing these agents into clinical drugs.Methods:  A review of the published literature from 1985 to the present day was performed using Medline and Web of Science search engines. Key words used were ‘gastrointestinal cancer’ and ‘chemoprevention’.Conclusion:  A huge number of agents with possible chemopreventive action has been identified. Pilot trials using molecular signatures of cancer activity can be used to select which agents should be included in large‐scale phase III clinical trials. Publications concerning chemoprevention are concentrated in the scientific and oncological literature but surgeons with their greater exposure to premalignant gastrointestinal disease need to be aware of current concepts in this rapidly expanding field. This knowledge would allow collaboration between oncologists and surgeons in clinical trials to further evaluate chemopreventive compounds and ascertain their clinical impact.
Postoperative confusion assessed with the Short Portable Mental Status Questionnaire
Authors: Eissa Amirarsalan , Andrew Marie J. , Baker Robert A. 
Published: September 2003

Background:  Confusion is a common occurrence after cardiac surgery. However, there is great variability in the reported incidence of confusion in patients following cardiac surgery, mainly due to the diagnostic methods and instruments employed in assessing confusion.Methods:  Forty‐eight cardiac surgery patients were assessed for postoperative confusion by a non‐structured physician interview, and by the short portable mental status questionnaire (SPMSQ) administered by a medical student.Results:  The non‐structured ward interviews detected confusion in one of the 48 patients (2%), whereas the SPMSQ diagnosed confusion in 15 of the 48 patients (31%).Conclusion:  Unlike a subjective ward interview, the SPMSQ is a brief and objective diagnostic tool that can be used to measure accurately both the presence and severity of confusion in postoperative cardiac surgery patients.
Management practices of Australian surgeons in the treatment of venous ulcers
Authors: Kruger Allan J. , Raptis Spero , Fitridge Robert A. 
Published: September 2003

Introduction:  Venous ulcers will affect 2% of the general population during the course of their lives causing significant morbidity. The aim of the present paper was to review assessment and treatment regimes used by surgeons throughout Australia and compare these with published guidelines.Methods:  A structured questionnaire was sent to all general and vascular surgeons in Australia. Questions detailing practice demographics, initial treatment, investigation and surgical intervention were asked. Responses were analysed using Fisher's exact test.Results:  A response rate of 36% was obtained from 1390 surgeons. This included 30% of the general surgeons and 67% of the vascular surgeons surveyed. Three hundred and seventy‐one of these surgeons managed patients with venous ulcers. Vascular surgeons recorded ankle‐brachial pressures (88%vs 55%; P < 0.0001) more frequently and used compression therapy more often than general surgeons (99%vs 61%; P < 0.0001). Superficial vein ablation was performed by 95% in the presence of superficial vein reflux and a normal deep system, 46% also performed this procedure in the setting of an incompetent deep system. Antibiotics were prescribed by 15% of surgeons with no evidence of infection.Conclusions:  Initially venous ulcers are well managed in Australia; however, antibiotics are overprescribed in their treatment. The current rate of compression therapy use is low for some groups of surgeons and should be improved. The failure to use compression in all cases of venous ulcers and the overprescription of antibiotics in the absence of cellulitis suggests that significant improvements can be made in the management of venous ulcers in Australia.
Hand‐assisted laparoscopic lymphadenectomy: a novel approach to a difficult area
Authors: Sutherland Andrew , Wright Gavin 
Published: September 2003

Background:  Hand‐assisted laparoscopic surgery (HALS) is an emerging technique that is gaining acceptance for a wide range of abdominal procedures. We drew upon our growing experience with hand‐assisted laparoscopic and thoracoscopic surgery to manage a case that was felt to require a major thoracoabdominal incision if it were to be completed by conventional open surgery.Methods:  A technique is described that combines the advantages of both laparoscopic and open surgery in the form of hand‐assisted laparoscopic surgery to permit safe dissection of a retrocrural mass extending into the chest.Results:  We used this technique successfully to completely resect a nodal deposit of metastatic embryonal carcinoma previously thought to be inaccessible to surgical resection.Conclusion:  The use of hand‐assisted laparoscopic surgery improves tactile and visual feedback for the operator. This allows complex procedures involving delicate dissection to be completed safely and with less morbidity than open surgery.
Methodological index for non‐randomized studies (MINORS): development and validation of a new instrument
Authors: Slim Karem , Nini Emile , Forestier Damien , Kwiatkowski Fabrice , Panis Yves , Chipponi Jacques 
Published: September 2003

Background:  Because of specific methodological difficulties in conducting randomized trials, surgical research remains dependent predominantly on observational or non‐randomized studies. Few validated instruments are available to determine the methodological quality of such studies either from the reader's perspective or for the purpose of meta‐analysis. The aim of the present study was to develop and validate such an instrument.Methods:  After an initial conceptualization phase of a methodological index for non‐randomized studies (MINORS), a list of 12 potential items was sent to 100 experts from different surgical specialities for evaluation and was also assessed by 10 clinical methodologists. Subsequent testing involved the assessment of inter‐reviewer agreement, test‐retest reliability at 2 months, internal consistency reliability and external validity.Results:  The final version of MINORS contained 12 items, the first eight being specifically for non‐comparative studies. Reliability was established on the basis of good inter‐reviewer agreement, high test‐retest reliability by the κ‐coefficient and good internal consistency by a high Cronbach's α‐coefficient. External validity was established in terms of the ability of MINORS to identify excellent trials.Conclusions:  MINORS is a valid instrument designed to assess the methodological quality of non‐randomized surgical studies, whether comparative or non‐comparative. The next step will be to determine its external validity when used in a large number of studies and to compare it with other existing instruments.
Effects of ursodeoxycholic acid, glutamine and polyclonal immunoglobulins on bacterial translocation in common bile duct ligated rats
Authors: Aldemir Mustafa , Faruk Geyik M. , Faruk Kökoğlu Ö. , Büyükbayram Hüseyin , Hoşoğlu Salih , Yağmur Yusuf 
Published: September 2003

Background:  The present study was conducted to investigate the effects of ursodeoxycholic acid (UDCA), glutamine and i.v. polyclonal immunoglobulins (IVIG) on the bacterial translocation (BT) and intestinal integrity of obstructive jaundice (OJ) in an animal model.Methods:  Fifty rats were randomized into five groups containing 10 rats each. All procedures were performed aseptically under general anaesthesia using intramuscular ketamine (25 mg/kg). The abdomen was opened and the common bile duct was identified, mobilized, doubly ligated using 5−0 silk and divided. In group 1 (the ‘sham’ group), the rats had a similar incision followed by mobilization of the common bile duct (CBD), without ligation or division. In group 2 rats, only common bile duct ligation (CBDL) was performed. In group 3, CBDL was performed and UDCA was administered by orogastric intubation once daily. In group 4 rats, CBDL was performed and glutamine was given by orogastric intubation once daily. Therapeutic substances were started orally on the day CBDL was fulfilled and were continued for 7 days. In group 5, IVIG was administrated via a femoral vein catheter just before CBDL. The animals were killed at the end of the 7th day, and serum levels of total bilirubin (TB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma‐glutamyl transpeptidase (GGT) were measured. Mesenteric lymph nodes (MLN), liver, spleen and blood were cultured. The terminal ileum specimens were examined histopathologically.Results:  Bacterial translocation significantly increased in the MLN and spleen of rats in group 2 as compared to groups 3, 4 and 5 (P < 0.05, P = 0.001, P = 0.001, respectively). The BT of the liver in group 2 was significantly higher than that of group 5 (P < 0.05). In the blood, the BT was significantly higher in group 2 than groups 3, 4 and 5 (P < 0.05). The bacterial counts, colony‐forming units per gram tissue (cfu/g), were found significantly higher in MLN, liver and spleen of rats in group 2 than those of groups 3, 4 and 5 (P = 0.000). The average villus height in the group 4 was significantly higher than that of groups 2, 3 and 5 (P = 0.000).Conclusion:  The present experimental study has demonstrated that the administration of glutamine, UDCA and IVIG reduce the incidence of BT and additionally glutamine preserves intestinal mucosal integrity.
Retrospective, 5‐year surgical audit comparing breast cancer in indigenous and non‐indigenous women in Far North Queensland
Authors: Shaw Ian M. , Elston Timothy J. 
Published: September 2003

Background:  Breast cancer is the third leading cause of cancer deaths in Aboriginal women after cervical and lung cancer.Methods:  A retrospective 5‐year surgical audit comparing breast cancer in indigenous and non‐indigenous women in Far North Queensland was undertaken.Results:  The mean age at diagnosis was similar for indigenous (54.0 years) and non‐indigenous (55.4 years) women. Indigenous women presented with slightly larger tumours (mean 32.2 mm vs 23 mm; P = 0.07). More indigenous women had involved lymph nodes (P = 0.03). Despite larger tumour size, indigenous women were considered suitable for breast conservation surgery at a rate similar to the non‐indigenous population.Conclusions:  Indigenous women present with more advanced breast cancer in Far North Queensland despite similar detection rates among the screened indigenous and non‐indigenous population. Indigenous women received similar rates of breast conservation surgery. Differences in mortality rates will require further study.
Breast reconstruction following mastectomy: current status in Australia
Authors: Sandelin Kerstin , King Elizabeth , Redman Sally 
Published: September 2003

Background:  Although breast reconstruction provides some advantages for women following mastectomy, few Australian breast cancer patients currently receive reconstruction. In Australia, the routine provision of breast reconstruction will require the development of specific health service delivery models. The present paper reports an analysis of the provision of breast reconstruction in eight sites in Australia.Methods:  A semi‐structured telephone interview was conducted with 10 surgeons offering breast reconstruction as part of their practice, including nine breast or general surgeons and one plastic surgeon.Results:  Surgeons reported offering breast reconstruction to all women facing mastectomy; the proportion of women deciding to have breast reconstruction varied between sites with up to 50% of women having a reconstruction at some sites. Most sites offered three types of reconstruction. Two pathways emerged: either the breast surgeon performed the breast surgery in a team with the plastic surgeon who undertook the breast reconstruction or the breast surgeon provided both the breast surgery and the reconstruction. Considerable waiting times for breast reconstruction were reported in the public sector particularly for delayed reconstruction. Surgeons reported receiving training in breast reconstruction from plastic surgeons or from a breast surgery team that performed reconstructions; a number had been trained overseas. No audits of breast reconstruction were being undertaken.Conclusions:  Breast reconstruction can be offered on a routine basis in Australia in both the private and public sectors. Women may be more readily able to access breast reconstruction when it is provided by a breast surgeon alone, but the range of reconstruction options may be more limited. If access to breast reconstruction is to be increased, there will be a need to: (i) develop effective models for the rural sector taking account of the lack of plastic surgeons; (ii) address waiting times for reconstruction surgery in the public sector; (iii) review costs to women in the private sector; (iv) develop a better understanding of women's views and how best to communicate about breast reconstruction; and (v) improve training in breast reconstruction.
Factors determining the return to normal activity after appendicectomy
Authors: Wagener Jenny , Windsor John 
Published: September 2003

Background:  The ability of a patient to return to their normal activities is an important outcome of an operation. The present study was designed to identify and rank factors that are important in determining this return to normal activity (RTNA) after appendicectomy.Methods:  Consecutive patients were identified prospectively following appendicectomy at North Shore Hospital between February and April 2000. Data regarding 25 different factors were obtained by a structured patient interview before and after discharge from hospital and by review of the medical records. Statistical analysis involved analysis of variance and logistic regression analysis.Results:  There were 98 patients (median age 28, range 15−69 years, male : female ratio 48:50) who had an appendicectomy. An open appendicectomy was performed in 74 patients, a laparoscopic appendicectomy in 22 patients and a laparotomy in two patients. This includes the 16 patients who were converted from laparoscopic to open appendicectomy (conversion rate 42% 16/38). Acute appendicitis was confirmed by histology in 67 (68%) patients. The significant independent variables identified by anova were ranked by logistic regression analysis. The most important determinant for the time to RTNA was what the doctor advised (χ‐squared 43.7, P < 0.0001). The other determinants were the physical activity of their primary occupation (χ‐squared 21.5, P < 0.017), the need for strong postdischarge analgesia (χ‐squared 21.1, P < 0.13), the American Society of Anesthesiologists (ASA) category (χ‐squared 13.6, P < 0.018) and the total sick leave obtained (χ‐squared 9.6, P < 0.08).Conclusion:  It has been shown that the most significant factor in determining the RTNA after appendicectomy was the advice given by the doctor, and that this was more important than the surgical approach, pathology, complications, age or occupation of the patient.
Cardiac surgery in Australian octogenarians: 1996−2001
Authors: Hewitt Timothy D. , Santa Maria Peter L. , Alvarez John M. 
Published: September 2003

Background:  The number of octogenarians receiving cardiac surgery is increasing. Concerns regarding the outcomes and significant expense required to provide this service have not been addressed because no prospective medium term outcomes of Australian octogenarians have been published.Methods:  Prospective analysis was undertaken of octogenarians having cardiac surgery from 1996 to 2001 in three hospitals of moderate case volume (400 patients per year) by: in‐hospital audit and data acquisition, 1‐year direct patient follow up in rooms, and a final follow up in late 2001 directly with the patient either in rooms or via telephone questionnaire.Results:  Sixty‐four patients had cardiac surgery. All patients were severely disabled by symptoms (CCVS: III−IV, NYHA: III−IV) preoperatively, 14% were advised not to proceed with a surgical option but did so. Total operative in‐hospital mortality was 6.3% (elective: 0%, urgent: 10.5%, P = 0.05), major complications were few 10.9% (seven patients; stroke: 1.6%, deep sternal infection: 1.6%, myocardial infarction: 1.6%, reoperation: 4.8%). At 1 year, despite 95% being free of significant cardiovascular symptoms (CCVS/NYHA: I−II), nearly one in five (19%) would not have proceeded with the surgery. However, at the final follow up (mean time: 2.8 years), freedom from cardiovascular symptoms remained high (95%), 94% remained independent and their quality of life was significantly better than before surgery. Although 59% suffered worsening of additional medical conditions, these conditions had a minor impact on their quality of life. Ninety‐eight per cent would recommend cardiac surgery. Actuarial survival for all patients and for hospital survivors at 4 years was 67.9 ± 4.1% and 74.2 ± 4%, respectively.Conclusion:  Medium‐term follow up of Australian octogenarians who were offered cardiac surgery revealed that 94% remain independent and with an excellent quality of life. Age alone must not be a barrier to access to cardiac surgery.
Clinical and angiographic outcome after Guglielmi detachable coil embolization of intracranial aneurysms
Authors: Darwish Balsam , Rajak Saul , Wickremesekera Agadha , Hunn Martin , Balakrishnan Venkatraman , Braithwaite Douglas , FitzJohn Trevor 
Published: September 2003

Background:  Between July 1997 and April 2001, forty patients underwent Guglielmi detachable coil (GDC) embolization of intracranial aneurysms at Wellington Hospital.Methods:  The clinical notes and imaging were reviewed retrospectively.Results:  Complete initial occlusion was achieved in 28 patients (70%). Eleven patients (27.5%) had small residual neck (>90% occlusion) and one patient (2.5%) had substantial filling of the aneurysm. Follow up angiographic assessment was obtained in 28 patients (70%) of whom 24 patients (85.7%) had no recurrence or stable residual neck and four patients (14.3%) had recurrence or enlargement of the residual neck. Stable occlusion was achieved in 100% of small and medium sized aneurysms and 50% of large and giant aneurysms. Technical complications occurred in 10% including aneurysms perforated in two patients (5%) and presumed parent artery occlusion in another two (5%).Conclusions:  The findings of the present study demonstrate the safety of GDC embolization. The initial clinical grade at presentation strongly predicted the clinical outcome. Although the number of patients in this study is small, there is evidence that the angiographic outcome is better for small and medium sized aneurysms. Our results are comparable to other published series.