bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved long‐term graft function in kidney transplant recipients with donor antigen‐specific hyporeactivity
Authors: Ferraris Jorge R. , Tambutti Mónica , Prigoshin Norma
Published: October 2006

Abstract:   We investigated the development of donor antigen‐specific hyporeactivity by using donor cells as stimulator cells in the MLC and comparing the pre‐ and post‐transplant responses of peripheral blood mononuclear cells. Twenty‐two haploidentical pediatric living‐relative donor recipients treated with daclizumab, methylprednisone, mofetil mycophenolate and calcineurin inhibitors were tested for study. Of these, 50% of the recipients developed in vitro donor antigen‐specific hyporeactivity. The recipients who did so have higher creatinine clearance levels at 12, 24 and 36 months post‐transplant (104, 92 and 81 mL/min/1.73 m2, respectively) than those who remained responsive to donor antigens (77, 74 and 70 mL/min/1.73 m2) (p < 0.05). Acute rejection episodes were not observed; however, no recipients with donor‐specific hyporeactivity have been diagnosed with CAN, unlike three recipients who remained responsive to donor antigens (0% vs. 27.3%, p = 0.06). Differences in accumulative doses of methylprednisone and mofetil mycophenolate were observed between hyporeactivity‐ and response‐patients to donor antigens at the three years end‐point (1.9 ± 0.8 g/m2 vs. 4.2 ± 0.5 g/m2, and 277 ± 89 g/m2 vs. 672 ± 16.0 g/m2; p < 0.01 and <0.02, respectively). We conclude that the development of donor antigen‐specific hyporeactivity correlate with improved graft function and may permit lower immunosuppression.
Bilateral laparoscopic nephrectomy with simultaneous peritoneal dialysis catheter implantation
Authors: Martínez Urrutia M.J. , Olivares Arnal P. , López Pereira P. , Lobato Romera R. , Alonso Melgar A. , Jaureguizar Monereo E.
Published: October 2006

Abstract:   Bilateral nephrectomy prior to transplantation is indicated in some patients with end‐stage renal disease. The indications for bilateral nephrectomy include persistent heavy proteinuria, refractory hypertension, and urinary tract infections. We report an eight‐month‐old baby with male pseudohermaphroditism and renal failure secondary to diffuse mesangial sclerosis. While awaiting renal transplantation, dialysis became necessary and the child presented standard drug therapy‐resistant hypertension. A bilateral nephrectomy was performed simultaneously to peritoneal dialysis catheter implantation by using laparoscopy. At the present time, the patient is doing well with ambulatory dialysis and all antihypertensive medication has been discontinued. We recommend this technique in children who require bilateral nephrectomy and peritoneal dialyisis. Not only is it somewhat less aggressive than traditional open surgery, but it also reduces post‐operative pain, allows earlier initiation of peritoneal dialysis, and improves cosmetic appearance.
Suicidal risk in bipolar I disorder patients and adherence to long‐term lithium treatment
Authors: Gonzalez‐Pinto Ana , Mosquera Fernando , Alonso Marta , López Purificación , Ramírez Fernando , Vieta Eduard , Baldessarini Ross J
Published: October 2006

Objectives:  Among the well‐established treatments for bipolar disorder (BPD), lithium continues to offer an unusually broad spectrum of benefits that may include reduction of suicidal risk.

Methods:  We examined the association of suicidal acts with adherence to long‐term lithium maintenance treatment and other potential risk factors in 72 BP I patients followed prospectively for up to 10 years at a Mood Disorders Research Center in Spain.

Results:  The observed rates of suicide were 0.143, and of attempts, 2.01%/year, with a 5.2‐fold (95% CI: 1.5–18.6) greater risk among patients consistently rated poorly versus highly adherent to lithium prophylaxis (11.4/2.2 acts/100 person‐years). Treatment non‐adherence was associated with substance abuse, being unmarried, being male, and having more hypomanic–manic illness and hospitalizations. Suicidal risk was higher with prior attempts, more depression and hospitalization, familial mood disorders, and being single and younger, as well as treatment non‐adherence, but with neither sex nor substance abuse. In multivariate analysis, suicidal risk was associated with previous suicidality > poor treatment adherence > more depressive episodes > younger age.

Conclusions:  The findings support growing evidence of lower risk of suicidal acts during closely monitored and highly adherent, long‐term treatment with lithium and indicate that treatment adherence is a potentially modifiable factor contributing to antisuicidal benefits.
Approximate entropy of self‐reported mood prior to episodes in bipolar disorder
Authors: Glenn Tasha , Whybrow Peter C , Rasgon Natalie , Grof Paul , Alda Martin , Baethge Christopher , Bauer Michael
Published: October 2006

Background:  Approximate entropy (ApEn) measures regularity in time series data, while traditional linear statistics measure variability. Using self‐reported mood data from patients with bipolar disorder, this preliminary study addressed whether ApEn could distinguish (i) the 60 days prior to the start of a manic or depressed episode from the 60 days prior to a month of euthymia, and (ii) the 60 days prior to a manic episode from the 60 days prior to a depressed episode.

Methods:  Self‐reported mood data from 49 outpatients with bipolar disorder receiving standard treatment were analysed. The data contained 27 episodes (12 manic and 15 depressed), and 43 periods of 1 month of euthymia. For the 60 days prior to episode or euthymia, the ApEn, linear statistics and the correlation between linear and non‐linear measures were calculated.

Results:  ApEn was significantly greater in the 60 days prior to a manic or depressive episode than the 60 days prior to a month of euthymia. The onset of an episode was associated with greater irregularity in mood. Variability was also significantly larger and correlated with ApEn. ApEn was significantly greater in the 60 days prior to a manic episode than in the 60 days prior to a depressed episode, whereas measures of variability were not significantly different. Mood in the 60 days prior to mania was more irregular than prior to depression.

Conclusions:  Non‐linear measures may complement traditional linear measures in the analysis of longitudinal data in bipolar disorder. A larger study is indicated.
EDARAVONE REDUCES MYOCARDIAL INFARCT SIZE AND IMPROVES CARDIAC FUNCTION AND REMODELLING IN RABBITS
Authors: Onogi Hirohito , Minatoguchi Shinya , Chen Xue‐Hai , Bao Narentuoya , Kobayashi Hiroyuki , Misao Yu , Yasuda Shinji , Yamaki Takahiko , Maruyama Rumi , Uno Yoshihiro , Arai Masazumi , Takemura Genzou , Fujiwara Hisayoshi
Published: October 2006

In the present study, we investigated the effect of 3‐methyl‐1‐phenyl‐2‐pyrazolin‐5‐one (edaravone), a free radical scavenger, on myocardial infarct (MI) size and cardiac function in an in vivo model of MI in rabbits. We further investigated the contribution of hydroxyl radicals, superoxide and nitric oxide (NO) to its effects.

Anaesthetized open‐chest Japanese white male rabbits were subjected to 30 min coronary occlusion and 48 h reperfusion. The control group (n = 10) was injected with saline 10 min before reperfusion. The edaravone group (n = 10) was injected with a bolus of 3 mg/kg edaravone 10 min before reperfusion. The edaravone + NG‐nitro‐l‐arginine methyl ester (l‐NAME) group (n = 5) was given 10 mg/kg, i.v., l‐NAME 10 min before the administration of 3 mg/kg edaravone. The l‐NAME group (n = 5) was given 10 mg/kg, i.v., l‐NAME 20 min before reperfusion. Infarct size was measured using the triphenyl tetrazolium chloride method and is expressed as a percentage of area at risk. Cardiac function was assessed by echocardiography 14 days after infarction.

In another series of experiments, rabbits were subjected to 30 min coronary occlusion and 30 min reperfusion and myocardial interstitial 2,3‐dihydroxybenzoic acid (DHBA) and 2,5‐DHBA levels, indicators of hydroxyl radical, were measured using a microdialysis technique.

Infarct size in the edaravone group was significantly reduced compared with that in the control group (27.4 ± 6.8 vs 43.4 ± 6.8%, respectively; P < 0.05). The edaravone‐induced reduction of infarct size was abolished by pretreatment with l‐NAME. Myocardial interstitial levels of 2,3‐DHBA and 2,5‐DHBA increased 20 and 30 min after ischaemia and peaked at 10 min reperfusion in the control group. Edaravone significantly inhibited the increase in 2,3‐DHBA and 2,5‐DHBA levels seen during reperfusion. Dihydroethidium staining showing in situ detectoion of superoxide was less intense in ischaemic myocardium in the edaravone‐treated group compared with the control group. Edaravone improved cardiac function and left ventricular remodelling 14 days after infarction.

In conclusion, edaravone significantly reduces MI size and improves cardiac function and LV remodelling by decreasing hydroxyl radicals and superoxide in the myocardium and increasing the production of NO during reperfusion in rabbits.
KYNURENINE PATHWAY METABOLISM IN PATIENTS WITH OSTEOPOROSIS AFTER 2 YEARS OF DRUG TREATMENT
Authors: Forrest Caroline M , Mackay Gillian M , Oxford Lynn , Stoy Nicholas , Stone Trevor W , Darlington L Gail
Published: October 2006

Metabolism of tryptophan along the oxidative pathway via kynurenine results in the production of quinolinic acid and kynurenic acid, which can act on glutamate receptors in peripheral tissues. We have now measured the concentrations of kynurenine pathway metabolites in the plasma of patients with osteoporosis before treatment with drugs, throughout and after 2 years of treatment with the drugs raloxifene or etidronate. Oxidative stress was assessed by measuring levels of the lipid peroxidation products malondialdehyde and 4‐hydroxynonenal. Kynurenines were analysed by HPLC. Bone density was measured using dual‐energy X‐ray absorptiometry scans.

Patients with osteoporosis showed significantly lower baseline levels of 3‐hydroxyanthranilic acid compared with healthy controls, but significantly higher levels of anthranilic acid and lipid peroxidation products. After 2 years treatment with etidronate and calcium, we observed significant therapeutic responses quantified by bone densitometric scanning. Significant improvements were not seen in patients treated with raloxifene.

In parallel, the levels of 3‐hydroxyanthranilic acid, anthranilic acid and lipid peroxidation products were restored to control values by both drug treatments studied and tryptophan levels were increased significantly compared with baseline values.

The results suggest that tryptophan metabolism is altered in osteoporosis in a manner that could contribute to the oxidative stress and, thus, to progress of the disease. The oxidative metabolism of tryptophan (the kynurenine pathway) could represent a novel target for the development of new drugs for the treatment of osteoporosis. In addition, we noted that etidronate is a more effective drug than raloxifene, but that the simultaneous use of non‐steroidal anti‐inflammatory drugs may reduce the efficacy of etidronate.
Floral changes in calcareous nannofossils and their paleoceanographic significance in the equatorial Pacific Ocean during the last 500 000 years
Authors: Chiyonobu Shun , Sato Tokiyuki , Narikiyo Reika , Yamasaki Makoto
Published: October 2006

Abstract  The late Quaternary calcareous nannofossil assemblages from Ocean Drilling Program Holes 807A and 846B, located in the western and eastern equatorial Pacific Ocean, respectively, were analyzed to clarify changes in surface‐water conditions during the last 500 000 years. The uppermost Quaternary sediments in both holes contain abundant nannofossils, and their assemblages are characterized by high species diversity. The absolute abundances of coccoliths (specimens/g) and relative numbers of small reticulofenestrids decreased drastically in both holes between 0.3 and 0.2 Ma, whereas the relative abundance of warm‐water species and Florisphaera profunda increased suddenly at this time. These data indicate that upwelling around the western and eastern equatorial Pacific regions weakened after 0.2 Ma, which was caused by a decrease in trade‐wind strength.
In situ hydraulic tests in the active fault survey tunnel, Kamioka Mine, excavated through the active Mozumi‐Sukenobu Fault zone and their hydrogeological significance
Authors: Nohara Tsuyoshi , Tanaka Hidemi , Watanabe Kunio , Furukawa Noboru , Takami Akira
Published: October 2006

Abstract  The spatial hydrogeological and structural character of the active Mozumi‐Sukenobu Fault (MSF) was investigated along a survey tunnel excavated through the MSF in the Kamioka Mine, central Japan. Major groundwater conduits on both sides of the MSF are recognized. One is considered to be a subvertical conduit between the tunnel and the surface, and the other is estimated to be a major reservoir of old meteoric water alongside the MSF. Our studies indicate that part of the MSF is a sub‐vertical continuous barrier that obstructs younger meteoric water observed in the south‐eastern part of the Active Fault Survey Tunnel (AFST) and water recharge to the rock mass intersected by the north‐western part of the AFST. The MSF might be a continuous barrier resulting in the storage of a large quantity of older groundwater to the northwest. The observations and results of in situ hydraulic tests indicate that the major reservoir is not the fault breccia associated with the northeast–southwest trending faults of the MSF, but the zone in which blocks of fractured rocks occur beside high angle faults corresponding to X shears whose tectonic stress field coincides with the present regional stress field and antithetic Riedel shears of the MSF. The results from borehole investigations in the AFST indicate that secondary porosity is developed in the major reservoir due to the destruction of filling minerals and fracture development beside these shears. The increase in hydraulic conductivity is not directly related to increased density of fractures around the MSF. Development of secondary porosity could cause the increase in hydraulic conductivity around the MSF. Our results suggest that minor conduits of the fracture network are sporadically distributed in the sedimentary rocks around the MSF in the AFST.
Determinants of sufficient daily activity in Australian primary school children
Authors: Spinks Anneliese , Macpherson Alison , Bain Chris , McClure Roderick
Published: October 2006

Aims:  Australian guidelines recommend that children participate in at least one hour of physical activity every day. We aimed to measure physical activity participation in a random sample of Australian primary school children and to determine the biological, behavioural, environmental and social influences associated with insufficient daily activity.

Method:  We analysed the following cross‐section data from a randomly selected sample of children (N = 518) aged 5 to 12 years: age, gender, socioeconmic status (SES) indicators, family size, home play equipment availability, transport method to school, and estimated time per week in physical and sedentary activity. Logistic regression analysis was performed to determine variables that were associated with insufficient (<60 minutes) daily activity.

Results:  Seventy‐six children (15% of the cohort) failed to meet the minimum activity recommendations of 60 minutes of daily activity. These children were significantly less likely to walk or cycle to school (adjusted odds ratio (OR) 0.43; 95% CI = 0.24 − 0.77) or participate in organised sports or activity (OR 0.42; 95% CI = 0.28 − 0.64) and were more likely to spend in excess of 2 hours a day watching television of using a computer for entertainment (OR 2.10 (1.16 − 3.78). Age, gender, SES and family size were not significantly associated with insufficient activity.

Conclusion:  There exists a significant proportion of the paediatric population who are insufficiently active. Interventions to encourage increased activity in this sub‐group may be successful if they seek to alter sedentary behaviour (namely television use) and method of transportation to and from school.
Evaluation of first unprovoked seizures in children by general paediatricians in New Zealand
Authors: Johnson Rachel E , Nolan Melinda A
Published: October 2006

Aim:  To determine current practice of general paediatricians in New Zealand in the investigation and management of a first unprovoked seizure in childhood.

Methods:  A self‐administered questionnaire was emailed to 109 general paediatricians in New Zealand. The questionnaire presented the participant with three hypothetical case scenarios representing a generalised tonic clonic seizure, a complex partial seizure and an episode of non‐specific collapse. The participant was asked to indicate what investigations and course of management was required.

Results:  Forty‐seven questionnaires were returned. Primary investigations included an electroencephalogram (EEG) in 47% of cases after a first generalised tonic clonic seizure increasing to 89% after a second. Ninety‐one per cent of paediatricians were likely to request an EEG after a complex partial seizure. No paediatrician would request neuroimaging following a first generalised tonic clonic seizure. Neuroimaging was requested by 10% of paediatricians following a second generalised tonic clonic seizure and by 47% following a complex partial seizure. No paediatrician elected to initiate antiepileptic drugs after a first generalised tonic clonic seizure, but 49% would initiate treatment after a second generalised tonic clonic seizure. Eleven per cent of paediatricians would start treatment after a single complex partial seizure.

Conclusion:  Less than 50% of general paediatricians would request an EEG after a first unprovoked seizure. This is an unexpectedly low rate that may reflect accessibility. New Zealand paediatricians had an appropriately low rate of requesting neuroimaging. As currently recommended no general paediatricians began antiepileptic drugs in the scenario of a single uncomplicated seizure in the absence of other risk factors.
Immunohistochemical study of the relationship between Ki‐67 labeling index of proliferating cells of gynecomastia, histological phase and duration of disease
Authors: Kono Seishi , Kurosumi Masafumi , Simooka Hanako , Kawanowa Kaori , Ninomiya Jun , Takei Hiroyuki , Suemasu Kimito , Kuroda Yoshikazu
Published: October 2006

Gynecomastia is a benign proliferative lesion caused by various etiological factors and may result from a relative imbalance between serum estrogen and androgen levels. The histological alterations are similar, and gynecomastia can progress from a florid type to a fibrous type. The Ki‐67 labeling index (LI) of gynecomastia specimen was investigated and higher Ki‐67 LI was observed in florid and intermediate than in fibrous gynecomastia (P = 0.017). A correlation was found between the duration of disease and Ki‐67 LI (P = 0.041): the shorter the duration the higher the Ki‐67 LI. Thus, Ki‐67 LI seems a useful tool to examine proliferation activity of gynecomastia and can assist in determination of appropriate treatment of gynecomastia with hormonal therapy.
SMARCB1/INI1 missense mutation in mucinous carcinoma with rhabdoid features
Authors: Cho Yong Mee , Choi Jene , Lee Ok‐Jun , Lee Hyang‐Im , Han Duck Jong , Ro Jae Y.
Published: October 2006

Malignant rhabdoid tumor (MRT) is a rare and aggressive tumor associated with deletion or mutation of a tumor suppressor gene SMARCB1/INI1, a member of the SWI/SNF chromatin‐remodeling complex. Reported herein is a case of pancreatic mucinous carcinoma accompanying rhabdoid features with immunohistochemical and ultrastructural studies as well as analysis of the SMARCB1/INI1 gene. A 65‐year‐old woman presented with a 2 month history of abdominal and chest pain. A well‐defined grayish tan fish‐flesh mass (11 × 9 × 7 cm) with focal mucinous area was present in the pancreatic tail. Microscopically, the tumor had a biphasic growth pattern: a mucinous carcinoma component and a poorly differentiated carcinoma component with rhabdoid features showing loosely cohesive cells with abundant eosinophilic cytoplasm, displaced nuclei, and prominent nucleoli. The rhabdoid component coexpressed vimentin and cytokeratin. Sequencing analysis of the DNA extracted from the mucinous and rhabdoid components showed a missense mutation CCC to ACC in codon 116 of the SMARCB1/INI1 gene. Being aware of rhabdoid features would help diagnose this rare and aggressive malignant tumor and may provide an opportunity for further evaluation of SMARCB1/INI1 gene alteration and determination of its prognostic significance.
De novo cancers and post‐transplant lymphoproliferative disorder in adult liver transplantation
Authors: Aseni Paolo , Vertemati Maurizio , De Carlis Luciano , Sansalone Cosimo Vincenzo , Bonacina Edgardo , Minola Ernesto , Oreste Pierluigi , Vizzotto Laura , Rondinara Gianfranco
Published: October 2006

De novo cancer is one of the most serious complications after organ transplantation. Chronic immunosuppression, viral agents, pretransplant chronic alcohol‐induced and other addictive behavior‐induced injury are important conditions associated with the development of de novo cancers in solid organ transplants. The aim of the study was to evaluate types and clinical course of de novo cancers in adult liver transplant recipients. Data regarding 502 adult patients who underwent to 554 liver transplantations have been collected. Sex, age at transplantation, immunosuppressive regimen, time from transplantation to diagnosis of cancer, cancer type, surgical and non‐surgical treatments and follow‐up time have been analyzed as well as acute rejection episodes and viral status. Thirty patients developed 31 de novo cancers. The predominant tumors were carcinoma of the skin, lymphomas and Kaposi's sarcoma. Kaposi's sarcoma and lung cancer were associated with greater mortality. In lymphomas and Kaposi's sarcoma, a high rate of graft involvement was observed. In liver transplant recipients, de novo cancers demand strategies focusing on prophylactic and careful long‐term screening protocols. Lymphomas and Kaposi's sarcoma should be ruled out in all patients with clinical manifestations of chronic biliary obstruction.
Transbronchial needle aspiration cytology of subcarinal lymph nodes for the staging procedure in the diagnosis of lung cancer
Authors: AONO Hiromi , OKAMOTO Hiroaki , KUNIKANE Hiroshi , NAGATOMO Akira , WATANABE Koshiro , NAGAI Atsushi
Published: October 2006

Objective and background:  The aim of this study was to improve the staging of lung cancer with or without lymphadenopathy on chest CT by using transbronchial aspiration cytology (TBAC).

Methods:  TBAC of the subcarinal lymph nodes was performed on 153 consecutive patients with lung cancer, with or without subcarinal lymphadenopathy on chest CT.

Results:  Thirty‐four patients had enlargement of the subcarinal lymph nodes (>1 cm). Eighteen of these had TBAC confirmation of metastases. Another seven patients with no mediastinal involvement on CT were positive for metastases on TBAC. TBAC was the only way to confirm lung cancer in two patients. Therefore, routinely performed subcarinal TBAC contributed to an improved non‐operative staging of the patients and diagnosis in 16% (25/153) of the patients with lung cancer. Forty‐nine patients with NSCLC had surgical resection of the tumour. Surgical procedure revealed metastases to the subcarinal lymph nodes in three patients in whom the preoperative TBAC diagnosis was normal. No significant complications due to TBAC occurred in any of the patients.

Conclusion:  TBAC of the subcarinal lymph nodes is a minimally invasive technique for staging of lung cancer and can provide useful information for the diagnosis of metastases to the subcarinal lymph nodes.
Temporal changes in cytokine/chemokine profiles and pulmonary involvement in severe acute respiratory syndrome
Authors: CHIEN Jung‐Yien , HSUEH Po‐Ren , CHENG Wern‐Cherng , YU Chong‐Jen , YANG Pan‐Chyr
Published: October 2006

Objective and background:  Pathological changes in severe acute respiratory syndrome (SARS) suggest that SARS sequelae are associated with dysregulation of cytokine and chemokine production. To improve understanding of the immuno‐pathological processes involved in lung injury associated with SARS, the temporal changes in cytokine/chemokine profiles in the sera of SARS patients were compared with those of patients with community‐acquired pneumonia (CAP), according to the degree of lung involvement.

Methods:  Serum levels of 11 cytokines and chemokines, in 14 patients with SARS and 24 patients with CAP, were serially checked using a bead‐based multiassay system. Sera from 12 healthy subjects were used as normal controls.

Results:  The serum levels of interferon‐γ‐inducible protein‐10 (IP‐10), IL‐2 and IL‐6 were significantly elevated during SARS infection. In patients with CAP, but not in those with SARS, the levels of interferon‐γ, IL‐10, IL‐8 and monokine induced by interferon‐γ (MIG) were significantly elevated compared with the levels in healthy controls. Among the chemokines/cytokines, IL‐6 levels correlated most strongly with radiographic scores (r = 0.62). The elevation of IP‐10 and IL‐2 antedated the development of chest involvement and reached peak levels earlier than the radiographic scores. In contrast, the dynamic changes in IL‐6, C‐reactive protein and neutrophils occurred synchronously with the changes in radiographic scores. The mean ratio of IL‐6 to IL‐10 in SARS patients (4.84; range 0.41–21) was significantly higher than that in CAP patients (2.95; range 0.02–10.57) (P = 0.04).

Conclusions:  The early induction of IP‐10 and IL‐2, as well as the subsequent over‐production of IL‐6 and lack of IL‐10 production, probably contribute to the main immuno‐pathological processes involved in lung injury in SARS. These changes in cytokine/chemokine profile are remarkably different from those observed in CAP patients.
Long‐term effect of bronchial artery embolization in Korean patients with haemoptysis
Authors: KIM Yong Gil , YOON Hyun‐Ki , KO Gi Young , LIM Chae‐Man , KIM Won Dong , KOH Younsuck
Published: October 2006

Objective and background:  Bronchial artery embolization (BAE) has been regarded as a bridging therapy in the management of massive haemoptysis until a more definite therapy can be pursued. The long‐term effectiveness of BAE and the factors associated with failure to control bleeding in an Asian setting of tuberculosis are unknown and were investigated.

Methods:  Over approximately 4 years, 139 patients received BAE to treat haemoptysis at a single centre, of these, 118 had been followed up for more than 1 year (median 23 months) and were retrospectively recruited into the study. Patients were divided into those who required readmission for treatment of recurrent haemoptysis after BAE (re‐bleeding group), and those who did not (non‐rebleeding group).

Results:  Of the 118 patients, 112 (95.8%) had haemoptysis of greater than 100 mL per day. The most common underlying cause of haemoptysis was pulmonary tuberculosis. Eight patients, four of whom had advanced lung cancer, died after BAE. There were 32 patients (27.1%) in the re‐bleeding group. Aspergillosis was significantly associated with re‐bleeding after BAE (P < 0.05). There were no differences in gender, age, degree of haemoptysis, or APACHE II scores between the re‐bleeding and non‐rebleeding groups. Twelve patients in the re‐bleeding group had a repeat BAE only, whereas seven underwent surgery after repeat BAE. Of the 118 patients who underwent initial BAE, one showed a transient spinal ischaemia.

Conclusions:  BAE with appropriate medical treatment should be sufficient for most patients with massive haemoptysis. In patients with massive haemoptysis due to aspergilloma, however, elective surgery should be considered if bleeding is not controlled by repeated BAE.
URBAN–RURAL DIFFERENCES IN THE MANAGEMENT OF SCREEN‐DETECTED INVASIVE BREAST CANCER AND DUCTAL CARCINOMA IN SITU IN VICTORIA
Authors: Kok David L. , Chang Jiun‐Horng , Erbas Bircan , Fletcher Ashley , Kavanagh Anne M. , Henderson Michael A. , Gertig Dorota M.
Published: October 2006

Background:  At least one‐third of primary breast cancers in Australia are discovered by population‐based mammographic screening. The aim of this study was to determine whether there were any differences in the surgical treatment of women diagnosed with breast cancer by BreastScreen Victoria between urban and rural populations and to investigate temporal changes in their pattern of care.

Methods:  An analysis of women diagnosed with breast cancer (invasive and non‐invasive) by BreastScreen Victoria from 1993 to 2000 was conducted. Descriptive analyses of the proportion of women undergoing each surgical treatment type over time were carried out. Logistic regression was used to assess the effect of urban–rural residence on each treatment outcome while accounting for possible confounding factors.

Results:  Rural women with invasive breast cancer were less likely to undergo breast‐conserving surgery (BCS) compared with urban women (odds ratio, 0.42; 95% confidence interval, 0.35–0.50). The same was also true for rural women with ductal carcinoma in situ (odds ratio, 0.53; 95% confidence interval, 0.29–0.96). This difference was independent of patient and tumour characteristics, including tumour size, surgeon caseload, patient’s age and socioeconomic status. It also persisted over time despite a steady overall increase in use of BCS for both invasive and non‐invasive cancers over the study period.

Conclusions:  Among Victorian women with screen‐detected breast cancer, urban women consistently had higher rates of BCS compared with rural women despite increased overall adoption of BCS. Reasons for this disparity are still unclear and warrant further investigation.
TUMOUR NECROSIS FACTOR: IMPLICATIONS FOR SURGICAL PATIENTS
Authors: Khalil Alizan A. , Hall John C. , Aziz Farah A. , Price Patricia
Published: October 2006

Tumour necrosis factor alpha (TNF‐α) is an inflammatory cytokine primarily produced by macrophages. It is a unique protein with contradictive properties; it has the ability to induce cellular death by apoptosis and oncosis, but can also induce cellular regeneration and growth. Genetic polymorphisms in TNFA have been associated with poor outcome in some surgical patients and this may provide a useful tool to screen for high‐risk patients. Manipulating TNF‐α levels in vivo may influence the progression of several pathological conditions. TNF‐α has anti‐cancer properties and has been used to treat cancer patients. Treatment with anti‐TNF‐α drugs and antibodies has been successful in rheumatoid arthritis and other autoimmune diseases, but disappointing in the management of patients with sepsis. This review article focuses on the biological activities, genetic polymorphism of TNFA and the role of TNF‐α and anti‐TNF‐α treatments, based on animal experiments and clinical trials.
DO ANTIBIOTICS CONTRIBUTE TO POSTOPERATIVE ILEUS? CONTRACTILE RESPONSES OF ILEUM SMOOTH MUSCLE IN GUINEA PIGS TO LONG‐TERM PARENTERAL CEFTRIAXONE AND AMPICILLIN
Authors: Ceran Canan , Karadas Baris , Kaya Tijen , Arpacik Mehmet , Bagcivan Ihsan , Sarac Bülent
Published: October 2006

Background: Antibiotics may impair small bowel smooth muscle contractility and contribute to postoperative ileus. The aim of this study was to compare the contractile responses of ileum smooth muscle to different agonists in guinea pigs treated with ceftriaxone (Rocephin; F. Hoffman–La Roche, Kaiseraugst, Switzerland) or ampicillin (Ampisina; Mustafa Nevzat İlaç Sanayii AŞ, Istanbul, Turkey).

Methods: Twenty‐four adult guinea pigs were randomly divided into three groups. Whereas eight of these received ceftriaxone sodium (100 mg/kg per day, i.m.) for 10 days, another eight guinea pigs received ampicillin (50 mg/kg per day, i.m.) for 10 days and the remaining eight served as the control group receiving 1 mL distilled water during 10 days as placebo. By the end of 10 days, the animals were killed and their ilea were excised. Ileum segments were placed in an organ bath; concentration–response relationship for carbachol and histamine were obtained by adding the reagent cumulatively to the bath.

Results: pD2values being the same, maximum contractile responses (Emax) to carbachol and histamine were significantly reduced in the ceftriaxone sodium group compared with the control group. No significant differences inEmaxand pD2values to carbachol and histamine were observed between the ampicillin group and the control group.

Conclusion: These data indicate that whereas ceftriaxone may impair small bowel smooth muscle contractility, ampicillin does not. There are implications for the long‐term use of parenteral antibiotics in the postoperative period.
MODIFIED EXTENDED PANCREATODUODENECTOMY: EN BLOC RESECTION OF THE PERIPANCREATIC RETROPERITONEAL TISSUE AND THE HEAD OF PANCREAS
Authors: Samra Jaswinder S. , Gananadha Sivakumar , Gill Anthony , Smith Ross C. , Hugh Thomas J.
Published: October 2006

Malignant periampullary tumours often invade into retroperitoneal peripancreatic tissues and a positive resection margin following pancreatoduodenectomy is associated with a poor survival. For complete extirpation of the tumour, en bloc resection of the pancreatic head with all retroperitoneal peripancreatic tissue is essential to achieve negative resection margin. A modified radical pancreatoduodenectomy technique that aims to resect all peripancreatic retroperitoneal tissue en bloc with the head of the pancreas is described. We have used this new technique in the last 30 consecutive cases of pancreatoduodenectomy with excellent results as presented in this paper. This technique allows complete en bloc resection of retroperitoneal peripancreatic tissues while preserving normal functional tissue. This technique’s advantage is that the resection can be carried out without breaching the retroperitoneal tumour extension plane, thereby minimizing tumour cell spillage.
COMBINED ARTERIOVENOUS FISTULA AND VENOUS ANEURYSM FOLLOWING KNEE ARTHRODESIS
Authors: Coleman Robert
Published: October 2006

We study a case of a 65‐year‐old woman who developed popliteal arteriovenous fistula (AVF) and venous aneurysm following left knee arthrodesis. Presenting features included left popliteal and calf pain, a tender pulsatile mass posterior to her left knee, popliteal bruit and a thrill at the popliteal fossa and ankle. Left femoral angiography showed an AVF arising from the right tibioperoneal trunk and an aneurysm at the level of the AVF. Findings at open investigation included AVF between the tibioperoneal trunk and the popliteal vein, and a venous aneurysm arising from the popliteal vein opposite the neck of the arteriovenous communication. The aneurysm and fistula were repaired using prolene suture.
Targeted in utero delivery of a retroviral vector for gene transfer in the rodent brain
Authors: Stott Simon R. W. , Kirik Deniz
Published: October 2006

In vivo application of viral vectors for gene transfer is a commonly used tool in anatomical and functional studies, as well as in development of neuroprotective and restorative strategies for therapy. Although the most common route of administration is via direct injection into the brain parenchyma in adult animals, a number of short‐term studies have been performed in the developing central nervous system. Here we investigated the long‐term transgene expression following in utero delivery of a retroviral vector encoding for the green fluorescent protein (GFP) marker gene at embryonic days 14.5–17.5 using an ultrasound‐guided injection system. Intraparenchymal injections of the ganglionic eminence were compared with vector delivery to the intracerebroventricular space. Injections into the ganglionic eminences resulted in a predominantly unilateral transduction localized to the forebrain, giving rise to GFP‐positive (GFP+) neurons and astrocytes in the striatum, olfactory bulb, cortex and hippocampus. When the vector was injected into the lateral ventricle, on the other hand, widespread expression of GFP was seen throughout the brain. The total number of GFP+ cells in the striatum was estimated to be between 20 000 and 50 000 cells using a computerized stereological quantification tool. Phenotypic characterization of these transduced cells using confocal microscopical analysis showed that 64% were NeuN+ neurons, 14% APC+ oligodendrocytes and 15% glial cells labelled with GFAP, S100β and Iba1, when the vector injection was performed at E14.5. Delivery into later embryos resulted in a reduction in neuronal profiles with a reciprocal increase in glial cells.
Usefulness of colour tissue Doppler imaging in assessing aortic elastic properties in Type 1 diabetic patients
Authors: Karamitsos T. D. , Karvounis H. I. , Didangellos T. P. , Papadopoulos C. E. , Dalamanga E. G. , Karamitsos D. T. , Parharidis G. E. , Louridas G. E.
Published: October 2006

Aims  Diabetes mellitus (DM) is associated with macrovascular disease and impaired aortic function. We hypothesized that the change in aortic elastic properties could be investigated with colour tissue Doppler imaging (CTDI) in Type 1 diabetic patients and that these findings could be related to the aortic stiffness index.

Methods  We examined by echocardiography 66 patients with Type 1 DM (mean age 35 ± 10 years, mean duration of disease 20 ± 9 years) without a history of arterial hypertension or coronary artery disease (negative thallium‐201 stress test) and 66 age‐ and sex‐matched normal subjects. Arterial pressure was measured before echocardiography was performed. Internal aortic systolic and diastolic diameters by M‐mode echocardiography and aortic systolic upper wall tissue velocity (Sao, cm/s) by CTDI were measured 3 cm above the aortic valve. Aortic distensibility and aortic stiffness index were calculated using accepted formulae.

Results  Aortic stiffness, distensibility and Sao velocity differed significantly between the studied groups. In the diabetic group, duration of diabetes correlated with aortic stiffness (r = 0.53, P < 0.001), distensibility (r = −0.61, P < 0.001) and Sao velocity (r = −0.48, P < 0.001). There was a negative correlation between aortic stiffness and Sao velocity (r = −0.49, P < 0.001). Multiple stepwise linear regression analysis in the diabetic group revealed that aortic S velocity (β = 0.30, P = 0.005) and duration of diabetes (β = −0.49, P = 0.001) were the main predictors of aortic distensibility (overall R2 = 0.48).

Conclusions  Aortic elastic properties can be directly assessed by measuring the movements in the upper aortic wall. Reduced aortic S velocity is associated with increased aortic stiffness in Type 1 diabetic patients.
Gestational diabetes: utility of fasting plasma glucose as a screening test depends on the diagnostic criteria
Authors: Agarwal M. M. , Dhatt G. S. , Punnose J.
Published: October 2006

Aims  To demonstrate the effect of diagnostic criteria, as defined by four international expert panels, on the usefulness of fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM).

Methods  We tested 4602 pregnant women using a 75‐g oral glucose tolerance test (OGTT) for universal GDM screening. The area under the receiver operating characteristic curve (AUC) was used to determine the FPG performance to detect GDM by the criteria of the American Diabetes Association (ADA), the Australasian Diabetes in Pregnancy Society, the European Association for the Study of Diabetes, and the World Health Organization (WHO).

Results  By applying ADA, Australasian, European and WHO criteria, respectively, the FPG: (i) AUC (95% CI) was 0.882 (0.866–0.897), 0.830 (0.809–0.852), 0.808 (0.791–0.825) and 0.690 (0.670–0.710); (ii) independently could ‘rule‐in’ GDM (with 100% specificity) in 74 (10.9%), 620 (53.5%), 252 (45.3%) and 74 (7.6%) women; (iii) independently could ‘rule‐out’ GDM in an additional 2864 (62.2%), 928 (20.2%), 1510 (32.8%) and 1171 (25.4%) women, at FPG thresholds (with 85% sensitivity); (iv) false‐positive rate (FPR) was 29.4, 75.5, 63.8 and 71.2%, at these thresholds.

Conclusions  The value of the FPG as a screening test for GDM is highly dependent on the diagnostic criteria. The performance is excellent with the ADA criteria. With the other criteria, the high FPR (poor specificity) would limit its utility as a screening test. Regardless of the criteria used, initial testing by FPG can significantly decrease the number of cumbersome OGTTs needed for the diagnosis of GDM.
Evidence‐based financial reporting regulation
Authors: Buijink Willem
Published: October 2006

In this introductory paper at the Abacus Forum on International Financial Reporting, I contend that it is difficult to argue that financial reporting and disclosure regulation around the world is evidence‐based. Anecdotes and references to more systematic research and surveys of research are used to demonstrate this. ‘Evidence‐based’ is a term that I borrow from medicine. There the term stands for basing medical patient care and health policy choices on the ‘current best [scientific] evidence’. I contend that financial reporting and disclosure regulation (and perhaps practice as well) are currently not evidence‐based in the specific sense of not being based on the current best scientific evidence available about accounting and auditing. Next I discuss possible causes of this state of affairs and look at future possibilities for financial reporting and disclosure regulation to become (more) evidence‐based. The discussion ends by providing a link with the papers that follow in this issue.
A MODEL OF SHOPPING CENTERS*
Authors: Arakawa Kiyoshi
Published: October 2006

ABSTRACT In this paper, we propose a model of developers' strategies for tenant mixes and the locations of shopping centers (SCs). Consumers have preferences for product variety, and tenants in the SCs sell differentiated goods. The consumers can choose two shopping behaviors: patronizing one or both of the two SCs. We show that if the consumers have strong preferences for product variety, the SCs agglomerate to free‐ride on the rivals' product varieties, and the consumers patronize both SCs. On the other hand, if consumer preferences are weak, the SCs locate at different locations, and the consumers patronize one of the two SCs.
Democratization of Brazilian Health Councils: The Paradox of Bringing the Other Side into the Tent
Authors: COELHO VERA SCHATTAN P.
Published: October 2006

Contemporary discussions of ‘democratic innovation experiences’ have evolved into a heated debate about how effective these ‘new spaces’ are in including ordinary citizens, particularly those traditionally marginalized and excluded. This article focuses on the Brazilian experience with Health Councils and begins by discussing the conditions that have been pointed out by previous studies as favouring the inclusion of these groups in these ‘new spaces’. On the basis of these studies, one question that remains is about the democratic legitimacy of these experiences, as it seems that there is a bias towards the inclusion of those that already have political ties with the traditional political system. The local Health Councils in 31 subprefeituras(new administrative subdivisions) of the city of São Paulo were researched and a continuum was observed: ranging from a small number of one or two sectors that have historical ties with political parties included in the council to a far more diversified composition, including up to seven sectors with autonomous representatives and various types of association. Using these results as their starting‐point, the analyses conclude with a discussion of the relative significance of the factors previously identified as central in establishing the democratic legitimacy of these ‘new democratic spaces’.
Individual and Service Factors Affecting Deinstitutionalization and Community Use of People with Intellectual Disabilities
Authors: Baker Peter A.
Published: October 2006

Background  The aim was to evaluate the effect of the closure of a small intellectual disability hospital on the community use of those people involved. In addition, the study sought to identify those factors that might influence the community use of people with intellectual disabilities.

Methods  The impact of resettlement was investigated using a mixed design in which changes in the dependent variable (The Guernsey Community Participation and Leisure Assessment, GCPLA scores) were measured within‐subjects (before and after leaving hospital) and between‐subjects (using a comparison group of people who lived in the community throughout the study). In addition, a standard multiple regression design was employed to explore the relative contribution of client and service variables to GCPLA scores.

Results  Resettlement from hospital corresponded with significant increase in the range and frequency of leisure and community contacts, although community use remained low in comparison with the general population and in relation to other people with intellectual disabilities. Community and leisure use was found to be related to the place of residence, adaptive behaviour and the robustness of community goals within the service user's individual plan.
Sense of Coherence, Parenting Attitudes and Stress among Mothers of Children with Autism in Hong Kong
Authors: Mak Winnie W. S. , Ho Anna H. Y. , Law Rita W.
Published: October 2006

Background  The moderating and mediating relationships among sense of coherence, parental attitudes and parenting stress for caregiving parents of children with autism were tested.

Materials and Methods  One hundred and fifty‐seven mothers of children with autism recruited from representative community service centres in Hong Kong completed the Chinese versions of Sense of Coherence Scale (SOC), Confidence and Acceptance subscales of Parent‐Attitude Survey Scales and Parenting Stress Index Short Form.

Results  Accounting for mothers’ demographic background, SOC showed a moderating effect with child's symptoms and parenting stress. Mothers with a strong SOC perceived lower stress than their counterparts even when their children presented with more severe autistic symptoms. Two proximal factors in parenting, parental confidence and acceptance of the child, were found to partially mediate SOC and stress.

Conclusions  The stress experience of mothers of children with autism is related strongly to a global sense of coherence as well as more specific parenting attitudes.
Non‐dipolar content of the T‐wave as a measure of repolarization inhomogeneity in ST‐elevation myocardial infarction
Authors: Kesek Milos , Bjorklund Erik , Jernberg Tomas , Lindahl Bertil , Xue Joel , Englund Anders
Published: October 2006

The non‐dipolar content of the T‐wave, i.e. the component of the signal, which cannot be explained by a dipolar model, has been suggested as a measure of the local repolarization inhomogeneity. Our purpose was to study the non‐dipolar content of the T‐wave during the initial course of ST‐elevation myocardial infarction (STEMI), when local repolarization inhomogeneity presumably is markedly increased. Twelve‐lead ECG was semicontinuously collected in 211 patients with STEMI, treated with a thrombolytic agent. The T‐wave was processed by principal component analysis. The absolute and relative T‐wave residues were used as measures of the non‐dipolar content. The median values for each hour and for the entire monitoring time were computed. Changes in the parameters were closer studied in two windows, 0–10 respectively, 11–24 h after start of ECG‐monitoring. The median of the absolute T‐wave residue during the entire monitoring period was 25 000 units in the STEMI‐group and 13 500 units in the comparison group. The median for hour 1 was 36 500 units and 28 800 units for hour 2. The decrease was greater in patients with ≥50% resolution of the ST‐elevation at 60 min. The moment of change, identified by cumulative sum‐method, showed no correlation to the time for 50% ST‐resolution. We conclude, that patients with thrombolysed STEMI have an increased non‐dipolar content of the T‐wave. Resolution of the ST‐elevation is associated with a decrease. The increased non‐dipolar content reflects a property of the repolarization phase, which is related to but separated from the ST‐elevation.