bluuebunny/crossref_metadata_2025 huggingface dataset:
Review of the clinical experience with a modified release form of tacrolimus [FK506E (MR4)] in transplantation
Authors: Wente Moritz N. , Sauer Peter , Mehrabi Arianeb , Weitz Jürgen , Büchler Markus W. , Schmidt Jan , Schemmer Peter
Published: November 2006

Abstract:  Non‐compliance in solid transplantation recipients is a major factor in acute graft rejection, which influences patient survival. Nowadays, tacrolimus is one of the most widely used immunosuppressant agents together with cyclosporine following kidney and liver transplantation with a standardized twice‐daily dosing regimen. To improve the patients’ compliance to the prescribed immunosuppressive therapy, FK506E (MR4), a modified release (MR) oral dosage form of tacrolimus has been developed for a once‐daily dosing regimen. This report reviews the most recent results of clinical trials with MR tacrolimus after kidney and liver transplantation.
Wound complications following kidney and liver transplantation
Authors: Mehrabi A. , Fonouni H. , Wente M. , Sadeghi M. , Eisenbach C. , Encke J. , Schmied B.M. , Libicher M. , Zeier M. , Weitz J. , Büchler M.W. , Schmidt J.
Published: November 2006

Abstract:  Advances in surgical techniques and immunosuppression (IS) have led to an appreciable reduction in postoperative complications following transplantation. However, wound complications as probably the most common type of post‐transplantation surgical complication can still limit these improved outcomes and result in prolonged hospitalization, hospital readmission, and reoperation, consequently increasing overall transplant cost. Our aim was to review the literature to delineate the evidence‐based risk factors for wound complications following kidney and liver transplantation (KTx, LTx), and to present the preventive and therapeutic modalities for this bothersome morbidity. Generally, wound complications are categorized as superficial and deep wound dehiscences, perigraft fluid collections and seroma, superficial and deep wound infections, cellulitis, lymphocele and wound drainage. The results of several studies showed that the most important risk factors for wound complications are IS and obesity. Additionally, there are surgical and/or technical factors, including type of incision, reoperation, and surgeon's expertise, as well as comorbidities such as advanced age, diabetes mellitus, malnutrition, and uremia. Preventive management of wound complications necessitates defining their etiological factors so that their detrimental effects on healing processes can be addressed and reduced. IS modalities and agents, especially sirolimus (SRL), and steroids (ST) should be adjusted according to the patient's co‐existing risk factors. SRL should be administered three months after transplantation and ST should be tapered as soon as possible. A body mass index (BMI) lower than 30 kg/m2 is advisable for inclusion in a transplantation program, but higher BMIs do not exclude recipients. Surgical risk factors can be prevented by applying precise surgical techniques. Therapeutic modalities must focus on the most efficient and cost‐effective medications and/or interventions to facilitate and improve wound healing.
Prevention of hepatitis B virus recurrence after liver transplantation
Authors: Eisenbach Christoph , Sauer Peter , Mehrabi Arianeb , Stremmel Wolfgang , Encke Jens
Published: November 2006

Abstract: Liver transplantation for hepatitis B virus (HBV)‐related liver disease has changed from a contraindication to outcomes comparable with non‐HBV‐related liver transplantations during the last two decades. Mainly the implementation of immunoprophylaxis with hepatitis B immunoglobulin (HBIG) and the use of nucleoside analogs such as lamivudine and adefovir account for this dramatic change. The standard of care in most centers today consists of lamivudine treatment in replicating hepatitis B pre‐orthotopic liver transplantation (OLT) and a combination regimen of lamivudine and HBIG post‐OLT. With adefovir, a potent antiviral drug became available in recent years that allows for the treatment of patients with lamivudine‐resistant tyrosine‐methionine‐aspartate‐aspartate (YMDD)‐mutant HBV. In the transplantation setting, first studies indicate that a triple prophylactic therapy consisting of lamivudine, adefovir, and HBIG will become the standard of care for YMDD‐mutant‐related hepatitis B. With new drugs emerging for the treatment of chronic HBV, there is optimism for new options also in the transplant setting.
Pediatric liver transplantation. Introduction of a program for southern Germany in Heidelberg
Authors: Engelmann Guido , Meyburg Jochen , Schmidt Jan , Lenhartz Henning
Published: November 2006

Abstract:  Pediatric liver transplantation in Germany is exclusively performed in four centers in the north of Germany. We report our experience with the implementation of a new pediatric liver transplantation program in Heidelberg for children living in the south of Germany. In a pilot phase, we have transplanted eight children with various transplantation techniques including reduced size, left lateral split (segments 2 and 3), and full left split (segments 1–4). All transplantations were successful. No vascular complications occurred. The immunosuppressive regimen we used was cyclosporine A and methylprednisolone. The rate of acute rejection was three of eight patients. No patient required a retransplantation. One patient died due to a severe fungal sepsis he had acquired prior to transplantation. We conclude that in a multidisciplinary approach with careful patient selection a new program for pediatric liver transplantation can be successfully established.
Microsatellite typing of the human leucocyte antigen region: analytical approach and contribution to rheumatoid arthritis immunogenetic studies
Authors: Barnetche T. , Constantin A. , Gourraud P.‐A. , Abbal M. , Garnier J.‐G. , Cantagrel A. , Cambon‐Thomsen A.
Published: November 2006

Within the major histocompatibility complex (MHC), the human leucocyte antigen (HLA)‐DRB1 locus is clearly associated with rheumatoid arthritis (RA). Using a microsatellite (MSat) typing approach, we aimed to identify other loci associated with RA susceptibility and/or severity within the MHC. A panel of nine MSat HLA loci [D6S291, D6S2876 (G51152), D6S1666 (DQCAR II), D6S273, D6S2789 (TNFd), D6S2810 (MIB), D6S265, D6S2222, D6S2239], and HLA‐A, ‐B and ‐DRB1 genes were typed in 170 RA cases and 282 controls. For susceptibility analysis, MSat and HLA allele distribution were compared between cases and controls, before and after stratification on HLA‐DRB1*04. Haplotype frequencies were estimated using an expectation–maximization algorithm in a permutation test procedure. For severity analysis, we compared the distribution of structural damage score at onset and after 4 years of follow‐up in RA cases carrying susceptibility alleles. Two MSat polymorphisms were positively associated with RA susceptibility: allele*136 of D6S265 [odds ratio, OR (confidence interval, CI) = 1.55 (1.11–2.17), P= 0.007], allele*116 of D6S2239 [OR = 1.34 (1–1.79), P= 0.03] and HLA‐A2 [OR = 1.46 (1.08–1.98), P= 0.01]. Two MSat polymorphisms were negatively associated with RA susceptibility: allele*133 of D6S273 [OR = 0.3 (0.1–0.75), P= 0.005] and allele*177 of D6S291 [OR = 0.72 (0.53–0.96), P= 0.02]. The association between allele*136 of D6S265 and RA susceptibility remained unchanged after stratification on HLA‐DRB1*04. The haplotypic analysis showed an overrepresentation of D6S265*136/HLA‐A*02 haplotype, which suggests an effect independent of HLA‐DRB1 locus in RA susceptibility. While HLA‐A2 and HLA‐DR4 were associated with RA severity, no MSat polymorphism was associated with structural damage score.
Multiplex family–based study in systemic lupus erythematosus: association between the R620W polymorphism of PTPN22 and the FcγRIIa (CD32A) R131 allele
Authors: Balada E. , Villarreal‐Tolchinsky J. , Ordi‐Ros J. , Labrador M. , Serrano‐Acedo S. , Martinez‐Lostao L. , Vilardell‐Tarrés M.
Published: November 2006

A functional polymorphism in PTPN22, a gene encoding a phosphatase involved in T‐cell signaling, has been associated with autoimmunity. We checked for the prevalence of the PTPN22 R620W polymorphism in multiplex families affected with systemic lupus erythematosus (SLE) and other autoimmune diseases. Its association with other polymorphisms in mannose binding lectin (MBL) and FcγRIIa (CD32A) genes was also studied. Deoxyribonucleic acid samples were obtained from 233 Spanish individuals who belonged to 21 families in which at least two members had been diagnosed with some autoimmune disease, mainly SLE. A healthy control population was also included (n= 129). Genotyping for the R620W single‐nucleotide polymorphism (SNP) was performed by restriction fragment length polymorphism analysis of polymerase chain reaction products. Allele frequency for the T allele was slightly higher in the families with autoimmune disease, especially when considering the affected individuals (0.094 vs 0.062). Actually, 18.8% affected family members vs 11.6% controls had the polymorphism (P= 0.179). Nineteen percent of affected individuals had both the PTPN22 T and the CD32A R131 alleles, whereas only 8.5% unaffected relatives had both susceptibility alleles simultaneously [P= 0.031, odds ratios 2.508 (95% confidence interval 1.066–5.896)]. The tendency toward finding the T allele more frequently in members affected with some particular autoimmune disorder suggests that this SNP may confer susceptibility to autoimmunity. The fact that more affected than unaffected relatives carried both the T and the R131 alleles simultaneously leads us to think about the existence of a combinatorial effect between genes that could help define individuals prone to autoimmune diseases.
Cytochrome and alternative pathway activity in roots of thermal and non‐thermal Agrostis species in response to high soil temperature
Authors: Rachmilevitch Shimon , Xu Yan , Gonzalez‐Meler Miquel A. , Huang Bingru , Lambers Hans
Published: November 2006

Partitioning of respiration between the cytochrome pathway (CP) and the alternative pathway (AP) may play an important role in plant adaptation to extreme environments. We examined changes in partitioning between CP and AP, and viability of roots associated with plant exposure to high soil temperature for two Agrostis species: Agrostis scabra Willd., a species adapted to high‐temperature soils in geothermal areas in Yellowstone National Park, and Agrostis stolonifera L. (cv. Penncross) a heat‐sensitive grass widely used in cool‐climate regions. Roots of A. scabra and A. stolonifera were exposed to soil temperature of 37 or 20°C, while shoots were exposed to 20°C for 28 days. Root viability decreased, and total root respiration increased for both species at 37°C. The decline in root viability and the increase in respiration rates were less pronounced for A. scabra than for A. stolonifera. A larger proportion of total root respiration was attributed to the AP in A. scabra compared with that in A. stolonifera when both species were exposed to 37°C. At 7 and 14 days at 37°C, the relative proportion of respiration passing through AP increased by 12 and 10%, respectively, in A. scabra, whereas in A. stolonifera, AP increased by 4 and 1%, respectively. Our results suggest that maintaining a higher proportion of AP at a high soil temperature may contribute to root thermo‐tolerance in A. scabra in comparison with A. stolonifera, and alternative respiration may play an important role in plant adaptation to high soil temperature.
Contribution of the cytochrome and alternative pathways to growth respiration and maintenance respiration in Arabidopsis thaliana
Authors: Florez‐Sarasa Igor D. , Bouma Tjeerd J. , Medrano Hipólito , Azcon‐Bieto Joaquin , Ribas‐Carbo Miquel
Published: November 2006

The activities of the cytochrome and alternative respiratory pathways were measured during the growth cycle in Arabidopsis thaliana using a newly developed Isotope Ratio Mass Spectrometer (IRMS) dual‐inlet system that allows very precise measurements of oxygen‐isotope fractionation under low oxygen consumption rates. Under optimum growth conditions, the relative growth rate was highly dependent on the activity of the cytochrome pathway. The activity of the alternative pathway was almost constant irrespective of the growth rate and appeared mostly involved in the maintenance respiration component, although the alternative pathway also played a role under optimum growth conditions. This is the first time that the contribution of the two respiratory pathways to the two main respiratory components (growth and maintenance) has been analyzed with the use of the oxygen‐isotope fractionation technique. The respiration efficiency of the specific costs for growth and maintenance (adenosine triphosphate/O2 ratio) was determined by a modified regression model. The ability to measure oxygen‐isotope fractionation during respiration in A. thaliana opens the door to a wider set of studies that are discussed.
Branched‐chain amino acid metabolism in higher plants
Authors: Binder Stefan , Knill Tanja , Schuster Joachim
Published: November 2006

Valine, leucine and isoleucine contain short branched carbohydrate residues responsible for their classification as branched‐chain amino acids (BCAA). Among the proteinogenic amino acids, BCAA show the highest hydrophobicity and are accordingly the major constituents of transmembrane regions of membrane proteins. BCAA cannot be synthesized by humans and thus belong to the essential amino acids. In contrast, plants are able to synthesize these amino acids de novo and are an important source for these compounds in the human diet. However, BCAA cannot only be synthesized in plants, leucine and probably also valine and isoleucine can also be degraded. Many enzymes operating in turnover are found in mitochondria, while some catabolizing activities are located in peroxisomes. The breakdown of BCAA is physically separated from their biosynthesis in chloroplasts. Additionally, in the order of the Capparales, enzymes of the leucine metabolism seem to be evolutionary related to or may even participate in the methionine chain elongation pathway, the early part of the biosynthesis of aliphatic glucosinolates. In summary, in higher plants a complex network of pathways interferes with the homeostasis of Val, Leu and Ile.
The influence of polyphenol rich apple pomace or red‐wine pomace diet on the gut morphology in weaning piglets
Authors: Sehm J. , Lindermayer H. , Dummer C. , Treutter D. , Pfaffl M. W.
Published: November 2006

Alternative food ingredients, e.g. secondary plant compounds, are discussed to have beneficial effects and improve gut health. In this study, the effect of three different diets – normal piglets starter without additives, with apple pomace or with red‐wine pomace – on the intestinal morphology was investigated from 3 days prior to weaning to 4 weeks post‐weaning. At five time points, six piglets from each treatment group were slaughtered; at first time point only six animals from control group were slaughtered. Villus height, crypt depth and breadth of villi and crypts were determined in the jejunum, ileum and colon in 78 piglets. Additionally, the area of the Peyer's patches in the ileum was measured. In jejunum (p < 0.01) and ileum (p < 0.001) the villus length in the control group decreased after weaning but increased over the entire feeding experiment (p < 0.001). In the two‐pomace groups, no decrease was measured after weaning. In jejunum, an increase in villi breadth occurred, 73% in the control group and approximately 10% in both treatment groups. A 35% increase was found in the ileum in all groups. Peyer's patches area increased approximately 21% in the control group over 26 days of treatment, whereas in other groups no significant differences were found. Different polyphenol rich pomaces have diverse effects in the gastrointestinal tract. Red‐wine pomace has an inhibitory effect on the jejunum villi growth, whereas apple and red‐wine pomace have stimulating effect on crypt size in piglet colon. Apple and red‐wine pomace can reduce the GALT activation via the Peyer's patches in the ileum. In conclusion, the flavanoids rich feeding regimen showed positive effects on villi morphology, GALT activation and can improve pig health.
Effects of feeding fat‐coated butyrate on mucosal morphology and function in the small intestine of the pig
Authors: Claus R. , Günthner D. , Letzguß H.
Published: November 2006

As shown earlier, pig rations with high starch and purine content initiate mucosal hypertrophy by stimulating mitotic activity and DNA formation in the small intestine, whereas in the colon butyrate inhibits apoptosis and thus increases crypt depth. It was the aim of this study to combine these effects by targeting fat‐coated butyrate into the small intestine where it usually does not occur, and to investigate effects on mucosal development and function. Three groups of five pigs were fed 3.6 kg/day of either a low‐energy ration [deficit group, 6.6 MJ metabolizable energy (ME)/kg] or a high‐energy ration (13.7 MJ ME/kg) that was supplemented with brewing yeast as a source of purines. The third ration was of high energy and contained purines and was additionally supplemented with coated butyrate (13.5 MJ ME/kg; 29 g calcium butyrate/kg). Rations were fed for 5 days. After killing, tissue samples were obtained from the proximal, medial and distal parts of jejunum for histology. Chyme samples were obtained from the ileum of all animals and used for sucrase determination. Villus size was not changed by feeding, but butyrate had an effect on plica height and area mainly in the medial jejunum. Plica area in the butyrate group (4.2 mm2) was significantly higher (p ≤ 0.01) compared with that of the deficit group (2.3 mm2) and high‐energy group (2.7 mm2; p ≤ 0.01). For the butyrate group, sucrase activity in the ileum was 119.1 U/ml and thus significantly higher (0.05) compared with the high‐energy group (61.7 U/ml) and the deficit group (28.0 U/ml; p ≤ 0.001). Targeting butyrate into the small intestine thus improves digestive and absorptive capacities. The mechanism probably is a specific effect on enterocyte mitosis which in turn leads to an increased plica size by crypt fission.
Early use of a phosphodiesterase inhibitor after brachytherapy restores and preserves erectile function
Authors: Schiff Jonathan D. , Bar‐Chama Natan , Cesaretti Jaime , Stock Richard
Published: November 2006

Associate Editor

Michael G. Wyllie

Editorial Board

Ian Eardley, UK

Jean Fourcroy, USA

Sidney Glina, Brazil

Julia Heiman, USA

Chris McMahon, Australia

Bob Millar, UK

Alvaro Morales, Canada

Michael Perelman, USA

Marcel Waldinger, Netherlands

OBJECTIVE

To investigate whether the early use of phosphodiesterase inhibitors (PDEIs) after brachytherapy (BT) is associated with better erectile function, as of men potent before BT 38–70% have erectile dysfunction afterward.

PATIENTS AND METHODS

We evaluated a prospectively created database of 2500 patients who had had BT at our institution since 1992. We measured baseline age, cancer stage, Gleason grade, prostate specific antigen (PSA) level at diagnosis, implant type, use of neoadjuvant and adjuvant hormonal suppression therapy, use of external beam radiotherapy in conjunction with interstitial therapy, and follow‐up PSA levels. Men were stratified by their use of PDEIs at <1 year (early group) or >1 year after implantation (late group). We excluded all men who did not have baseline Sexual Health Inventory for Men (SHIM) scores and at least one follow‐up SHIM score; the latter were obtained at 6‐month intervals after BT. Data were analysed using the Mann‐Whitney U‐test.

RESULTS

In all, 210 men met the inclusion criteria; 85 began using PDEIs within a year of BT, and 125 started after a year. The mean time to PDEI use was 191 days in the early and 595 days in the late group. The median age was 62 years in the early and 63 years in the late group (P = 0.02). Baseline Gleason scores did not differ, nor did PSA levels between the groups. Of men in the early group, 48% received neoadjuvant and/or adjuvant hormonal suppression therapy, vs half of men in the late group. Baseline SHIM scores were not significantly different, nor were scores at the first two follow‐up assessments, but the scores at 18–36 months after BT were significantly different.

CONCLUSION

The early use of PDEIs after BT is associated with a significant improvement in and maintenance of erectile function compared with late use. Men undergoing BT should be encouraged to use PDEIs early after implantation, to preserve erectile function.
Does obesity influence the operative course or complications of robot‐assisted laparoscopic prostatectomy
Authors: Khaira Herkanwal S. , Bruyere Franck , O’Malley Patrick J. , Peters Justin S. , Costello Anthony J.
Published: November 2006

Associate Editor

Ash Tewari

Editorial Board

Ralph Clayman, USA

Inderbir Gill, USA

Roger Kirby, UK

Mani Menon, USA

OBJECTIVE

To determine if obesity is associated with prolonged surgery or more complications during and after surgery in patients undergoing robot‐assisted laparoscopic prostatectomy (RALP).

PATIENTS AND METHODS

Between December 2003 and September 2005 data were collected prospectively for all patients undergoing RALP. Obesity was defined as a body mass index of ≥ 30 kg/m2. The duration of surgery was recorded, determining the duration of steps, including overall, robotic assistance, and vesico‐urethral anastomosis. In all, 285 patients had RALP by one of two surgeons; 236 were classified as not obese and 49 as obese.

RESULTS

The characteristics of the two groups were similar before and after RALP (mean age 60.7 vs 60.3 years, prostate‐specific antigen level 7.9 vs 7.9 ng/mL, prostate weight 47.3 vs 45.3 g, length of stay 3.2 vs 3.5 days, and indwelling catheterization 8.3 vs 7.9 days). The mean duration of surgical steps was less for the non‐obese than the obese group, with urethral dissection requiring 16 vs 19.3 min (P < 0.05), anastomotic time 30 vs 36 min (P < 0.01), and port closure 11 vs 14.5 min (P < 0.001), but the total duration of surgery, at 190 vs 205 min, was not significantly different (P = 0.07). In the non‐obese group there were seven (3%) prolonged drain tube leaks, vs four (8%) in the obese group (P = 0.08).

CONCLUSIONS

Obesity was associated with longer anastomotic times, but the overall duration was similar. Overall complication rates were not significantly different. The continuing follow‐up will determine if obesity predisposes patients to greater long‐term morbidity after RALP.
Risk and presenting features of prostate cancer amongst African‐Caribbean, South Asian and European men in North‐east London
Authors: Chinegwundoh Frank , Enver Mohamed , Lee Angela , Nargund Vinod , Oliver Tim , Ben‐Shlomo Yoav
Published: November 2006

OBJECTIVE

To determine whether there are ethnic differences in the incidence and presenting features of all patients with prostate cancer presenting in North‐east London, UK.

PATIENTS AND METHODS

All newly diagnosed men with prostate cancer between 1999 and 2000 who were resident in the East London and City Health Authority were identified from various sources. Key clinical features were extracted from hospital records. The age‐adjusted incidence rates for European, South Asian and African‐Caribbean patients were calculated using census denominator data.

RESULTS

For men aged >50 years the annual age‐adjusted incidence rates (95% confidence interval) were 213 (186–240), 647 (504–789) and 199 (85–310) for the European, African‐Caribbean and South Asian patients, respectively. African‐Caribbean men had a three times greater risk (risk ratio 3.07, 2.40–3.93, P < 0.001) than European men. South Asian men had a lower risk of prostate cancer but this could have been compatible with chance. There was no evidence of marked ethnic differences for prostate‐specific antigen levels, clinical staging and Gleason scores.

CONCLUSION

The greater risk of prostate cancer for African‐Caribbean men in South‐east England is consistent with data from the USA and the Caribbean. Future work needs to determine whether this risk differs according to country of origin, and which genetic and/or environmental risk factors might be important in explaining these observations.
Inhibition of the epidermal growth factor receptor in bladder cancer cells treated with the DNA‐damaging drug etoposide markedly increases apoptosis
Authors: Munk Mathias , Memon Ashfaque Ahmed , Nexo Ebba , Sorensen Boe Sandahl
Published: November 2006

OBJECTIVE

To investigate the effect of the epidermal growth factor receptor (EGFR) on the induction of apoptosis by the chemotherapeutic agent etoposide (VP16), and to examine the effect of combining VP16 with gefitinib to see if the cell‐survival mechanism can be prevented.

MATERIALS AND METHODS

The bladder cancer cell lines RT4 and T24, representing low‐ and high‐malignancy grades respectively, were treated with VP16 (10 or 50 µm) and the level of apoptosis determined using a commercial kit. EGFR receptor activity was determined by western blotting using antibodies against phosphorylated EGFR. The EGFR was either activated by heparin‐binding (HB)‐EGF (1 nm) or inhibited with the specific EGFR inhibitor gefitinib (1 or 5 µm). The pan‐caspase inhibitor Z‐VAD (30 µm) was used to test the involvement of caspase activity.

RESULTS

Treatment of T24 bladder cancer cells with VP16 (50 µm) for 48 h induced phosphorylation of the EGFR and activation of the EGFR prevented the apoptosis induced by VP16. Thus, treatment of T24 cells with 50 µm VP16 for 48 h resulted in 19% apoptosis. However, activation of the EGFR with HB‐EGF (1 nm) with VP16 (50 µm) significantly reduced the level of apoptosis by 25% (P < 0.05) showing that activating the EGFR has a cell‐survival function. Inhibiting the EGFR with gefitinib (5 µm) blocked the VP16‐induced activation of the EGFR. Combined treatment with gefitinib and VP16 resulted in 45% apoptotic cells, i.e. more than double the percentage of apoptotic cells with VP16 alone. This was found in both T24 and RT4 cells. Gefitinib used alone (1 and 5 µm) generated no apoptosis in the cells. Treatment of T24 cells with Z‐VAD showed that apoptosis induced by both VP16 alone and VP16 with gefitinib was caspase‐mediated.

CONCLUSION

These results suggest that activation of the EGFR induced a cell‐survival function when bladder cancer cells were treated with the DNA‐damaging drug VP16, and that combined treatment with VP16 and the EGFR inhibitor gefitinib might improve the efficacy of treatment.
Ureteric embolization: an alternative treatment strategy for urinary fistulae complicating advanced pelvic malignancy
Authors: Natarajan Vaithianathan , Boucher Nigel R. , Meiring Pieter , Spencer Paul , Parys Bo T. , Oakley Neil E. ,   for the Stent (Society for Endourology in North Trent) group
Published: November 2006

Palliative procedures have been developed for use as an alternative to major surgery in patients with a short life‐expectancy due to advanced malignancy or other conditions. Authors from the UK describe a technique for ureteric embolization in such patients who have urinary fistulae, finding it to be safe and effective.

OBJECTIVE

To report experience with a minimally invasive technique for palliation of urinary fistula/incontinence complicating advanced pelvic malignancy or its treatment.

PATIENTS AND METHODS

We used ureteric embolization with permanent nephrostomy drainage in eight renal units in five patients for palliation of symptoms. All procedures were done under local anaesthesia as day‐case procedures. Nephrostomy tubes were changed at regular intervals on an outpatient basis. Embolization was repeated when required.

RESULTS

The follow‐up was 2–84 months; four patients died from the underlying malignancy during the follow‐up. All patients were continent and had effective palliation of their symptoms. Two patients required repeat embolization. There were no embolization‐related complications.

CONCLUSIONS

Ureteric embolization is a safe and effective minimally invasive palliative treatment option in urinary fistulae or incontinence complicating advanced pelvic malignancy.
Short‐term outcome after high‐intensity focused ultrasound in the treatment of patients with high‐risk prostate cancer
Authors: Ficarra Vincenzo , Antoniolli Stefano Zecchini , Novara Giacomo , Parisi Alice , Fracalanza Simonetta , Martignoni Guido , Artibani Walter
Published: November 2006

OBJECTIVE

To assess the short‐term outcome in patients with high‐risk prostate cancer treated by transrectal high‐intensity focused ultrasound (HIFU).

PATIENTS AND METHODS

From April 2003 to November 2004, 30 patients with high‐risk prostate cancer were enrolled in this prospective study; all had transurethral resection of the prostate before transrectal HIFU treatment, using the Ablatherm device (EDAP, Lyon, France) during the same session, associated with hormonal therapy with luteinizing hormone‐releasing hormone analogues. After the procedure, all the patients were evaluated every 3 months by physical examination, prostate‐specific antigen (PSA) assay and a continence questionnaire. The follow‐up schedule also included a transperineal prostate biopsy 6 months after the treatment. All the patients had a minimum follow‐up of 12 months.

RESULTS

The HIFU treatment took a median (interquartile range, IQR) of 140 (100–160) min. No complications were reported during treatment. The mean (IQR) hospitalization was 2.2 (1–4) days, and the suprapubic drainage tube was removed after 12 (7–18) days. The complications after treatment were: urinary tract infections in five patients (16%), stenosis of the intraprostatic and membranous urethra in three (10%), and secondary infravesical obstruction in four (13%). At 12 months after the procedure, 28 patients (93%) were continent. Seven of the 30 men (23%) had a positive prostate biopsy. At the 1‐year follow‐up only three of the 30 patients with high‐risk prostate cancer had a PSA level of >0.3 ng/mL.

CONCLUSIONS

HIFU is a modern, minimally invasive therapy for prostate cancer, often used in selected patients with localized disease. The present results show that HIFU was also feasible in patients with high‐risk prostate cancer. The low complication rates and favourable functional outcome support the planning of further larger studies in such patients. The oncological efficacy of HIFU should be assessed in further studies with a longer follow‐up.
The clinical significance of bone mineral density and testosterone levels in Korean men with non‐mosaic Klinefelter’s syndrome
Authors: Seo Ju Tae , Lee Jae Seok , Oh Tae Hee , Joo Kwan Joong
Published: November 2006

OBJECTIVE

To measure bone mineral density (BMD) and testosterone levels in patients with non‐mosaic Klinefelter’s syndrome (KS), as a low BMD is common in hypogonadal men, but little is known about the relationship between BMD and serum testosterone levels in men with KS.

PATIENTS, SUBJECTS AND METHODS

The study included 40 patients with KS and 20 healthy fertile men recruited as controls. Serum testosterone, follicle‐stimulating hormone (FSH) and luteinizing hormone (LH) levels were measured by radioimmunoassay. The BMD was obtained at the lumbar spine (L2–4), femoral neck and Ward’s triangle, by dual‐energy X‐ray absorptiometry.

RESULTS

The serum testosterone level was lower, while FSH and LH were higher, in patients with KS than in the control group (P < 0.001). Patients with KS had a significantly lower mean (sd) BMD at the lumbar spine, femoral neck and Ward’s triangle, than the controls, at 0.88 (0.13) vs 1.09 (0.10) (P < 0.001), 0.78 (0.12) vs 0.87 (0.10) (P = 0.006) and 0.65 (0.12) vs 0.76 (0.11) g/cm2 (P = 0.001), respectively. There was a linear correlation between all BMD values and serum testosterone levels in men with KS who had a low serum testosterone level.

CONCLUSIONS

There was a relationship between a lower BMD and testosterone levels in patients with KS. These findings suggest that low testosterone levels cause inadequate bone development and a low BMD in men with KS; therefore, testosterone replacement might be necessary to prevent bone mineral deficiency and future risk of fractures in men with KS who also have low serum testosterone levels.
The urologist’s guide to low dose‐rate interstitial brachytherapy with permanent seed implants for localized prostate cancer
Authors: Bratt Ola
Published: November 2006

I hope the mini review section will continue to be of interest to the readership. We concentrate on selecting topics of which many are outside the mainstream of subjects usually covered by reviews. In addition, most of the writers of these mini‐reviews are asked to present shorter reviews than usually seen, with a limited number of references. The purpose of this section is to provide interesting reading which will both educate and entertain.
Present strategies in the treatment of metastatic renal cell carcinoma: an update on molecular targeting agents
Authors: Bellmunt Joaquim , Montagut Clara , Albiol Santiago , Carles Joan , Maroto Pablo , Orsola Anna
Published: November 2006

The understanding of cellular processes underlying tumour biology has allowed the development of novel molecular‐targeted drugs with optimistic results in renal cell carcinoma (RCC). Mutations in the von Hippel‐Lindau gene are found in 75% of sporadic RCCs, which results in upregulation of several genes involved in angiogenesis, e.g. vascular endothelial growth factor and platelet‐derived growth factor. Other activated pathways in RCC are the epidermal growth factor receptor and the mTOR pathway, which regulate survival and cell growth. In addition to temsirolimus (an mTOR inhibitor) two different strategies have been studied to inhibit these targets: monoclonal antibodies, e.g. bevacizumab, and small molecule tyrosine‐kinase inhibitors such as sorafenib, sunitinib and AG 013736. Phase II studies with these drugs reported substantial clinical activity in advanced RCC. Survival benefit was reported with temsirolimus, sunitinib and sorafenib in randomized trials, which led to the accelerated approval of sorafenib and sunitinib for advanced RCC by regulatory authorities in the USA and Europe. Nevertheless, as new therapies develop, new challenges arise for the optimum use of these targeted drugs. We discuss the rationale and the clinical development of these novel molecular‐targeted agents, with special emphasis on updated information presented at recent meetings because of the relevance of the data reported and the potential future impact in the management of patients with RCC.
Renal cell carcinoma sub‐typing by histopathology and fluorescence in situ hybridization on a needle‐biopsy specimen
Authors: Barocas Daniel A. , Mathew Susan , DelPizzo Joseph J. , Vaughan E. Darracott , Sosa R. Ernest , Fine Ronnie G. , Akhtar Mohamed , Scherr Douglas S.
Published: November 2006

OBJECTIVE

To determine the subtype of renal cell carcinoma (RCC) on needle‐core biopsies of renal masses using histopathology and fluorescence in situ hybridization (FISH), and to evaluate the use of interphase FISH to augment the accuracy of needle‐core biopsies.

PATIENTS AND METHODS

Histology correlates with prognosis in RCC but, historically, biopsies are inaccurate for histological subtype. As histological subtypes of RCC have distinct cytogenetic abnormalities (loss of 3p in clear cell, trisomy 7 or 17 in papillary and widespread chromosomal losses in chromophobe), we hypothesized that FISH would improve the accuracy of biopsies. Forty patients with renal masses underwent nephrectomy, yielding 42 tumours. Needle‐core biopsies were taken of the mass immediately after surgery. Interphase FISH was performed on one core for chromosomes 3, 7, 10, 13, 17, and 21 and the locus 3p25–26. Histopathology was performed on a second core. Results were compared in a ‘blinded’ fashion with final pathology.

RESULTS

In all, 36 of 42 masses were RCC or oncocytoma. Histopathology of the biopsy correctly identified the tumour subtype in 27 (75%), while four (11%) were incorrectly classified and five (14%) were inadequate for diagnosis. With the addition of FISH, 31 (86%) were correctly subtyped, while two (6%) were incorrect and three (8%) were inadequate. In cases with adequate tissue, histology alone was 87% accurate, while the combined method was 94% accurate.

CONCLUSION

Needle‐core biopsy of renal tumours provides adequate material for evaluation of histological subtype. Adding FISH to histopathology might improve the accuracy of kidney tumour biopsies, providing important prognostic information that can guide management decisions.
Bone mineral density and bone turnover markers of patients with Behçet's disease
Authors: Tekin NS , Ozdolap S , Sarikaya S , Esturk E , Gumustas S
Published: November 2006

Background  Behçet's disease (BD) is a systemic inflammatory disease of unknown aetiology. The pathogenesis of rheumatological findings and the status of bone metabolism in this disease are unknown. Inflammatory diseases may predispose to a decrease in bone mineral density (BMD) and there are many studies concerning osteoporosis in chronic inflammatory diseases.

Objective  The aim of this study was to investigate BMD and bone turnover markers in patients with BD.

Methods  Thirty BD patients (17 male and 13 female patients, mean age 36.9 ± 12.6 years) and a total of 30 age‐ and sex‐matched healthy controls (17 male and 13 female controls, mean age 34.9 ± 8.95 years) recruited from the general population were enrolled in the study. Bone mineral density was measured at the lumbar spine (L1‐4) and the left hip (total hip) using dual energy X‐ray absorptiometry. Serum samples were collected between 8 and 10 am after overnight fasting. Serum calcium (Ca), phosphate (P), parathormone (PTH), total alkaline phosphatase (ALP), osteocalcin (OC), erythrocyte sedimentation rate (ESR), and C‐reactive protein (CRP) were measured. Free deoxypyridinoline cross‐links (DPD) in second‐void urine and total daily urinary calcium excretion were analysed.

Results  No statistically significant difference in lumbar spine or femoral BMD and bone turnover markers were found between BD patients and control groups (P > 0.05).

Conclusion  Although it is difficult to draw definite conclusions because of the limited number of patients involved, our study indicates that bone mineral density and bone turnover markers in Behçet's disease were no different than in healthy subjects.
Hepatitis B: overview of the burden of disease in the Asia‐Pacific region
Authors: Lesmana Laurentius A. , Leung Nancy Wai‐Yee , Mahachai Varocha , Phiet Pham Hoang , Suh Dong Jin , Yao Guangbi , Zhuang H.
Published: November 2006

Abstract: Hepatitis B virus (HBV) infection and its liver‐related complications are a substantial health concern in the Asia‐Pacific region. Over the last two decades, public health interventions and the implementation of universal vaccination programs have substantially reduced the incidence of HBV infections in many countries in this region. However, large proportions of individuals remain chronically infected and subject to an increased risk for serious sequelae, including cirrhosis, decompensated liver disease, and hepatocellular carcinoma. The management of HBV infection varies throughout the Asia‐Pacific region, with each country confronting different issues related to prevention, screening, and treatment. These issues include the availability of diagnostic testing and treatment, the cost of diagnosis and treatment, the availability of trained medical professionals and medical facilities, and disease awareness among primary care physicians and the public. This article reviews the epidemiology of HBV infection in the Asia‐Pacific region, explains factors influencing hepatitis B prevalence and prevention, and discusses barriers to prevention and treatment of chronic hepatitis B and its liver‐related complications.
Molecular virology of hepatitis B virus and the development of antiviral drug resistance
Authors: Locarnini Stephen , Omata Masao
Published: November 2006

Abstract: The active replication phases of the hepatitis B virus (HBV) are marked by a high frequency of mutational events resulting from an enormous daily viral turnover rate and an error‐prone polymerase. Because HBV is not directly cytopathic, it is the host's immune response that accounts for most of the liver disease associated with persistent infection. HBV escape mutants can be found at the transitional phases of chronic hepatitis B, such as hepatitis B e antigen (HBeAg)‐positive versus HBeAg‐negative infection, and these mutants are selected out from the diverse quasispecies pool comprising the HBV population at that time. Not surprisingly, the introduction of nucleoside and nucleotide analog therapy has also seen the emergence of drug resistance, which has become the major factor limiting the long‐term application of antiviral agents for patients with chronic hepatitis B. Thus, the prevention of resistance requires the adoption of strategies that effectively control virus replication and exploit a detailed understanding of the mechanisms and processes that drive the emergence of drug resistance.
Perceptions of Children's Body Sizes Among Mothers Living on the Texas‐Mexico Border (La Frontera)
Authors: Reifsnider Elizabeth , Flores‐Vela Alma R. , Beckman‐Mendez Diana , Nguyen Hoang , Keller Colleen , Dowdall‐Smith Shannon
Published: November 2006

ABSTRACT
Objectives: The objectives of this study were to quantify mothers' perceptions of their children's sizes and explore mothers' views of child growth, diet, activity, and health. Photographs of children from the Berkeley Longitudinal Growth Study (on Centers for Disease Control and Prevention [CDC] Web site) were used to stimulate discussion with mothers about child sizes.

Design: A descriptive, cross‐sectional study examined mothers' perceptions of their children's size and their beliefs about child size, growth, and health.

Sample: The convenience sample included 25 mother–child dyads of 3‐year‐old children at two Head Start Centers in a county on the Texas–Mexico border. All mothers self‐identified as Hispanic.

Measurement: Photographs of children were shown to elicit mothers' perceptions of children's body sizes. The children and mothers were weighed and measured and their body mass indices (BMIs) were computed. The mothers were interviewed about their beliefs on child health, growth, and feeding.

Results: No congruence was found between mothers' perceptions of child sizes in the pictures and their children's sizes.

Conclusions: Using CDC photographs does not appear to be a useful way to educate mothers about child body sizes. A child who is happy, active, and can accomplish normal childhood activities is not considered by mothers as overweight, regardless of the child's BMI.
Psychosocial Factors and Coping Strategies of Adolescents in a Rural Pennsylvania High School
Authors: Sung Kyung Mi , Puskar Kathryn R. , Sereika Susan
Published: November 2006

ABSTRACT Objectives:To evaluate the coping levels of rural adolescents and gender differences of coping strategies and psychosocial factors. To identify the relationships of coping strategies with psychosocial factors of rural adolescents.

Design:A cross‐sectional study.

Sample:A convenience sample of 72 students attending a rural high school in southwestern Pennsylvania.

Measurements:Subjects completed the Coping Response Inventory‐Youth (CRI‐Y), the State‐Trait Anger Expression Inventory (STAXI), the Screen for Child Anxiety Related Emotional Disorder (SCARED), the Reynolds Adolescent Depression Scale (RADS), and the Rosenberg Self‐Esteem Scale (RSES).

Results:Significant gender differences were found for psychosocial factors of depression, self‐esteem, and anxiety. Several significant relationships were observed between coping strategies and psychosocial factors of rural adolescents. Additionally, using content analysis, seven categories were determined based on the content of the open‐ended question on the CRI: familial factors, peer relationships, etc.

Conclusions:These rural adolescents endorsed higher levels of avoidance coping than normative samples. Rural adolescents reported many problems needing proper coping skills in their everyday lives. This study provides information to public health professionals working with rural adolescents that could be used to help them attain more effective coping strategies.
Partial Examination of the Public Health Impact of the People with Arthritis Can Exercise (PACE®) Program: Reach, Adoption, and Maintenance
Authors: Gyurcsik Nancy C. , Brittain Danielle R.
Published: November 2006

ABSTRACT
Objective: To partially evaluate the public health impact (i.e., reach, adoption, maintenance) of People with Arthritis Can Exercise® (PACE®) programs, which were initiated as a result of two PACE® instructor‐training workshops.

Design: The study design involved a one‐time only, cross‐sectional assessment of reach, adoption, and maintenance, conducted 6 months after the workshops.

Sample: Participants were 11 adults (nfemales=10) trained to be PACE® instructors at one of the workshops.

Measurements: One‐on‐one phone interviews, developed using the RE‐AIM framework, assessed reach, adoption, and maintenance.

Results: Eight of the 11 individuals trained as instructors subsequently began PACE® in one of 10 organizations across various communities, indicating high program adoption. However, on average, only 7 individuals with arthritis participated in each PACE® program, indicating a low program reach. Within 6 months of beginning PACE®, only 3 organizations continued to offer PACE®, indicating low program maintenance. Two primary challenges to initiating PACE® included recruiting a sufficient number of people to participate in the program and in finding a convenient time to offer it so more individuals could join.

Conclusion: The public health impact, as assessed by reach, adoption, and maintenance, of PACE® programs initiated as a result of 2 instructor‐training workshops was low.
Successful Implementation of Universal Woman Abuse Inquiry
Authors: Grafton Denise , Wright Bonnie Lynn , Gutmanis Iris , Ralyea Susan
Published: November 2006

ABSTRACT
Objective: This study investigated a year‐long professional development strategy to improve Public Health Nurse (PHN) documented abuse inquiry among low‐risk postpartum women. Strategies included workshops and small group work at regular intervals.

Design: A retrospective chart audit of cross‐sectional data collected as part of the Healthy Babies/Healthy Children Program was conducted 1 year before and after the introduction of the Routine Universal Comprehensive Screening (RUCS) Program.

Sample: Charts of all postpartum women who lived in one Ontario county (Canada) and who received a PHN home visit were reviewed (pre‐RUCS, n=1,151; post‐RUCS, n=1,193).

Measurement: Information regarding mother's age group and parity, month of PHN visit, abuse inquiry, and whether or not the woman was a single parent was abstracted.

Results: Originally, there was documentation of abuse inquiry on only 0.8% of low‐risk postpartum client charts. Women aged <20 years and single parents were significantly (p<.001) more likely to be asked, suggesting case‐finding among PHNs. Post‐RUCS abuse inquiry increased to 20.5% with no demographic differences between those groups asked.

Conclusion: Policy changes providing specific expectations and documentation cues can improve routine abuse inquiry. New policies can be effectively combined with existing programs and infrastructure, facilitating the longer term success of new initiatives.