A BPA survey of recently appointed consultants

A postal survey of recently appointed consultant paediatricians was undertaken to determine whether they perceived their training had adequately equipped them for their current job. The response rate was 69% (207/299). After excluding replies from consultants trained outside the UK the analysis was carried out on 167 replies. Trainees held a mean 5.2 posts during general and higher professional training, necessitating a mean 1.8 house moves. Altogether 82% felt moves were beneficial to training but 46% found moves 'very disruptive' to family life. Only 12% of district general hospital and 22% of teaching hospital senior registrars took two research sessions a week. Supervision and training in research was absent or poor for more than 60%; 24% felt major changes and 55% moderate changes were needed to current training. Training in non-clinical skills was particularly in demand and a curriculum for both trainers and trainees with regular appraisals is required. Research at senior registrar level needs review and educational methods improved to achieve better training in a shorter period.     

Enhanced Hatching Rate of Bovine IVM/IVF/IVC Blastocysts Using a 1.48-μm Diode Laser Beam

Purpose: Our purpose was to test whether zona pellucida (ZP) drilling using a 1.48-m diode laser beam on bovine IVM/IVF/IVC blastocysts is effective for embryo hatching. Methods: Blastocysts produced in vitro at day 7 after IVF were divided into control and laser-drilled groups, respectively. Results: When the rates of in vitro development of bovine embryos were examined, the average cleavage rate (>two-cell) was 82.3% and the blastocyst rate at day 7 after IVF was 32.5%. Using these blastocysts, when the laser drilling effect was investigated at 48 hr after treatment, the total hatching rate in the laser-drilled group (98.0%) was significantly higher than that in the control group (60.0%)(P < 0.001). Especially, the hatched rate of the laser-drilled group (68.0%) was significantly enhanced compared with that of the control group (30.0%) (P < 0.001). Conclusions: These results demonstrated that laser ZP drilling on bovine IVM/IVF/IVC blastocysts can significantly increase the hatching rate.     

Can azathioprine and steroids alter the progression of severe Henoch-Schönlein nephritis in children?

To evaluate the effect of azathioprine with steroids on the clinical course and histologic parameters of severe Henoch-Schönlein nephritis (HSN), 20 patients with a median age of 9.3 years (range 4.4–17 years) and a follow-up period of 4.8 years (range 1–14 years) were included in this study. The patients were divided into two groups. Ten patients received azathioprine with steroids for 8 months (group A), and the other ten received steroids alone (group B). All patients underwent renal biopsy at presentation, and ten of them who were treated with azathioprine underwent follow-up biopsy after therapy. Six patients in group A achieved clinical remission, and the remaining four showed minor urinary abnormalities at the latest observation. The histological grades of the International Study of Kidney Disease in Children (ISKDC) improved in four of the ten patients, and the activity index decreased significantly from 6.8±2.0 to 4.3±2.3 (p=0.016). In group B, however, four patients had normal urine and renal function; two had minor urinary abnormalities; one had active renal disease, and three had chronic renal insufficiency, at the latest observation. The combination treatment of azathioprine and steroids may be beneficial in ameliorating histopathological features and improving the clinical course of severe HSN.     

Influence of Addition of Organoclays on Morphologies in Nylon 6/LLDPE Blends

Summary: Polymer blend nanocomposites containing linear low density polyethylene (LLDPE), nylon 6 and organoclays were prepared by melt mixing, and their morphologies and structures were examined with a field emission scanning electron microscope (FE‐SEM) and an X‐ray diffractometer (XRD). The size of phase‐separated domains decreased considerably with increasing content of organoclay. The d‐spacing of organoclay in the nanocomposites was increased from about 18.6 to over 28 Å. This effect was highly dependent on nylon 6 contents because nylon 6 is more polar and shows higher affinity to the organoclays compared to LLDPE.

     

Voltage-gated calcium channels play crucial roles in the glutamate-induced phase shifts of the rat suprachiasmatic circadian clock

The resetting of the circadian clock based on photic cues delivered by the glutamatergic retinohypothalamic tract is an important process helping mammals to function adaptively to the daily light-dark cycle. To see if the photic resetting relies on voltage-gated Ca(2+) channels (VGCCs), we examined the effects of VGCC blockers on the glutamate-induced phase shifts of circadian firing activity rhythms of suprachiasmatic nucleus (SCN) neurons in hypothalamic slices. First, we found that a cocktail of amiloride, nimodipine and omega-conotoxin MVIIC (T-, L- and NPQ-type VGCC antagonists, respectively) completely blocked both phase delays and advances, which were, respectively, induced by glutamate application in early and late night. Next, we discovered that: (i) amiloride and another T-type VGCC antagonist, mibefradil, completely obstructed the delays without affecting the advances; (ii) nimodipine completely blocked the advances while having less impact on delays; and (iii) omega-conotoxin MVIIC blocked largely, if not entirely, both delays and advances. Subsequent whole-cell recordings revealed that T-type Ca(2+) currents in neurons in the ventrolateral, not dorsomedial, region of the SCN were larger during early than late night, whereas L-type Ca(2+) currents did not differ from early to late night in both regions. These results indicate that VGCCs play important roles in glutamate-induced phase shifts, T-type being more important for phase delays and L-type being so for phase advances. Moreover, the results point to the possibility that a nocturnal modulation of T-type Ca(2+) current in retinorecipient neurons is related to the differential involvement of T-type VGCC in phase delays and advances.     

Prognosis of thymic epithelial tumors according to the new World Health Organization histologic classification

Background

The aim of this study was to document the prognosis of thymic epithelial tumors (TETs) according to new the World Health Organization (WHO) classification.

Methods

We retrospectively reviewed 150 patients with TETs that were confirmed pathologically during 11 years (from 1992 to 2002) in Severance Hospital, Seoul, Korea.

Results

TETs were classified as type A, AB, B1, B2, B3, or C, tumors and these represented 7 (4.7%), 26 (17.3%), 13 (8.7%), 45 (30.0%), 26 (17.3%), and 33 (22.0%) cases, and the 5-year survival rates were 100%, 93%, 89%, 82%, 71%, and 23%, respectively. Their Masaoka stages were I, II, III, IVa, and IVb, with 53 (35.3%), 39 (26.0%), 20 (13.3%), 22 (14.7%), and 16 (10.7%) cases. Tumor invasiveness, recurrence, completeness of resection, and tumor-related death were more frequent in types AB, B2, B3, and C than in types A and B1. Multivariate analysis showed that Masaoka stage (p < 0.001) and the WHO classification (p = 0.019) were significant independent prognostic factors.

Conclusions

The WHO classification is associated with tumor invasiveness, recurrence, completeness of resection, and tumor-related death, and has good correlation with Masaoka stage. The WHO histologic subtypes are an independently significant prognostic factor with respect to survival in our multivariate analysis. Types AB, B2, B3, and C showed invasive behaviors and R1 or R2 resections were frequently performed. Postoperative adjuvant radiotherapy was effective, but long-term follow-up is recommended because of decreased survival after 5 years following operation. The WHO classification may be helpful in clinical practice for the assessment and treatment of TET patients.     

Osteopontin expression and microvascular injury in cyclosporine nephrotoxicity

The aim of this study was to evaluate the role of osteopontin (OPN) in cyclosporine (CsA) nephrotoxicity of the human kidney. Renal biopsy samples obtained before and after 1–2 years of CsA treatment were evaluated in 18 children (2.2–13.0 years, 14 males, 4 females) diagnosed with minimal change nephrotic syndrome. The changes in tubular OPN expression between pre- and post-treatment samples were correlated with interstitial macrophage infiltration, transforming growth factor- (TGF-) expression, interstitial fibrosis, and microvascular density. OPN, TGF-, CD68, and CD34 positivity were quantitatively assessed by immunohistochemical staining. Light microscopy showed that interstitial fibrosis developed in two-thirds of patients after CsA treatment. However, CD68-positive macrophages infiltrated minimally in fibrotic areas and were found in only one-third of patients. OPN expression was significantly increased in the glomerular mesangium (P=0.001) and tubules (P=0.025) after CsA treatment, whereas the number of CD34-positive peritubular capillaries decreased (P=0.022). An inverse relationship was observed between tubular OPN expression and microvascular density (r=–0.644). However, tubular OPN expression was not related to proteinuria, interstitial fibrosis, or interstitial or tubular TGF- expression. This study indicates that increased OPN expression may be related to microvascular injury in human CsA nephrotoxicity. It also shows that OPN expression may be used as an early but non-specific marker of CsA toxicity before the manifestation of interstitial fibrosis.     

The comparison of VATS ramicotomy and VATS sympathicotomy for treating essential hyperhidrosis

This study was undertaken to determine if better results could be achieved by comparing the results of a thoracic sympathetic ramicotomy (division of rami communicantes) with a conventional thoracic sympathicotomy (division of sympathetic trunk) for treating essential hyperhidrosis. From August 2001 to February 2002, 29 consecutive patients underwent surgery of the sympathetic nerves in order to treat severe essential hyperhidrosis. Of these patients, a ramicotomy was performed under VATS (VATS-R) in 13 patients, sympathicotomy under VATS (VATS-S) in 13, a unilateral ramicotomy and contralateral sympathicotomy under VATS (VATS-RS) in 2 and a sympathicotomy via a thoracotomy (T-S) in 1. There was no significant difference between the VATS ramicotomy group (VATS-R, n=13) and VATS sympathicotomy group (VATS-S, n=13) in terms of gender, pleural adhesions or comorbidities. However, the age of the VATS-S group at surgery was higher than that of the VATS-R group (p=0.050). The operation times, and hospital stays of the groups were 51.5 and 41.9 minutes, and 2.0 and 2.3 days, respectively. The recurrence rate of the operated sites according to the surgical methods (ramicotomy and sympathicotomy regardless of VATS) was 21.4% (6/28) in the ramicotomy group and 6.7% (2/30) in the sympathicotomy group, but there was no statistical significance (p=0.101). This study compared the dryness of the enervated sites and the severity of compensatory sweating among the ramicotomy (n=11, excluded 2 re-operated cases from 13 VATS-R), sympathicotomy (n=14, VATS-S 13 and T-S 1) and the synchronous or metachronous ramicotomy/sympathicotomy groups (n=4, included 2 reoperated cases of VATS-R). The sympathicotomy group had an over-dryness of the enervated sites (dryness 1.4, from 1 to 3; 1:over-dried, 2:humid, 3:persistent sweating) and complained of severe compensatory sweating (severity 3.5, from 1 to 4; 1:absent, 2:mild, 3:embarrassing, 4:disabling). However, the patients whounderwent a ramicotomy maintained some humidity of the enervated sites (dryness 2.0, p=0.012) and showed milder compensatory sweating (severity 2.7, p=0.056) than those in the sympathicotomy group. Furthermore, the dryness of the ramicotomy side was different from that of the sympathicotomy side in 3 out of 4 ramicotomy / sympathicotomy (R+S) patients (the side of the ramicotomy was humid and that of the sympathicotomy was over-dried). The average dryness and the compensatory sweating at these sites were in the midst of the two groups (dryness and severity 1.6 and 3.0, respectively). A ramicotomy can prevent over-dryness of the enervated area and decrease the severity of compensatory sweating through the selective division of the rami communicantes of the thoracic sympathetic ganglia. Postoperatively, almost all ramicotomy patients had no functional problems in daily life or in their occupational activity, because they could maintain hand humidity. Moreover, they showed no more than a mild degree of compensatory sweating and reported high long-term satisfaction rates. Therefore, a sympathetic ramicotomy rather than a conventional sympathicotomy is recommended as a more selective and physiologic modality for treating essential hyperhidrosis.     

The effect of lidocaine on the globule size distribution of propofol emulsions

In this study, we sought to determine the globule size distribution of a propofol/lidocaine mixture as a function of lidocaine concentration and time elapsed after mixing in a standard formulation of propofol emulsion (Diprivan) and in a new formulation containing L-lysine to improve stability. The globule size was measured with a laser diffraction technique. The median diameter of the globule size in 20 mL of Diprivan immediately after the addition of 0, 10, 20, 30, 40, and 50 mg of lidocaine was similar to that of chylomicrons, ranging from 0.28 +/- 0.01 micro m to 0.30 +/- 0.02 micro m, over the whole range of lidocaine concentration. However, the maximum diameter increased slightly (from 0.97 +/- 0.01 micro m to 2.90 +/- 0.07 micro m) as the concentration of lidocaine increased. At 6 h after adding lidocaine, the maximum globule size had increased slightly (to 2.98 +/- 0.04 micro m) with 20 mg of lidocaine and increased considerably (to 51.76 +/- 0.62 micro m) when 30 mg of lidocaine was added. At 2 h after the addition of 50 mg of lidocaine, the maximum globule diameter had increased to 52.2 +/- 1.92 micro m. The maximum globule diameter in the propofol emulsion to which L-lysine was added as a stabilizer did not exceed 3.0 micro m even when the largest amount of lidocaine was added. This study demonstrated that when 30 mg of lidocaine was added to 20 mL of Diprivan and the solution was left for a period of time, the globule size increased. Its increase was minimized by the addition of L-lysine to the propofol emulsion.