bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of Autoantibodies to Natural Killer Cells in HIV‐Infected Patients
Authors: MÜLLER C. , SZANGOLIES M. , KUKEL S. , KIEHL M. , SORICE M. , GRIGGI T. , LENTI L. , BAUER R.
Published: November 2003

Natural killer (NK) cells in HIV‐infected patients have a reduced ability to generate non‐MHC restricted cytotoxicity to a variety of target cells. The authors investigated antibodies to NK cells in HIV‐infected patients and evaluated effects of these antibodies to NK cell numbers and function. Antibodies to NK cells were determined in 160 HIV‐infected patients and 35 healthy controls. Flow cytometric whole blood methods were developed to detect antibodies to NK cells. Antibodies to asialo‐GM1 were detected by TLC immunostaining. The presence of antibodies to NK cells was demonstrated in plasma of about one‐third (54/160) of HIV‐infected patients but rarely in controls (2/35). Autoantibodies bound to NK cells in vivo and were detected by a strong increase of surface immunoglobulin (Ig) on NK cells of HIV‐infected patients. Anti‐NK cell antibodies were warmreactive antibodies rather of IgG than of IgM phenotype. The prevalence of specific antibodies to asialo‐GM1 was low (12.5%). Numbers of circulating NK cells did not differ significantly between antibody positive (99.5/μl) and antibody negative (141/μl) patients (P = 0.3). However, pre‐incubation of healthy donors' NK cells with autoantibody positive plasma significantly inhibited cytotoxicity to K562 leukaemic cells (P = 0.002). Autoantibodies to NK cells in HIV‐infected patients are present in the plasma of one‐third of HIV‐infected patients and are bound to NK cells in vivo. There is evidence that these autoantibodies can induce NK cell defects similar to those seen in vivo
Mapping of the Epitope Recognized by Non‐Specific Cytotoxic Cells: Determination of the Fine Specificity Using Synthetic Peptides
Authors: EVANS D. L. , LEARY III J. H. , WEISMAN Z. , WARREN J. , JASO‐FRIEDMANN L.
Published: November 2003

NCC recognize a conserved target cell antigen (NKTag) expressed on protozoan parasites and on transformed tumour cells. In the present study, synthetic peptides corresponding to N‐terminal, C‐terminal and internal NKTag (deduced) amino acid sequences were tested for binding and inhibition of NCC lysis of sensitive target cells. A 20‐mer peptide equivalent to amino acids (aa) nos. 55–74 specifically inhibited NCC lysis of human EBV transformed target cells (IM‐9). Inhibitory effects were nonreversible and concentration dependent; and 30 min pre‐incubation produced optimum inhibition. The inhibitory 20‐mer peptide was truncated into 17, 14, 10, 9 and 6‐mer peptides and tested for inhibition of cytotoxicity. All produced almost complete inhibition except the 6‐mer which had no activity. The NKTag sequence required for NCC binding (minimally) consisted of seven amino acids [aa nos 68–74 (ARG‐ASN‐LEU‐THR‐PHE‐ILE‐LEU‐)]. The specificity of inhibition and the distribution of target cells expressing NKTag was determined. A 14‐mer peptide composed of aa nos 61–74 inhibited lysis of HL‐60, IM‐9, DAUDI, YAC‐1, U937 and NC‐37 target cells. Flanking peptides (aa nos 35–54 and 75–94) were negative. Biotinylated aa nos 61–74 bound to NCC effector cells. The recognition requirements for aa sequence versus aa content were determined. Randomization of the aa in the cognate 9‐mer obliterated the inhibitory effects. The 17‐mer (cognate) synthetic peptide inhibited conjugate formation between NCC and IM‐9 targets. These data demonstrate that NCC recognize a conserved antigen determinant on susceptible target cells consisting of a minimum of 7–9 amino acids in the N‐terminal region of NKTag.
Chemoembolization followed by orthotopic liver transplant for epithelioid hemangioendothelioma
Authors: St Peter Shawn D , Moss Adyr A , Huettl Eric A , Leslie Kevin O , Mulligan David C
Published: November 2003

Abstract:  Hepatic epithelioid hemangioendothelioma (HEHE) is a rare liver tumor with an indolent course relative to other hepatic malignancies. Over the past two decades, primary treatment for these lesions has been defined as resection for localized disease, or transplantation for diffuse and multifocal tumors. No published report to date has described effective pre‐ or post‐operative adjuvant treatment for this disease. In this report, we present the first case of HEHE effectively managed with chemoembolization followed by transplantation, documenting objective tumor response to embolization. Furthermore, diagnosis for this lesion can easily be mistaken, directing management in erroneous directions. This case illustrates diagnostic pitfalls affiliated with the work‐up of this tumor.
Pharmacokinetics of daclizumab and mycophenolate mofetil with cyclosporine and steroids in renal transplantation
Authors: Pescovitz Mark D , Bumgardner Ginny , Gaston Robert S , Kirkman Robert L , Light Susan , Patel Indravadan H , Nieforth Keith , Vincenti Flavio
Published: November 2003

Abstract: Daclizumab and mycophenolate mofetil (MMF) decrease the incidence of acute allograft rejection. This double‐blind, randomized, placebo‐controlled trial was performed primarily to assess the pharmacokinetics of MMF in an immunosuppressive regimen incorporating daclizumab. At five centers, 75 renal transplant recipients were randomized 2 : 1 to receive either daclizumab 1 mg/kg or placebo pre‐transplantation and every other week, for a total of five doses. All patients received cyclosporine, steroids, and MMF. Levels of mycophenolic acid (MPA), its glucuronide metabolite, and daclizumab were measured after dosing on days 28 and 56. Safety parameters evaluated included: adverse events, laboratory abnormalities, infections, patient/graft survival, incidence of lymphoproliferative disorders, and incidence of acute rejection at 12 months. The concomitant administration of daclizumab and MMF had no effect on the pharmacokinetics of MPA: AUC0−8 values (μg h/mL ± SD) on day 28 were 30.1 ± 13.3 for daclizumab‐treat patients vs. 31.1 ± 12.4 for placebo and on day 56, 37.7 ± 18.2 for daclizumab‐treated patients vs. 35.7 ± 14.0 for placebo. Adverse events were similar between the two groups. Acute rejection at 12 months occurred in 14% of patients receiving daclizumab and 20% of patients receiving placebo. The coadministration of daclizumab did not result in a pharmacokinetic interaction with MPA, the active metabolite of MMF.
Long‐term outcome of kidney transplant using non‐heart‐beating donor: multicenter analysis of factors affecting graft survival
Authors: Hattori Ryohei , Ono Yoshinari , Yoshimura Norio , Hoshinaga Kiyotaka , Nishioka Tsukasa , Ishibashi Michio , Ohshima Shinichi
Published: November 2003

Abstract: This multicenter study was retrospectively evaluated for the predictive factors affecting the long‐term graft survival of a kidney transplant from a non‐heart‐beating donor (NHBD).

Patients and method: A total of 706 patients received transplants from NHBD in 11 centers between 1986 and 2000 and the results were entered into the analysis. The patients were treated with cyclosporine‐ or tacrolimus‐based immunosuppressive therapy. Graft survival was calculated by the Kaplan–Meier method. Factors selected for univariate analysis were donor age, and acute early and acute late rejection. Hypertension (HT), hyperlipidemia (HL), and diabetes mellitus were also analyzed in 638 recipients whose graft survived for more than 1 yr.

Results: In the cases using NHBD, graft survival for 1, 5, and 10 yr was 87, 69, and 53%, respectively. Donor age of over 55 yr, acute early and late rejection, post‐transplant HT and diabetes at the first post‐operative year were shown to be significantly harmful on long‐term graft survival. For longer graft survival in NHBD kidney transplantations, reducing acute rejection, and controlling blood pressure and sugar are crucial.
Endothelial function is more impaired in hemodialysis patients than renal transplant recipients
Authors: Oflaz Huseyin , Pusuroglu Hamdi , Genchallac Hakan , Demirel Seref , Bugra Zehra , Sever Mehmet S , Yildiz Alaattin
Published: November 2003

Abstract: Background: Endothelial dysfunction (ED) is a common precursor and denominator of cardiovascular events including development of atherosclerosis. In this cross‐sectional, controlled study, we aimed to investigate ED measured by ischemia‐induced forearm vasodilatation in chronic hemodialysis (HD) patients and renal transplant recipients (rTX).

Patients and methods: Thirty‐nine HD patients, 39 rTX and 38 normotensive healthy controls were included. There was no difference in age and gender distribution among the study groups. The mean time spent on dialysis and transplantation were 74 ± 46 and 68 ± 39 months. Serum high sensitive C‐reactive protein (hs‐CRP) and plasma fibrinogen levels were measured. Endothelium dependent post‐ischemic vasodilatation of brachial artery was used to evaluate ED.

Results: The hs‐CRP and plasma fibrinogen levels were significantly increased in HD patients when compared with rTX. On high resolution ultrasonographic examination, post‐ischemic vasodilatation values in HD patients (9.55 ± 6.47%) were significantly lower than rTX (14.39 ± 8.06%, p = 0.007) and controls (20.42 ± 6.10%, p < 0.001). Renal transplant recipients also had significantly lower post‐ischemic vasodilatation values than controls (p = 0.001). The hs‐CRP levels were negatively correlated with endothelium‐dependent dilatations in TX (r = −0.59, p = 0.001), however, this correlation was not detected in HDp.

Conclusion: Patients with end‐stage renal disease have ED. Endothelial function is more impaired in HD patients than rTX. Different mechanisms might be responsible for ED in HD patients and rTX.
Hypoglycaemia after pancreas transplantation: usefulness of a continuous glucose monitoring system
Authors: Esmatjes Enric , Flores Lilliam , Vidal Merce , Rodriguez Lucia , Cortés Antoni , Almirall Lourdes , Ricart Maria J , Gomis Ramón
Published: November 2003

Abstract:Background:After pancreas transplantation (PTx) some patients report occasional symptoms of hypoglycaemia and at times, serious hypoglycaemia. Continuous blood glucose monitoring (CBGM) allows determination of the daily glucose profile and detection of unrecognized hypoglycaemia. The aims of our study were to determine the incidence of hypoglycaemia in PTx and evaluate whether the use of CBGM helps to detect unrecognized nocturnal hypoglycaemia.

Patients and methods:We studied 12 patients (six males) with normal functioning PTx and kidney transplantation for more than 3 yr, with systemic drainage of endocrine secretion and stable immunosuppression. A 24‐h CBGM using a microdialysis technique (GlucoDay, A. Menarini Diagnostics, Florence, Italy) was performed in all the patients.

Results:Three patients had asymptomatic recorded glucose levels below 3.3 nmol/L during the nocturnal period (01:00–07:00 hours) with the glucose levels during these episodes being 2.6, 2.5 and 2.5 nmol/L, and the duration of nocturnal hypoglycaemia being 27, 62 and 93 min, respectively, rising spontaneously without intervention. Patients with hypoglycaemia presented lower glycosylated haemoglobin levels when compared with those not presenting hypoglycaemic episodes, although basal glucose and insulin levels and insulin antibody titres were similar. In one of the three patients presenting hypoglycaemia CBGM was re‐evaluated after including an extra snack at bedtime, with subsequent normalization of the blood glucose profile being observed.

Conclusion:Unrecognized nocturnal hypoglycaemia is relatively frequent in patients with PTx and 24‐h CBMG may be useful to detect these episodes.
Placental mesenchymal dysplasia initially diagnosed as partial mole
Authors: Matsui Hideo , Iitsuka Yoshinori , Yamazawa Koji , Tanaka Naotake , Mitsuhashi Akira , Seki Katsuyoshi , Sekiya Souei
Published: November 2003

Placental mesenchymal dysplasia is a rare condition of pregnancy that presents as macroscopic features of molar change in the placenta and normal karyotype fetus. These cases are often misdiagnosed as partial mole. We report a new case of mesenchymal dysplasia. A 27‐year‐old Japanese primigravida delivered an 820 g female baby (46XX karyotype) without congenital anomalies at 27 weeks gestation due to massive bleeding with placenta previa. The placenta had mimicking partial moles, grape‐like vesicles and normal villi that diffusely occupied the area on the maternal surface of the placenta. Pathologically, enlarged stem villi contained loose, moderately cellular connective tissue with focal cistern‐like formation, and peripherally located vessels. Abnormal trophoblastic proliferation and trophoblastic inclusions were not observed in any of the sections examined. Some villi contained chorioangiomatoid changes. The mother and child were followed up for more than 5 years and showed no sign of trophoblastic disease or Beckwith–Wiedemann syndrome features.
Elevated urinary 8‐hydroxydeoxyguanosine, a biomarker of oxidative stress, and lack of association with antioxidant vitamins in chronic obstructive pulmonary disease
Authors: IGISHI Tadashi , HITSUDA Yutaka , KATO Kazuhiro , SAKO Takanori , BURIOKA Naoto , YASUDA Kazuhito , SANO Hiroyuki , SHIGEOKA Yasushi , NAKANISHI Hirofumi , SHIMIZU Eiji
Published: November 2003

Objective:  The purpose of this study was to investigate whether patients with COPD are under oxidative stress and to elucidate the relationship between the level of oxidative stress and antioxidant vitamins.

Methodology:  Nineteen male patients with COPD and 13 age‐ matched male control subjects were studied. Urinary 8‐hydroxydeoxyguanosine (8‐OHdG) concentrations were determined using an enzyme‐linked immunosorbent assay kit and corrected for creatinine concentrations. Serum levels of vitamin C, α‐tocopherol, and β‐carotene were determined by high performance liquid chromatography.

Results:  The median (interquartile range) 8‐OHdG excretion was 8.1 ng/mg (5.3–10.9 ng/mg) in control subjects and 12.2 ng/mg (9.8–15.5 ng/mg) in COPD patients (P < 0.01). Urinary 8‐OHdG levels were significantly elevated in ex‐smokers in the COPD group compared with ex‐smokers in the control group. Urinary 8‐OHdG level was negatively correlated with FVC (r = −0.42, P = 0.016), FEV1 (r = −0.49, P = 0.0048), and oxygen tension in arterial blood (r = −0.41, P = 0.0005). No significant differences in antioxidant levels were demonstrated between the two groups. There were no significant correlations between urinary 8‐OHdG excretion and the serum concentrations of antioxidant vitamins.

Conclusion:  The burden of oxidative stress was observed to increase in COPD patients as judged by urinary 8‐OHdG. A depletion of antioxidant vitamins in serum was not essential for this phenomenon. Elevated urinary 8‐OHdG level may not be attributable to smoking status or to antioxidant vitamins in COPD.
Effects of IL‐1β, TNF‐α, and macrophage migration inhibitory factor on prostacyclin synthesis in rat pulmonary artery smooth muscle cells
Authors: ITOH Akihide , NISHIHIRA Jun , MAKITA Hironi , MIYAMOTO Kenji , YAMAGUCHI Etsuro , NISHIMURA Masaharu
Published: November 2003

Objective:  Cytokines have been implicated in the pathophysiology of pulmonary hypertension. We sought to explore the possibility that prostacyclin is a link.

Methodology:  We tested the effects of the cytokines interleukin‐1β (IL‐1β), tumour necrosis factor‐α (TNF‐α), and macrophage migration inhibitory factor (MIF) on arachidonic acid metabolism of pulmonary artery smooth muscle cells (PASMCs) with special regard to prostacyclin (PGI2) that protects against pulmonary hypertension. Cultured rat PASMCs were treated with IL‐1β, TNF‐α, or MIF. Expression of prostacyclin synthase (PGIS) and cyclooxygenase‐2 (COX‐2) mRNAs, and PGI2 synthesis, were measured.

Results:  We found that PGIS mRNA expression was suppressed by high concentrations of TNF‐α and MIF, while COX‐2 mRNA was induced by all three cytokines tested. IL‐1β increased PGI2 production in a dose‐dependent manner. TNF‐α and MIF also increased PGI2 production, but to a far lesser degree at high concentrations. TNF‐α paradoxically decreased PGI2 production at a low concentration.

Conclusions:  These results suggest that TNF‐α and MIF are potentially antagonistic to the action of PGI2 in rat PASMCs via down‐regulation of PGIS mRNA. Simultaneous induction of COX‐2 mRNA may further counteract the action of PGI2 by increasing the levels of eicosanoids other than PGI2.
Progressive form of pulmonary Langerhans’ cell histiocytosis in a female adult non‐smoker
Authors: BENČIĆ Dubravka , SMOJVER Silvana , BORAS Zagorka , POTOČKI Kristina , BATINIĆ Drago
Published: November 2003

Abstract:  Little is known about the cause, nature, treatment and prognosis of pulmonary Langerhans’ cell histiocytosis (LCH) in adults. We report the case of a 44‐year‐old female non‐smoker suffering from pulmonary histiocytosis who after a 7‐year remission period relapsed with both lung and bone disease. Using a combination of corticosteroids, methotrexate and bone irradiation treatment, the patient achieved total disease remission. The patient was a non‐smoking female who has had long‐term and swift remission of the disease on two occasions.
The airway epithelium: Structural and functional properties in health and disease
Authors: KNIGHT Darryl A. , HOLGATE Stephen T.
Published: November 2003

Abstract:  The major function of the respiratory epithelium was once thought to be that of a physical barrier. However, it constitutes the interface between the internal milieu and the external environment as well as being a primary target for inhaled respiratory drugs. It also responds to changes in the external environment by secreting a large number of molecules and mediators that signal to cells of the immune system and underlying mesenchyme. Thus, the epithelium is in a unique position to translate gene–environment interactions. Normally, the epithelium has a tremendous capacity to repair itself following injury. However, evidence is rapidly accumulating to show that the airway epithelium of asthmatics is abnormal and has increased susceptibility to injury compared to normal epithelium. Areas of detachment and fragility are a characteristic feature not observed in other inflammatory diseases such as COPD. In addition to being more susceptible to damage, normal repair processes are also compromised. Failure of appropriate growth and differentiation of airway epithelial cells will cause persistent mucosal injury. The response to traditional therapy such as glucocorticoids may also be compromised. However, whether the differences observed in asthmatic epithelium are a cause of or secondary to the development of the disease remains unanswered. Strategies to address this question include careful examination of the ontogeny of the disease in children and use of gene array technology should provide some important answers, as well as allow a better understanding of the critical role that the epithelium plays under normal conditions and in diseases such as asthma.
Continuous positive airway pressure therapy in sleep apnoea
Authors: HSU Anne A. L. , LO Constance
Published: November 2003

Abstract:  Sleep apnoea is associated with increased mortality and morbidity. The treatment goal is to reduce the neurocognitive and cardiovascular sequelae. CPAP therapy in sleep apnoea is discussed in two parts in the article. The first part will consider CPAP therapy in the more common form of sleep apnoea (i.e. obstructive or mixed sleep apnoea) and the second part will consider CPAP therapy in central sleep apnoea. Alternative positive airway pressure modalities are discussed. CPAP therapy has been extensively studied and it remains the mainstay of treatment in obstructive sleep apnoea, as it is still the most consistently efficacious and safe option. However, its major disadvantage is that it does not confer a cure to this disorder and hence therapy is generally life long with its usual treatment compliance problems. As such, there are continuous improvement strategies. The role of CPAP therapy in central sleep apnoea is more limited. There has been increasing data on the beneficial effect of CPAP on central sleep apnoea/Cheyne‐Stokes respiration in congestive heart failure. Evidence for CPAP therapy in sleep apnoea has evolved significantly over the last decade. However, more research and publication of large‐scale long‐term randomized trials of treatment in sleep apnoea to assess patient‐orientated outcomes and preferences are necessary.
Increased macrophage inflammatory protein‐1α and ‐1β in BAL fluid of bronchiolitis obliterans organizing pneumonia
Authors: ASANO Toru , OGUSHI Fumitaka , TANI Kenji , TAMIYA Hiroyuki , NISHIOKA Yasuhiko , SONE Saburo
Published: November 2003

Objective:  CC chemokines are mainly chemotactic for monocytes and lymphocytes. The aim of this study was to evaluate the involvement of the CC chemokines, macrophage inflammatory protein (MIP)‐1α and MIP‐1β, in the pathogenesis of bronchiolitis obliterans organizing pneumonia (BOOP).

Methodology:  The concentrations of MIP‐1α and MIP‐1β in BAL fluid (BALF) obtained from patients with BOOP (n = 13) and control patients (CP, n= 18) were measured by enzyme‐linked immunosorbent assay.

Results:  MIP‐1α in BALF was significantly higher in patients with BOOP (mean ± SD; 123.8 ± 98.0 pg/mL) than in CP (62.5 ± 46.1 pg/mL). Significantly higher MIP‐1β was also detected in patients with BOOP (51.6 ± 72.5 pg/mL) than in CP (6.4 ± 3.7 pg/mL). The concentration of MIP‐1α significantly correlated with the percentage of lymphocytes in BALF, and the concentration of MIP‐1β significantly correlated with the numbers of lymphocytes, neutrophils and eosinophils in BALF. Both MIP‐1α and MIP‐1β in BALF were decreased after corticosteroid therapy and this was accompanied by decreased lymphocytes in BALF.

Conclusion:  This study suggests that MIP‐1α and MIP‐1β may play important roles in the recruitment of immuno‐inflammatory cells into the lungs, and may contribute to the pathogenesis of BOOP.
Extrapulmonary presentation of asymptomatic pulmonary lymphangioleiomyomatosis
Authors: LAM Bing , OOI Gaik C. , WONG Maria P. , LEE Raymond , IP Mary S. , CHAN‐YEUNG Moira , LAM Wah K. , TSANG Kenneth W.
Published: November 2003

Abstract:  Lymphangioleiomyomatosis (LAM) is a rare parenchymal lung disease, which affects young women of childbearing age and is characterized pathologically by proliferation of interstitial smooth muscle and formation of cysts in the lung. While LAM is usually predominantly a respiratory disorder, it can also initially involve other extrapulmonary organs. We report the case of a 35‐year‐old Chinese woman, who presented with a 4‐week history of left thigh swelling which was found to be secondary to compression of pelvic veins by a mass lesion. The latter was found histologically to show LAM. Despite the patient being asymptomatic and displaying normal lung function, a thoracic high resolution CT scan showed typical features of early LAM. This case further illustrates that LAM can have multisystem involvement, and demonstrates the importance of being aware of the diagnosis in cases presenting with extrapulmonary manifestation, in order that patients are diagnosed and managed appropriately.
Antineutrophil cytoplasmic antibody positive alveolar haemorrhage during propylthiouracil therapy for hyperthyroidism
Authors: YAMAUCHI Keiko , SATA Makoto , MACHIYA Jun‐Ichi , OSAKA Daisuke , WADA Toshihiro , ABE Shuichi , OTAKE Kazuhisa , KUBOTA Isao
Published: November 2003

Abstract:  Recently, propylthiouracil (PTU) has been thought to be one of the possible causes of antineutrophil cytoplasmic antibody (ANCA)‐associated small vessel vasculitis syndrome, resulting in glomerulonephritis and, infrequently, diffuse alveolar haemorrhage (DAH). The mechanism of ANCA‐positive vasculitis during PTU therapy is still unknown. Herein, we describe the case of a 59‐year‐old woman who developed myeloperoxidase (MPO)‐ and proteinase 3 (PR3)‐ANCA positive DAH, without any other organ system involvement, during PTU therapy. Diminution and discontinuation of PTU resulted in a positive response. To our knowledge, this is the first documentation of both MPO‐ and PR3‐ANCA‐positive DAH, without systemic manifestations, developing during PTU therapy.
Legal strategies to reduce tobacco‐caused disease
Authors: SWEANOR David
Published: November 2003

Abstract:  In efforts to control diseases it is common to look at ways to control the vectors of disease. When dealing with tobacco‐caused disease this requires an understanding of the companies that manufacture and market tobacco products, and an examination of how to shape the behaviour of these companies. Since these corporations are created by law, and seek to maximize value for their owners within the constraints that laws place on the marketplace, it is only natural that a very significant part of tobacco control activities will consist of legal strategies. This paper identifies the underlying public health goal of tobacco control activities as being the reduction of death and disease. It then considers the roles that prevention, cessation, protection from environmental tobacco smoke and toxicity reduction can play as overall strategies for achieving this goal. This is followed by the identification of a broad range of legal strategies, primarily emphasizing governmental regulation, that can be used as part of these overall strategies. The paper looks specifically at a range of measures that impact on the accessibility of tobacco products, the provision of information for consumers, protection of the health and rights of non‐users and the significant potential health gains from regulation of tobacco products.
Underdiagnosis and undertreatment of COPD in primary care settings
Authors: TAKAHASHI Tsuneyuki , ICHINOSE Masakazu , INOUE Hiroshi , SHIRATO Kunio , HATTORI Toshio , TAKISHIMA Tamotsu
Published: November 2003

Objective:  The aim of this study was to improve the detection of COPD in a primary care setting and to evaluate the subsequent management of these patients by general practitioners.

Methodology:  A two‐step protocol was followed: patients were screened for airway obstruction and their subsequent management status reviewed. Screening spirometry was performed in 56 primary care settings (23 hospitals and 33 general practices). Inclusion criteria for screening subjects were: (i) ≥40‐year‐old smokers (both current and past smokers) and/or (ii) ≥40‐year‐old patients with respiratory symptoms of chronic cough and sputum. Patients with a previously diagnosed respiratory disease were excluded. In the second part of the study, the diagnosis and the subsequent management status of subjects with airway obstructive changes (FEV1/FVC <70%) were sought from their physician using a questionnaire 2 months after detection.

Results:  A total of 1168 patients were screened, with 128 not analysed because of incomplete data, leaving 1040 patients. The percentages of current smokers, ex‐smokers, and non‐smokers among all analysed subjects were 41.7%, 29.8% and 28.5%, respectively. Airway obstructive changes (FEV1/FVC <70%) were found in 27.0% (n = 281) of all analysed subjects. Questionnaires for 194 subjects (with positive screening tests) were sent back by the participating physicians. Eighty‐one per cent (n = 158) of the 194 subjects had COPD and 13.4% (n = 26) had asthma. Sixty‐one per cent (n = 96) of the subjects with moderate to severe COPD according to international guidelines (FEV1 <80% predicted). However, 31.3% (n = 30) did not receive any clinical intervention (smoking cessation advice and/or drug administration).

Conclusions:  Screening spirometry in outpatients in a primary care setting can identify many COPD patients. However, COPD management appears to be poor in Japan.
Chronic eosinophilic pneumonia associated with Schizophyllum commune
Authors: KAWAYAMA Tomotaka , FUJIKI Rei , RIKIMARU Toru , AIZAWA Hisamichi
Published: November 2003

Abstract:  We describe the first known Japanese patient with chronic eosinophilic pneumonia caused by Schizophyllum commune. The patient presented to Social Insurance Tagawa Hospital, Fukuoka, Japan with cough, wheezing, dyspnoea, and fever. Computed tomograms of the chest showed bilateral areas of consolidation with air bronchograms as well as interstitial infiltrates in the upper lobe, without ectasia of proximal bronchi. Fibreoptic bronchoscopy revealed no impacted mucus in the bronchi. BAL fluid from the right upper lobe yielded an increased total cell count with a high percentage of eosinophils. A transbronchial lung biopsy specimen showed a bronchoalveolar chronic inflammatory infiltrate composed of eosinophils, lymphocytes and plasma cells, associated with fibrosis of the alveolar walls. S. commune was identified in lavage fluid. Antibodies to this organism were present in the serum, confirming that S. commune was the cause of chronic eosinophilic pneumonia. Inhaled corticosteroids without accompanying oral corticosteroids or antifungal agents decreased the respiratory symptoms, and the infiltrates disappeared from the chest radiograph within a few days.
Pulmonary strongyloidiasis presenting as chronic bronchitis leading to interlobular septal fibrosis and cured by treatment
Authors: MUKERJEE Chitta M. , CARRICK Jane , WALKER John C. , WOODS Robert L.
Published: November 2003

Abstract:  Two patients presented with long‐standing chronic bronchitis and exertional dyspnoea of 5 and 3 months’ duration, respectively, and had interlobular septal fibrosis on chest high resolution CT. In the past both had lived in areas in which Strongyloides stercoralis was known to be endemic. Serological tests confirmed the diagnosis of pulmonary strongyloidiasis, and both patients were treated with anti‐helminthic medications, including albendazole and ivermectin. Following this there was complete resolution of both symptomatic and radiological manifestations of their disease. An awareness of the possibility of Strongyloides infection presenting with respiratory symptoms in patients exposed to this parasite is important in the management of such patients.
‘Iron lung’: Distinctive bronchoscopic features of acute iron tablet aspiration
Authors: KIM Samuel T. , KAISAR Omar M. , CLARKE Belinda E. , VANDENBURG Russell A. , ALLEN David H. , BELL Scott C. , FONG Kwun M.
Published: November 2003

Abstract:  Three confirmed cases of acute iron tablet‐induced necrosis due to a fulminant chemical burn injury to the tracheobronchial tree as a result of accidental inhalation and/or aspiration of iron tablets are described. Although histological confirmation has been relied upon for diagnosis, the distinctive bronchoscopic features may allow prompt recognition and treatment by bronchoscopists to prevent this potentially fatal condition.
Smokeless tobacco and health in India and South Asia
Authors: GUPTA Prakash C. , RAY Cecily S.
Published: November 2003

Abstract:  South Asia is a major producer and net exporter of tobacco. Over one‐third of tobacco consumed regionally is smokeless. Traditional forms like betel quid, tobacco with lime and tobacco tooth powder are commonly used and the use of new products is increasing, not only among men but also among children, teenagers, women of reproductive age, medical and dental students and in the South Asian diaspora. Smokeless tobacco users studied prospectively in India had age‐adjusted relative risks for premature mortality of 1.2–1.96 (men) and 1.3 (women). Current male chewers of betel quid with tobacco in case‐control studies in India had relative risks of oral cancer varying between 1.8–5.8 and relative risks for oesophageal cancer of 2.1–3.2. Oral submucous fibrosis is increasing due to the use of processed areca nut products, many containing tobacco. Pregnant women in India who used smokeless tobacco have a threefold increased risk of stillbirth and a two‐ to threefold increased risk of having a low birthweight infant. In recent years, several states in India have banned the sale, manufacture and storage of gutka, a smokeless tobacco product containing areca nut. In May 2003 in India, the Tobacco Products Bill 2001 was enacted to regulate the promotion and sale of all tobacco products. In two large‐scale educational interventions in India, sizable proportions of tobacco users quit during 5–10 years of follow‐up and incidence rates of oral leukoplakia measured in one study fell in the intervention cohort. Tobacco education must be imparted through schools, existing government health programmes and hospital outreach programmes.
Assessing the impact of abstracts from the Thoracic Society of Australia and New Zealand in Cochrane reviews
Authors: HOPEWELL Sally
Published: November 2003

Objective:  The aim of this study was to assess the potential impact of including trials, reported in conference abstracts from the Thoracic Society of Australia and New Zealand, in Cochrane reviews.

Methodology:  Abstracts from the Thoracic Society of Australia and New Zealand, published in the Australian and New Zealand Journal of Medicine (1981–1998), were read to identify all reports of randomized trials. A search was carried out of the Cochrane Database of Systematic Reviews (Issue 1, 2002) for each trial reported in a conference abstract to try to identify Cochrane reviews in which the conference abstract might be eligible for inclusion. If it was unclear, the authors of the review were contacted.

Results:  A total of 187 reports of randomized trials were identified: 101 (54%) had been published as a full report and 86 (46%) remained unpublished. Thirty‐four (72%) were reports of randomized controlled trials and 52 (28%) were quasi‐randomized or possibly randomized trials. The total number of patients included in the trials was 9691; range 4–1203 (median 20; IQR 11–47). No possible Cochrane review was found for 145 of the 187 trials reported in the conference abstracts. Possible reviews were identified for 42 trials, 24 of which were already mentioned in Cochrane reviews. For the remaining 18 trials, only three were said to be eligible for inclusion.

Conclusion:  A search of conference abstracts identified a number of reports of randomized trials, potentially eligible for inclusion in reviews of health care. However, the majority of trials were not relevant for inclusion in an existing Cochrane review. This is most likely because there are currently too few reviews to deal with the topics covered in the abstracts.
Pilot study of the safety and effect of intranasal delipidated acid‐treated Mycobacterium vaccae in adult asthma
Authors: SHIRTCLIFFE Philippa M. , GOLDKORN Alexandra , WEATHERALL Mark , TAN Paul L. J. , BEASLEY Richard
Published: November 2003

Objective:  There is epidemiological and experimental evidence that exposure to mycobacteria has the potential to suppress the development of atopy and/or asthma. Delipidated, deglycolipidated and arabinogalactan‐depleted autoclaved Mycobacterium vaccae (delipidated acid‐treated M. vaccae) has been shown to suppress allergen‐induced airway eosinophilia in mice.

Methodology:  Thirty‐seven adults with stable moderately severe asthma who were skin prick test‐positive to house dust mite were randomized to receive two doses 2 weeks apart of delipidated acid‐treated M. vaccae (first dose 0.4 mg and second dose 0.8 mg) or phosphate buffered saline, given as drops intranasally. Safety, tolerability and markers of asthma severity (including peak flow, FEV1, major and minor exacerbations, symptom scores and beta‐agonist use), and nasal symptom scores, blood eosinophil and IgE levels were monitored for 8 weeks.

Results:  Delipidated acid‐treated M. vaccae was safe and well tolerated although there was an occasional mild local reaction. There were no statistically significant differences between the treatment group and placebo for any of the outcome variables.

Conclusions:  There is a requirement to elucidate the reasons why mycobacterial‐based vaccines have not shown equivalent efficacy in human trials compared with animal models. The role of factors such as duration of disease, route of administration and the active component of mycobacteria need to be addressed.
Effect of ascorbic acid on airway responsiveness in ovalbumin sensitized guinea pigs
Authors: BOSKABADY Mohammad Hossein , ZIAEI Toctam
Published: November 2003

Objective:  The most important pathological feature of asthma is airway inflammation, which results in airway hyper‐responsiveness. We hypothesized that excessive oxidation is likely to contribute to airway inflammation in asthma. The aim of this study was to evaluate the effects of both acute exposure and a 30‐day administration of ascorbic acid (AA), which has an antioxidant effect, on airway responsiveness in sensitized guinea pigs.

Methodology:  Guinea pigs sensitized to ovalbumin (OA), were given drinking water without AA (group 2) or with AA (group 3). The responses of tracheal chains of control animals (group 1) and both groups of sensitized guinea pigs (n = 10, for all groups) to cumulative concentrations of methacholine were measured, and the effective concentrations of methacholine causing 50% of maximum response (EC50 M) were obtained. The response of tracheal chains to 0.1% OA, relative to contraction obtained with 10 µmol/L methacholine, was also measured. The tracheal responses to methacholine and OA were measured on tissues both incubated and not incubated with AA.

Results:  The tracheal responses of group 2 tissues were significantly greater than those of groups 1 and 3 to both OA and methacholine (P < 0.05). There were no significant differences in tracheal responses to OA and methacholine between groups 1 and 3. Acute incubation of tissues caused a reduction of tracheal response to methacholine in all groups, but this was only significantly differ‐ent for group 3 (P < 0.05). Acute incubation of tissues did not change tracheal response to OA significantly.

Conclusion:  These results showed that although short‐term administration of AA had no major effect on tracheal responsiveness among sensitized animals, 30‐day administration of AA could lead to a decrease in airway responsiveness of sensitized guinea pigs to both OA and methacholine.
Examination of expandable metallic stent removed at autopsy
Authors: HOSOKAWA Yoshifumi , TSUJINO Ichiro , SYODA Toshiaki , HORIKOSHI Akira , SAWADA Shigemasa
Published: November 2003

Objective:  We evaluated the damage to expandable metallic stents (EMS) based upon analysis of EMS removed at autopsy.

Methodology:  Seventeen EMS were obtained during autopsy from the main bronchi of nine patients with lung cancer. Each EMS was categorized into one of the following three groups, according to the degree of EMS damage: no damage at all (ND), damage to part of the EMS (PD), and marked damage (MD) that caused loss of function of the airway stent. The removed EMS were examined using a scanning electron microscope.

Results:  Of the 17 stents, ND occurred in 13 (7/9 primary, 6/8 secondary), PD in four (all secondary), and MD in none. None of the stents had completely lost the ability to function as an airway stent. Bacterial biofilm formation (BBF) was detected on EMS from four patients.

Conclusions:  Bacterial biofilm forms on EMS implanted into the airway. Some physical damage was present in four of 17 EMS, but all remained functional.
Use of the laryngeal mask airway during repair of atrial septal defect in children
Authors: Zerafa M. , Baulch S. , Elliott M.J. , Petros A.J.
Published: November 2003

We describe the elective use of the laryngeal mask airway in two children undergoing cardiopulmonary bypass for repair of an atrial septal defect. Total surgical time was short and cardiopulmonary bypass performed at normothermia allowing removal of the laryngeal mask airway on the operating table on completion of surgery. We were able to adequately oxygenate and ventilate the children throughout the procedure using positive pressure ventilation and spontaneous ventilation. The use of caudal fentanyl and rectal diclofenac aided postoperative pain management. Atrial septal defect repair has become one of the more straightforward cardiac operations partly as a result of new cardiopulmonary bypass techniques. Avoidance of intubation and postoperative ventilation in appropriate patients would make this procedure ideal for ‘fast tracking’ and offers the potential advantages of decreased length of stay in hospital and reduction in overall costs.
A different under vision approach to a difficult intubation
Authors: Arul A. , Jacob R.
Published: November 2003

A simple and safe technique of intubation with minimal discomfort to the patient using a nasopharyngeal airway, fibreoptic bronchoscope and guide wire in a three‐year‐old is presented.
An audit of postoperative analgesia after pyloromyotomy
Authors: Habre W. , Schwab C. , Gollow I. , Johnson C.
Published: November 2003

Seventy‐two cases of pyloric stenosis treated in our institution in the last five years were reviewed in an attempt to determine the need for postoperative analgesia after pyloromyotomy in infants. All children had their wound infiltrated with a mean dose of 2.16±1.43 mg·kg−1 of bupivacaine, and first analgesia was required 9.12±8.04 h after surgery. Paracetamol was the main analgesic administered (average of two doses of approximately 20 mg·kg−1). Only three patients required postoperative opioids. In conclusion, there was a low consumption of analgesics after pyloromyotomy. Furthermore, infiltration of the wound appeared to be beneficial since time to administration of first postoperative analgesia was delayed.
A confirmatory factor analysis evaluation of the coronary heart disease risk factors of metabolic syndrome with emphasis on the insulin resistance factor
Authors: Novak S. , Stapleton L. M. , Litaker J. R. , Lawson K. A.
Published: November 2003

Aim:  The goals of this study were: (1) to analyse the underlying associations between coronary risk factors and the metabolic syndrome and (2) to evaluate the construct validity of the variables used to measure each factor.

Methods:  The subjects were from a previously studied cohort of 284 middle‐aged Caucasian males from Goteborg, Sweden, who were selected from the National Population Register. A confirmatory factor analysis was performed using EQS Multivariate Software Version 5.7b with maximum likelihood estimation. Hypertension, obesity, insulin resistance and hyperlipidaemia were the latent factors hypothesized.

Results:  The final, four‐factor model showed good fit, with significant intercorrelations noted between all factors. The highest correlations were noted between the insulin resistance factor and the obesity factor (r = 0.887) and the insulin resistance factor and the lipid factor (r = 0.835). All factors exhibited good values for construct reliability and variance extracted except for the insulin resistance factor, which was measured with the variables of fasting insulin and fasting glucose levels.

Conclusions:  A four‐factor model of metabolic syndrome including the coronary heart disease risk factors of hypertension, obesity, insulin resistance and hyperlipidaemia was developed using this sample of European, middle‐aged Caucasian males. Insulin resistance was not well defined using the variables of fasting insulin and fasting glucose levels. Other possible variables to include in the measurement of this factor are discussed.
SEM studies on the early larval development of Triops cancriformis (Bosc)(Crustacea: Branchiopoda, Notostraca)
Authors: Møller Ole S. , Olesen Jørgen , Høeg Jens T.
Published: November 2003

We investigated early larval development in the notostracan Triops cancriformis (Bosc, 1801–1802) raised from dried cysts under laboratory conditions. We document the five earliest stages using scanning electron microscopy. The stage I larva is a typical nauplius, lecithotropic and without trunk limbs. The stage II larva is feeding and has trunk limb precursors and a larger carapace. Stage III larvae have larger trunk limbs and a more adult shape. Stage IV larvae have well developed trunk limbs, and stage V larvae show atrophy of the antennae. We describe the ontogeny of selected features such as trunk limbs and carapace, discuss ontogeny and homologization of head appendages, follow the development of the feeding mechanism, and discuss trunk limb ontogeny.
The subepithelial gland in ants: a novel exocrine gland closely associated with the cuticle surface
Authors: Gobin Bruno , Ito Fuminori , Billen Johan
Published: November 2003

Two glandular systems were discovered that secrete their products onto the cuticular surface in ants. The first, the subepithelial gland, was previously undescribed in ants, and is found throughout the body just beneath the epithelium. This gland consists of independent secretory units, each made up of a single gland cell and an associated duct cell that penetrates the cuticle. Its ultrastructural appearance is consistent with possible hydrocarbon production. Examining 84 ant species, the subepithelial gland was found in eight subfamilies (out of 13), although not necessarily in all species. In a single ant species, Harpegnathos saltator, it was the epithelium itself that was enlarged and functioned as a gland. The enlarged epithelial cells secrete their products directly onto the cuticle through distinct cuticular crevasses.
The effects of kin and familiarity on interactions between fish
Authors: Ward Ashley J W , Hart Paul J B
Published: November 2003

Fish have been shown to discriminate between individuals on very general bases such as species, body length and colour. More recently, evidence has been accumulating from a number of species that relatedness and familiarity may be extremely important in mediating a range of interactions between individual fish. Studies have shown that fish are able to recognize kin and/or familiars, and that this ability potentially conveys significant benefits, including increased inclusive fitness, reduced inbreeding costs, reduced competition and enhanced antipredator behaviour. Here, we review the literature and consider future directions and applications for this research.
Co‐evolution in Strategic Renewal Behaviour of British, Dutch and French Financial Incumbents: Interaction of Environmental Selection, Institutional Effects and Managerial Intentionality*
Authors: Flier Bert , Bosch Frans A. J. Van Den , Volberda Henk W.
Published: November 2003

abstractHow do incumbent firms and environments co‐evolve and how are firm‐level adaptation and selection at industry level interrelated? Can and do large established organizations renew themselves to adapt to their environment? Three single‐lens theories, relating to environmental selection, institutional theory, managerial intentionality, and a co‐evolutionary perspective are used to investigate strategic renewal of incumbent firms. We derive propositions and distinguish between three dimensions of strategic renewal and develop metrics to investigate our propositions in a multi‐level, multi‐country, longitudinal study of the European financial services industry.

Our results provide the following insights. From an environmental selection perspective, we found incumbents have a preference for exploitation renewal actions. Country institutional environments appear to explain to what extent incumbents prefer internal and/or external renewal actions. Managerial intentionality seems to explain outlier behaviour and firm‐specific frequency and timing of renewal actions. From a co‐evolutionary perspective, interaction effects explain deviations from predictions derived from the single‐lens theories applied in this paper.
THE NEW NEO‐KANTIAN AND REDUCTIONIST DEBATE
Authors: Behrendt Kathy
Published: November 2003

Abstract:  Has Derek Parfit modified his views on personal identity in light of Quassim Cassam's neo‐Kantian argument that to experience the world as objective, we must think of ourselves as enduring subjects of experience? Both parties suggest there is no longer a serious dispute between them. I retrace the path that led to this truce, and contend that the debate remains open. Parfit's recent work reveals a re‐formulation of his ostensibly abandoned claim that there could be impersonal descriptions of reality. I show why Parfit still needs this claim, and how it conflicts with the neo‐Kantian view.