bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of vascular endothelial growth factor and its receptors correlates closely with formation of the plexiform lesion in human pulmonary hypertension
Authors: Hirose Shigemichi , Hosoda Yasuhiro , Furuya Susumu , Otsuki Takashi , Ikeda Eiji
Published: March 2003

The pulmonary vasculature exhibits various morphological changes in patients with pulmonary hypertension (PH). Among them, the plexiform lesion is one of the most characteristic vascular lesions, although nothing is known about the molecular mechanisms of its formation. In the present study, the expression of vascular endothelial growth factor (VEGF), an endothelial cell‐specific angiogenic mitogen, and its receptors, fms‐like tyrosine kinase (Flt‐1) and kinase insert domain‐containing receptor (KDR), in the lungs of five cases with PH, were examined. By in situ hybridization, VEGF expression was found in modified smooth muscle cells inside the plexiform lesions as well as in medial smooth muscle cells of the arteries adjacent to the lesions. The expression of Flt‐1 mRNA was observed in endothelial cells of the arteries adjacent to the plexiform lesions, while KDR mRNA was expressed in the endothelial cells inside the plexiform lesions. VEGF was immunolocalized to the endothelial cells expressing its receptors as well as the modified smooth muscle cells producing VEGF. These results demonstrate that VEGF and its receptors are upregulated with a close correlation to the plexiform lesions, and suggest that VEGF expressed by smooth muscle cells may activate the endothelial cells to form the plexiform lesions.
Pigmented villonodular synovitis secondary to laceration of the perforating branch of the peroneal artery
Authors: Ozasa Yasuhiro , Kawaguchi Satoshi , Wada Takuro , Kaya Mitsunori , Usui Masamichi , Ikeda Tatsuru
Published: March 2003

A case of peroneal artery injury subsequently developed into a lesion resembling an extra‐articular tenosynovial giant cell tumor, which is a type of pigmented villonodular synovitis (PVNS). This case supports the hypothesis that accident trauma, such as a vascular injury, can be the etiology of PVNS.
Embryonal sarcoma of adult and pediatric kidneys: Report of a case with localized submucosal invasion of the renal pelvis and long‐term survival
Authors: Ito Jishu , Monobe Yasumasa , Sakamoto Kazuhiro , Tanaka Hiroyoshi
Published: March 2003

A case of cystic embryonal sarcoma of the kidney (CESK) with a rapidly fatal outcome was recently reported. 1 Here, we report another case of a 12‐year‐old boy with a localized but ill‐defined submucosal lesion of CESK in the right renal pelvis. The tumor consisted principally of small mesenchymal cells with oval to spindle nuclei and scanty cytoplasm, infiltrating in dense arrangements. Two growth patterns were distinguished in the tumor cells: (i) a diffuse infiltrating pattern without an epithelial component; and (ii) a foliated pattern with an epithelial lining over the surface. Foci of the diffuse pattern predominated over those that were lobular, infiltrating superficial layers of renal sinuses and along pyramids, in both of which remarkable intravenous invasion was evident. Foci of the foliated pattern invaded deeper portions of a few sinuses and frequently penetrated into their veins, producing together with their epithelial lining a characteristic foliated structure. Lining epithelial cells around lobular foci often appeared hob‐nailed or eosinophilic in the cytoplasm. Despite the remarkable intravenous encroachment, the patient has remained well without a recurrence for more than 26 years after a simple nephrectomy. The present case report expands our understanding of the biological nature of CESK.
Myxoid adrenal cortical adenoma
Authors: Honda Koichi , Kashima Kenji , Daa Tsutomu , Gamachi Ayako , Nakayama Iwao , Yokoyama Shigeo
Published: March 2003

Myxoid adrenal cortical adenoma is a rare tumor and, to our knowledge, only 16 cases have been reported. We present the case of a 56‐year‐old Japanese man who was admitted to hospital because of a right adrenal mass that was discovered during a routine physical examination. The resected mass was well circumscribed and contained canary yellow multinodular regions that were surrounded by a brown gelatinous region. Histologically, the multinodular regions resembled a conventional adrenal cortical adenoma, being composed of solid aggregates of large clear or eosinophilic cells. In the gelatinous region, anastomosing small eosinophilic or vesicular cells were visible within a myxoid stroma that contained large amounts of acidic mucopolysaccharides. Light‐microscopic findings were consistent with a diagnosis of adenoma. Immunohistochemical staining revealed that a small number of tumor cells were positive for vimentin, and the MIB‐1 labeling index was less than 1%. Flow cytometry demonstrated that cells were diploid. At the ultrastructural level, many fat droplets were found in the large clear cells in the multinodular regions. Small eosinophilic cells in the myxoid region contained many mitochondria but few fat droplets. There were no findings suggestive of malignancy. Although the adrenal cortex might have the potential to produce connective tissue‐type mucin as a consequence of its mesodermal origin, the mechanism of production of acidic mucopolysaccharides in a myxoid adrenal cortical tumor remains to be clarified.
Differential expression of RET finger protein in testicular germ cell tumors
Authors: Tezel Gaye , Nagasaka Tetsuro , Shimono Yohei , Takahashi Masahide
Published: March 2003

Testicular germ cell cancer is a common cancer in young adults and its incidence has risen dramatically over the past several decades in Western countries. Because RET finger protein (RFP), which belongs to the large B‐box RING finger protein family, has been reported to be expressed in different stages of spermatogenesis, we investigated its expression in testicular germ cell tumors. These comprised 13 pure seminomas, five pure non‐seminomatous germ cell tumors (NSGCT) and seven mixed germ cell tumors, four of which contained seminomatous component. In normal adult testis, the expression of RFP was strong in the germ cells, particularly in spermatogonia and primary spermatocytes. RFP immunoreactivity was seen uniformly and specifically in 12 of the 13 pure seminomas examined. It was also detected in seminomatous components of mixed germ cell tumors, whereas pure NSGCT were negative for RFP expression. The expression of RFP in male germ cells and seminomas together with the lack of its expression observed in highly aggressive NSGCT suggested that RFP could be associated with the regulation of germ cell proliferation and/or histological‐type of germ cell tumors.
Ex‐situ conservation of protistan and cyanobacterial biodiversity: CCAP‐NIES collaboration 1991–1997
Authors: Day John G. , Watanabe Makoto M. , Turner Michael F.
Published: March 2003

The Culture Collection of Algae and Protozoa (CCAP) and the National Institute for Environmental Studies (NIES) act as service collections in the UK and Japan, respectively. Since 1991, the collections have collaborated on a wide range of topics of mutual interest. These include: algal taxonomy, bio‐informatics, collection management, conservation of microbial biodiversity, cryopreservation, and cyanobacterial toxin research. The main activities have focused on the re‐examination of cyanobacterial isolates housed in both collections and cryopreservation research.

The preliminary data generated in the survey of cyanobacterial strains were used in the production of the latest CCAP catalogue and database. This project is ongoing at NIES and forms a key component of a major project on cyanobacterial taxonomy.

To date, many protists are apparently freeze‐recalci‐trant. A primary mode of lethal cell injury is the formation of intracellular ice. In this study, intracellular ice formation was observed in Tetraselmis suecica (Ky‐lin) Butcher under suboptimal cooling conditions, Tetraselmis chui Butcher under both fast and slow cooling and in both pigmented and achlorophylous strains of Euglena gracilis Klebs. These findings have significant implications for the development of successful cryopreservation strategies.

In addition to the above activities, a variety of algal strains have been examined in taxonomic and ultra‐structure research projects and cyanobacterial cultures have been screened for novel toxins.
Duration of tachyphylaxis in response to methacholine in healthy non‐asthmatic subjects
Authors: Fujimura Masaki , Myou Shigeharu , Kamio Yumie , Hashimoto Takuma , Matsuda Tamotsu
Published: March 2003

It is well recognized that bronchial responsiveness to methacholine is reduced after methacholine‐induced bronchoconstriction in non‐asthmatic subjects, but not in asthmatic subjects. However, it is unknown how long the methacholine tachyphylaxis lasts. The present study was conducted to elucidate duration of the methacholine tachyphylaxis in healthy non‐asthmatic subjects. Measurements of methacholine responsiveness were repeated six times at intervals of 1 h and 1, 2, 3 and 7 days in eight healthy non‐asthmatic young female subjects in whom methacholine concentrations causing a 20% fall in forced expiratory volume in 1 sec (FEV1; PC20‐Meth) were 40 mg/mL or less. Geometric mean value (GSEM) of PC20‐Meth was 10.6 (1.44) mg/mL at the first challenge, 63.4 (1.85) at the 1‐h interval, 50.2 (1.67) at the 1‐day interval, 49.7 (1.68) at the 2‐day interval, 17.3 (1.51) at the 3‐day interval and 13.1 (1.44) mg/mL at the 7‐day interval. The values at intervals of 1 h to 3 days were significantly greater than the initial value. These results indicate that measurements of methacholine responsiveness should be separated by at least 7 days to avoid the tachyphylaxis when the tests are repeated in non‐asthmatic subjects.
Video‐assisted thoracic surgery: A renaissance in surgical therapy
Authors: Yim Anthony , Izzat Mohammad Bashar , Lee Tak‐Wai , Wan Song
Published: March 2003

Within a few years, video‐assisted thoracic surgery (VATS) has become the accepted or preferred approach over a wide range of thoracic procedures. The authors review the development of this technique, the basic operative strategies and the current surgical indications. Technical pitfalls and future developments are also discussed.
Perception of bronchodilation in subjects with asthma and smokers with airflow limitation
Authors: Massasso David , Salome Cheryl , King Gregory , Seale J , Woolcock Ann
Published: March 2003

Perception of the efficacy of bronchodilators in relieving airflow obstruction is a likely determinant of compliance with treatment in patients prescribed these drugs on an ‘as needed’ basis. This study aimed to determine whether bronchodilator‐induced improvements in lung function are associated with improvements in breathing difficulty in subjects with asthma or smokers with airflow limitation. Twenty smokers with airflow limitation and 16 subjects with previously physician‐diagnosed asthma received salbutamol (200 μg) and ipratropium bromide (80 μg). Spirometry and lung volumes were measured before and 40 min after bronchodilator. Subjects recorded changes in ‘difficult breathing’ on a visual analogue scale (VAS). After bronchodilator, forced expiratory volume in 1 s (FEV1) increased by 23.0 ± 6.4% of baseline (mean ± 95%CI) in smokers, and by 25.2 ± 8.5% in the asthmatics, while VAS improved by 31 ± 23% in smokers and 45 ± 25% in asthmatics. However, these changes were not significantly correlated in either smokers (r = – 0.04) or asthmatics (r = 0.15). In the asthmatic subjects, good perceivers (> 25% improvement in VAS) had greater improvements in lung volumes, as percentage predicted, than did poor perceivers. In the smokers, changes in lung function did not differ significantly between good and poor perceivers. Improvement in FEV1, as percentage predicted, was significantly correlated with improvement in VAS in good perceivers (asthma: r = 0.78, P < 0.01; smokers: r = 0.68, P < 0.05), but not in poor perceivers. Asthmatic subjects had good perception of improvements in lung function. However, in smokers with airflow limitation there is little correlation between improvement in lung function and sensation of breathing difficulty. In these subjects symptoms appear to be an unreliable guide for ‘as needed’ use of bronchodilators.
The glandular component in congenital cystic adenomatoid malformation of the lung
Authors: Wang Nai‐San , Chen Moy‐Fong , Chen Fen‐Fen
Published: March 2003

Although severe congenital cystic changes (CCC) of the lung may be fatal, less severe forms may regress or vanish spontaneously. With recent advances in sonography, asymptomatic CCC are increasingly found. Whether all CCC should be promptly excised, or not, is uncertain. Con‐genital cystic changes conceptually are bronchopulmonary foregut malformations (BPFM) with a predilection for malignant degeneration. Among all BPFM, congenital cystic adenomatoid malformation (CCAM) is most common. We therefore searched for evidence of early malignant transformation in five surgically excised and three autopsy lungs with CCAM. By light microscopy, CCAM resembled poorly formed and dilated bronchi, bronchioles and respiratory air spaces. Four lungs had multiple nodular aggregates of mucus producing cells; the glandular component (GC). By scanning electron microscopy, GC appeared as multiple micropolyps, resembling neuroepithelial bodies. By transmission electron microscopy, GC had a surface proliferation of cells with granules of the mucous type and a basal increase in cells with owl‐eyed neuroendocrine granules. The glandular component in CCAM appeared similar to the mucous cells in hyperplastic polyps of the colon and a type of mucus producing bronchioloalveolar carcinoma. Our findings support the hypothesis that CCAM is caused by dysregulated paracrine growth of mature cells and extracellular matrices and that GC could have the potential for malignant transformation. Further clinical and laboratory studies of BPFM are needed for the appropriate management of congenital cystic changes.
Multifocal peripheral bronchial carcinoid tumour
Authors: Akashiba Tsuneto , Matsumoto Kenji , Kosaka Naoko , Saito Osamu , Horie Takashi , Nemoto Norimichi
Published: March 2003

Peripheral bronchial carcinoids sometimes arise as single solid or nodular lesions in the periphery of the lung. We encountered a 74‐year‐old Japanese male with bronchial carcinoids that were widely disseminated throughout the lung parenchyma. Pulmonary function tests revealed mild airflow obstruction. A metastatic process was ruled out from primary malignancy and a histological examination revealed findings consistent with a peripheral bronchial carcinoid. Based on these findings, we concluded that this patient had a primary multifocal peripheral bronchial carcinoid. An immunohistochemical examination revealed immunoreactivity for chromogranin A and bombesin. The present case appears to be an unusual case of diffuse multifocal peripheral bronchial carcinoid, confirmed by immunohistochemistry.
Malignant mesothelioma presenting as pulmonary metastasis ahead of growth of primary tumour
Authors: Heki Ytako , Fujimura Masaki , Kasahara Kazuo , Matsubara Fujitsugu , Matsuda Tamotsu
Published: March 2003

A 59‐year‐old woman was admitted to Houju Memorial Hospital, Ishikawa, Japan, because of cough and fever on 30 March 1997. A diagnosis of pneumonia was made and she was given antibiotics. Her symptoms improved but failed to resolve completely on antibiotic therapy. On 9 September 1997, she revisited the hospital because of bodyweight loss and malaise. There was no history of exposure to asbestos. The chest roentgenogram revealed infiltrative shadows with vague and indistinct margins suggesting inflammatory processes, which were more extensive than those investigated on her last visit. One month later, a giant tumour was detected rapidly growing from the mediastinum and open biopsy was performed. The histological examination confirmed that the tumour was a malignant mesothelioma and the intrapulmonary nodules were its metastases. This is a rare case of pulmonary metastasis being present for several months before an appearance of primary mesothelioma.
Ciliary assessment in bronchiectasis
Authors: Tsang Kenneth Wt , Zheng Ling , Tipoe George
Published: March 2003

Objective:

Bronchiectasis is a common condition among the Oriental population and affected patients suffer from chronic sputum production punctuated by recurrent infective exacerbations. Cilia are minute structures present on the surface of respiratory and other epithelial cells that beat continuously to maintain a sterile mucosal surface in the respiratory tract. Patients with primary ciliary dyskinesia could potentially develop recurrent sinotrachrobronchitis, bronchiectasis, serous otitis media, hydrocephalus, and male infertility. The assessment of cilia has, however, received little attention until recently and generally involves elaborate methods that require complex and expensive technology. This brief article discusses application of the saccharine test, light microscopy assessment of ciliary beat, and transmission electron microscopy assessment of the ultrastructure of cilia. The rationale and indications for ciliary assessment are also listed along with illustrations showing ciliary structure, equipment required for sampling and assessment of cilia, and transmission electron micrographs of ciliary ultrastructural abnormalities.
A double‐blind, placebo‐controlled steroid‐sparing study with budesonide Turbuhaler in Japanese oral steroid‐dependent asthma patients
Authors: Miyamoto Terumasa , Takahashi Terumi , Nakajima Shigenori , Makino Sohei , Yamakido Michio , Mano Kenji , Nakashima Mitsuyoshi , Tollemar Ulf , Selroos Olof
Published: March 2003

Objective:

The aim of this study was to evaluate the oral steroid‐sparing capacity of budesonide Turbuhaler®.

Methodology:

One hundred and thirteen oral steroid‐dependent patients were treated for 6 months with placebo or budesonide 800 μg or 1600 μg daily. Every second week the oral steroid dose was reduced if asthma control permitted.

Results:

The reductions in oral steroid doses were 9, 35 and 60% in the placebo and budesonide 800 μg and 1600 μg groups, respectively. Oral steroid treatment could be discontinued in 4% (placebo), 15% (800 μg) and 23% (1600 μg). Mean peak expiratory flow values increased by 21 and 24 L/min in the budesonide groups but decreased by 6 L/min in the placebo group. Asthma attack, activity and sleep scores remained unchanged showing maintained efficacy. Plasma cortisol levels increased and an adrenocorticotropic hormone test showed improved adrenocortical response in both budesonide groups, indicating improved safety. Adverse drug reactions were infrequent and mild in all study groups.

Conclusion:

Budesonide Turbuhaler, 800 μg and 1600 μg daily, resulted in a significant reduction in oral steroid usage in steroid‐dependent patients. The effect was achieved with maintained asthma control together with improvements in lung and adrenal functions.
An inverse correlation between estimated tuberculosis notification rates and asthma symptoms
Authors: SHIRTCLIFFE PHILIPPA , WEATHERALL MARK , BEASLEY RICHARD
Published: March 2003

Background: A recent ecological analysis demonstrated a strong inverse relationship between tuberculosis notification rates and the prevalence of asthma symptoms in 13–14‐year‐old children as obtained from the International Study of Asthma and Allergies in Childhood (ISAAC). However, the analysis was confined to the 23 countries in which the tuberculosis notification rates were considered to be of sufficient validity.

Methods: A similar analysis was performed using estimated tuberculosis incidence rates obtained from the World Health Organization Global Tuberculosis Programme and asthma symptom prevalence data from ISAAC for both the 6–7 and 13–14 years age groups in 38 and 55 countries, respectively.

Results: For the 6–7‐year‐old children, there was a significant inverse relationship between estimated tuberculosis incidence and the prevalence of key asthma symptoms. However, in the 13–14 year age group, a significant inverse relationship was only demonstrated for ‘asthma ever’.

Conclusion: The present study extends the inverse relationship between tuberculosis rates and asthma prevalence to the 6–7‐year‐old age group and suggests that the association, if causal, may be stronger at this younger age.
The causes of haemoptysis in Malaysian patients aged over 60 and the diagnostic yield of different investigations
Authors: WONG Catherine Mee‐Ming , LIM Kim Hatt , LIAM Chong‐Kin
Published: March 2003

Objective:  In southeast Asia, pulmonary tuberculosis (TB) is the most frequently presumed diagnosis for haemoptysis. This study was designed to assess the causes of haemoptysis, the diagnostic yield of causes in different diagnostic modalities and the distribution of older patients.

Methods:  All patients presenting to the University of Malaya Medical Centre, Kuala Lumpur, Malaysia with haemoptysis were recruited prospectively and evaluated.

Results:  One hundred and sixty patients were evaluated for haemoptysis; 71 (44.4%) were aged 60 years or more. Significantly more patients smoked in the older age group (P = 0.002). The main causes of haemoptysis in the older patients were bronchogenic carcinoma (49.3%), pneumonia (11.3%), bronchiectasis (8.6%), cryptogenic (5.6%) and active TB (4.2%). Significantly more older patients had carcinoma (P < 0.001), while the younger patients more often had TB (P < 0.001). Chest pain was significantly more common in the older patients (P = 0.025), particularly in patients with carcinoma. Bronchoscopy alone or combined with CT of the thorax was significantly more diagnostic in the older patient (P = 0.006).

Conclusion:  Bronchogenic carcinoma is the commonest cause of haemoptysis in patients aged 60 years and above. Presumptive anti‐TB therapy should not be encouraged despite the regional high prevalence of TB.
Response of Trifolium repens to a mosaic of bare and vegetated patches
Authors: Leeflang Lizelotte
Published: March 2003

In herbaceous vegetation, plants are subjected to a spatial heterogeneous distribution of light. Trifolium repens was tested on its ability to avoid vegetated patches by change of stolon growth direction, reduced branching or reduced growth. Treatments consisted of a no grass control, grass on the west side and grass on the north side. When Trifolium was growing beside a grass patch on the west side, plants reduced branching but did not change direction nor was there reduced growth in stolons that were growing towards/in the vegetated patch compared to the control plants. When the grass patch was situated to the north of the plant, plants did not show reduced branching except of the primary stolon, nor was there change of growth direction or reduced growth. The biomass and number of ramets were reduced in the vegetated patch of the west treatment and the patch adjacent to the grass patch. In the north treatment biomass and number of ramets were only reduced in the vegetated patch. Compared to the control, total plant biomass was reduced in the west‐grass‐patch treatment but not in the north‐grass‐patch treatment. Reduced branching near grass patches could be an added mechanism by which to avoid vegetated patches; it is not very effective, however, because biomass production did not increase in the open patches but was only reduced in the vegetated patches.
Expansion of Elaeagnus umbellata on a gravel bar in the Naka River, Shikoku, Japan
Authors: Kohri Mari , Kamada Mahito , Yuuki Toyokatsu , Okabe Takeshi , Nakagoshi Nobukazu
Published: March 2003

Abstract The present study seeks to identify the expansion process of the shrub Elaeagnus umbellata Thunb. (Elaeagnaceae) on a gravel bar in the Naka River, Shikoku, Japan, in relation to the hydrogeomorphologic regime of the habitat. The establishment pattern was determined by a series of aerial photographs, and the establishment years were confirmed by examining tree rings taken from five different areas within the population. The topographic change of the river cross‐section was analyzed and it was found that the establishment occurred exactly when and where the riverbed began to stabilize. The three cohorts of 15‐, 10‐ and 4‐year‐olds were recognized, the younger individuals being downstream. The episodic age pattern was significantly synchronized with large floods occurring during the autumn fruit‐ripening season. These spatial and temporal occurrence patterns indicated the probability of hydrochory, which ultimately enhanced the dissemination of endozoochorous E. umbellata seeds into the newly created habitat on the downstream part of the gravel bar. Another cause of quick dominance was its vigorous sprouting ability, which enabled the established E. umbellata to withstand damage and sediment burial by strong floods. The erosion of the deepest part of the riverbed increased the relative elevation of the vegetated stand, which ultimately decreased the frequency and magnitude of disturbance during flood inundation after the 1980s. Consequently the hydrogeomorphic regime of the floods played an important role in habitat creation, seed dispersal, and in the survival of the established individuals, and it determined the population formation and expansion of E. umbellata on the riparian gravel bar.
Examining the effects of fragmentation on genetic variation inPlatanthera leucophaea(Orchidaceae): Inferences from allozyme and random amplified polymorphic DNA markers
Authors: Wallace Lisa E.
Published: March 2003

AbstractSpecies that have become rare or endangered due to human disturbance are at increased risk of extinction as a result of environmental, demographic, and genetic stochasticity. Smaller populations, which can be typical of endangered species, are especially vulnerable to loss of variation through stochastic events. For 10 populations ofPlatanthera leucophaea(Nuttall) Lindley (Orchidaceae), a threatened species, genetic variation at allozyme and random amplified polymorphic DNA (RAPD) loci was measured to assess the potential effects of fragmentation and reduced population size on the future viability of populations. Allozymes revealed very low levels of diversity (AP = 1.18; PP = 12%; HO = 0.008) and high levels of population differentiation (FST = 0.75). Additionally, inbreeding coefficients were very high in five of the 10 populations surveyed, due largely to the fixation of alternative alleles at two loci in different populations. In contrast, every individual displayed a unique RAPD fingerprint, yielding higher levels of polymorphism (PP = 45%) and gene diversity (Nei's H = 0.159). Estimates of population differentiation based on RAPD are moderate as measured byamova(ΦST = 0.21), Wright's F‐statistics (GST = 0.26), or Shannon's information index (Hamong = 0.30). However, genetic and geographic distances are not significantly correlated, suggesting a lack of interpopulation gene flow and/or genetic drift within populations. Population size is not a good predictor of genetic variation in the present study, and it is hypothesized that plant dormancy patterns and chaotic fluctuations in population size from year to year may buffer against stochastic events, especially in small populations.
Effects of growth hormone replacement therapy on lipids, lipoproteins and apolipoproteins: Is the increased apolipoprotein A‐1/B ratio the only benefit?
Authors: Yildiz, Metin , Arslanoglu, Ilknur , Yildiz, Nurdan , Nartop, Filiz , Isik Kutay , Isguven Pinar
Published: March 2003

Abstract

Background
: The aim of the present study was to investigate the controversial role of growth hormone (GH) therapy in lipid regulation.

Methods
: We studied serum levels of cholesterol and subgroups, triglyceride and apolipoprotein A‐1 and B in 41 GH‐deficient children (with subgroups of untreated and short‐ and long‐term treated subjects) and 20 healthy controls.

Results
: Cholesterol and low‐density lipoprotein cholesterol levels (in mmol/L) were found to be 4.92~1.34 and 3.02~1.58 in untreated, 4.15~0.72 and 2.46~0.65 in short‐term (3 month) treated, 4.93~1.39 and 3.15~1.38 in long‐term (> 1 year) treated and 4.11~0.5 and 2.0~0.74 in control subjects, respectively. The apolipoprotein A‐1:B ratio was 1.98~0.5 in long‐term treated and 1.6~0.6 in control subjects.

Conclusions
: The improvement of lipid composition with short‐term GH therapy is temporary, but the increase in apo A‐1:B is not and seems to be the particular benefit of this therapy.
Influenza virus‐induced encephalopathy: Clinicopathologic study of an autopsied case
Authors: Takahashi Mitsuo , Yamada Tatsuo , Nakashita Yoshio , Saikusa Hiroaki , Deguchi Masatune , Kida Hiroshi , Tashiro Masato
Published: March 2003

Abstract

Background
: Rapid progressive encephalopathy with a high fever, consciousness loss and recurrent convulsions has been occasionally reported in children during influenza pandemics in Japan since 1995. We examined a 2‐year old girl with hemorrhagic shock and encephalopathy syndrome associated with acute influenza A virus infection (A/Nagasaki/76/98; H3N2), to answer several questions for which no histologic or virologic data exist.

Methods
: A clinicopathologic study using immunohistochemical staining and viral genome detection by reverse transcriptase polymerase chain reaction (RT‐PCR) was performed with this autopsied case.

Results
: The virus antigen was positive in CD8+ T lymphocytes from the lung and spleen. The virus infected a very limited part of the brain, especially Purkinje cells in the cerebellum and many neurons in the pons, without inducing an overt immunologic reaction from the host. The RT‐PCR used for detecting the hemagglutinin gene demonstrated positive bands in all frozen tissues and cerebrospinal fluid taken at autopsy and not in samples obtained on admission.

Conclusions
: The pathologic change induced by the direct viral invasion cannot be responsible for all of the symptoms, especially for the rapid and severe clinical course of the disease within 24–48 h after the initial respiratory symptoms. Together with the rapid production of several inflammatory cytokines, the breakdown of the blood–brain barrier may induce severe brain edema and can be a major pathologic change for the disease. Any therapeutic strategy to control this multistep progression of the disease could be effective.
Child rotavirus infection in association with acute gastroenteritis in two Chinese sentinel hospitals
Authors: Fang Zhao‐Yin , Yang Hui , Zhang Jing , Li Yong‐Fu , Hou An‐Cun , Ma Li , Sun Li‐Wei , Wang Cheng‐Xun
Published: March 2003

Abstract Rotavirus gastroenteritis is an important pediatric disease in China. In a survey of rotavirus infection at two sentinel hospitals in China (Beijing Friendship Hospital and Changchun Children’s Hospital), 296 cases were detected. A total of 283 (95.6%) cases of rotavirus infection occurred in children under 5 years of age. Serotype G1 (62%) was most prevalent followed by G2 (28.5%), G3 (5%) and G4 (2%). Mixed infections (n=8, 3%) were rare, and 16 isolates (5.5%) remained non‐typeable. A consistent epidemic occurred during the winter. Rotavirus was responsible for about 61.8% of diarrhea‐related hospitalizations in children under 5 years of age, with a mean hospital stay of 5.6 days (1.0–21 days). The estimated rate of rotavirus‐attributed hospitalizations was 16/1000 children under 5 years of age per year. Rotavirus‐related death is rare in Changchun and Beijing. The present findings suggest that a rotavirus vaccine for the prevention of severe disease and a reduction of treatment costs would be of significant benefit to China.
Development of a simple and rapid latex test for rotavirus in stool samples
Authors: Kohno Hideki , Akihara Shiho , Nishio Osamu , Ushihima Hiroshi
Published: March 2003

Abstract In the fields of infectious diseases, a variety of immunoassay methods has been reported. More simple, rapid and cost‐effective manual tests for infectious diseases are needed. For the purpose of simple diagnosis of rotavirus infection, a rapid test against human rotavirus was developed. As for the preparation of the reagent, clinically isolated human rotavirus was cultured using MA‐104 cells. Then, the cultured virus was purified by an ultracentrifugation method. The purified virus was inactivated with formaldehyde for use as antigen for immunization of rabbits. The antibody was purified and applied to sensitize the surface of latex particles to react with rotavirus in diarrheal stools. The latex agglutination test showed that the sensitivity was 98.2% and the specificity was 94.8%, in comparison with electron microscopy as the gold standard. Furthermore, to measure the virus concentration in stool samples, an automated latex photometric immunoassay system (LPIA) was used, which has been developed for quantitative measurement of agglutination. The range of the reactive viruses detected by the LPIA system was 3`10
7–10
9 virions/mL. The rotavirus‐positive and rotavirus‐negative subjects were clearly discriminated. The results were in good accordance with electron microscope results. Those results showed that the latex agglutination test is a good tool for the simple and rapid detection of rotavirus in stool samples.
Urinary pyrimidine analysis in healthy newborns, infants, children, adults and patients with congenital metabolic diseases
Authors: Asai Masami , Sumi Satoshi , Kidouchi Kiyoshi , Imaeda Hiromi , Togari Hajime , Wada Yoshiro
Published: March 2003

Abstract Background: In previous reports, the reference range for urinary pyrimidine was determined on the basis of a small number of samples, with data for only a few patients being reported. In the present study, we measured urinary pyrimidine compounds in 25 healthy newborns, 33 healthy infants, 130 healthy children and 166 healthy adults. In addition, we also analyzed urinary pyrimidine compounds in various patients with abnormal pyrimidine metabolism, such as congenital pyrimidine metabolism disorders and urea cycle disorders.

Methods
: We analyzed urines by high‐performance liquid chromatography with column switching. Analyses were performed with both a reverse‐phase column and an anion‐exchange column. The columns were connected by a column switch, with all systems being controlled automatically by a computerized system controller.

Results
: The excretion of pyrimidine compounds in patients with abnormal pyrimidine metabolism (containing heterozygotes) was out of our reference ranges.

Conclusions
: These results suggest that urinary pyrimidine analysis is a useful index for the diagnosis of pyrimidine metabolism disorders, urea cycle disorders and these heterozygotes. Based on this large‐group analysis of healthy individuals, we were able to determine the reference ranges of urinary orotic acid, dihydrouracil and uracil for each age group.
Celiac disease in Turkish children: Presentation of 104 cases
Authors: Demir Hülya , Yüce Aysel , Koçak Nurten , Özen Hasan , Gürakan Figen
Published: March 2003

Abstract Background: Celiac disease is characterized by life‐long gluten intolerance. Clinical features of patients with celiac disease are variable. In the present study, clinical, laboratory and histologic features of 104 patients with celiac disease were evaluated.

Methods
: Intestinal biopsy and serum antigliadin and anti‐endomysium antibodies were used for the diagnosis of patients. Mucosal lesions were classified according to the criteria of Marsh. Antigliadin antibodies were measured with a commercial enzyme‐linked immunosorbent assay. Anti‐endomysium antibodies were analyzed by indirect immunoflourescence with the use of a section of monkey esophagus. Routine hematological and biochemical analyses and measurement of immunoglobulin levels were undertaken.

Results
: The mean (± SD) patient age was 5.9~4.1 years (range 10 months–16 years) and the most common symptom was diarrhea (81.7%) followed by abdominal distention, weight loss, anorexia and failure to thrive. Abdominal distention (60.6%), short stature (45.2%) and iron‐deficiency anemia were the most common findings. High serum alanine aminotransferase levels were found in 38.3% of patients and these levels became normal after adoption of a gluten‐free diet in all but two patients with cirrhosis. Immunoglobulin A, IgG antigliadin antibodies and IgA anti‐endomysium antibodies were found in 76, 94 and 90% of patients, respectively. Biopsy of the small intestine revealed that 95, two and seven patients had type 3, type 2, and type 1 lesions, respectively, according to the Marsh classification. There was no statistically significant difference between patients and control groups with regard to antinuclear antibody, antismooth muscle antibody, anti‐DNA and anticardiolipin antibodies (IgG and IgM).

Conclusions
: Although classical celiac disease was seen in most patients in the present study, clinical variability of the condition should be kept in mind. In particular, patients with uncommon findings, such as short stature, cryptogenic liver disease and iron‐deficiency anemia, should also be screened for celiac disease.
Killing of human Herpes virus 6‐infected cells by lymphocytes cultured with interleukin‐2 or ‐12
Authors: Kida Kazunori , Isozumi Rie , Ito Masahiro
Published: March 2003

Abstract

Background
: Human Herpes virus 6 (HHV‐6) is a causative agent of exanthema subitum and replicates mainly in lymphocytes. The aim of present study was to investigate cytotoxicity against HHV‐6‐infected cells by cord blood mononuclear cells (CBMC) and adult peripheral blood mononuclear cells (PBMC).

Methods
: Human herpes virus 6‐infected and ‐uninfected lymphocytes were used as target cells. Killing of target cells by CBMC and PBMC was investigated by the chromium release cytotoxicity assay.

Results
: Freshly isolated CBMC and PBMC did not lyse HHV‐6‐infected and ‐uninfected cells. When CBMC and PBMC were cultured with interleukin (IL)‐2, HHV‐6‐infected cells were significantly lysed compared with uninfected cells. Deletion of CD16+ cells by treatment of effector cells with anti‐ Leu‐11b (CD16) antibody with complement reduced cytotoxicity against HHV‐6‐infected cells and T lymphocyte‐rich cells did not lyse HHV‐6‐infected cells. Treatment of effector cells with anti‐Fas ligand antibody and treatment of HHV‐6‐infected cells with anti‐Fas antibody reduced cytotoxicity against HHV‐6‐infected cells. DNA fragmentation was detected in the supernatant from HHV‐6‐infected cells cultured with IL‐2‐activated lymphocytes. Culture of CBMC and PBMC with IL‐12 also enhanced cytotoxicity against HHV‐6‐infected cells.

Conclusions
: These data suggest that lymphocytes cultured with IL‐2 or IL‐12 mediate killing against HHV‐6‐infected cells and killing of HHV‐6‐infected cells was through apoptosis. Fas–Fas ligand interaction is one pathway by which HHV‐6‐infected cells are killed. Killing of HHV‐6‐infected cells by NK cells activated by cytokines may play a role in the recovery from HHV‐6 infection in vitro.
Effect of high‐frequency oscillatory ventilation on the upper airways of kittens
Authors: Liu Dongmei , Miyasaka Katsuyuki , Nakagawa Satoshi , Hashizume Kohei
Published: March 2003

Abstract

Background
: High‐frequency oscillatory ventilation (HFOV) has become the preferred method of ventilation for the fragile lungs of neonates and infants because its beneficial effects on lungs are well known; however, its benefits on upper airways are not yet known. We investigated the effects of HFOV and conventional mechanical ventilation (CMV) on the airways of kittens with normal lungs.

Methods
: Ten healthy cross‐bred kittens, 2–3‐months‐old, with a mean bodyweight of 0.98 kg, were randomly divided into two groups: HFOV and CMV. Kittens were intubated and ventilated for 24 h. A semiquantitative scoring system was used to grade histopathological tissue changes in the cricoid, mid‐trachea, carina and left bonchus. The injury scores of the two groups were ranked and compared using a two‐tailed Mann–Whitney rank test.

Results
: Histopathologic changes were similar and mild in both groups under light microscopic examination. There was no significant difference in airway injury between the two groups.

Conclusions
: We conclude that, in this animal model, HFOV results in minimal airway damage when properly managed and causes no greater tracheobronchial injury than CMV.
Serum levels of neutrophil activation cytokines in Kawasaki disease
Authors: Suzuki Hiroyuki , Noda Eisaku , Miyawaki Masakazu , Takeuchi Takashi , Uemura Shigeru , Koike Michio
Published: March 2003

Abstract

Background
: The aim of the present study was to investigate whether neutrophils are early effector cells for vascular endothelial damage in the acute phase of Kawasaki disease (KD) by examining serial changes in neutrophil counts and serum levels of neutrophil activation cytokines, such as granulocyte colony stimulating factor (G‐CSF) and interleukin (IL)‐8.

Methods
: From October 1994 to June 1998, a total of 52 patients with KD were included in the study. Thirty‐three patients had some infectious diseases, while 20 healthy children served as control subjects. Serial changes in neutrophils were counted by the optimal Wright–Giemsa staining method and serum levels of IL‐8 and G‐CSF in patients with KD were measured by an enzyme‐linked immunosorbent assay system.

Results
: Serum G‐CSF levels both before and after intravenous immunoglobulin therapy (IVIG; P<0.05) and neutrophil counts after IVIG (P<0.005) were higher in KD patients with coronary arterial lesions (CAL) than those without CAL. However, serum IL‐8 levels before and after IVIG showed no significant differences in these two groups.

Conclusions
: These data suggest that neutrophils may be important as early effector cells for vascular endothelial damage and that G‐CSF may play a more important role than IL‐8 in KD.
Risk factors for severe respiratory syncytial virus‐associated lower respiratory tract infection in children
Authors: Kaneko Mitsunobu , Watanabe Jun , Ueno Etsushi , Hida Mariko , Sone Tomofumi
Published: March 2003

Abstract

Background
: Respiratory syncytial virus (RSV) is the most important cause of viral lower respiratory tract infection that can be a life‐threatening disease in infants and children. This study was conducted to look for independent risk factors for severe respiratory syncytial virus‐associated lower respiratory tract infection (RSV‐LRI) that required oxygen supplementation or mechanical ventilation.

Methods
: Medical records of patients younger than 4 years hospitalized with RSV‐LRI at Shizuoka Red Cross Hospital from July 1, 1995 to June 30, 1999 were reviewed. The patients were compared using univariate and multivariate logistic regression analysis.

Results
: A total of 157 patients were hospitalized with RSV‐LRI at Shizuoka Red Cross Hospital from the study time period. Of these, 20 patients (12.7%) were diagnosed with severe RSV‐LRI. Subjects younger than 3 months of age had an odds ratio (OR) of 59.9 (95% confidence interval (CI) 14.7_244.0) for the dependent variable of severe RSV‐LRI (P<0.0001). Subjects with a history of congenital heart disease also had an OR of 99.2 (95% C1 8.5–1160.1) (P<0.0005).

Conclusions
: Infants younger than 3 months without any underlying diseases may be at high risk for severe RSV‐LRI. Respiratory syncytial virus prophylaxis is needed not only for high‐risk patients, but for healthy early infants.
Cardiovascular effects of a phosphodiesterase III inhibitor, amrinone, in infants: Non‐invasive echocardiographic evaluation
Authors: Teshima Hidetaka , Tobita Kimimasa , Yamamura Hideshi , Takeda Atsuhito , Motomura Hideki , Nakazawa Makoto
Published: March 2003

Objective
: The inotropic effect of amrinone is still controversial in management of congestive heart failure in pediatric patients, especially in infants. In order to determine the cardiovascular effect of amrinone in pediatric patients, we performed echocardiographic evaluation in 11 infants (mean age of 2 months) after intracardiac surgery.

Methods
: Amrinone was loaded with a dose of 1.0 mg/kg, followed by continuous infusion with 10 µg/kg per min. We performed echocardiographic measurements before and immediately after loading of amrinone, and evaluated its cardiovascular effect.

Results
: After loading of amrinone, the heart rate increased by 5% in average, but there was no change in blood
pressure. Left ventricular (LV) fractional shortening and mean velocity of circumferential fiber shortening corrected for heart rate increased
significantly (0.25 ± 0.09 to 0.28 ± 0.08 and 0.94 ± 0.35 to 1.10 ± 0.34, respectively).
Left ventricular end‐systolic wall stress decreased from 36.6 ± 18.5 to 29.1 ± 14.4 g/cm2, indicating
the reduction of LV afterload. Stress‐velocity index, a sensitive index of left ventricular contractility, was elevated significantly
(Z‐score: −1.45 ± 4.21 to 0.04 ± 4.11).

Conclusion
: Amrinone has not only vasodilative effects, but definite positive inotropic effects in infants with heart failure.
Human herpesvirus‐6 infection in neonates: Not protected by only humoral immunity
Authors: Sugimoto Tomoko , Tanaka‐Taya Keiko , Ono Jiro , Miyoshi Hiroko , Okada Shintaro , Yamanishi Koichi
Published: March 2003

Background
: Infants are usually protected from various viral infections, including human herpesvirus‐6 (HHV‐6) and human herpesvirus‐7 (HHV‐7) infections, during the early infantile period by antibodies transferred from their mothers. However, rare cases of exanthem subitum (ES) in neonates have been described in published reports.

Methods
: From the infantile patients of febrile illness, HHV‐6 and HHV‐7 DNA were examined by the polymerase chain reaction method. Antibodies to HHV‐6 and HHV‐7 were detected by indirect immuno­fluorescence assay and neutralization test. Viral isolation was attempted from the patient’s peripheral blood mononuclear cells (PBMC) during the acute phase of febrile illness.

Results
: Human herpesvirus‐6 was verified virologically in two neonates who were clinically diagnosed as ES within the first month of life. Although high copies of HHV‐6 DNA were detected in their PBMC during the acute phase, the isolation of HHV‐6 from their PBMC was not successful. Neutralizing antibodies to HHV‐6 were detected in sera of the acute phase, and those antibodies were considered to be transferred from their mothers. Antibody titers showed fourfold elevation in sera of the convalescent phase. The HHV‐6 infection occurred despite the presence of pre‐existing maternal antibody. Human herpesvirus‐7 and HHV‐7 DNA were not detected from their clinical samples.

Conclusions
: This observation suggests that HHV‐6 infection could not be protected by only humoral immunity.
Expert thinking in nursing practice: Implications for supporting expertise
Authors: Peden‐McAlpine Cynthia
Published: March 2003

AbstractThe complexity of the art of expert nursing practice is an elusive phenomenon, which is difficult to articulate in concrete terms that can be translated into achieving quality patient care outcomes. The present study describes the findings of two hermeneutic (interpretive) studies on expert thinking that captured the holistic practice of expert clinicians. The findings from these studies provide insight into how expert practice can be administratively supported. These findings also have strong implications for strategies to facilitate the development of expertise in practice. In order to provide holistic care, nurses must spend time with their patients so that the particularities and meaning inherent in each unique patient situation can be understood. The art of expert thinking is a temporal and ethical activity, which needs to be supported and cultivated in a changing health‐care delivery system.