bluuebunny/crossref_metadata_2025 huggingface dataset:
Learning from litigation. The role of claims analysis in patient safety
Authors: Vincent Charles , Davy Caroline , Esmail Aneez , Neale Graham , Elstein Max , Cozens Jenny Firth , Walshe Kieran
Published: March 2006

Claims for malpractice and medical negligence are a potentially important source of information on the causes of harm to patients and have provided valuable lessons in the past. However today, with many additional sources of information and methods of analysis, the role of claims analysis needs to be reappraised. We consider the role of claims analysis in relation to other methods of studying adverse outcomes, review previous studies of claims and summarize the findings of four recent British specialty claims reviews. Claims analysis has a number of inherent limitations. We suggest that there is now no case for ad hoc claims reviews which rely on data that have been assembled for legal purposes only. Claims review is still potentially useful for rare events or in cases where other sources of data are not available. However, future claims reviews need to meet basic criteria before being undertaken; these include prospective identification of the relevant questions and variables, adequacy and completeness of the data set, availability of expert reviewers and clear protocols for review.
Patients’ conceptions of quality care and barrier care
Authors: Lymer Ulla‐Britt , Richt Bengt
Published: March 2006

Aim  To describe patients’ conceptions of quality care and barrier care.

Methods  As this study concerned conceptions of care, a phenomenographic approach was chosen. Fourteen adult orthopaedic patients participated. Data‐collection was performed by means of semi‐structured interviews. The qualitative data were analysed with two foci, conceptions of quality care and conceptions of barrier care. Different categories of understanding, that is, conceptions, constitute the the essential outcome of phenomenographic analysis. The research was conducted in one county hospital and in one regional hospital situated in different cities in the south of Sweden.

Results and Conclusions  Patients’ conceptions of quality care resulted in six categories. When comparing the findings with previous research in this field, the findings of the present study confirmed to a large extent the findings from other studies of quality care. Patients’ conceptions of barrier care resulted in five categoris. The conceptions of barrier care must be considered as elements in patients’ conceptions of quality care, and this must be called atention to in efforts to measure patient satisfaction and in analyses of good care. It also can influence health care workers’ compliance to guidelines in infection control procedures.
Antihistone antibodies in linear scleroderma variants
Authors: El‐Azhary Rokea A. , Aponte Carole C. , Nelson Audrey M. , Weaver Amy L. , Homburger Henry A.
Published: March 2006

Background  Linear scleroderma occurs as two clinically distinct variants: the frontoparietal en coup de sabre type, and the torso‐extremity type. Antihistone antibodies (AHAs), which traditionally are markers for drug‐induced lupus, may also be linked to linear scleroderma.

Methods  Retrospective review of all patients presenting with linear scleroderma who had AHA titers measured.

Results  A total of 35 patients were identified. Twenty patients with linear scleroderma of the torso and/or extremities comprised 14 pediatric patients (≤ 18 years old; positive AHA, 10/14 = 71%; positive ANA, 3/13 = 23%) and six adults (four positive AHA; five positive ANA). Among the 15 patients with frontoparietal linear scleroderma, en coup de sabre type, 11 were pediatric patients (positive AHA, 5/11 = 45%; positive ANA, 4/11 = 36%) and four were adults (1 positive AHA/ANA).

Conclusion  The two clinical variants of linear scleroderma are not only clinically distinct, but also may be serologically different. The AHA titers may be related to the extent of involvement as well as disease activity in linear scleroderma.
Serum and erythrocyte adenosine deaminase activities in patients with Behçet's disease
Authors: Canpolat Filiz , Ünver Mehmet , Eskioğlu Fatma , Kösebalaban Şebnem , Durmazlar Selda Pelin Kartal
Published: March 2006

Objectives  Adenosine deaminase (ADA) is a non‐specific marker of the activation of the T cell, which has an important role in the etiology of Behçet's disease (BD). The purpose of this study was to investigate the determination of ADA activity as an index of T‐lymphocyte function in BD, which is known to have an T‐cell‐mediated immune response.

Materials and Methods  Adenosine deaminase activities in both serum and erythrocytes were measured in 23 untreated patients with BD and in 20 healthy controls. The patients with BD were divided into two groups: active (n = 10) and inactive (n = 13).

Results  When compared with the control group, serum ADA activity was high (P < 0.01) and erythrocyte ADA activity was significantly low (P < 0.01) in BD. Serum ADA activity of active BD was higher than that of inactive BD (P < 0.01), but erythrocyte ADA activity was found to be lower in active BD than inactive BD (P < 0.01).

Comment  These findings may provide an additional benefit for the diagnosis of BD and sub‐typing of active and inactive BD.
Long‐term follow‐up after recurrence of primary biliary cirrhosis after liver transplantation in 100 patients
Authors: Jacob Dietmar A. , Neumann Ulf P. , Bahra Marcus , Klupp Jochen , Puhl Gero , Neuhaus Ruth , Langrehr Jan M.
Published: March 2006

Abstract: Orthotopic liver transplantation (OLT) is the only effective curative therapy for end‐stage primary biliary cirrhosis (PBC). Survival after OLT is excellent, although recent data have shown a recurrence rate of PBC of up to 32% after transplantation. The aim of this study is to investigate the course after disease recurrence, particularly with regard to liver function and survival in a long‐term follow‐up. Between April 1989 and April 2003, 1553 liver transplantations were performed in 1415 patients at the Charité, Virchow Clinic. Protocol liver biopsies were taken after one, three, five, seven, 10 and 13 yr. One hundred (7%) patients suffered from histologically proven PBC. Primary immunosuppression consisted of cyclosporine (n=54) or tacrolimus (Tac) (n=46). Immediately after OLT, all patients received ursodeoxycholic acid. Corticosteroids were withdrawn three to six months after OLT. The median age of the 85 women and 15 men was 55 yr (range 25–66 yr). The median follow‐up after liver transplantation was 118 months (range 16–187 months) and after recurrence 30 months (range 4–79 months). Actuarial patient survival after five, 10 and 15 yr was 87, 84 and 82% respectively. Ten patients (10%) died after a median survival time of 32 months. Two of these patients developed organ dysfunction owing to recurrence of PBC. Histological recurrence was found in 14 patients (14%) after a median time of 61 months (range 36–122 months). Patients with Tac immunosuppression developed PBC recurrence more often (p<0.05) and also earlier (p<0.05). Fifty‐seven patients developed an acute rejection and two patients a chronic rejection episode. Liver function did not alter within the first five yr after histologically proven PBC recurrence. Multivariate analysis of the investigated patients showed that the recipient's age and Tac immunosuppression were significant risk factors for PBC recurrence. Long‐term follow‐up of up to 15 yr after liver transplantation, owing to PBC, in addition to maintenance of liver function, shows excellent organ and patient survival rates. Although protocol liver biopsies revealed histological recurrence in 14 (14%) patients, only two patients developed graft dysfunction. Tac‐treated patients showed more frequently and also earlier histologically proven PBC recurrence; however, in our population we could not observe an impact on graft dysfunction and patient's survival.
Pancreas transplantation: advantages of both enteric and bladder drainage combined in a two‐step approach
Authors: Van De Linde Pieter , Van Der Boog Paul J.M. , Baranski Andrzej G. , De Fijter Johan W. , Ringers Jan , Schaapherder Alexander F.M.
Published: March 2006

Abstract: Background:Although there is a tendency to perform enteric drainage of pancreas transplants in simultaneous pancreas–kidney (SPK) transplantation, bladder drainage is still preferable in pancreas transplantation alone (PTA) or after a previous kidney transplantation (PAK). Our hypothesis was that enteric conversion of a bladder drained pancreas is an effective and safe procedure. We studied the complication rate and physiological effects of enteric conversion in patients with primary bladder‐drained SPK transplantation.

Patients:We performed 51 enteric conversions in bladder‐drained SPK transplant recipients. As we observed a low complication rate, with time enteric conversions were also performed for less strict and severe indications.

Results:The main indications for conversion were urological problems, metabolic complications and reflux‐pancreatitis. The median transplantation–conversion interval was 12 months (range 2–40 months). Post‐operative complications consisted of seven urinary tract infections, two low‐grade superficial wound infections, one minor bleeding, one phlebitis and one paralytic ileus. In two patients, a relaparotomy was necessary. No graft rejection following enteric conversion was found. Long‐term renal and pancreatic function were not affected by the enteric conversion. Three‐year patient, kidney and pancreas survival rates after enteric conversion were 93, 97 and 93%, respectively (censored data).

Conclusion:Enteric conversion after pancreas transplantation is an effective and safe procedure. Therefore, we suggest a policy of a two‐step approach of primary bladder drainage followed by an enteric conversion of the pancreas in a selected group of SPK patients.
Impact of stress, distress and feelings of indebtedness on adherence to immunosuppressants following kidney transplantation
Authors: Achille Marie A. , Ouellette Amélie , Fournier Stéphanie , Vachon Mélanie , Hébert Marie‐Josée
Published: March 2006

Abstract:  In order to ensure transplantation's long‐term success, transplant recipients need to comply with a strict regimen of immunosuppressant medication on a daily basis for the rest of their lives. Nonadherence is one of the major causes of organ rejection. Because compliance is voluntary, it is likely to be influenced by an individual's beliefs and feelings. This study examined the impact on compliance of the following factors: (1) transplant‐related stress; (2) general perceived stress; (3) psychosocial distress and (4) feelings of indebtedness and guilt towards the donor. Fifty kidney recipients (34 men, 16 women) filled out self‐report questionnaires. The results indicate that 46% acknowledged sub‐optimal compliance in the last month; patients more often reported not taking the medication exactly as prescribed than forgetting to take it. The results also suggest that psychological distress and general perceived stress affect compliance negatively, whereas feelings of indebtedness improve it. These results have implications for the understanding and management of compliance following organ transplantation.
Isolated heart and liver transplant recipients are at low risk for polyomavirus BKV nephropathy
Authors: Puliyanda Dechu P. , Amet Nurmamet , Dhawan Archana , Hilo Lara , Radha Raju K. , Bunnapradist Suphamai , Czer Lawrence , Martin Paul , Jordan Stanley , Toyoda Mieko
Published: March 2006

Abstract:  Background:  BKV infection and nephropathy is a significant cause of allograft dysfunction in kidney transplantation. BKV viremia, rather than viruria, corresponds to BKV nephropathy. The prevalence of BKV viremia in non‐renal solid organ transplants has not been systematically evaluated.

Methods:  We determined prevalence of BKV viremia in kidney, combined kidney–heart, kidney–liver, kidney–pancreas, kidney–heart–liver, and heart and liver transplant recipients using BKV‐PCR.

Results:  Seven out of 173 (4%) kidney transplant recipients had BKV viremia, with BKV>2 × 105 copies/mL in 6/7 and 1.9 × 103 in the remaining one patient. BKV viremia was not found in 24 heart transplant recipients, whereas 1/37 (2.7%) liver transplants showed low copy numbers (≤103). BKV‐PCR≤103 copies/mL were also found in one of each combined kidney–heart and kidney–liver transplant recipients. BKV nephropathy was proven by biopsy in 4/6 patients with high BKV viral loads. All six patients showed renal dysfunction, requiring reduction in immunosuppression and antiviral therapy. All four patients with low BKV viral loads (1.9 × 103 or ≤103) showed stable renal function after reduction of immunosuppression or no treatment, respectively.

Conclusion:  Higher BKV levels in plasma are associated with renal dysfunction. Kidney transplant recipients are at high risk compared with recipients of isolated heart or liver allografts, for development of BKV nephropathy.
The Absence of Phosphorylated Tyrosine Hydroxylase Expression in the Purkinje Cells of the Ataxic Mutant Pogo Mouse
Authors: Lee N. S. , Kim C. T. , Han S. Y. , Kawk J. H. , Sawada K. , Fukui Y. , Jeong Y. G.
Published: March 2006

The pogo mouse is a new ataxic autosomal recessive mutant that arose in Korean wild mice (KJR/Mskist). Its ataxic phenotype includes difficulty in maintaining a normal posture and the inability to walk in a straight line. Several studies have reported that tyrosine hydroxylase (TH) is persistently ectopically expressed in particular subsets of Purkinje cells in a parasagittal banding pattern in several ataxic mutant mice, e.g. tottering alleles and pogo mice. In this present study, we examined the expression of an enzymatically active form of TH and phosphorylated TH at Ser40 (phospho‐TH) by using immunohistochemistry and double immunofluorescence in the cerebellum of pogo mice. TH immunostaining appeared in some Purkinje cells in pogo, but in only a few of Purkinje cells of their heterozygous littermate controls. In all groups of mice, no phospho‐TH immunoreactive Purkinje cells were observed in the cerebellum, although subsets of TH immunoreactive Purkinje cells were found in adjacent sections. This study suggests that TH expression in the Purkinje cells of pogo abnormally increases without activation of this enzyme by phosphorylation. This may mean that TH in the Purkinje cells of these mutants does not catalyse the conversion of tyrosine to l‐DOPA, and is not related to catecholamine synthesis.
A Morphological and Immunohistochemical Study of Healthy and Atretic Follicles in the Ovary of the Sexually Immature Ostrich (Struthio camelus)
Authors: Madekurozwa M.‐C. , Kimaro W. H.
Published: March 2006

The morphology of healthy and atretic follicles in the ovary of the sexually immature ostrich was described in the present study. In addition, the distribution of the intermediate filaments desmin, vimentin and smooth muscle actin, in these ovarian follicles, was demonstrated. Healthy and atretic primordial, pre‐vitellogenic and vitellogenic follicles were present in the ovaries of the sexually immature ostrich. Atresia occurred during all stages of follicular development. Atretic primordial and pre‐vitellogenic follicles were characterized by the presence of a shrunken oocyte surrounded by a multilayered granulosa cell layer. Two forms of atresia (types 1 and 2) were identified in vitellogenic follicles. In the advanced stages of type 1 atresia the follicle was dominated by a hyalinized mass. In contrast, in type 2 atresia the granulosa and theca interna cells differentiated into interstitial gland cells. Positive immunostaining for desmin was observed in the granulosa cells of only healthy primordial and pre‐vitellogenic follicles. Atretic primordial and pre‐vitellogenic follicles were immunonegative for desmin. Vimentin immunoreactivity was demonstrated in the granulosa cells of all follicles except the vitellogenic atretic follicles. The results of the present study indicate that ovarian follicles in the sexually immature ostrich undergo a cycle of growth and regression, which is similar to that reported in other avian species. Furthermore, based on the results of the immunohistochemical study, it would appear that the distribution and immunostaining of intermediate filaments changes during follicular development and atresia.
Transient Ischaemia Affects Plasma Membrane Glutamate Transporter, not Vesicular Glutamate Transporter, Expressions in the Gerbil Hippocampus
Authors: Kim D.‐S. , Kwak S.‐E. , Kim J.‐E. , Jung J.‐Y. , Won M. H. , Choi S.‐Y. , Kwon O.‐S. , Kang T.‐C.
Published: March 2006

In the present study, we investigated expressions of vesicular glutamate transporter (VGLUT) and of the plasma membrane glutamate transporters [glutamate transporter 1 (GLT‐1), glutamate/aspartate transporter (GLAST) and excitatory amino acid carrier 1 (EAAC‐1)] in the gerbil hippocampus following transient ischaemia. The expressional levels and distribution patterns of VGLUT immunoreactivities were unaltered until 3 days after ischaemic‐insults. However, VGLUT‐2 immunoreactivity in the CA1 region was reduced at 4 days after ischaemia due to delayed neuronal death. In addition, both GLT‐1 and GLAST immunoreactivities in the CA1 region were enhanced at 30 min – 12 h after ischaemia‐reperfusion and their expression began to reduce at 24 h after ischaemia‐reperfusion. In contrast, EAAC‐1 immunoreactivity was transiently reduced in the CA1 region at 30 min after ischaemia, re‐enhanced at 3–12 h after ischaemia, and re‐reduced at 24 h after ischaemia. These findings suggest that malfunctions of plasma membrane glutamate transporters, not of VGLUT, may play an important role in the elevation of extracellular glutamate concentration following ischaemic insults.
Olaquindox and cyadox stimulate growth and decrease intestinal mucosal immunity of piglets orally inoculated with Escherichia coli
Authors: Ding M.X. , Yuan Z.H. , Wang Y.L. , Zhu H.L. , Fan S.X.
Published: March 2006

One hundred and fifty piglets were randomly allotted to one of six treatments to determine the effects of olaquindox and cyadox on growth and intestinal immune response including the number of intraepithelial lymphocytes and immunoglobulin A secreting cells (ASCs) during the three‐week period. A 2 × 3 factorial arrangement of treatments was employed with the following factors: (1) Escherichia coli (O139:K88, 1010 CFU) inoculation or control and (2) no antimicrobials, 100 mg/kg olaquindox and 100 mg/kg cyadox in the basal diet respectively. The antimicrobial supplementations improved (p < 0.01) average daily gain and feed conversion ratio (FCR) during the experiment. Average daily gain and FCR in the cyadox‐supplemented pigs were higher (p < 0.05) than those in the olaquindox‐supplemented pigs. Intraepithelial lymphocytes and ASCs decreased (p < 0.05) when the diets were supplemented. Jejunal ASCs in the cyadox‐supplemented pigs were lower (p < 0.05) than those in the olaquindox‐supplemented pigs. Olaquindox and cyadox suppressed E. coli‐induced intestinal immune activation, which may be involved in the observed growth promotion.
Digestion coefficients achieved by the black rhinoceros (Diceros bicornis), a large browsing hindgut fermenter
Authors: Clauss M. , Castell J. C. , Kienzle E. , Dierenfeld E. S. , Flach E. J. , Behlert O. , Ortmann S. , Streich W. J. , Hummel J. , Hatt J.‐M.
Published: March 2006

In contrast to the grazing white (C. simum) and Indian (R. unicornis) rhinoceros, the black rhinoceros (D. bicornis) is an exclusive browser. Due to the particular fermentation characteristics of browse, one would expect browsers to display both shorter ingesta retention times and lower digestion coefficients on comparable diets than grazers. In order to generate a database to test this hypothesis, we performed digestibility studies in eight black rhinoceroses (D. bicornis) from three zoological institutions, using total faecal collection for the quantification of faecal output. One to three regularly fed zoo rations of roughage, concentrates and varying proportions of browse material were used per animal. Additional data was taken from three hitherto unpublished studies as well as several published sources. When compared with horses on similar rations, black rhinoceroses achieved lower digestion coefficients for organic matter and CF. In general, an increase in dietary CF content led to a steeper decrease in organic matter and GE digestibility in black rhinoceroses than in horses. When comparing available data for rhinoceroses, browsing species showed a steeper decrease in organic matter digestibility than grazing species with increasing dietary cell wall content. Endogenous losses as determined by linear regression analysis were within the range reported for horses and Indian rhinoceroses. The results suggest that the horse is not a useful model animal for evaluating diets for black rhinoceroses energetically. In general, diets fed to captive black rhinoceroses seem to include higher proportions of concentrates than diets for other rhinoceros species, and an increase in browse or roughage would reduce digestion coefficients to levels observed in animals fed natural forage.
Actual number of tumor budding as a new tool for the individualization of treatment of T1 colorectal carcinomas
Authors: Masaki Tadahiko , Matsuoka Hiroyoshi , Sugiyama Masanori , Abe Nobutsugu , Sakamoto Atsuhiko , Atomi Yutaka
Published: March 2006

Background and Aim:  Treatment of T1 colorectal carcinomas, either local excision including endoscopic polypectomy or radical surgery, has always been problematic in everyday practice. Although previous studies have revealed that tumor budding at the invasive margin can be a marker for the malignant potential of T1 colorectal carcinomas, the evaluation of tumor budding has not been standardized as yet. In the present study, we attempted to apply the actual number of tumor budding units for the individualization of treatment in T1 colorectal carcinomas.

Methods:  In 76 T1 colorectal carcinomas, associations between lymph node metastasis and clinicopathological parameters were examined statistically. A mathematical formula for predicting the risk of lymph node metastasis was constructed and decision analysis was attempted to determine individually the indication for additional surgery after endoscopic mucosal resection of T1 colorectal carcinomas.

Results:  Of the clinicopathological parameters examined, multivariate analysis showed that the actual number of tumor budding units alone was significantly associated with lymph node metastasis. The probability of lymph node metastasis was calculated as Z = 0.07 × (budding counts) − 3.726, probability = 1/1 + e–Z. The more the budding counts, the higher the probability of lymph node metastasis. This formula was able to accurately predict lymph node metastasis in successive cases. The actual number of tumor budding units can be applied to decision analysis in determining an indication for additional surgery after endoscopic mucosal resection of T1 colorectal carcinomas.

Conclusions:  The actual number of tumor budding units may be useful in the decision making for patient‐oriented treatment of T1 colorectal carcinomas.
Factors determining post‐colonoscopy abdominal pain: Prospective study of screening colonoscopy in 1000 subjects
Authors: Lee Yi‐Chia , Wang Hsiu‐Po , Chiu Han‐Mo , Lin Chih‐Peng , Huang Shih‐Pei , Lai Yo‐Ping , Wu Ming‐Shiang , Chen Ming‐Fong , Lin Jaw‐Town
Published: March 2006

Background:  Factors determining post‐colonoscopy abdominal pain remain poorly understood. Accordingly, a prospective study was conducted to reveal the key determinants.

Methods:  One thousand consecutive and asymptomatic patients (569 men, 431 women; mean age 51 years, range 19–84 years) undergoing total colonoscopy were evaluated to assess their abdominal pain. Their demographic data, psychological profiles (determined on the Brief Symptom Rating Scale and Maudsley Personality Inventory), and endoscopic findings were treated as independent variables in polytomous logistic regression in which pain severities were treated as outcome variables. Factors affecting the duration of pain were evaluated on multivariate linear regression.

Results:  Colonoscopy duration (s; odds ratio [OR]: 1.001, 95% confidence interval [CI]: 1–1.002, P < 0.01) and female sex (OR: 1.368, 95%CI: 1.02–1.853, P = 0.03) were significantly associated with abdominal pain, but age, body mass index, psychological traits, conscious sedation, use of i.v. hyoscine butylbromide, and colonic preparation were not. Duration of the colonoscopy was longer in female than male subjects (P = 0.04). On stepwise linear regression, irritable bowel syndrome (regression coefficient: 27.47, 95%CI: 6.99–47.67, P < 0.01) and conscious sedation (regression coefficient: −22.17, 95%CI: −42.52 to −1.42, P = 0.036) were the best predictors of prolonged pain in 485 patients who had pain.

Conclusions:  Female sex and duration of colonoscopy increased the likelihood of post‐procedural abdominal pain. Conscious sedation temporarily suppressed the pain but had no effect on its occurrence. Irritable bowel syndrome may have prolonged the discomfort.
The Vienna classification applied to colorectal adenomas
Authors: Rubio Carlos A , Nesi Gabriella , Messerini Lucca , Zampi Gian Carlo , Mandai Koichi , Itabashi Masayuki , Takubo Kaiyo
Published: March 2006

Background and Aim:  In 1999, a group of Western and Asian pathologists gathered in Vienna reached consensus regarding the classification of gastrointestinal epithelial neoplasia. In this study, that classification is applied to colorectal adenomas.

Methods:  Colorectal adenomas from 1552 patients were histologically classified according to the categories listed in Vienna: category 3, low‐grade dysplasia; 4.1, high‐grade dysplasia; 4.2, carcinoma in situ; 4.3, suspicious of intramucosal carcinoma; 5.1, intramucosal carcinoma; and 5.2, submucosal carcinoma. The criteria used to diagnose these lesions are described in detail. Adenomas with dysplasia (categories 3 and 4.1) or with carcinoma (categories 4.2, 4.3, 5.1 and 5.2) were analyzed separately. On basis of their configuration, adenomas were classified into tubular, tubulovillous, villous, serrated, microtubular and combined phenotypes (i.e. other than tubulovillous).

Results:  The highest percentage of adenomas with carcinoma was found amongst villous adenomas (29.6%), followed by combined adenomas (27.8%). Villous adenoma with carcinoma was the most frequent neoplasia at all ages; combined adenomas with carcinoma were more frequent among younger patients. In elderly patients (≥60 years of age) the highest percentage of adenomas with carcinoma was recorded in villous adenomas (28.1%), followed by serrated adenomas (19.2%). Villous adenomas and combined adenomas with carcinoma were more frequent in males.

Conclusion:  The Vienna classification of colorectal adenomas seems to be influenced by parameters inherent to the patient such as age and sex and by the histological phenotype of the adenoma. With the recent improvement in medical technology it is possible to laser‐microdisect a defined group of neoplastic glands (such as with carcinoma in situ or with intramucosal carcinoma) for specific molecular analysis. This modern technology will permit in future the translation of histological structures into molecular terms.
Endoscopic therapy for bleeding esophageal varices improves the outcome of Child C cirrhotic patients
Authors: Hori Shinichiro , Takaki Akinobu , Okada Hiroyuki , Fujiwara Akiko , Takenaka Ryuta , Makidono Chiho , Shiratori Yasushi
Published: March 2006

Background and Aim:  Bleeding from esophageal varices is one of the frequent severe complications arising in patients with liver cirrhosis. The management of esophageal varices is therefore important for patient survival. The purpose of this study was to clarify the predictive factors for mortality in patients with Child C cirrhosis presenting with variceal bleeding.

Methods:  A retrospective analysis of 77 Child C cirrhotic patients with bleeding from esophageal varices was conducted. All patients received endoscopic therapy. Twenty‐nine patients received endoscopic variceal ligation, and 48 patients received endoscopic injection sclerotherapy or endoscopic injection sclerotherapy with ligation. Univariate and multivariate analyses of clinical data were performed to identify the prognostic factors for survival for these 77 patients.

Results:  Fifty‐seven of 77 patients received endoscopic therapy within 24 h after variceal bleeding, and bleeding was controlled in 55 (96.5%). The remaining 20 patients received endoscopic therapy more than 24 h after bleeding. Higher bilirubin level and rebleeding were the predictive parameters for 6‐week survival in the 77 patients, according to univariate and multivariate analysis. Higher bilirubin level, refractory ascites, and the presence of hepatocellular carcinoma were the predictive parameters for mortality in 77 patients as determined by multivariate analysis.

Conclusions:  Endoscopic therapy was effective in controlling acute variceal bleeding of Child C cirrhotic patients. The prognosis of Child C stage patients presenting with variceal bleeding depended on the severity of liver damage and the presence of hepatocellular carcinoma.
Genetic variability and population structure of dorada (Brycon moorei sinuensisDahl) in the Sinú River, Córdoba, Colombia
Authors: López Liliana
Published: March 2006

Six microsatellite loci, isolated forPiaractus mesopotamicus(Characidae, Serrasalminae) were used to evaluate the genetic variability of the dorada (Brycon moorei sinuensis, Characidae, Bryconinae) population in the Sinú River, Córdoba, Colombia, and to facilitate management recommendations for this species. The six loci were polymorphic, with an average of 9.25 alleles for dimeric loci (Pme2, Pme4, Pme5 and Pme20), and five alleles for trimeric loci. Tests for linkage disequilibrium were used to determine that the six loci had an independent distribution. The observed heterozygosities were lower than the expected ones for all loci, and the population was not in Hardy–Weinberg equilibrium because of heterozygote deficiency.F‐statistics indicated inbreeding and a low population substructure. The homogeneity of the population was confirmed by high values of genetic flux and an agglomerated representation of the individuals, based on factor correspondence analysis. Recent bottlenecks were detected for three sample sites under the assumption of an infinite allele mutation model. Proposals for the management of the dorada population are made and validated with a genetic simulation.
Eutrophication of lakes in urbanized areas: The case of Yaounde Municipal Lake in Cameroon, Central Africa
Authors: Kemka Norbert , Njiné Thomas , Togouet Serge Hubert Zébazé , Menbohan Samuel Foto , Nola Moïse , Monkiedje Adolphe , Niyitegeka Domitille , Compère Pierre
Published: March 2006

A 1 year qualitative and quantitative evaluation of phytoplankton and chlorophyll‐a, as well as some physicochemical parameters, was recorded in a shallow tropical lake in Cameroon: the Yaounde Municipal Lake. Physicochemical measurements also were regularly made in its main tributary (Mingoa Stream). These analyses aimed to assess the lake's trophic status and to propose measures for controlling its degradation process. The Secchi disk transparency was low and rarely exceeded 100 cm. Conductivity was higher near the lake bottom. The oxygen deficiency, and sometimes anoxia, recorded from a 2.5 m depth leads to high quantities of ammonium‐nitrogen. The total phosphorus concentrations varied from 80–2290 µg P L−1 and the total Kjeldhal nitrogen concentrations fluctuated between 3 and 15 mg  L−1. Upstream to the lake, in the Mingoa Stream, total phosphorus concentrations ranged from 0.6–3.8 mg P L−1 and total Kjeldhal nitrogen concentrations ranged from 10–22 mg  L−1. There are up to 102 phytoplankton‐specific taxa, with Euglenophyta and Chlorophyta particularly more diversified. The phytoplankton biomass and chlorophyll‐a concentrations reached 225 µg mL−1 and 566 mg m−3, respectively. The analyses pointed out the allogenic nature of the functioning of this ecosystem as a result of bad waste management in the surrounding landscape. Urgent actions need to be undertaken in order to rehabilitate this lake, which rapidly shifted to a hypertrophic status.
Importance of life history studies for conservation of fragmented populations: A case study of the understory herb,Trillium camschatcense
Authors: OHARA MASASHI , TOMIMATSU HIROSHI , TAKADA TAKENORI , KAWANO SHOICHI
Published: March 2006

Trillium camschatcenseis a common perennial woodland spring herb in Hokkaido, Japan. Anthropogenic land conversion (e.g. road construction and agricultural development) has resulted in a highly fragmented landscape with a large number of forest remnants andT. camschatcenseis now often found in the understory of small remnant forests surrounded by pastureland or agricultural fields in the Hidaka region, Hokkaido. Accordingly,T. camschatcensein this region must have experienced dramatic changes in population size and spatial distribution, which may have significantly reduced seed production and genetic diversity. First, we summarize a series of life history studies onT. camschatcense. Second, we introduce approaches to understand the effects of forest fragmentation on the understory herb,T. camschatcense. Finally, we conclude that integration of data on demographic, reproductive biology and genetic approaches is essential for plant conservation, and we emphasize that it is important to have basic life history data, such as long‐tem demographic data and variation in breeding system, on ‘common species’ before those species become ‘new rares’.
Role of sexual reproduction in the spread of an invasive clonal plant Solidago canadensis revealed using intersimple sequence repeat markers
Authors: DONG MEI , LU BAO‐RONG , ZHANG HONG‐BO , CHEN JIA‐KUAN , LI BO
Published: March 2006

Invasive species, second only to habitat loss as a cause of biodiversity loss, pose serious threats to native biodiversity and ecosystems. Little is known about the mechanisms that some exotic plants use to become invasive in their non‐native ranges. Solidago canadensis, native to North America, was intentionally introduced to many countries where it has become an invasive plant. To understand the roles that reproductive mode plays in successful invasion of exotic plants, and the relative importance of sexual reproduction and clonal growth, the genetic diversity and clonal structure of two S. canadensis populations from Shanghai, China were investigated using intersimple sequence repeats. Samples were collected in a grid pattern with intervals of 2 m among adjacent individuals within the studied area (approximately 30 m × 30 m) for each population. Results showed that the percentages of polymorphic loci for the two populations were 97.9% and 96.5% and clonal diversity measured using the Simpson Diversity Index was 1.00 for both populations. No identical genotypes were found among the analyzed samples. It is suggested from this study that sexual reproduction facilitates the establishment of new S. canadensis populations, whereas clonal expansion maintains and enlarges the established populations. Thus, limiting sexual reproduction of S. canadensis may effectively control the invasion of this species.
Life‐history monographs of Japanese plants. 5: Trillium tschonoskii Maxim. (Trilliaceae)
Authors: OHARA MASASHI , KAWANO SHOICHI
Published: March 2006

Life‐history characteristics and demography of Trillium tschonoskii (Trilliaceae) were studied and are described here. Trillium tschonoskii is the most wide‐ranging species among Asiatic Trillium, ranging from southern Sakhalin, the Japanese Islands (excepting Kyushu) to the Korean Peninsula, Taiwan and further to inland China and the Himalayas. The ecological range of T. tschonoskii is broad, extending from lowland forests to montane and further to subalpine mixed forests consisting of conifers and subalpine birch, Betula ermani. This species is a typical polycarpic perennial, similar to all other Japanese Trillium species, and flowers in early to late April in lowland populations and in mid‐June to early July in subalpine habitats. Trillium tschonoskii typically has three white petals and three sepals, and its pollinators are diverse, for example, flies, beetles and bees such as Scatophagiae (Diptera), Oedemera lucidicollis (Coleoptera) and Andrena sp. (Hymenoptera). Pollen/ovule ratios of T. tschonoskii are approximately 700, thus T. tschonoskii is potentially an inbreeder. Seed outputs per plant are variable, 29–190 (mean 85.0) in 1980, and 28–168 (mean 79.8) in 1984. Seeds with a large soft juicy elaiosome attract ants, which are effective dispersal agents, but nocturnal elaiosome predators, mainly ground beetles, are also very active. Our long‐term observations indicate that it takes approximately 10 years to reach a sexually mature stage and the life expectancy of mature plants is assumed to be exceedingly long, extending over 40 years.
Re‐examining the ontogeny of substantia nigra dopamine neurons
Authors: Gates Monte A. , Torres Eduardo M. , White Anna , Fricker‐Gates Rosemary A. , Dunnett Stephen B.
Published: March 2006

Recently, the need to detail the precise ontogeny of nigrostriatal dopamine neurons has grown significantly. It is now thought that the gestational day on which the majority of these neurons are born is important not only for maximizing the yield of primary cells for transplantation but also for extracting suitable dopamine neural precursors (as stem cells) for expansion in vitro. Historically, peak ontogeny of substantia nigra pars compacta (SNc) dopamine neurons in the rat has been considered to occur around embryonic day (E)14. However, such a concept is at odds with recent studies that reveal not only that substantial numbers of tyrosine hydroxylase‐immunopositive cells reside in the ventral mesencephalic region of rats at E14 but that many of these cells have matured extensive axonal projections to the ventral forebrain. Here, then, the ontogeny of SNc neurons in rats commonly used as a source of donor tissue for experimental cell transplantation in animal models of Parkinson's disease has been re‐examined. Using a combination of bromodeoxyuridine (BrdU) administration at E11, E12, E13 or E14 with immunocytochemical stainings for both BrdU and tyrosine hydroxylase after 4 weeks of postnatal development, this characterization reveals that the vast majority (perhaps 80%) of SNc dopamine neurons are probably born on E12 in Sprague‐Dawley rats. Such findings are important in refining the use of embryonic tissues for primary cell transplantation and may provide more precise timing for identifying the cellular and molecular events that drive neural stem cells toward a dopaminergic phenotype during development.
Gene expression changes in thalamus and inferior colliculus associated with inflammation, cellular stress, metabolism and structural damage in thiamine deficiency
Authors: Vemuganti Raghu , Kalluri Haviryaji , Yi Jae‐Hyuk , Bowen Kellie K. , Hazell Alan S.
Published: March 2006

Identification of gene expression changes that promote focal neuronal death and neurological dysfunction can further our understanding of the pathophysiology of these disease states and could lead to new pharmacological and molecular therapies. Impairment of oxidative metabolism is a pathogenetic mechanism underlying neuronal death in many chronic neurodegenerative diseases as well as in Wernicke's encephalopathy (WE), a disorder induced by thiamine deficiency (TD). To identify functional pathways that lead to neuronal damage in this disorder, we have examined gene expression changes in the vulnerable thalamus and inferior colliculus of TD rats using Affymetrix Rat Genome GeneChip analysis in combination with gene ontology and functional categorization assessment utilizing the NetAffx GO Mining Tool. Of the 15 927 transcripts analysed, 125 in thalamus and 141 in inferior colliculus were more abundantly expressed in TD rats compared with control animals. In both regions, the major functional categories of transcripts that were increased in abundance after TD were those associated with inflammation (∼33%), stress (∼20%), cell death and repair (∼26%), and metabolic perturbation (∼19%), together constituting ∼98% of all transcripts up‐regulated. These changes occurred against a background of neuronal cell loss and reactive astro‐ and microgliosis in both structures. Our results indicate that (i) TD produces changes in gene expression that are consistent with the observed dysfunction and pathology, and (ii) similar alterations in expression occur in thalamus and inferior colliculus, brain regions previously considered to differ in pathology. These findings provide important new insight into processes responsible for lesion development in TD, and possibly WE.
Transmitter release face Ca2+ channel clusters persist at isolated presynaptic terminals
Authors: Sun Li , Li Qi , Khanna Rajesh , Chan Allen W. , Wong Fiona , Stanley Elise F.
Published: March 2006

Ca2+ influx through N‐type Ca2+ channels (CaV2.2) is known to be critical for transmitter release at many synapses. These channels are known to be localized to transmitter release sites, but their anchoring mechanism remains unknown. Recent studies have demonstrated that presynaptic organization is subject to interactions with the postsynaptic cell or the intervening extracellular matrix. We used a previously described high‐affinity antibody against the N‐type Ca2+ channels, Ab571, to localize Ca2+ channel clusters at the release face of an isolated giant calyx‐type synapse to test whether the maintenance of these clusters requires an intact extracellular matrix or contact with the postsynaptic cell. Because the number of Ca2+ channel clusters was unchanged after extracellular matrix dispersal or nerve terminal isolation, we conclude that presynaptic transmitter release face Ca2+ clusters can be maintained independently of extracellular influences. Our results suggest that a presynaptic molecular scaffold is responsible for the maintenance of release site Ca2+ channel clusters.
Transient expression of A‐type K+ channel α subunits Kv4.2 and Kv4.3 in rat spinal neurons during development
Authors: Huang Hsin‐Yi , Liao Chien‐Wei , Chen Pei‐Hsuan , Tsaur Meei‐Ling
Published: March 2006

A‐type K+ currents (IAs) have been detected from the ventral horn neurons in rat spinal cord during embryonic day (E) 14 to postnatal day (P) 8 but not in adulthood. It is not known which types of neurons and which A‐type K+ channel α subunits express the IAs and what the possible function might be. Here, we examined the expression of two A‐type K+ channel α subunits, Kv4.2 and Kv4.3, in rat spinal cord at various developmental stages by immunohistochemistry. We found a transient expression of Kv4.2 in somatic motoneurons during E13.5–P8 with a peak around E17.5, which coincides temporally with the natural selection of motoneurons. Transient expression of Kv4.2 and Kv4.3 was also observed in the intermediate gray (IG) interneurons. During E19.5–P14, some IG interneurons express Kv4.2, some express Kv4.3 and a subset co‐express Kv4.2 and Kv4.3. Peak expression of Kv4.2 and Kv4.3 in the IG interneurons was detected around P1, which coincides temporally with the developmental selection of IG interneurons. In contrast to the IA‐expressing subunits Kv4.2 and Kv4.3, a delayed‐rectifier K+ channel α subunit Kv1.6 is persistently expressed in somatic motoneurons and IG interneurons. Together, these data support the hypothesis that expression of IAs may protect IA‐expressing somatic motoneurons, and possibly also IG interneurons, from naturally occurring cell death during developmental selection.
Intrauterine proximity to male fetuses affects the morphology of the sexually dimorphic nucleus of the preoptic area in the adult rat brain
Authors: Pei Minjuan , Matsuda Ken‐ichi , Sakamoto Hirotaka , Kawata Mitsuhiro
Published: March 2006

Previous studies on polytocous rodents have revealed that the fetal intrauterine position influences its later anatomy, physiology, reproductive performance and behavior. To investigate whether the position of a fetus in the uterus modifies the development of the brain, we examined whether the structure of the sexually dimorphic nucleus of the preoptic area (SDN‐POA) of rat brains accorded to their intrauterine positions. Brain sections of adult rats gestated between two male fetuses (2M) and between two female fetuses (2F) in the uterus were analysed for their immunoreactivity to calbindin‐D28k, which is a marker of the SDN‐POA. The SDN‐POA volume of the 2M adult males was greater than that of the 2F adult males, whereas the SDN‐POA volume of the 2M and 2F adult females showed no significant difference. This result indicated that contiguous male fetuses have a masculinizing effect on the SDN‐POA volume of the male. To further examine whether the increment of SDN‐POA volume in adulthood was due to exposure to elevated steroid hormones during fetal life, concentrations of testosterone and 17β‐estradiol in the brain were measured with 2M and 2F fetuses during gestation, respectively. On gestation day 21, the concentrations of testosterone and 17β‐estradiol in the brain were significantly higher in the 2M male rats as compared with the 2F male rats. The results suggested that there was a relationship between the fetal intrauterine position, hormone transfer from adjacent fetuses and the SDN‐POA volume in adult rat brains.
The effect of accounting firm mergers on the market for audit services: New Zealand evidence
Authors: Baskerville Rachel , Hay David
Published: March 2006

This article examines the outcomes of accounting firm mergers using data about the frequency of audit switches, the numbers of partners in the respective firms, and perceptions revealed in interviews with partners. Evidence from client switches does not show any evidence that the mergers were followed by cost reductions, or of collusion to force prices up. The effects of the mergers appear to have been elsewhere—the merging firms reduced partner numbers substantially, increasing partner leverage so that individual remaining partners were better off. Data from interviews confirm these findings, and show that the culture of individual firms had a significant effect on determining which group of partners controlled the merged firm.
Reporting on software development projects to senior managers and the board
Authors: Oliver G. R. , Walker R. G.
Published: March 2006

It is contended that the scale of some in‐house software projects (and the potential impact of project failure on an organization's operating capabilities and reputation) is such that the progress of those projects warrants the concentrated attention of senior managers (and possibly, the Board). The article utilizes a case study to illustrate how the adoption of key proposals outlined in the business information systems and software engineering literatures for the management of these projects may not necessarily be effective. This work augments Walker and Oliver (2005), which examined the options when accounting for software expenditure and recommended expensing for consistent treatment. This article then reviews the ‘information needs’ of senior managers, and presents a set of six reporting templates to facilitate the effective monitoring of progress of software projects (including post‐migration expenditure on system enhancements and maintenance, and efforts to capture planned benefits). In some circumstances, the scale and risks associated with software development projects warrant oversight of these projects by the Board, possibly through the establishment of specialist ‘IT governance’ subcommittees. Accordingly, a model charter for an IT governance committee is presented in an appendix.