bluuebunny/crossref_metadata_2025 huggingface dataset:
Androgens, insulin resistance and vascular disease in men
Authors: Kapoor D. , Malkin C. J. , Channer K. S. , Jones T. H.
Published: August 2005

Type 2 diabetes mellitus is increasing globally and is an established risk factor for the development of atherosclerotic vascular disease. Insulin resistance is the hallmark feature of type 2 diabetes and is also an important component of the metabolic syndrome. There is evidence to suggest that testosterone is an important regulator of insulin sensitivity in men. Observational studies have shown that testosterone levels are low in men with diabetes, visceral obesity (which is strongly associated with insulin resistance), coronary artery disease and metabolic syndrome. Short‐term interventional studies have also demonstrated that testosterone replacement therapy produces an improvement in insulin sensitivity in men. Thus hypotestosteronaemia may have a role in the pathogenesis of insulin‐resistant states and androgen replacement therapy could be a potential treatment that could be offered for improvements in glycaemic control and reduction in cardiovascular risk, particularly in diabetic men.
The T1799A BRAF mutation is not a germline mutation in familial nonmedullary thyroid cancer
Authors: Xing Mingzhao
Published: August 2005

Objective  Familial nonmedullary thyroid cancer (FNMTC) is relatively common but its predisposing genetic alteration is unclear. As the somatic T1799A BRAF mutation is highly prevalent in papillary thyroid cancer, the aim was to test whether this mutation was a susceptibility mutation for FNMTC.

Subjects and methods  The T1799A BRAF mutation as a possible germline mutation was examined in 40 subjects from 23 families with a history of FNMTC. Direct DNA sequencing was performed on white blood cell DNA samples to analyse the mutation status.

Results  No T1799A BRAF mutation was found in this group of subjects as germline mutation.

Conclusion  The T1799A BRAF mutation is not a germline mutation or susceptibility genetic event for FNMTC.
Development of a sensitive enzyme immunoassay for anti‐Müllerian hormone and the evaluation of potential clinical applications in males and females
Authors: Al‐Qahtani A. , Muttukrishna S. , Appasamy M. , Johns J. , Cranfield M. , Visser J. A. , Themmen A. P. N. , Groome N. P.
Published: August 2005

Background and objective  Recent studies have found anti‐Müllerian hormone (AMH) to be a potentially important marker for the assessment of ovarian reserve and prediction of the success of in vitro fertilization (IVF) treatment. The objectives of this study were to develop a sensitive and specific assay for AMH and to evaluate the potential application of the assay. This assay will be then available to our collaborators in the UK and overseas.

Design  Samples obtained as part of another prospective cross‐sectional study from infertility patients and another prospective longitudinal study from pregnant women were used in this study to measure AMH using a new double‐antibody enzyme‐linked immunosorbent assay (ELISA).

Patients and measurements  AMH levels were evaluated in (i) serum and seminal fluid from males (normal and male factor infertility males), (ii) serum and follicular fluid from females (normal and female with unexplained infertility) and (iii) serum, amniotic fluid (AF) and coelomic fluid (CF) from pregnant women. AMH levels in the samples were measured by a newly developed ELISA.

Result  The assay had a detection limit of < 0·078 ng/ml. High recoveries of spiked recombinant protein were observed from male and female sera and also from follicular, seminal, coelomic and amniotic fluids. The intra‐ and interassay coefficients of variation (CVs) were 3·6% and 4·0%, respectively. Serially diluted human samples gave dose–response curves parallel to the standard curve. Immunoreactivity was stable to sample storage at room temperature for several days and to multiple cycles of freezing and thawing. In seminal fluid, the AMH concentrations in a group of men with male factor infertility were insignificantly different from those in fertile men. By contrast, serum AMH concentrations were lower in the male factor infertility group than the normal group of patients. Women with unexplained infertility had similar concentrations of AMH in serum and follicular fluid compared to controls. Pregnant women had higher concentrations of AMH in the circulation in early pregnancy compared with nonpregnant women, suggesting a foeto‐placental contribution and a possible biological role for this molecule in early pregnancy.

Conclusion  We have developed a sensitive and specific assay for AMH. Serum AMH in men with male factor infertility is lower than in normal men. Levels of AMH in pregnancy are higher than normal menstrual cycle levels suggesting a foeto‐placental contribution.
Is dermolipectomy effective in improving insulin action and lowering inflammatory markers in obese women?
Authors: Rizzo M. R. , Paolisso G. , Grella R. , Barbieri M. , Grella E. , Ragno E. , Grella R. , Nicoletti G. , D’Andrea F.
Published: August 2005

Objective  Obesity is a major risk factor for coronary heart disease, and surgical treatment of obese patients as part of a multidisciplinary approach seems to provide faster results than diet therapy. The aim of this study was to evaluate the effect of dermolipectomy on insulin action and inflammatory markers in 20 obese women.

Patients  At baseline and 40 days after dermolipectomy, 20 obese women underwent indirect calorimetry and hyperinsulinaemic glucose clamp. Twenty obese nonsmoking females (age range 25–40 years) volunteered for the study. All subjects had a stable body weight for 2 months before the study. No patient was affected by cardiovascular and/or pulmonary disease, type 2 diabetes, thyroid dysfunction, acute or chronic hepatitis, renal insufficiency or cancer. No patients was receiving any drug therapy and all measurements were made during the follicular phase of the menstrual cycle.

Results  At baseline, fat mass (FM) correlated with plasma triglycerides (r = 0·58, P < 0·009), free fatty acids (FFA) (r = 0·73, P < 0·001), insulin (r = 0·70, P < 0·002), leptin (r = 0·55, P < 0·01), adiponectin (r = –0·32, P < 0·02) and resistin (r = 0·31, P < 0·01), insulin sensitivity (IS) (r = –0·59, P < 0·005) and respiratory quotient (Rq) (r = 0·62, P < 0·002). With regard to inflammatory markers, FM was significantly correlated with plasma interleukin (IL)‐6 (r = 0·71, P < 0·001), IL‐10 (r = –0·67, P < 0·002), tumour necrosis factor‐α (TNF‐α) (r = 0·78, P < 0·001) and soluble IL‐6 receptor (sIL‐6r) (r = –0·65, P < 0·003). Dermolipectomy resulted in a significant decline in total FM of 2·3 ± 0·2 kg. A significant decline in BMI was also observed (30·0 ± 0·08 vs. 31·1 ± 0·7 kg/m2). After 40 days a significant decline in plasma resistin (P < 0·001) and inflammatory markers and an increase in plasma adiponectin (P < 0·03) were observed. Those metabolic changes were accompanied by a significant improvement in insulin‐mediated glucose uptake (P < 0·001), substrate oxidation and degree of inflammation. Changes in FM following dermolipectomy correlated with the changes in IS (P < 0·01), substrate oxidation and FFA (P < 0·001).

Conclusions  In obese patients, dermolipectomy is associated with weight lost, improved glucose handling and lower inflammatory markers.
Effect of different therapeutic modalities on spontaneous GH secretion in acromegalic patients
Authors: Resmini Eugenia , Barreca Antonina , Ferone Diego , Giusti Massimo , Sidoti Marilena , Minuto Francesco
Published: August 2005

Objectives  Three major therapeutic modalities (transsphenoidal surgery, radiotherapy and medical therapy) are currently available for acromegaly. Although surgery is regarded as the primary option, 50–60% of macroadenomas require further treatment in the form of radiotherapy and/or medical therapy. Recent studies have suggested that radiotherapy might damage the normal hypothalamic–pituitary axis and also rarely leads to IGF‐I normalization. The aims of this study were: (1) to examine the effect of different therapeutic modalities (transsphenoidal surgery, TSS; radiotherapy, RT; medical treatment with somatostatin analogues, SSA) on the daily spontaneous GH secretory pattern (day curve); and (2) to determine the relationship between the characteristics of the GH secretory pattern and the circulating concentration of IGF‐I, acid‐labile subunit (ALS) and IGFBP‐3.

Design and measurements  Spontaneous GH secretion was evaluated at hourly intervals from 0800 to 1800 h. IGF‐I, IGFBP‐3 and ALS were measured in basal conditions. The mean and the minimum values obtained from the day curve profile and the coefficient of variation (CV) of single values, which are expressions of the magnitude of the spontaneous secretory pulses, were used for statistical analysis.

Patients  In a group of 45 acromegalic patients (28 women, mean age 51 years, range 26–83 years, and 17 men, mean age 57 years, range 37–78 years) treated with different protocols, including TSS, RT and SSA therapy, we evaluated GH secretion to determine the effect of single treatment options on the spontaneous secretory profile. Subjects were grouped on the basis of different therapeutic modalities: TSS + RT + SSA (group 1), TSS + SSA (group 2), SSA (group 3), TSS (group 4), TSS + RT (group 5). In patients treated with somatostatin analogues (SSA), tests were performed about midway between two injections.

Results  The number of deficiencies of the other pituitary functions (PD) was significantly higher in the groups that underwent RT (groups 1 and 5) than in the other groups; in both cases, P < 0·01. No significant differences were observed with regard to the mean GH, IGF‐I, ALS or IGFBP‐3 among the different treatment groups. A significant difference in the GH nadir was found between groups 2 and 4 (P = 0·042) and between groups 3 and 4 (P = 0·015). GH CV showed lower values in subjects who underwent RT (groups 1 and 5) than in the other groups. The difference was statistically significant between group 5 and groups 2, 3 and 4 (P < 0·05), between group 1 and groups 3 and 4 (P < 0·05), and between groups 2 and 4 (P = 0·007).

Conclusions  Our data confirm that radiation therapy decreases GH variability, and that this effect is probably due to hypothalamic damage, as already reported by others. In irradiated patients, a single random sample should therefore be sufficient to evaluate spontaneous GH secretion.
Phase‐shifts of 24‐h rhythms of hormonal release and body temperature following early evening administration of the melatonin agonist agomelatine in healthy older men
Authors: Leproult Rachel , Van Onderbergen Anne , L’Hermite‐Balériaux Mireille , Van Cauter Eve , Copinschi Georges
Published: August 2005

Objective  Older adults are less responsive to the phase‐shifting effects of light than younger subjects and may have difficulties adapting to abrupt time shifts. This study aims to determine whether the potent melatonin agonist agomelatine (S‐20098) is capable of phase‐shifting overt circadian rhythms in older adults.

Subjects and design  Eight healthy elderly men participated in a double‐blind, two‐period, cross‐over study of 15 days of daily administration of either agomelatine (50 mg) or placebo at 1830 h.

Measurements  At the end of each treatment period, the 24‐h profiles of body temperature and of the plasma levels of GH, PRL, cortisol and TSH were collected and sleep was monitored polygraphically.

Results  Phase‐advances, averaging nearly 2 h, were observed for the temperature profile and for the variables characterizing the temporal organization of cortisol secretion following agomelatine administration. A similar trend was observed for the circadian rise of plasma TSH. There was no effect of agomelatine on any of the sleep variables. Agomelatine stimulated GH secretion during the wake period and was associated with a transient elevation of PRL levels.

Conclusions  Melatonin agonists such as agomelatine may be useful to phase‐shift at least some overt circadian rhythms in older adults.
Erythropoietin administration does not influence the GH–IGF axis or makers of bone turnover in recreational athletes
Authors: Nelson A. E. , Howe C. J. , Nguyen T. V. , Seibel M. J. , Baxter R. C. , Handelsman D. J. , Kazlauskas R. , Ho K. K.
Published: August 2005

Objective  Measurement of biochemical markers of the IGF‐system and of collagen turnover is a potential approach to detect GH abuse in sport. These markers are increased in patients on dialysis treated with recombinant human erythropoietin (r‐HuEPO), mimicking the effects of GH. The aim was to determine whether r‐HuEPO induces similar effects on the IGF‐system and collagen turnover in healthy athletes.

Subjects and measurements  Young male Caucasian recreational athletes were administered 50 U/kg r‐HuEPO (n = 14) or placebo (n = 16) three times a week for 25 days, followed by a 4‐week wash‐out period. IGF‐I, IGFBP‐3, the acid labile subunit (ALS), N‐terminal propeptide of type I collagen (PINP), C‐terminal telopeptide of type I collagen (ICTP) and N‐terminal propeptide of type III collagen (PIIINP) were measured in samples collected at baseline (two samples), after 10, 22 and 24 days of r‐HuEPO treatment and at the end of the 4‐week wash‐out period.

Results  Treatment with r‐HuEPO resulted in approximately threefold elevation of serum EPO and marked elevation of markers of erythropoiesis. There was no significant treatment effect of r‐HuEPO compared to baseline on IGF‐I, IGFBP‐3, ALS, PINP, ICTP or PIIINP.

Conclusions  r‐HuEPO administration did not change markers of the IGF‐system and of collagen turnover in young healthy male athletes. Therefore, use of r‐HuEPO in athletes should not affect the validity of a GH doping test using these GH‐responsive markers.
Effects of 10 years of growth hormone (GH) replacement therapy in adult GH‐deficient men
Authors: Arwert Lucia I. , Roos Jan C. , Lips Paul , Twisk Jos W. R. , Manoliu Radu A. , Drent Madeleine L.
Published: August 2005

Objective  GH‐deficient adults have changes in body composition, bone mineral density (BMD) and lipid profile that can be altered by GH substitution. However, long‐term data on GH substitution (up to 10 years of follow‐up) are limited.

Design  The effects of 10 years of GH replacement therapy on BMD, body composition, bone parameters, serum lipids and glucose metabolism were studied.

Patients  Twenty‐three childhood‐onset GH‐deficient men (mean age at baseline 28·6 years) were studied during 10 years of GH substitution therapy. A group of 19 age‐matched healthy men served as a control group for BMD measurements at baseline and after 10 years.

Results  BMD of the lumbar spine increased during the 10 years of GH therapy. Bone markers and BMD in the hip increased during the first 5 years of GH therapy, but were not different from baseline after 10 years. BMD changes over time in the lumbar spine and femoral neck were significantly different in the patients compared to the controls. After 10 years the difference between the groups had decreased, but BMD was still higher in the controls than in the patients. Lipid profile had improved after 10 years of GH therapy, but body mass index (BMI), waist–hip ratio (WHR), fasting glucose and glycosylated haemoglobin (HbA1c) had increased compared to baseline.

Conclusions  This long‐term follow‐up study found that 10 years of GH substitution in GH‐deficient men causes sustained improvements in BMD in the lumbar spine and lipid profile but not in body composition.
Association of LMNA 1908C/T polymorphism with cerebral vascular disease and diabetic nephropathy in Japanese men with type 2 diabetes
Authors: Liang Hua , Murase Yuko , Katuta Yuko , Asano Akimichi , Kobayashi Junji , Mabuchi Hiroshi
Published: August 2005

Objective  The LMNA 1908C/T polymorphism has been reported to be associated with dyslipidaemia, metabolic syndrome, adipose tissue metabolism and obesity phenotypes, suggesting that this polymorphism presents an increased risk of atherosclerosis and vascular diseases. However, there have been no previous reports on the relationship between the LMNA 1908C/T polymorphism and vascular diseases. The aim of this study therefore was to investigate the association between the LMNA 1908C/T polymorphism and the prevalence of vascular disease in Japanese patients with type 2 diabetes.

Design  A cross‐sectional, hospital‐based study of diabetic complications with an LMNA gene background.

Patients  One hundred and sixty‐six Japanese men with type 2 diabetes.

Measurements  LMNA 1908C/T polymorphism (by polymerase chain reaction restriction fragment length polymorphism, PCR‐RFLP); diabetic retinopathy (by standard fundus photography); diabetic nephropathy (by urinary albumin excretion rate); diabetic neuropathy (by signs, symptoms and/or nerve conduction velocity); coronary heart disease (by symptoms of typical chest pain and/or history of myocardial infarction, and ischaemic electrocardiographic alteration and/or coronary artery bypass graft surgery); cerebral vascular disease (by ultrasonography, computed tomography and/or magnetic resonance imaging).

Results  Carriers of the LMNA 1908T allele manifested a significantly higher prevalence of diabetic nephropathy and cerebral vascular disease than carriers of the C allele. Multiple regression analysis showed that the LMNA 1908T allele tended to be associated with cerebral vascular disease, but was independent of age, hypertension, total cholesterol or triglyceride [odds ratio (OR) 7·03, P = 0·0611]. Similarly, the LMNA 1908T allele showed a significant association with diabetic nephropathy, not independent of total cholesterol or triglyceride.

Conclusions  The LMNA 1908C/T polymorphism plays an important role in the development of cerebral vascular disease and diabetic nephropathy in Japanese men with type 2 diabetes.
Surgical or medical decompression as a first‐line treatment of optic neuropathy in Graves’ ophthalmopathy? A randomized controlled trial
Authors: Wakelkamp I. M. M. J. , Baldeschi L. , Saeed P. , Mourits M. P. , Prummel M. F. , Wiersinga W. M.
Published: August 2005

Objective  Only a small percentage of Graves’ ophthalmopathy (GO) patients develop optic neuropathy with impending loss of visual acuity. Therapy with methylprednisolone pulses is the treatment of first choice in severe and active GO patients. When the effect is insufficient, patients are usually treated with surgical decompression. We investigated whether surgery could become the first‐line treatment, thus preventing treatment with steroids.

Design and subjects  We performed a randomized trial in 15 patients with very active GO and optic neuropathy. Six patients were treated with surgical decompression, and nine with methylprednisolone i.v. pulses for 2 weeks, followed by oral prednisone for 4 months. The primary outcome was determined by changes in visual acuity. If the eye disease deteriorated despite treatment or did not improve sufficiently, patients were switched to the other treatment arm.

Results  The severity and activity of GO in both groups were similar at baseline. The Clinical Activity Score (CAS) was 6·3 ± 0·8 in the surgical group vs. 6·0 ± 0·5 in the steroids group and the Total Eye Score was 24 ± 6 vs. 25 ± 6. In the surgery group, 5/6 patients (82%) did not respond because of insufficient improvement in vision (n = 3) or persistent chemosis (n = 2), and all needed further immunosuppression. In the steroids group, 4/9 patients (45%) did not improve in visual acuity (P = 0·132 vs. surgery group), and these needed decompressive surgery. All patients in whom therapy failed were switched to the other treatment arm and visual acuity improved in almost all patients. Visual acuity improved from 0·36 (0·02–0·40) to 0·90 (0·63–1·0) in the surgery group and from 0·50 (0·32–0·63) to 0·75 (0·32–1·0) in the steroids group at 52 weeks. At long‐term follow‐up in the surgery group 3/6 patients required squint surgery and 5/9 patients in the steroids group. Eyelid surgery was performed in 5/6 patients in the surgery group and in 4/9 patients in the steroids group.

Conclusion  Immediate surgery does not result in a better outcome and therefore methylprednisolone pulse therapy appears to be the first‐choice therapy.
Distribution and determinants of adiponectin, resistin and ghrelin in a randomly selected healthy population
Authors: Vilarrasa Nuria , Vendrell Joan , Maravall Javier , Broch Montse , Estepa Araceli , Megia Anna , Soler Joan , Simón Inma , Richart C. , Gómez Jose Manuel
Published: August 2005

Objective  Adiponectin, resistin, ghrelin and the IGF‐I system seem to play an important role in the regulation of body composition throughout life, but the mechanisms are not well understood. The aim of our study was to analyse the distribution among sexes and all decades of the adult life of adiponectin, resistin and ghrelin and their relationship with anthropometric, body composition parameters and the IGF‐I system.

Subjects  One hundred and thirty‐four men and 127 healthy women were included in the study.

Measurements  Plasma concentration of adiponectin, resistin, ghrelin, total IGF‐I, free IGF‐I and IGFBP‐3 were determined in all subjects. Body composition was evaluated by bioelectrical impedance.

Results  Resistin and ghrelin were not affected by age. Plasma adiponectin correlated negatively with age, body mass index (BMI), waist‐to‐hip ratio (WHR), waist circumference (WC), fat mass (FM) and body fat (BF) in men. Adiponectin correlated negatively with WHR and positively with free IGF‐I in women. Resistin correlated positively with BMI and WC only in men, and ghrelin correlated positively with WC, BMI and FM and negatively with free IGF‐I in men. In multiple regression analysis adiponectin remained associated with WHR (β = −0·19, P = 0·01) in women. Resistin was positively associated with BMI (β = 0·30, P = 0·003) in women and ghrelin was negatively related to free IGF‐I (β = −0·158, P = 0·019) in men.

Conclusions  Plasma adiponectin declines with age and is negatively associated with FM in men. Our data suggest the existence of a positive correlation of adiponectin and the IGF‐I axis in women and of an inverse relationship between ghrelin and the IGF‐I system in men.
Salivary cortisol determined by enzyme immunoassay is preferable to serum total cortisol for assessment of dynamic hypothalamic–pituitary–adrenal axis activity
Authors: Gozansky W. S. , Lynn J. S. , Laudenslager M. L. , Kohrt W. M.
Published: August 2005

Objective  The aim of this study was to determine whether salivary cortisol measured by a simple enzyme immunoassay (EIA) could be used as a surrogate for serum total cortisol in response to rapid changes and across a wide range of concentrations.

Design  Comparisons of matched salivary and serum samples in response to dynamic hypothalamic–pituitary–adrenal (HPA) axis testing.

Subjects  Healthy women (n = 10; three taking oral oestrogens) and men (n = 2), aged 23–65 years, were recruited from the community.

Measurements  Paired saliva and serum samples were obtained during three protocols: 10 min of exercise at 90% of maximal heart rate (n = 8), intravenous administration of corticotrophin‐releasing hormone (CRH; n = 4), and dexamethasone suppression (n = 7). Cortisol was measured in saliva using a commercial high‐sensitivity EIA and total cortisol was measured in serum with a commercial radioimmunoassay (RIA).

Results  The time course of the salivary cortisol response to both the exercise and CRH tests paralleled that of total serum cortisol. Salivary cortisol demonstrated a significantly greater relative increase in response to the exercise and CRH stimuli (697 ± 826%vs. 209 ± 150%, P = 0·04 saliva vs. serum). A disproportionately larger increase in free cortisol, compared with total, would be expected when the binding capacity of cortisol‐binding globulin (CBG) is exceeded. In response to dexamethasone suppression, relative decreases in cortisol were not significantly different between the two media (−47 ± 56%vs.−84 ± 8%, P = 0·13 saliva vs. serum). Although a significant linear correlation was found for all paired salivary and serum total cortisol samples (n = 183 pairs, r = 0·60, P < 0·001), an exponential model provided a better fit (r = 0·81, P < 0·001). The linear correlations were strengthened when data from subjects on oral oestrogens (n = 52 pairs, r = 0·75, P < 0·001) were separated from those not taking oestrogens (n = 131 pairs, r = 0·67, P < 0·001).

Conclusions  Salivary cortisol measured with a simple EIA can be used in place of serum total cortisol in physiological research protocols. Evidence that salivary measures represent the biologically active, free fraction of cortisol includes: (1) the greater relative increase in salivary cortisol in response to tests that raise the absolute cortisol concentration above the saturation point of CBG; (2) the strong exponential relationship between cortisol assessed in the two media; and (3) the improved linear correlations when subjects known to have increased CBG were analysed separately. Thus, an advantage of measuring salivary cortisol rather than total serum cortisol is that it eliminates the need to account for within‐subject changes or between‐subject differences in CBG.
Effect of gender and gonadal status on the long‐term response to somatostatin analogue treatment in acromegaly
Authors: Colao Annamaria , Pivonello Rosario , Cappabianca Paolo , Briganti Francesco , Tortora Fabio , Auriemma Renata S. , De Martino Maria Cristina , Marzullo Paolo , Lombardi Gaetano
Published: August 2005

Background  GH and IGF‐I secretion is related to gender and age.

Objective  To evaluate the impact of gender and gonadal status on the long‐term sensitivity to the somatostatin analogues depot octreotide long‐acting release (OCT‐LAR) and lanreotide (LAN).

Patients  Seventy‐three patients with active acromegaly (37 women, median age 34 years; 36 men, median age 38 years) who had not previously been treated with somatostatin analogues were studied: 24 women and 23 men were newly diagnosed; 22 men (61·1%) and 17 women (45·9%) had hypogonadism (P = 0·28). Exclusion criteria were age > 45 years, follow‐up less than 12 months, mixed GH/PRL‐secreting adenomas.

Study design  Observational, analytical, retrospective.

Outcome measures  (1) Disease control measured as serum GH < 2·5 µg/l and IGF‐I normal for age and gender; (2) reduction in tumour volume graded as absent (< 25%), mild (25–50%) and notable (> 50%).

Results  Basal GH, but not IGF‐I, levels were higher in women than in men both in the entire series and in ‘de novo’ patients (97·8 ± 42·2 vs. 71·1 ± 32·6 µg/l, P = 0·021). After 12 and 24 months of treatment, respectively, disease control was achieved similarly in men (57·1 and 86·7%) and women (48·6 and 86·7%). Hypogonadal men had longer disease duration than eugonadal men (P = 0·022), without any difference in the other parameters. No difference was found between eugonadal and hypogonadal women. Eugonadal men had a smaller tumour volume at baseline than eugonadal women (1396 ± 794 vs. 2896 ± 2871 mm3, P = 0·025). In men undergoing testosterone replacement and withdrawal, there was no change in GH and IGF‐I levels after 12 and 24 months of treatment with either LAR or LAN. In the seven women receiving oestro‐progestinic replacement, after 24 months of LAR or LAN treatment GH levels were higher during replacement than at withdrawal and IGF‐I levels were lower during replacement than withdrawal. Tumour volume decreased significantly in both women and men without any difference between them: the percentage tumour shrinkage in men and women was similar either after 12 (34·4 ± 24·4 vs. 40·7 ± 22·5%, P = 0·38) or 24 months of treatment (58·5 ± 17·4 vs. 56·1 ± 23·6%, P = 0·75). Similarly, there was no difference in tumour volume between hypogonadal and eugonadal women and men.

Conclusions  The results of this study demonstrate that long‐term responsiveness to OCT‐LAR is similar in women and men. Care should be taken in women with acromegaly and hypogonadism treated with somatostatin analogues and oral oestro‐progestinic as in this case GH levels are higher while IGF‐I levels are lower than after the somatostatin analogues alone.
The climate of the future: clues from three million years ago
Authors: Haywood Alan , Williams Mark
Published: August 2005

In the eighteenth century, James Hutton came up with a theory that revolutionized the science of geology, ‘The present is a key to the past’. But could the past also be a guide to our future? The world three million years ago was warmer than present. What might it tell us about global climate change in the near future?
Highlights of Jurassic Warwickshire
Authors: Radley Jonathan D.
Published: August 2005

Southern and eastern parts of the central English county of Warwickshire are underlain by a poorly exposed but well‐preserved and richly fossiliferous succession of Lower and Middle Jurassic strata. This article outlines the nature of the Jurassic sediments and their palaeoenvironments, and highlights some of the more important sites and discoveries.
Central venous catheter‐related infection due to Candida membranaefaciens, a new opportunistic azole‐resistant yeast in a cancer patient: a case report and a review of literature
Authors: Fanci Rosa , Pecile Patrizia
Published: August 2005

An unusual central venous catheter (CVC)‐related infection caused by Candida membranaefaciens in a patient with non‐Hodgkin's lymphoma is described. Clinical signs and microbiological results observed in this case may support the hypothesis of an emerging CVC‐related fungaemia, because of new azole‐resistant yeast, successfully treated with liposomal amphotericin B. To date C. membranaefaciens (the teleomorph of Pichia membranaefaciens) has traditionally been considered non‐pathogenic and this report seems to be the first case of systemic fungal infection. We believe that another fungus can be added to the list of opportunistic strains.
In vitro susceptibility of Cryptococcus neoformans clinical isolates from Egypt to seven antifungal drugs
Authors: Abdel‐Salam Hassan A.
Published: August 2005

The in vitro susceptibility of 29 clinical isolates of Cryptococcus neoformans to fluconazole, miconazole, itraconazole, ketoconazole, flucytosine, nystatin and amphotericin B was tested by broth and colorimetric microdilution methods. Most of the isolates showed uniform patterns of susceptibility to the used antifungal agents. Only three isolates exhibited resistance [fourfold or greater rise in the minimum inhibitory concentrations (MICs)] to the tested antifungal drugs. The MIC50 and MIC90 were 0.5–8 mg l−1 for 5‐flucytosine, 0.2–8.25 mg l−1 for nystatin, 0.5–16 mg l−1 for fluconazole and 0.2–12.5 mg l−1 for miconazole. However, MIC50 and MIC90 were in narrow range for the clinical yeast isolates in both methods used and showed 0.5–1 mg l−1 for amphotericin B and 0.016–0.25 mg l−1 for both ketoconazole and itraconazole. The combination of fluconazole plus flucytosine showed greater synergistic and fungicidal activity compared with that of fluconazole plus amphotericin B or the use of individual drugs.
The nail under fungal siege in patients with type II diabetes mellitus
Authors: Piérard Gérald E. , Piérard‐Franchimont Claudine
Published: August 2005

Few studies have examined the prevalence of onychomycosis among diabetic patients. Given the morbidity linked to onychomycosis, and the ever‐growing size of the diabetic population, a better recognition of this nail infection is welcome. To revisit the relative prevalence of dermatophyte, yeast and non‐dermatophytic mould onychomycoses in diabetic adults in a prospective study using combined histomycology and cultures. Toenail clippings were collected for 3 years in 190 type II diabetic patients (136 men and 54 women) and from an age‐ and gender‐matched group of non‐diabetic subjects. All sampled nails showed clinical alterations reminiscent of onychomycosis. Histomycology and cultures were performed on each sample to distinguish onychomycosis from non‐infectious onychodystrophy. Compared to non‐diabetic subjects with nail alterations, diabetics showed a higher proportion of onychomycosis relative to non‐fungal onychodystrophy. Diabetic men suffered more frequently from onychomycosis and onychodystrophy than diabetic women. When considering the nature of the fungal pathogens, dermatophytes predominated largely over yeast and non‐dermatophytic moulds, both in diabetic and non‐diabetic patients. Diabetic patients, particularly men, are at increased risk of developing onychomycosis. The morbidity linked to this disorder, and its impact on the foot status in diabetic subjects merit to be better appreciated by clinicians.
Immunolocalization of secretory proteins of Aspergillus fumigatus using monospecific polyclonal antibodies in a murine model
Authors: Raghuwanshi S. K. , Kumar M. , Kavishwar A. , Chaturvedi A. K. , Murthy P. S. R. , Shukla P. K.
Published: August 2005

The incidence of life‐threatening mycoses caused by opportunistic fungi has increased dramatically in recent years with members of the genera Candida and Aspergillus being the most commonly encountered species. Prompt initiation of antifungal therapy for good prognosis of such cases is highly dependent on accurate diagnosis. The potential of metabolic antigens in the diagnosis of aspergillosis was investigated in the present study. Two proteins of 18 and 70 kDa were identified with success rate of 35% and 60% respectively based on their reactivity with patient sera of clinically diagnosed cases of aspergillosis. The antibodies raised against 70 and 18 kDa proteins in rabbits were found to be useful in detection of A. fumigatus in the kidneys of a mouse model of aspergillosis.
Antifungal activities of extracts from Thai medicinal plants against opportunistic fungal pathogens associated with AIDS patients
Authors: Phongpaichit Souwalak , Subhadhirasakul Sanan , Wattanapiromsakul Chatchai
Published: August 2005

In this study, 36 extracts derived from 10 plant species were selected to screen for their antifungal activity against clinical isolates of Candida albicans, Cryptococcus neoformans and Microsporum gypseum. Selection was based on their use by traditional Thai healers or their reported antimicrobial activities in an attempt to find bioactive medicines for use in the treatment of opportunistic fungal infections in AIDS patients. The disc diffusion and hyphal extension–inhibition assays were primarily used to test for inhibition of growth. Minimum inhibitory concentration was determined by dilution methods. The chloroform extracts of Alpinia galanga and Boesenbergia pandurata had pronounced antifungal activity against C. neoformans and M. gypseum, but exhibited weak activity against C. albicans. Alpinia galanga and B. pandurata are excellent candidates for the development of a remedy for opportunistic fungal infections in AIDS patients.
Prevalence of Candida dubliniensis among germ tube‐positive Candida isolates in a maternity hospital in Kuwait
Authors: Al‐Sweih Noura , Ahmad Suhail , Khan Zia U. , Khan Seema , Chandy Rachel
Published: August 2005

In this study, 1644 germ tube‐positive Candida isolates from a maternity hospital was prospectively examined for the prevalence of Candida dubliniensis. Candida species were isolated from different clinical specimens, but majority (>90%) of them came from high vaginal swabs and urine specimens. The phenotypic and molecular identification methods for C. dubliniensis included production of rough colonies and chlamydospores on simplified sunflower seed agar, determination of assimilation profile by Vitek 2 yeast identification system, specific amplification of rDNA of internally transcribed spacer (ITS)‐2 region by semi‐nested PCR and direct DNA sequencing of the ITS‐1 and ITS‐2 regions. Three germ tube‐positive Candida isolates were identified as C. dubliniensis with an overall prevalence of 0.2%. Of these, two came from urine specimens and one from a vaginal swab. None of the C. dubliniensis isolates showed resistance against fluconazole, voriconazole and amphotericin B. The study reinforces the usefulness of sunflower seed agar in presumptive identification of C. dubliniensis and confirms the prevailing view that this species forms only a minor constituent of Candida species occurring in vagina or other anatomic sites of non‐HIV/AIDS‐infected individuals.
Acid proteinase, phospholipase and adherence properties of Candida parapsilosis strains isolated from clinical specimens of hospitalised patients
Authors: Dagdeviren M. , Cerikcioglu N. , Karavus M.
Published: August 2005

In this study, we investigated the presence of virulence factors in a total of 33 Candida parapsilosis strains, including adherence, acid proteinase and phospholipase production capabilities. Of the 33 strains, 19 were isolated from blood cultures of hospitalised fungaemic patients (study group 2). We also investigated the importance of other factors present in the development of fungaemia. The mean adherence values of 19 blood isolates and 14 non‐blood isolates were found to be 52.63 and 57.96, respectively; these values did not differ significantly (P > 0.05). Nine non‐blood strains (64.29%) of study group 2 and five blood strains (26.31%) of study group 1 were found to be positive for acid proteinase production; this difference was statistically significant (P < 0.05). Phospholipase production was found in five strains (26.31%) of the 19 blood isolates. None of the 14 non‐blood strains exhibited phospholipase activity; this difference between the two groups was statistically significant (P < 0.05). In this study, correlations between adherence‐phospholipase, and adherence‐acid proteinase properties of strains were detected as well. In the present study, it has been observed that phospholipase production can be an important virulence factor in bloodstream infections caused by C. parapsilosis.
Qualitative evaluation of regular morning meetings aimed at improving interdisciplinary communication and patient outcomes
Authors: Aston Judy , Shi Edward , Bullôt Helen , Galway Robyn , Crisp Jackie
Published: August 2005

Effective interdisciplinary communication is at the heart of clinical decision‐making in contemporary health‐care environments. Efforts to enhance communication and work processes among nurses and doctors in an infants‐and‐toddler ward of a specialist paediatric hospital led to the establishment of Surgical Morning Meetings (SMMs). To evaluate the experiences of nursing and medical team members and their perceptions of the changes brought about by the SMM, qualitative evaluation of the SMM was undertaken through semistructured interviews. The analysis identified four major areas of impact: predictability: a nice way to start the day, which captured the ways in which the SMM led to better planning of the day's activities, knowledge and perspectives: learning from each other, which highlighted the way that ongoing discussions led to greater understanding and respect, relationships and support: getting to know you, which reflected the benefits derived from greater commitment, and desired outcomes: making a difference to staff, children and families. Overall, we believe that initiatives as simple as discussions among nurses and doctors can enhance personal and professional experience and lead to improved health outcomes for our patients.
The effects of a cognitive behavioural therapy programme for self‐care on haemodialysis patients
Authors: Nozaki Chieko , Oka Michiyo , Chaboyer Wendy
Published: August 2005

A nurse‐delivered haemodialysis patient education programme incorporating cognitive behavioural therapy (CBT) was developed. The effects of the CBT programme were compared with those of a standard patient education (SPE) programme on patients’ salt intake and weight gain using a quasi‐experimental design. There were 22 participants (11 CBT, 11 SPE) undergoing outpatient haemodialysis therapy at one clinic. Daily weight gain rates decreased in the intervention period compared with the baseline period in both the CBT and SPE groups. This effect lasted for 12 weeks in the CBT group but for only eight weeks in the SPE group. In addition, daily salt intake decreased in the intervention period compared with the baseline period in both the CBT and SPE groups, persisting for 12 weeks. From these results, both programmes were shown to be effective, but CBT had a longer effect.
Less money, less care: How nurses in long‐term care allocate hours of needed care in a context of chronic shortage
Authors: Morin Diane , Leblanc Nancy
Published: August 2005

The average funding of long‐term care in Quebec, Canada, currently covers < 70% of the care hours required, which means that 30% of needs are unmet. The aims of this study were to understand how nurses, when they are in a position to do so, assign care hours, which needs are unmet by care dimensions and whether dimensions with unmet needs vary with client profiles. One‐hundred‐and‐four nurses working in long‐term care facilities participated in the study. They filled out individual questionnaires containing three case studies in the form of vignettes. When obliged to cut 30% of the care hours, the nurses ensured that treatment and diagnostic methods were done as prescribed and that vital feeding and elimination functions were preserved. However, they made the choice to cut some mobility and personal‐care activities and, especially, communication with patients, families and other professionals. In this, they partly follow the theoretical care prioritization approach of Lefebvre and Dupuis, who take into account the degree of discomfort caused by the situation, the problem's place in Maslow's hierarchy of needs and the availability of a solution. Thus, although the choices made by the nurses follow a logical pattern, they could result in medium‐term deterioration in the functional autonomy of their older patients. The overall consequences of these decisions are discussed.
The influence of HIV/AIDS on the practice of primary care nurses in Jordan: Rhetoric and reality
Authors: Nawafleh Hani , Francis Karen , Chapman Ysanne
Published: August 2005

The role of nurses in raising community awareness about HIV/AIDS is well‐reported. However, little is known about the practice of Jordanian nurses and the role they play in the prevention and control of HIV/AIDS. This interpretive ethnographic study sought to illuminate the role of primary care nurses and examine the influence of HIV/AIDS on their practice. The study was undertaken in Jordan in three rural and three urban primary health‐care centres. Data collection included participant observation, key informant interviews and document analysis. These data informed the development of descriptive ethnographic accounts that allowed for the subsequent identification of common and divergent themes reflective of factors recognized as influencing the practice of the nurse participants. The findings indicate that the rhetoric offered by all levels of administration and endorsed in policy is not reflective of the reality of practice. Poor resources and educational preparation, a limited nursing skill mix and access to professional development, lack of nursing leadership and role models, cultural beliefs and geographic isolation are factors that reduced the capacity of the primary care nurses to raise awareness and, therefore, influence the prevention and control of HIV/AIDS.
Analysis of adenocarcinoma of the colon and rectum: detection of human papillomavirus (HPV) DNA by polymerase chain reaction
Authors: Pérez L. O. , Abba M. C. , Laguens R. M. , Golijow C. D.
Published: August 2005

Objective  The aim of the present work was to evaluate the presence of human papillomavirus genotypes in malignant and normal mucosa of the colon and rectum in order to determine if a relationship exists between HPV infection and colon neoplasms.

Materials and methods  Thirty normal colon tissues and 54 sporadic adenocarcinomas were screened for HPV positivity using nested‐PCR. Detection of viral types 6, 11, 16, 18, 33, 34 and 51 was performed by the LIS‐SSCP (Low Ionic Strength‐Single Strand Conformational Polymorphism) procedure.

Results  Significant differences in high risk HPV infection were found between normal samples and adenocarcinomas (P < 0.001). Among the cases, an inverse association between HPV infection and Dukes staging was also found (P = 0.020). Finally, there was no significant association between HPV and some classical clinicopathological features, although a gradient of infection form rectum to cecum was evident.

Conclusion  The present study demonstrates that HPV may infect the glandular mucosa of the colon and suggests a possible association between HPV and colorectal cancer.
Thirty‐day mortality after surgery for colorectal cancer in Denmark
Authors: Nickelsen T. N. , Jørgensen T. , Kronborg O.
Published: August 2005

Objective  This study aimed to estimate the 30‐day mortality after colorectal cancer (CRC) surgery in Denmark. Mortality was compared to other studies, and between departments, unadjusted and adjusted for case‐mix.

Materials and methods  All patients in Denmark with a first‐time colorectal adenocarcinoma operated between 1 May 2001 and 31 December 2002 were eligible, 5187 patients were included. Mortality was adjusted for age, sex, urgency, tumour location, Dukes' stage and ASA‐score.

Results  The 30‐day mortality in Denmark after CRC‐surgery was 9.9%. Adjusted for case‐mix, four departments had significantly higher mortality than average. The variation between the 44 departments was significant both for radically operated (P = 0.02) patients and for all operated patients (P = 0.01).

Conclusion  The 30‐day mortality in Denmark seems to be higher than in studies from other countries, but the lack of comparable nationwide studies makes it difficult to evaluate. To uncover the reasons for the departments to diverge significantly from average, further studies are needed.
Effect of sacral neuromodulation for faecal incontinence on sexual activity
Authors: Jarrett M. E. D. , Nicholls R. J. , Kamm M. A.
Published: August 2005

Introduction  Faecal incontinence affects a percentage of the population and can have a significant effect on their ability to establish and maintain sexual relations.

Patients and methods  Sixteen consecutive patients with permanent sacral neuromodulation (SNM) for faecal incontinence completed a ‘Sex Life Questionnaire’ at their follow up visit to ascertain whether there was any improvement in this aspect of their life.

Results  Nine of the sixteen patients was sexually active. These nine patients (median age 56 (35–61) years) had a significant reduction in faecal incontinence episodes per week from a median of 12 (1–55) to 1.5 (0–8.5) (P = 0.008). All nine patients reported that their sex life had been affected by feacal incontinence prior to SNM and seven had felt benefit from implantation. The median improvement in their sex life was 40% (1–100) and the percentage improvement was inversely correlated to age (r = −0.834, P = 0.005).

Conclusion  SNM improves the quality of sexual activity in 78% of patients. More improvement seems to be gained the younger the patients.