bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunization coverage of Australian‐born children of Arabic‐speaking background in Central Sydney
Authors: Karr M , Mira M , Alperstein G , Labib S
Published: March 2003

Objectives: To examine the immunization coverage rates of 12–36‐month‐old Australian‐born children from an Arabic‐speaking background in Central Sydney as determined by parental report and documentary evidence.

Methodology: Eligible children were identified by examination of the records of five hospitals. Eligibility criteria were that the mother gave an Arabic speaking country of birth and a Central Sydney post code (as her place of residence) and the child was born between 1 May 1994 and 30 April 1996. Parents of all eligible children were invited to participate, either by a special appointment to answer a structured questionnaire, or by telephone survey. Of the 1157 eligible children identified from hospital birth records, only 641 could be contacted, of whom 584 (91.1%) agreed to participate. Full information on age appropriate immunization rates, as reported by parents and documented in records, could be assessed for 403 children.

Results: Parents reported that 97.6% of children were fully immunized. When the child’s immunization status could be verified from either the child’s personal health record and/or the service provider, the rate of full, age‐appropriate immunization was 94.3% (95% confidence intervals 92.0–96.6) compared to a parent‐reported rate of 98.0%. General practitioners provided 76.2% of immunizations.

Conclusion: While a substantial proportion of children identified from birth records could not be contacted, comparisons with census data and other analyses indicate that this sample is likely to be representative of the general population of 12–36‐month‐old Australian‐born children from an Arabic‐speaking background. This group appeared to be highly immunized. Further studies examining why the rates for this ethnic group are high in Central Sydney may determine strategies which will enhance immunization rates in other communities.
Risk of hepatitis C virus infection in multiply transfused premature neonates
Authors: Beeby PJ , Spencer JD , Cossart YE
Published: March 2003

Background: Reports from around the world indicate that multiply transfused patients are at increased risk of hepatitis C virus (HCV) infection, with reported rates of between 4% and 44%. Such reports are mostly of haematological and renal patients. As recipients of blood products in the newborn period, premature infants share this risk, but there is little information regarding their risk.

Aim: To assess the risk of HCV infection in children who, as premature neonates, received multiple blood products prior to the introduction of screening of donated blood for HCV.

Methods: Premature infants born between January 1985 and January 1990 who had attended our high‐risk follow‐up clinic were selected on the basis of the number of transfusions of blood, platelets or fresh frozen plasma they received in the newborn period. Ethical approval to offer HCV testing to parents was obtained from the Central Sydney Area Health Service Ethics Review Committee. Parents of infants who received three or more transfusions were then contacted by mail with the approved letter explaining the study, and offered HCV testing. Detection of anti‐HCV antibodies was undertaken using second, and later third generation enzyme immunoassay kits. Samples which were found to be ‘indeterminate’ were tested using a Wellcozyme HCV western blot assay (Murex Diagnostics Ltd, Datford, UK). Hepatitis C virus–ribonucleic acid (RNA) was detected using an ‘in‐house’ polymerase chain reaction (PCR) assay. Alanine transaminase (ALT) was also measured, with values above 55 U/L considered abnormal.

Results: Consent was obtained for 45 children (25 males, 20 females). The mean (± SEM) gestational age and weight of the children at birth was 26.7 ± 0.2 weeks and 938 ± 27 g, respectively. The children received 198 transfusions of blood products, an average of 4.4 U per child. All of the infants except for one were negative for anti‐HCV antibodies. One infant was ‘indeterminate’ (low positive on third generation test but negative on second generation test), but proved negative subsequently on both western blot and PCR testing. HCV–RNA was not detected in any of the infants on PCR testing. All of the samples had normal ALT values, the mean being 16 U/L (range 8–52).

Conclusion: None of the children consenting to this study had evidence of current HCV infection. Because of the sample size, we were not able to estimate the true risk of infection from this study, except that the upper limit for the risk is about 1/200 per transfused blood sample.
Abolishing the bag: A quality assurance project on urine collection
Authors: Greaves J , Buckmaster A
Published: March 2003

Objective: To audit practice in diagnosis of urinary tract infection (UTI) and implement a protocol to reduce the number of falsely diagnosed or missed UTI in febrile children.

Methodology: Data were obtained from the microbiology database on the number of urine samples collected for culture, the methods of collection and the culture results over a 3 month period. Using these data and published evidence, a protocol was developed for the collection of urine in febrile children. An education program was instituted which included the adoption of the protocol. Further data were collected and compared with those obtained before the program.

Results: Total urine samples sent for culture decreased from 219 in 1998 to 143 in 1999. The percentage collected by bag fell from 60% (n = 132) to 14% (n = 20). The number of definite UTI diagnosed was 15 in both time periods. The number of children given antibiotics before an appropriate sample could be collected fell from nine to two for the respective 3‐month periods.

Conclusions: Through the development of a new protocol, its introduction and an education program, a change in management was effected and a reduction in the chance of missed or mistaken diagnosis of UTI occurred.
Clinical correlates of response to pneumococcal immunization
Authors: Akikusa JD , Kemp AS
Published: March 2003

Objective: The inability to form antibodies to polysaccharide antigens may occur as a part of a more significant immunodeficiency or as an isolated defect. The latter has been reported in some children with recurrent upper and lower respiratory tract infections and evaluation of the responsiveness of such patients to polysaccharide antigens is indicated as part of their assessment. The present study evaluated the pattern of antibody responses of patients immunized with pneumococcal vaccine as part of the investigation of recurrent upper and lower respiratory tract infections to determine if any correlation exists between these responses and clinical presentation.

Methodology: An analysis was performed of antibody responses to pneumococcal serotypes 3, 4 and 6 following immunization with a 23‐valent vaccine in 42 children with normal IgG levels who were evaluated for recurrent infections. Antibody responses were assessed in relation to clinical features and the results of other immunological investigations.

Results: Of the 42 patients evaluated, 25 (59%) were responders to all serotypes tested. Failure to respond to serotype 3 alone was the least common pattern of non‐response. Recurrent pneumonia, but not otitis media with discharge or chronic productive cough, was significantly associated with a lack of response to two or three serotypes. Failure to respond to serotype 3 alone or in combination with other serotypes was associated with more significant immune abnormalities.

Conclusion: In a selected population of children with recurrent bacterial infections, pneumococcal serotype 3 is a strong immunogen. In this clinical group recurrent pneumonia is associated with a defect in response to multiple pneumococcal serotypes.
Chest physiotherapy and porencephalic brain lesions in very preterm infants
Authors: Knight DB , Bevan CJ , Harding JE , Teele RL , Kuschel CA , Battin MR , Rowley RSH
Published: March 2003

Objective: National Women’s Hospital is one of two hospitals to report a destructive brain lesion, namely encephaloclastic porencephaly (ECPE), in extremely preterm infants. It has been associated with non‐cephalic presentation, early hypotension and the number of chest physiotherapy treatments in the first month. The aim of the present study was to determine the temporal relationship between ECPE and chest physiotherapy use in very low‐birth weight (VLBW) infants in our unit.

Methodology: Cerebral ultrasound scan reports, post‐mortem reports, clinical and physiotherapy records and, if indicated, original ultrasound films were reviewed for all VLBW babies admitted between 1985 and 1998.

Results: Over the 14 year period in question, 2219 babies with a birth weight ≤ 1500 g were admitted. Encephaloclastic porencephaly was found in only the 13 previously reported babies born between 1992 and 1994. Encephaloclastic porencephaly was excluded in 1564 (70%) babies. In 621 (28%) babies who did not have late ultrasound scans, ECPE was thought to be unlikely either because the babies never had any chest physiotherapy (n = 479) or because they had chest physiotherapy but were known to be neurodevelopmentally normal on follow up (n = 142). Data were incomplete for 21 babies (0.9%). The number of chest physiotherapy treatments per baby decreased from a median of 95 prior to 1989 to 38 and the age of starting treatment increased from 5 to 8 days after 1990. The use of chest physiotherapy ceased in 1995.

Conclusions: Encephaloclastic porencephaly emerged as a problem at a time when the use of chest physiotherapy had decreased. The cluster of cases seen between 1992 and 1994, although associated with the number of chest physiotherapy treatments given, began to appear because of some other factor.
Introduction of a conjugate meningococcal type C vaccine programme in the UK
Authors: Salisbury D
Published: March 2003

Objective: The purpose of the UK initiative was to accelerate the development and introduction of new conjugate meningococcal C vaccine into the routine immunisation programme, and to implement a catch‐up campaign based on the disease epidemiology.

Methodology: Collaboration between Government supported institutions and the vaccine industry lead to a collaborative programme of research designed to answer policy specific questions and to accelerate the availability of new vaccines.

Results: Three new conjugate meningococcal C vaccines were developed and licensed for use in the UK after satisfactory data on safety and immunogenicity had been generated. A nationwide campaign was designed to offer vaccine to all infants at the same time as their three doses of primary immunisations, two doses were offered to children over 4 months and under 1 year old; all those over 1 and under 18 years old were offered a single dose of vaccine. The programme was on course for completion within approximately twelve months, with around 15 million immunisations being offered. The programme was implemented simultaneously through school and primary care services.

Conclusions: A safe and effective new vaccine, against group C meningococcal disease, has been introduced into the UK immunisation programme after just a 5 year development to implementation process. Early indications point to high coverage and impacts on disease are already apparent in the groups that have been immunised. These vaccines may play an equally important role in other countries where there is a significant burden from Group C meningococcal disease.
Regional and urban Victorian diabetic youth: Clinical and quality‐of‐life outcomes
Authors: Cameron FJ , Clarke C , Hesketh K , White EL , Boyce DF , Dalton VL , Cross J , Brown M , Thies NH , Pallas G , Goss PW , Werther GA
Published: March 2003

Objectives:  To compare groups of urban and regional Victorian diabetic children and assess their quality of life, diabetes knowledge, access to services and metabolic control.

Methods:  Forty‐seven children from three regional Victorian communities (Horsham, Warrnambool and Sale; n = 16, 18 and 13, respectively) were compared with 120 age‐, sex‐ and duration of diabetes‐matched children attending the Royal Children's Hospital (RCH) diabetes clinic in Melbourne. Quality of life, diabetes knowledge, use of services, and metabolic control were assessed using the child health questionnaire (CHQ PF‐50/CF‐80); a diabetes‐knowledge questionnaire; access to a diabetes nurse educator (DNE), dietitian and complication screening; and indices of mean HbA1C (values are taken every 3 months in the ‘yearly HbA1C’), respectively.

Results:  Comparisons of CHQ data showed that regional diabetic youth scored significantly lower on most subscales. The greatest deficits were seen in areas of mental health, self‐esteem, parent impact (emotional) and family cohesion. Diabetes knowledge and median yearly HbA1C for patients were not significantly different between the regional and urban centres (8.1%, 8.9%, 8.4% and 8.6% at RCH, Horsham, Warrnambool and Sale, respectively). Patients in regional centres had reportedly less access to team‐based diabetes care.

Conclusions:  Regional youth in Victoria, with similar levels of metabolic control and diabetes knowledge as their urban counterparts, have a markedly lower quality of life, implying a negative synergy between diabetes and the demands of regional lifestyles.
Children with disruptive behaviours I: Service utilization
Authors: Hazell PL , Tarren‐Sweeney M , Vimpani GV , Keatinge D , Callan K
Published: March 2003

Objective: To describe the demographic characteristics and patterns of service utilization in the Hunter region (NSW, Australia) of families caring for a child manifesting disruptive behaviour.

Methodology: Families were eligible to participate in the survey if they had at least one child known to have one of the DSM‐IV disruptive behaviour disorders, autistic spectrum disorders, behaviour problems associated with rarer forms of brain disease, brain injury or mild intellectual disability, or identified by school personnel as having significant behaviour problems. Families were recruited to the survey via schools, early education centres and clinical services. Parents completed a mail survey about demographic details and service utilization.

Results: In total, 1412 families responded to the survey, a participation rate of approximately 65%. The demographic characteristics of respondent families were similar to those of the regional population. A high proportion (85%) of children from respondent families were receiving treatment. Nearly half those children attending clinical services were attending two or more services. Approximately one‐third each of the sample was attending public clinics, private clinics or a combination of both. Children were more likely to be treated by a paediatrician (64%) than a child psychiatrist (39%) or a psychologist (23%). Compared with a normative Australian sample, parents of children manifesting disruptive behaviour reported a high level of family stress.

Conclusions: Families of children manifesting disruptive behaviour are a highly stressed group who often access several clinical services. Paediatricians make a significant contribution to the management of children with disruptive behaviours and need to be considered in service planning.
Is being Aboriginal or Torres Strait Islander a risk factor for poor neonatal outcome in a tertiary referral unit in north Queensland?
Authors: Panaretto KS , Muller R , Patole S , Watson D , Whitehall JS
Published: March 2003

Objective: To compare perinatal outcomes for all births, and the morbidity and mortality patterns of babies admitted to neonatal intensive care, for non‐Indigenous, Aboriginal and Torres Strait Islander (TSI) people in a major remote urban centre.

Methods: A prospective cohort study of all births and consecutive admissions to the Neonatal Intensive Care Unit/Special Baby Care Unit (NICU/SCBU) at Kirwan Hospital for Women (KWH), Townsville (a tertiary referral hospital) was conducted from January 1998 to June 1999.

Results: There were 2575 births, with 2392 (93%) booked into KWH for delivery. The Aboriginal group differed from the non‐Indigenous group only in the prevalence of low‐birthweight births. The TSI group had significantly higher perinatal mortality rates, preterm and low‐birthweight births than the non‐Indigenous group. Seven hundred and fifty‐eight babies were admitted to NICU/SCBU: 586 (77%) non‐Indigenous, 129 (17%) Aboriginal, 43 (6%) TSI. There were significantly more preterm, lower birthweight and longer stay length Aboriginal and TSI babies. Being Indigenous was not associated with neonatal death. Gestation of less than 28 weeks, congenital anomalies, and high‐grade cerebral haemorrhage, but not ethnicity, were independent risk factors for neonatal death. Maternal risk factors, including poor antenatal care attendance, were more prevalent amongst Indigenous women.

Conclusion: Neonatal outcomes for Aboriginal infants were better than expected from national and State reports. Outcomes for Torres Strait Islander infants were worse than expected. Ethnicity was not a risk factor for neonatal death. These findings suggest that outcomes may be further improved by programmes to increase access for Indigenous women to antenatal care services.
Uncovering the causes of poor quality pathology laboratory services in acute myocardial infarction
Authors: ISOUARD G
Published: March 2003

A study was undertaken to identify the causes that contributed to poor quality pathology services for hospitalized patients with acute myocardial infarction. Through the use of continuous quality improvement (CQI) strategies, the procedure involved a systematic process analysis which assessed the types and sources of variation, and possible causal factors for changes in performance. Thirteen suspected causes of poor quality were identified and data collected to confirm or reject their involvement. The study demonstrated that even strongly suspected causes of poor quality need to be confirmed by data. We found that 23% of the suspected root causes were not substantiated by the data collected. The CQI approach was process driven and should be adaptable to other clinical situations and not just pathology services.
Towards the safer use of non‐steroidal anti‐inflammatory drugs
Authors: Day RO , Rowett D , Roughead EE
Published: March 2003

Abstract Musculoskeletal conditions afflict most of us at some time in our lives, and we all have relatives and friends who suffer the pain and disability sometimes associated with conditions such as back or neck pain, fibrositis and osteoarthritis. The goal of those of us who try to help individuals with these conditions is to achieve effective, but also safe, management of their musculoskeletal disorders, the commonest symptom of which is pain. This goal can be achieved by better diagnosis and problem formulation (allowing better selection of treatment options); informed selection of non‐drug and drug therapeutic options, based on relative cost‐benefit considerations; and the judicious, appropriate and safe use of drugs, particularly non‐steroidal anti‐inflammatory drugs (NSAID). Setting realistic goals and maintaining regular surveillance of patients are also important considerations. Finally, the active involvement of the patient in their own management is associated with better and safer outcomes.
Towards safer blood transfusion practice
Authors: Hodgkinson B , Fitzgerald M , Borbasi S , Walsh K
Published: March 2003

Abstract The objective of this study was to determine the current state of transfusion practice at a large metropolitan hospital in South Australia, with a view to making recommendations to improve safety. Transfusion practice was monitored using a questionnaire and a concurrent audit design. Patients identified as having received a packed red blood cell transfusion in the previous 24 h, were selected by a random number generator. Questions included those about blood pack identification, documentation of the transfusion process, and patient observation. The results of this audit indicated that areas of documentation, primarily patient consent, blood pack administration times and patient monitoring required re‐evaluation. Recommendations to improve practice were made based on these results. This is an ongoing service provided by the hospital, which has proven invaluable in identifying deficiencies in transfusion practice in order to improve patient care.
Adverse events in health care: Setting priorities based on economic evaluation
Authors: Rigby K , Clark RB , Runciman WB
Published: March 2003

Abstract Adverse events arising from health‐care management, rather than a disease process, may place as great a burden on society as all other forms of injury put together. By analysing data from the Quality in Australian Health Care Study (a retrospective review of 14 179 medical records representative of admissions to Australian acute care hospitals in 1992), and applying costing techniques based on Diagnosis Related Group (DRG) cost weights, it is possible to compare the economic impacts of different kinds of adverse events. This can assist in determining priorities for interventions. However, due to limitations inherent in DRG cost weights, there is a need to employ further techniques to refine the costing base of adverse events so that it more closely reflects their resource use. Decisions to invest resources in strategies that reduce the risk of adverse events can then be properly informed by economic data.
The characteristics of asthma education programs within New South Wales
Authors: Mcdonald V , Toneguzzi R , Pratt P , Kessell C , Hazell J , Gibson P
Published: March 2003

Abstract The aim of the study was to examine the characteristics of asthma education programs within NSW. A cross‐sectional questionnaire survey concerning the aims and characteristics of 42 asthma education programs was administered to members of the Asthma Educators Association (AEA) of NSW. While most programs sought to improve asthma knowledge (78%), only a small number sought to improve asthma management skills (38%), asthma control (33%) and attitudes (10%). Most programs performed one‐to‐one (69%) education. Medical intervention was under‐utilized by most programs and only 4% gave feedback to the referring doctor. Program evaluation was incompletely linked to program aims. There was incomplete evaluation of knowledge gain as an outcome. The study reviewed the characteristics of education programs within NSW. Existing programs appropriately employ a variety of educational methods and target a broad range of people with asthma. There remains a need to use a combined approach utilizing education and medical management, and to employ methods to evaluate programs.
Making the surgical beds go around
Authors: Fletcher John P , Hodges B
Published: March 2003

Abstract A planned surgical admission is a major event for a patient and, when cancelled, not only causes great distress to the patient and relatives but is also a frustrating waste of resources if a fully staffed operating theatre lies idle. At Westmead Hospital, a bed management team was established with the appointment of a Clinical Nurse Consultant as Bed Manager to co‐ordinate admissions in conjunction with all staff involved in the processing of surgical patients. Despite a reduced number of available surgical beds, throughput was maintained with a significantly reduced number of cancelled booked cases, which decreased to zero and have remained so since the end of 1995. It has been found that it is possible to achieve a situation where all booked surgical patients can be admitted as planned while still providing for emergency patients. This requires a co‐ordinated approach with an emphasis on teamwork led by a dedicated Bed Manager working with medical and nursing staff on surgical wards together with the bookings office, pre‐admission clinic, operating theatre and anaesthetics department.
Quality use of Allopurinol in the elderly
Authors: Smith Penelope , Karlson Noeline , Nair Balakrishnan R.
Published: March 2003

Abstract Allupurinol is a commonly prescribed drug. However, the use of this drug is not based on evidence and guidelines. We audited Allopurinol prescriptions in patients aged 65 years and over in a teaching hospital over 22 weeks. In 47% of patients the dose was higher than recommended and in 40% it was lower. Quality use of medications is an important issue to maintain quality of life in the elderly.
The appropriateness of admissions and the influences on a decision to admit
Authors: Dempsey J
Published: March 2003

Abstract Within health services there is concern that escalating costs may reflect an inappropriate use of services and that services should avoid admitting patients who do not require acute care. The problem is, if these patients exist, how may they be identified and is this the sole consideration in patient management? This triangulated study examines the appropriateness of admissions, factors that influence that admission, and the potential to develop alternate models of care for medical patients. A utilization review, auditing 521 medical patients, provided a percentage of appropriateness of admission and stay, identified the barriers to discharge and those patients suitable for programs such as hospital in the home. Complementing the review, interviews with eight physicians explored how they decided to admit patients, what factors influenced that decision and their attitude to the development of these models of care.
The seasonal pattern of dissolved oxygen, and hypolimnetic deoxygenation, in two tropical Australian reservoirs
Authors: Townsend Simon A.
Published: March 2003

The dissolved oxygen concentrations in Darwin River Reservoir (DRR) and Manton River Reservoir (MRR), both located in the wet/dry tropics of Australia, were investigated over an 8‐year period. Average oxygen concentrations were lower in MRR than in DRR, indicating the dominance of consumptive processes not compensated by photosynthetic production of oxygen, despite MRR’s higher chlorophyll a concentration. With the onset of thermal stratification, dissolved oxygen in the hypolimnion of each reservoir was depleted at average rates of 3.4–7.1 mg L−1 month−1. These are higher than rates reported for temperate water‐bodies (0.10–3.0 mg L−1 month−1). This was ascribed primarily to the effect of temperature on microbial metabolism, while the influence of the reservoirs’ high epilimnion to hypolimnion volumetric ratios (approximately 10:1) and reservoir trophic state were considered secondary. Due to the temperature dependence of hypolimnetic oxygen depletion, the trophic classification of lakes based on hypolimnetic deoxygenation and anoxia is not globally applicable, but is applicable to water‐bodies of similar hypolimnetic temperatures, especially when morphometric influences are also taken into account. Both reservoirs experienced long periods of anoxia (average: 9 months in MRR, 5 months in DRR). In DRR, the extent of hypolimnetic anoxia was related to hypolimnion volume. Hypolimnetic anoxia in the reservoirs, when quantified by the anoxic factor (AF; number of days that a sediment area, equal to the whole‐lake surface area, is overlain by anoxic waters), was high compared with similar water‐bodies in North America, providing quantitative evidence that anoxia in more prevalent in tropical reservoirs. Ammonia, iron and manganese accumulated in the hypolimnion of both DRR and MRR, with concentrations decreasing exponentially from the sediments to the oxycline. Sediment phosphorus release was detected in MRR, but not detected in DRR, despite the reservoir’s long periods of hypolimnetic anoxia. The high water temperatures and lengthy periods of hypolimnetic anoxia of the reservoirs provided a favourable environment for anoxygenic phototrophic bacteria.
Spatial and temporal heterogeneity in the Jurumirim Reservoir, São Paulo, Brazil
Authors: Nogueira M. G. , Henry R. , Maricatto F. E.
Published: March 2003

Jurumirim is a large tropical reservoir with remarkable spatial gradients. This structure seems to be determined by a longitudinal gradient in the trophic conditions along the main axis of the reservoir. Nutrient‐rich waters enter from the main tributary river, Paranapanema, and towards the dam there is a lacustrine zone that is deeper and more oligotrophic. Additional variability is derived from two important lateral components: the entrance of the Taquari River, the second largest tributary, bringing waters with higher pH and alkalinity; and the Ribeirão das Posses arm, a sheltered bay where the hydrodynamic conditions promote a high growth of phytoplankton. However, such a spatial pattern is not static. It can become either more defined, during the dry season (late autumn and winter), or less evident, during the expansion of the lotic conditions in the rainy period (late spring and summer). Seasonal processes of stratification/destratification determine the temporal changes in the lacustrine zone but, unlike the upstream regions, the dam zone of the reservoir seems to be little affected by periodic pulses of modifications produced by intensive rains. The presence of extensive wetlands and oxbow lagoons in the mouth zones of the main rivers also constitutes an important source of spatial variability and should be considered in the future.
Prognostic value of the immunoexpression of chemoresistance‐related proteins in cerebral glioblastomas: An analysis of 168 cases
Authors: Korshunov Andrey , Golanov Andrey , Sycheva Regina , Pronin Igor , Fadeeva Luidmila
Published: March 2003

A variety of chemotherapy protocols have been in‐troduced for the treatment of glioblastoma, although overall these have not contributed to patient outcome. Data on the prognostic value of immunoexpression of chemoresistance‐related proteins in malignant gliomas are very limited. One hundred and sixty‐eight patients with cerebral glioblastomas who received combined treatment were studied retrospectively. Tumor specimens were immunohistochemically examined with antibodies to glutathione S‐transferase pi (GST pi), P‐glycoprotein (P‐GP) and metallothioneins (MT). The results demonstrated that survival time was found to be significantly shorter for glioblastomas containing = or > 20% of GST pi‐immunostained cells and for tumors with P‐GP positivity in neoplastic cells. In contrast, the survival time was found to be significantly longer in patients with neoplasms containing = or > 50% of MT‐positive cells. Multivariate Cox regression analysis with application of clinical and immunohistochemical factors revealed independent prog‐nostic significance for all of the above‐mentioned varia‐tions of protein expression. The findings suggest that variables of expression of the chemoresistance‐related antigens are predictors for outcome in glioblastoma and that immunohistochemical analysis may provide useful information for the determination of optimal anti‐cancer strategies in each case.
Malignant lymphoma of the cranial vault: Analysis of three cases
Authors: Yoshida Kazunari , Kagami Hiroshi , Shimazaki Kenji , Kondoh Arata , Ishimori Hisatsugu , Kawase Takeshi , Ikeda Eiji
Published: March 2003

The clinicopathological features of three cases with a cranial vault tumor as the initial manifestation of malignant lymphoma are described. Two of them (involving a 47‐year‐old female and a 53‐year‐old female) were primary cranial vault lymphoma. Another case (a 50‐year‐old male) was revealed to have multiple tumors in the cranial vault, right iliac bone and spleen at the first admission examination. All of the cranial vault tumors, which were painless and rapidly growing, invaded the muscle and dura mater from the skull, but not the subdural space or the outside of the superficial fascia. Histological diagnosis of the three cranial vault tumors was non‐Hodgkin diffuse large lymphoma. Moreover, the expression pattern of the lymphocytic cell markers, which were examined by immunohistochemistry, was identical; LCA(+), CD20/cy(+), CD79a(+), CD45RO(−), VS38c(−) and CD30(−) indicated that the tumors were B‐cell origin without plasmacytic differentiation.
Nitrotyrosine immunoreactivity in gerbil hippocampal CA1 region after transient forebrain ischemia
Authors: Asai Satoru , Murata Akira , Tamagaki Chiharu , Sakata Tetuji , Gonno Kazutoshi , Takase Katunori , Kinoshita Toshihiko
Published: March 2003

We examined whether or not nitration of tyrosine residues takes place in the gerbil hippocampal CA1 region after transient forebrain ischemia. The nitration of tyrosine residues to produce nitrotyrosine is a footprint of peroxynitrite, a reaction product of nitric oxide (NO) with superoxide. Nitrotyrosine immunoreactivity had been detected in the CA1 region from the early stage in a reperfused brain at 30 min after transient ischemia until DNA fragmentation and neuronal death appeared at 4 days after transient ischemia. In electron microscopy, we detected, prominently, nitrotyrosine immunoreactivity after transient ischemia in the cytoplasm of the CA1 neurons. Therefore, it is considered that the nitration of tyrosine residues by peroxynitrite may be closely related to apoptosis after transient ischemia.
Immunohistochemical studies of the PrPCJD deposition in Creutzfeldt‐Jakob disease
Authors: Tanaka Shinichiro , Saito Masaya , Morimatsu Mitsunori , Ohama Eisaku
Published: March 2003

The PrPCJD deposition in eight brains of sporadic Creutzfeldt‐Jakob disease (CJD) was examined immunohistochemically using both hydrolytic autoclaving and formic acid pretreatment in order to understand the pathogenesis of CJD. Synaptic‐type PrP immunoreactivity was revealed in the gray matter in all cases and had a tendency to be weaker in devastated areas in cases with a longer duration of illness. However, in one particular case with numerous prion plaques, the degeneration was relatively mild while PrPCJD immunoreactivity was intense despite the longest duration of illness among the examined cases. Deep layer accentuation of PrPCJD immunoreactivity was observed in the cerebral cortices in most cases. This staining pattern, however, disappeared in a burnt‐out lesion exhibiting status spongiosus. The granular layer was damaged mostly in the cerebellum of the advanced cases. PrPCJD and synaptophysin immunoreactivities decreased as the tissue degeneration progressed. Interestingly, the Purkinje cells had no positivity for PrPCJD in all cases, although the neurons in relatively preserved cerebellum showed apparent positivity for synaptophysin. In the Ammon’s horn and subiculum the neurons were well preserved despite the marked immunoreactivity for PrPCJD in all cases, although some cases demonstrated severe spongiform change. Approximately half of the cases showed intracytoplasmic inclusion body‐like immunoreactivity for PrPCJD in neurons of the dentate nucleus. These findings suggest that PrPCJD deposition may be an event that precedes neuronal degeneration evolving from deeper layers of the cerebral cortex. Although the Ammon’s horn and subiculum showed striking PrPCJD deposition and spongiform change, neuronal loss did not take place, suggesting that deposited PrPCJD itself seems not to be directly harmful to the neurons. Some investigators have assumed that microglia activated by PrPCJD plays an important role in neuronal degeneration. Considering this, we speculate that microglia in the Ammon’s horn and subiculum may have a unique characteristic of not responding to PrPCJD.
Clustering of Pick bodies in the dentate gyrus in Pick's disease
Authors: Armstrong RA , Cairns NJ , Lantos PL
Published: March 2003

In patients with Pick's disease (PD), high densities of tau positive Pick bodies (PB) have been observed within the granule cell layer of the dentate gyrus. This study investigated the spatial patterns of PB along the granule cell layer in coronal sections of the hippocampus in eight patients with PD. In all patients, there was evidence of clustering of PB within the granule cell layer; however, there was considerable variation in the pattern of clustering. In five patients, the clusters of PB were regularly distributed along the dentate gyrus, and in two of these patients, the smaller clusters were aggregated into larger superclusters. In three patients, a single large cluster of PB, more than 1200 μm in diameter, was present. Clustering of PB may reflect a primary degenerative process within the granule cells or the degeneration of pathways that project to the dentate gyrus.
Understanding synaptic competition in theory and in practice
Authors: Lichtman Jeff W. , Balice‐Gordon Rita J.
Published: March 2003

Stent's theoretical approach to synptic competition is compared with experimental studies at the mammalian neuromuscular junction.
Renal impairment in deoxycorticosterone acetate‐salt hypertensive rats
Authors: Dallemagne Catherine , Ooi Sze‐Yuan , Brown Lindsay , GobÉ Glenda , Endre Zoltan
Published: March 2003

Summary: This study has compared renal function in deoxycorticosterone (DOCA)‐salt hypertensive Wistar rats (uninephrectomy followed by administration of DOCA 25 mg subcutaneously every fourth day and 1% NaCl in the drinking water) with various control rats using the isolated perfused kidney preparation. The systolic blood pressure of DOCA‐salt hypertensive rats was 180 ± 10 mmHg (uninephrectomy controls: 136 ± 9 mmHg) while normalization of calcium intake (DOCA‐Ca rats, 1% CaCl2 in water) attenuated this increase (systolic blood pressure, 146 ± 5 mmHg). Renal mass corrected for body weight increased by 25% after uninephrectomy, 55% in uninephrectomized rats given NaCl, 152% in DOCA‐salt rats and 147% in DOCA‐Ca rats. At a renal perfusion pressure of 135 mmHg, isolated perfused kidneys from DOCA‐salt rats showed decreases of 48% in glomerular filtration rate and 69% in sodium excretion with an increase of 44% in renal vascular resistance compared with uninephrectomized rats. There were no significant differences in renal function between DOCA‐salt and DOCA‐Ca rats. Histological assessment of renal pathology showed proximal tubular hypertrophy and hyperplasia, marked focal distal tubular atrophy, interstitial fibrosis and glomerular hypercellularity in DOCA rats compared with UNX rats. Lesions were less obvious in UNX‐salt or DOCA‐Ca rats. The lack of direct correlation between alterations in function and pathology may be explained by the compensatory effect of remaining healthy or hypertrophied nephrons. Thus, the DOCA‐salt model of hypertension in rats is associated with marked structural kidney damage and severely decreased kidney function. Marked attenuation of systemic hypertension by normalizing calcium intake in DOCA‐salt rats did not prevent impairment of kidney function.
Quantification of platelet‐derived growth factor A, factor B and receptor β in human renal biopsy tissue using competitive reverse transcriptase polymecase chain reaction: comparison between immunoglobulin A nephropathy and thin membrane nephropathy
Authors: Langham Robyn G , Egan Melissa K , DOWLING2 John P , THOMSON1 Napier M
Published: March 2003

SUMMARY Platelet‐derived growth factor (PDGF) is a pleiotropic cytokine synthesized by various resident renal cells and infiltrating cells. Its best‐studied role in the kidney is in the mediation of glomerular mesangial cell proliferation. The relationship between expression of PDGFA, PDGFB and the receptor β (PDGFRβ) in human renal biopsies of immunoglobulin A nephropathy (IgAN), a disease characterized by mesangial cell proliferation, and thin membrane nephropathy (TMN), a non‐proliferative glomerulopathy, was studied. Using competitive reverse transcriptase‐polymerase chain reaction (RT‐PCR), the quantity of mRNA molecules of each growth factor and the receptor was determined in renal biopsies from 20 patients with IgAN and 16 with TMN. In addition, eight nephrectomy samples with paired cortical and medullary samples were studied. There was no significant difference between the disease groups for PDGFA (TMN, 1409 ± 475 copy number/microgram RNA; IgAN, 691 ± 133, P = 0.35), PDGFB (TMN, 2280 ± 467; IgAN, 1465 ± 197, P = 0.10) or PDGFRβ (TMN, 1387 ± 273; IgAN, 1402 ± 344, P = 0.68). Analysis of nephrectomy samples showed higher constitutive expression of PDGFA and PDFGB in the medulla as compared with the cortex. However, further analysis of cortical samples in the IgAN group again failed to show a significant difference compared with TMN. We conclude that whole tissue analysis may have masked upregulation at glomerular level although it should reflect mRNA expression in the tubulointerstitial compartment.
IgA aggregates stimulate monocyte chemotactic peptide‐1 expression in human mesangial cells
Authors: Ihm Chun‐Gyoo , Park Jae Kyung , Lee Tae Won , Kim Myung Jae , Cha Dae Ryong
Published: March 2003

SUMMARY:

It has been observed that mesangial cells (MC) possess receptors for IgG and IgA and that IgG immune complexes activate MC to produce monocyte chemotactic peptide‐1 (MCP‐1). Therefore, we examined whether IgA immune complexes could stimulate MCP‐1 mRNA expression in human MC by using semiquantitative reverse transcription‐polymerase chain reaction (PCR). Incubation of MC with IgA or IgG immune aggregates (Agr) effectively enhanced the ratio of PCR products for MCP‐1 to glyceraldehyde‐3‐phosphate dehydrogenase on densitometric results at 24 h. When the monocyte chemotactic activity was examined, MC supernatants produced by IgA or IgG Agr increased the monocyte chemotactic activity. Additional experiments were performed to examine whether protein kinase C (PKC) could regulate the IgA or IgG Agr‐induced MCP‐1 expression. Phorbol myristate acetate, a PKC activator, increased MCP‐1 expression which was inhibited by calphostin C, a PKC inhibitor. One hour of prior incubation of MC with calphostin C could reduce the MCP‐1 expression induced by IgA or IgG Agr. These findings demonstrate that IgA as well as IgG immune Agr directly increase MCP‐1 expression by MC and it is partly mediated by PKC. The MCP‐1 expression induced by IgA or IgG Agr may contribute to monocyte infiltration in the early stage of immune complex glomerulonephritis such as IgA nephropathy or lupus nephritis.
Comparison of immunological and histopathological changes between oral and intraperitoneal immunization of outer membrane of Haemophilus parainfluenzae antigens in mice
Authors: Yamamoto C , Suzuki S , Kimura H , Yoshida H
Published: March 2003

IgA nephropathy (IgAN) was first reported by Berger in 1968, and characterized by diffuse IgA deposits in glomerular mesangium and mesangial proliferative glomerulonephritis. Clinically, patients with IgAN have frequently episodic macroscopic haematuria accompanied with pharyngitis, tonsillitis, gastroenteritis, bronchitis, or sinusitis. These findings suggest that IgAN is related to inflammatory and immune responses to mucosal infections.

We have reported that primary IgAN patients with acute onset are often associated with mucosal infections such as pharyngitis and tonsillitis, and Haemophilus parainfluenzae (HP) is more frequently isolated from the pharynx of patients with IgAN than from those with other diseases.1 We also demonstrated glomerular deposition of outer membrane of HP (OMHP) antigens and the presence of IgA antibody against OMHP in patients with IgAN.1 These findings suggest that HP has a role in the aetiology of primary IgAN.

In the present study, we attempt to develop an experimental model of IgAN induced by oral and intraperitoneal immunization of OMHP antigens, and evaluate the difference in immunological and histopathological changes between these two administration routes.

Four‐week‐old female C3H/HeN mice were fed mouse chow. One hundred and twenty mice were divided into oral (PO group) and intraperitoneal (IP group) administration groups of OMHP antigens and each control groups. Mice of the PO group received OMHP antigens for daily drinking water and intragastric intubation once a week, and mice in the IP group received intraperitoneal injection of 0.1 mL of OMHP antigens, once a week. Six mice from each group were killed at 10, 20, 30, 40 and 50 weeks of age to examine sequential glomerular changes. We also measured serum IgG, IgA, IgM antibody against OMHP antigens, and serum IL‐10 and IFN γ by ELISA. Throughout experiments, haematuria and proteinuria were analysed every 5 weeks.

IgA antibodies against OMHP significantly increased in PO and IP groups compared with the control, and the degree of increase in IgA antibodies against OMHP was more prominent in the PO group. In the IP group, IgG and IgM antibodies against OMHP increased more markedly. Glomerular deposition of IgA and increase of mesangial matrix were observed in the PO group from 40 weeks of age and in the IP group from 30 weeks of age, respectively. Mice in both groups showed glomerular deposition of OMHP antigens. Haematuria was not detected in any group. Serum IL‐10 tended to increase in the PO and IP groups, and IFN γ did not increase significantly in any group.

These results suggest that oral administarion of OMHP antigens induce glomerular deposition of IgA and mesangial proliferation with increase of IgA antibodies against OMHP antigens in mice, and these observations in the PO group resemble the changes of human IgAN more closely than in the IP group.
Mesangial deposition of IgA2 subclass and lectin pathway‐mediated complement activation in IgA glomerulonephritis
Authors: Hisano S , Matsushita M , Fujita T , Endo Y , Takebayashi S
Published: March 2003

Three pathways are recognized in the complement activation cascade. The aim of our study was to elucidate immunohistologically which complement pathway is associated with the activation in IgA glomerulonephritis (GN) and the relation of IgA subclass to the complement activation. Immunohistological staining was performed on biopsied renal specimens from 36 patients with IgA GN, 10 with systemic lupus erythematosus (SLE) and 16 with other glomerulonephritides using polyclonal antibodies of IgG, IgA, IgM, C3c, C4, C1q and monoclonal antibodies of IgA1, IgA2, mannose‐binding lectin (MBL) and MBL‐associated serine protease‐1 (MASP‐1). Mesangial deposits of IgA1, IgA2, C3c, C4, MBL and MASP‐1 were detected in 19 of the 36 patients with IgA GN, and IgA2 and MBL/MASP‐1 were colocalized in the mesangium in these 19 patients. The remaining 17 patients showed mesangial deposition of IgA1 alone. Twelve of these 17 patients presented mesangial deposition of C3c without deposition of C4, MBL and MASP‐1. No deposition of C1q was evident in IgA GN patients. Three of the 10 SLE patients showed glomerular deposition of MBL and MASP‐1 without deposition of IgA2. No patient with other glomerulonephritides showed glomerular deposition of IgA1, IgA2, MBL and MASP‐1. There was no correlation in clinical and pathological indicators between IgA2‐positive and IgA2‐negative patients with IgA GN. In conclusion, alternative pathway‐mediated complement activation is associated in patients with mesangial deposition of IgA1 alone in IgA GN. In those with the deposition of both IgA1 and IgA2, both alternative and lectin pathways are activated, and mesangial deposition of IgA2 is associated with the lectin pathway‐mediated complement activation in IgA GN.