bluuebunny/crossref_metadata_2025 huggingface dataset:
Cartilaginous injury limits cryopreservation of tracheal isograft
Authors: Kumon Bing C. , Shiraishi Takeshi , Makihata Satoshi , Kawahara Katsunobu , Shirakusa Takayuki
Published: March 2003

Objective:

Histological recovery of tracheal grafts after cryopreservation was investigated using a rat heterotopic tracheal transplant model in order to evaluate the clinical applicability of tracheal cryopreservation.

Methodology: Heterotopic syngeneic tracheal transplantation was performed between F344 rats. Recipient animals received either a non‐cryopreserved or a cryopreserved tracheal graft for direct comparison with regard to the effect of cryo‐injury. In the non‐cryopreserved group (CP(–)), tracheal segments were transplanted syngeneically between F344 rats immediately after harvest. Grafts were implanted into the abdominal space and wrapped with the greater omentum. In the cryopreserved group (CP(+)), grafts were implanted after cryopreservation for 7 days at –85°C. Recipient rats were killed on days 7, 14, 21, 28, and at 2 months after surgery. Epithelial regeneration and cartilage changes were evaluated using a semiquantitative four grade scoring system.

Results: Squamous epithelium without ciliated structure was observed on day 7 in both groups. Bronchial epithelium was then regenerated gradually and normally ciliated epithelium was observed on day 28 in both groups. The condition of the epithelium was still well maintained in the CP(–) group at 2 months post‐transplantation; however, a severe epithelial defect was observed in the CP(+) group. Bronchial cartilage showed a normal shape and mostly viable chondrocytes with proliferative cell nuclear antigen (PCNA) positive staining at all time points in the CP(–) group until 2 months after surgery. However, in the CP(+) group, a massive loss of viable chondrocytes was observed at 2 months post‐transplantation. Macroscopically, CP(+) grafts showed a diminished structure without satisfactory airway lumen at 2 months.

Conclusion: The epithelium of a tracheal graft can be temporarily recovered after implantation followed by 7 days cryopreservation. However, bronchial cartilage may be severely damaged by freezing, which results in late destruction with loss of viable chondrocytes. It is suggested here that establishing a method of safe cryopreservation for tracheal cartilage will be imperative to making tracheal cryopreservation possible.
A randomized trial of peak‐flow and symptom‐based action plans in adults with moderate‐to‐severe asthma
Authors: ADAMS ROBERT J. , BOATH KAREN , HOMAN SEAN , CAMPBELL DONALD A. , RUFFIN RICHARD E.
Published: March 2003

Objective: Peak flow meters (PFM) continue to be recommended as an important part of asthma self‐management plans. It remains unclear if there is an advantage in using PFM in people with moderate‐to severe asthma who are not poor perceivers of bronchoconstriction.

Methodology: Prospective, randomized controlled trial of 134 adults with moderate‐to‐severe
asthma who did not have evidence of poor perception of bronchoconstriction on histamine
challenge testing, who were recruited from inpatients and outpatients of a university
teaching hospital. Comparison was made over 12 months of the effectiveness of written
action plans using either peak flow monitoring or symptoms to guide management. Subjects
were contacted at monthly intervals by telephone for reinforcement and evaluation
of use of the action plans, and to provide ongoing education. Spirometry and PD20 histamine were measured at 3‐monthly intervals. Measures of health care utilization and morbidity (asthma exacerbations; hospitalizations; emergency department (ED) visits; days absent from work or school due to asthma; medication use and a self‐rating of asthma severity) were made monthly. A psychosocial questionnaire (attitudes and beliefs, state‐trait anxiety, denial) was given at entry and at 12‐months or at withdrawal from the study.

Results: There were significant improvements for both groups for hospitalizations, ED visits,
days off from school or work, and PD20 histamine, but no between‐group
differences. Appropriate use of action plans was 85% in the symptoms group
and 86% in the PFM group. For all subjects, those who subsequently had an
ED visit had significantly higher levels of denial (P = 0.04) and lower scores
for self‐confidence (P = 0.04), compared to those who did not have an ED visit.

Conclusions: Use of written action plans, combined with regular contact to reinforce self‐management, improved airway reactivity and reduced health care utilization. However, use of PFM was not superior to symptom‐based plans.
Bronchial hyperresponsiveness in a patient with systemic mastocytosis
Authors: MOCHIZUKI Hiroyuki , MORIKAWA Akihiro , KUROSAWA Motohiro
Published: March 2003

In order to investigate the possible involvement of airway mast cells in bronchial hyperresponsiveness (BHR), we examined whether a patient with systemic mastocytosis would demonstrate BHR against ultrasonically nebulized distilled water (UNDW) and histamine inhalation challenge. A 56‐year‐old man with systemic mastocytosis underwent both UNDW and histamine inhalation challenge. We also evaluated the effect of beclomethasone dipropionate inhalation (BDI) treatment on the histamine inhalation challenge. The results showed that UNDW inhalation caused no changes in forced expiratory volume in 1 s (FEV1) for this patient. The provocative dose causing a 20% fall (PC20) in FEV1 in the histamine inhalation challenge was 625 μg/mL. After BDI treatment for 8 weeks, the histamine PC20 was still 625 μg/mL. These data suggest that UNDW‐induced bronchoconstriction may be independent of airway mast cells and that the mechanism of histamine‐induced bronchoconstriction in systemic mastocytosis may be independent of airway inflammation, which is often present in asthmatics.
Cavitary sarcoidosis: Analysis of two cases
Authors: ÖZSEKER Z. Ferhan , YILMAZ Adnan , BAYRAMGÜRLER Birol , GÜNEYLIOGLU Döndü
Published: March 2003

The most commonly encountered radiological finding in sarcoidosis is bilateral hilar lymph node enlargement. Cavitation is extremely rare and the acute cavitary form is seen infrequently in young adults with acinar or nodular sarcoidosis. This unusual form of sarcoidosis may be misdiagnosed and treated as tuberculosis in countries where the prevalence of tuberculosis is high. Herein, we report on two patients with cavitary sarcoidosis who had been misdiagnosed and treated for tuberculosis.
Population biology of Aesculus turbinata Blume: A demographic analysis using transition matrices on a natural population along a riparian environmental gradient
Authors: Kaneko Yuko , Takada Takenori , Kawano Shoichi
Published: March 2003

Population structure and dynamics of a riparian canopy species, Aesculus turbinata (Japanese horse chestnut), were analyzed based on the census data collected for the 8 years from 1989 to 1996 in temperate deciduous forests in Ashiu, Kyoto Prefecture, Japan. The censuses were conducted in three permanently established study plots over an environmental gradient that included the lower hill slope, river terrace, and floodplain of a riparian area within a forest stand of approximately 3 ha. Transition matrix based on the data from 1989 to 1996 was provided for the total population made by pooling population data from all subpopulations in three different habitats (i.e. slope, terrace, floodplain). The total Aesculus population showed positive population growth (λ = 1.0298). From the elasticity analysis, larger elasticity values were obtained with increasing size‐ or stage‐classes. A combined transition matrix was also constructed for the life‐history processes consisting of three subpopulations developed on an environmental gradient. This whole population linked by seed flow showed an increase in population size (λ = 1.0286). The elasticity matrix showed the relative importance of the slope subpopulation, suggesting its significant role as a mainland source population. Log‐linear analyses were carried out to examine spatiotemporal variations of life‐history parameters; significant effects of stage and plot were recognized, while no effect of year was detected on any life‐history parameters except for fecundity.
Extrafloral nectaries and chemical signals of Fallopia japonica and Fallopia sachalinensis (Polygonaceae), and their roles as defense systems against insect herbivory
Authors: Kawano Shoichi , Azuma Hiroshi , Ito Motomi , Suzuki Kunio
Published: March 2003

Extrafloral nectaries formed at the petiole base and periphery of stem nodes of two Fallopia species, Fallopia japonica (= Polygonum cuspidatum) and Fallopia sachalinensis (= Polygonum sachalinense), were examined anatomically, scanning electron microscopy (SEM) observations were made, and the sugar contents of the nectar were analyzed. Ants and other insect species attracted to the extrafloral nectaries were collected and identified, and insect herbivores were observed, collected and identified. Volatile substances were emitted from damaged leaves after insect predation was chemically determined, and a herbivore‐induced leaf volatile, (E)‐4,8‐dimethyl‐1,3,7‐nonatriene, as a general parasitoid attractant, was emitted 4–6 h after leaf damage. Complex plant–insect interactions in two Fallopia species are discussed in light of the evidence obtained in the present study, and the roles of extrafloral nectaries in combination with chemical signals for defense of insect herbivory are evaluated.
The function of each sepal in pollinator behavior and effective pollination in Aconitum japonicum var. montanum
Authors: Fukuda Yoko , Suzuki Kazuo , Murata Jin
Published: March 2003

The flower in Aconitum has five violet sepals. Its morphology is unique and thought to be adapted for pollination by bumblebees. To assess the adaptive significance of Aconitum flower morphology, we examined the function of the five sepals in bumblebee‐pollination. We manipulated the flower by removing the sepals and then observed and measured bumblebee pollination efficiency in a single visit. Bumblebee behavior differed somewhat on the manipulated flowers. Manipulation of the two lower sepals led to a pollination efficiency that was the same as no manipulation. Pollination efficiency was lowered significantly after lateral sepal manipulation, and this was caused by the absence of the arch structure normally formed by two lateral sepals changing the posture of the pollinator. Therefore, it was postulated that the arch structure formed by the lateral sepals functions to ensure correct pollination.
Heterostylous morph differences in pollen transfer and deposition patterns in Primula sieboldii on a visitation by a queen bumblebee, measured with a semi‐natural experimental system
Authors: Matsumura Chizuru , Washitani Izumi
Published: March 2003

Abstract Under a semi‐natural setting the between‐morph pollen exchange patterns were studied in distylous Primula sieboldii flowers by measuring pollen removal from the anthers on a single visit by a Bombus diversus tersatus queen, and stigmatic pollen deposition along the sequence of the visitation of the opposite‐morph flowers by the bee. Despite the twofold larger number of pollen grains produced in a single flower of the long‐styled morph compared to that of the short‐styled morph, no significant difference in pollen removal from a flower was found between the morphs. The stigmas of the long‐styled morph received significantly more opposite‐morph pollen grains than those of the short‐styled morph on a single visit by the bee. Sufficient legitimate pollen grains, surpassing the ovule number, were loaded on the stigmas of 27% and 17% of visited flowers of the long‐ and short‐styled morphs, respectively. The short‐styled morph could more efficiently donate pollen to the opposite morph stigmas than the long‐styled morph.
Relationship of insulin‐like growth factor‐I, insulin‐like growth factor binding protein‐3, insulin, growth hormone in cord blood and maternal factors with birth height and birthweight
Authors: Yang Sei Won , Yu Jee Suk
Published: March 2003

Abstract Background: To determine whether the following factors are related to birthweight or birth height, we measured insulin‐like growth factor (IGF)‐I, insulin‐like growth factor binding protein (IGFBP)‐3, insulin and growth hormone (GH) levels in cord blood and also observed the relationship between birthweight, birth height and maternal factors.

Methods
: One hundred and ninety‐four cord bloods were collected, 106 from males and 88 from females. Three newborns were small for gestational age (SGA), 168 were appropriate (AGA) and 23 were large (LGA); 21 newborns were preterm and 172 were term.

Results
: Levels of IGF‐I and IGFBP‐3, measured by enzyme‐linked immunosorbent assay, were significantly lower in preterm babies (35.3~15.1 and 1025.6~562.8 ng/mL, respectively) than in term babies (61.6~39.5 and 1252.6~403.2 ng/mL, respectively; P<0.01), but neither insulin nor GH levels, measured by radioimmunoassay, showed any significant difference between the two groups (P>0.05). Among term babies, IGF‐I and IGFBP‐3 levels were significantly higher in the LGA group (96.1~34.1 and 1544.7~418.1 ng/mL, respectively) than in the AGA group (56.4~37.6 and 1212.8~383.4 ng/mL, respectively; P<0.01). Levels of IGF‐I and IGFBP‐3 showed significant correlation with birthweight and length, respectively (P<0.01), although GH and insulin levels did not (P>0.05). There was a significant correlation between IGF‐I and IGFBP‐3 levels (P<0.01, r=0.64), but IGF‐I and IGFBP‐3 levels showed no relationship with GH or insulin levels. Birthweight correlated significantly with prepartum maternal weight, maternal weight gain and maternal height (P<0.05), but birth length correlated significantly only with maternal height (P<0.05).

Conclusions
: Our results suggest that fetal growth depends on fetal levels of IGF‐I and IGFBP‐3 and maternal factors, not on insulin or GH. Levels of IGF‐I and IGFBP‐3 may not be regulated by insulin alone, but by the complex interactions between several factors, such as insulin, GH and maternal factors.
Expression of tumor necrosis factor‐α protein in the myocardium in fatal myocarditis
Authors: Jibiki Toshiaki , Terai Masaru , Tateno Shigeru , Toyozaki Tetsuya , Horie Hiroshi , Nakajima Hiromichi , Niwa Koichiro , Niimi Hiroo
Published: March 2003

Abstract Background: Tumor necrosis factor (TNF)‐α is the most studied cytokine in the failing human heart and in experimental murine myocarditis. We have investigated the expression of TNF‐α in the myocardium in human myocarditis.

Methods
: We examined endomyocardial biopsy (n=4) and autopsy (n=5) tissues obtained from nine patients diagnosed with myocarditis by the Dallas criteria. Expression of TNF‐α in the hearts was immunohistochemically studied using monoclonal antibodies against human TNF‐α.

Results
: Tumor necrosis factor‐α protein was expressed in the myocardium of six of the nine patients studied. Four of five fatal patients showed intense immunoreactivity for TNF‐α compared with survivors. Furthermore, left ventricular systolic function was reduced in patients with TNF‐α‐positive hearts.

Conclusions
: These findings may support the suggestion that TNF‐α plays an important role in cardiac dysfunction and myocytic damage in fatal human myocarditis.
Effects of bathing immediately after birth on early neonatal adaptation and morbidity: A prospective randomized comparative study
Authors: Nako Yasushi , Harigaya Akira , Tomomasa Takeshi , Morikawa Akihiro , Amada Mieko , Kijima Chie , Tsukagoshi Seiko
Published: March 2003

Objective
: Because the risks and benefits of early bathing of newborn infants are not well established, we investigated the effects of bathing immediately after birth on rectal temperature, respiratory rate, heart rate, blood pressure, percutaneous arterial blood oxygen saturation (SpO2) and early neonatal morbidity.

Methods
: The study was designed as a randomized prospective comparative study in the neonatal care unit of a university hospital. A total of 187 healthy term and near‐term newborn infants, who were delivered vaginally without asphyxia, between January and December 1997 were the study subjects. We compared findings in newborns who were bathed 2–5 min after birth (n=95) with those of a control group (n=92) who received dry care instead. Groups were comparable with respect to gestational age, birthweight, male : female ratio, Apgar score and umbilical blood pH. Rectal temperature was measured with an electronic thermometer immediately before the intervention bathing or dry care and at 30 min and 1, 2, 3, 8 and 12 h after birth. Heart rate, respiratory rate, systolic and diastolic blood pressure and SpO2 were measured at 1, 2, 8 and 12 h after birth. The incidence of early neonatal morbidity, including hyperbilirubinemia and gastrointestinal and respiratory problems, was also compared.

Results
: Rectal temperature changed over time postnatally in both groups (P<0.0001,
ANOVA) and there was a significant difference in rectal temperature between groups (P<0.0001,
ANOVA). Mean (± SEM) rectal temperature at 30 min after birth (i.e. approximately within 20 min after intervention) was significantly higher in the bathed group than in the control (dry care) group (37.30~0.06 vs 37.00~0.05°C, respectively; P=0.000022). Respiratory rate, heart rate, blood pressure and the ratio of the number of infants with SpO2 90–94% and 95–100% did not differ significantly between the two groups. The incidence of early neonatal morbidity, including vomiting, acute gastric mucosal lesion, polycythemia, need for tube feeding, phototherapy and oxygen therapy, also did not differ between the two groups.

Conclusions
: Early bathing, minutes after birth, did not appear to adversely affect the adaptation of healthy full‐term and near‐term newborn infants.
Low serum lipids suggest severe bone marrow failure in children with aplastic anemia
Authors: Yokoyama Masaru , Suto Yoshimasa , Sato Hideko , Arai Koji , Waga Shinobu , Kitazawa Junichi , Maruyama Hidekazu , Ito Etsuro
Published: March 2003

Abstract

Background
: Significantly low serum lipid levels are occasionally seen at the time of diagnosis in children with aplastic anemia (AA). The aim of the present study was to clarify the pathologic and clinical significance of pretreatment serum lipid levels in AA.

Methods
: A questionnaire seeking precise data about AA in pediatric patients, including the initial laboratory data at the time of onset of AA and the clinical course of these patients, was sent to 18 institutes in Japan; 13 institutes responded to the questionnaire. In this retrospective study, data concerning hematologic examination and serum lipids were available for analysis in 127 children with AA. Serum lipoprotein patterns were analyzed using conventional agarose electrophoresis in eight patients. In order to elucidate the cause of hypolipidemia in AA, we assayed serum macrophage colony stimulating factor (M‐CSF), which is well known to have apparent cholesterol‐lowering activity, by using an enzyme‐linked immunosorbent assay in seven patients with hypocholesterolemia and compared the results with those obtained in patients with iron‐deficiency anemia (IDA).

Results
: We found that pretreatment total cholesterol (TC) and triglyceride levels in the serum correlated well with counts of both nucleated cells and hemopoietic cells in the bone marrow (BM) and were inversely correlated with the lymphocyte ratio in both the BM and peripheral blood. Patients with serum TC lower than 150 mg/dL showed a poor response to any form of therapy except BM transplantation. There was no difference in the serum lipoprotein patterns between the controls and patients examined. The serum M‐CSF level was significantly higher in patients with TC levels lower than 150 mg/dL compared with controls.

Conclusions
: These results indicate that the pretreatment serum lipid level may reflect hematopoietic activity within the BM and can help to predict the therapeutic response of each case of AA to treatment with immunosuppressive drugs, corticosteroids and anabolic steroids. These results also indicate that M‐CSF may be one of the contributing causes of the hypocholesterolemia that occurs in both AA and IDA.
Diastolic flow velocity of the left pulmonary artery of patent ductus arteriosus in preterm infants
Authors: Suzumura Hiroshi , Nitta Akihisa , Tanaka Goro , Arisaka Osamu
Published: March 2003

Abstract

Background
: The usefulness of diastolic pulmonary flow velocity determined by echocardiography in the assessment of symptomatic patent ductus arteriosus (sPDA) in preterm infants has not been confirmed.

Methods
: Echocardiography was performed daily in infants ranging from 23 to 31 gestational weeks of age, and diastolic flow velocity of the left pulmonary artery (DFLPA) was measured. The DFLPA data before indomethacin administration for sPDA were compared with data obtained after indomethacin administration. The normal range of DFLPA was also determined from serial measurements performed in infants who did not develop sPDA during the first 7 days of life. Then, this range was compared with data from infants who did develop sPDA during this time.

Results
: In infants who underwent indomethacin treatment, DFLPA increased with the development of sPDA and decreased when the symptoms of sPDA disappeared. On the basis of results from serial DFLPA measurement, the sensitivity and specificity of DFLPA for assessing sPDA was found to be 0.82 and 0.83, respectively.

Conclusions
: Measurement of DFLPA by echocardiography is a useful method for assessing sPDA in preterm infants.
Development of sucking behavior in infants who have not been fed for 2 months after birth
Authors: Mizuno Katsumi , Ueda Aki
Published: March 2003

Abstract
 

Background
: Term infants are able to develop sucking behavior after birth. However, the requirements for this development have not yet been fully elucidated. In the present study, we investigated whether an oral‐feed practice is necessary for the development of sucking behavior and whether non‐nutritive sucking could support the development of this behavior while the infants cannot be fed.

Methods
: Subjects of the present study were four term or near‐term infants who had never been fed orally for approximately 2 months after birth because of gastrointestinal problems. Sucking pressure was measured with a silicone tube inserted into an artificial nipple and sucking efficiency was calculated during an entire feeding.

Results
: Sucking pressure, frequency and duration at the first time oral feed corresponded to values obtained for normal‐term infants at their first oral feed. Although infants who had not received oral feeding demonstrated poor sucking abilities initially, sucking performance improved with practice. Sucking parameters measured 1 month since oral feeding was initiated in these infants corresponded to values obtained for normal‐term infants at 1 month of age. Although infants who had not received oral feeding had often sucked a pacifier for sedation, this non‐nutritive sucking did not result in the development of sucking behavior.

Conclusions
: These results demonstrate that an oral feeding practice is necessary for the development of sucking behavior and that non‐nutritive sucking does not affect the development of sucking.
Proinflammatory cytokines, prostaglandins and zinc in febrile convulsions
Authors: Tütüncüoğlu Sarenur , Kütükçüler Necil , Kepe Lütfü , Çoker Canan , Berdeli Afig , Tekgül Hasan
Published: March 2003

Abstract
 

Background
: Some changes in the levels of proinflammatory cytokines, prostaglandins and zinc (Zn) in peripheral blood and cerebrospinal fluid (CSF) have been suggested to occur for the pathogenesis of febrile convulsions (FC).

Methods
: In order to test this hypothesis, the levels of tumor necrosis factor (TNF)‐α, interleukin (IL)‐1α, IL‐1β and prostaglandins (PGE2, PGF2α, PGD2) in the CSF and plasma and the levels of Zn in serum and CSF were investigated in children during the acute and late phases of FC. Results were compared with control subjects with meningismus.

Results
: During the acute phase of FC, children had significantly elevated plasma levels of IL‐1β, CSF levels of TNF‐α, plasma levels of PGE2, PGF2α and PGD2 and CSF levels of PGD2 (P<0.05). A positive correlation between the degree of fever and plasma IL‐1β levels was observed in both patients and controls. Three months after the acute phase of FC, plasma levels of IL‐1β had returned to levels seen in controls. Children with FC also had significantly decreased serum Zn levels during the acute phase (P<0.05). Hovewer, there was no significant difference between the groups with respect to CSF Zn levels (P>0.05).

Conclusions
: During the acute phase of FC, patients had significantly increased plasma IL‐1β and prostaglandin levels and decreased serum Zn levels. These changes may be responsible for FC pathogenesis.
Plasma and liver carnitine status of children with chronic liver disease and cirrhosis
Authors: Selimoğlu Mukadder A , Aydoğdu Sema , Yağci Raşit V , Huseyinov Afig
Published: March 2003

Abstract

Background
: Carnitine is an essential cofactor in the transfer of long‐chain fatty acids across the inner mitochondrial membrane for oxidation. As its synthesis is performed in the liver, alterations in carnitine metabolism is expected in liver diseases, especially in cirrhosis.

Methods
: In this study, we investigated plasma and liver carnitine concentrations of 68 children with chronic liver disease, 36 of whom had cirrhosis as well. Carnitine level was determined by enzymatic method.

Results
: Plasma and liver carnitine concentrations were not correlated. Mean plasma carnitine level of cirrhotic children was significantly lower than that of the control group (P<0. 0001). While there was no difference between liver carnitine concentrations of children with chronic liver disease and cirrhosis (P>0.05), mean plasma level of cirrhotics were lower (P<0.05). Plasma carnitine was correlated with albumin, triglyceride and gamma glutamyl transpeptidase (GGT) in patients with chronic liver disease (P<0.05). Liver carnitine was correlated with GGT in cirrhotic patients (P<0.005). Children with malnutrition had higher plasma and liver carnitine levels (P<0.05). The highest plasma and liver carnitine levels were detected in children with biliary atresia and criptogenic cirrhosis, respectively. Both the lowest plasma and liver carnitine levels were detected in Wilson’s disease.

Conclusion
: Children with cirrhosis have low plasma carnitine concentrations. This finding is prominent in children with Wilson’s disease. As carnitine is an essential factor in lipid metabolism, the carnitine supplementation for patients with cirrhosis in childhood, especially with Wilson’s disease, seems to be mandatory.
Cytomegalovirus DNA among children attending two day‐care centers in Tokyo
Authors: Kashiwagi Yasuyo , Nemoto Shiori , Hisashi  , Kawashima  , Takekuma Kouji , Matsuno Tetsuhiko , Hoshika Akinori , Nozaki‐Renard Junko
Published: March 2003

Abstract

Background
: In the USA, a high prevalence rate of cytomegalovirus (CMV) excretion among children in day‐care centres was reported. However, there is no research about the prevalence rate of CMV among children in day‐care centres in Japan.

Methods
: The CMV excretion was studied in 54 children’s saliva samples, collected from two different day‐care centres in Tokyo. As a control, the prevalence of CMV was studied among 61 healthy children who did not attend any day‐care centers. The CMV DNA in saliva were examined by polymerase chain reaction (PCR) analysis with one pair of primers for the immediate early region. The sequence of CMV genomes were examined in CMV PCR positive samples.

Results
: Of the 54 saliva samples, 20.6% (6/29) and 24% (6/25) were CMV PCR positive in children at A and B day‐care centres, respectively. The overall positivity of CMV PCR in saliva was 22.2% (12/54). Of the 61 saliva samples as the control study, 6.5% (4/61) were CMV PCR positive. There was a difference in the positivity in each age group of day‐care centres and normal control. Each sample of the same day‐care center gave conclusive and identical sequence results.

Conclusion
: We suspected that in each day‐care center that there was one prevailing viral strain. We suppose that CMV infections were acquired inside the day‐care centres. This is a first report which described viral transmission in day‐care centres in Japan.
Giant coronary aneurysms due to Kawasaki disease: A case−control study
Authors: Nakamura Yosikazu , Yashiro Mayumi , Oki Izumi , Tanihara Shinichi , Ojima Toshiyuki , Yanagawa Hiroshi
Published: March 2003

Background
: Epidemiologic features of giant coronary aneurysm due to Kawasaki disease and its risk factors are still not clear.

Methods
: Sixty‐six patients with giant coronary aneurysms were reported to a 15th nationwide survey of Kawasaki disease in Japan. With all other patients treated in the same hospital as a control group, odds ratios were calculated for certain potential risk factors.

Results
: Infant males aged less than 1 year, neutrophil concentration among leukocyte, late administration of Intravenous gammaglobulin (IVGG) therapy and additional administration of IVGG were considered as risk factors of giant coronary aneurysms due to Kawasaki disease. In univariate analysis, use of IVGG therapy and a large amount of IVGG (2500+ mg/kg) elevated the risk, whereas the relationship disappeared after the adjustment.

Conclusions
: The observation of 66 cases with giant coronary aneurysms due to Kawasaki disease reported to the nationwide survey provides some risk factors and consideration about the aneurysms.
Detection of neutrophil‐associated immunoglobulin using flow cytometry in autoimmune neutropenia of infancy
Authors: Yamada Shinji , Yasui Kozo , Shinozaki Koji , Nagumo Haruo , Kumagai Toshiko
Published: March 2003

Background
: Autoimmune neutropenia of infancy (ANI) is a common form of chronic childhood neutropenia, which is caused by antineutrophil antibodies. The syndrome is characterized by a severe selective neutropenia accompanied with recurrent bacterial infections.

Methods
: We investigated 10 ANI patients in our hospital. Neutropenia in ANI patients was found in patients aged between 9 and 19 months. They had no life‐threatening infections and their infections episode could be controlled by the conventional antibiotic therapy in general. The correlation of absolute neutrophil counts (ANC) and neutrophil‐associated immunoglobulin (NAIg) levels in each case was analyzed and their clinical courses followed.

Results
: The NAIg levels were high in all cases at the diagnosis, however, they had no relationship with ANC. The severity of infection and the period of neutropenia in our patients have no correlation to NAIg levels either. In our four cases, neutropenia disappeared after a median of 26 months (range, 18−29 months). The periods of neutropenia were nearly similar to previous reports. After the NAIg level began to wane, neutrophil counts increased in four patients whose neutrophil counts had recovered finally.

Conclusions
: Detection of NAIg is useful for the diagnosis, and the observation of changes in NAIg may be helpful one by one for prediction of the prognosis.
Intrafamilial transmission of Salmonella oranienburg
Authors: Niizuma Takahiro , Terada Kihei , Matsuda Kazuyuki , Ogita Satoko , Kataoka Naoki
Published: March 2003

Backgroud
: There were diffuse outbreaks of Salmonella oranienburg in Japan since March 1999 which included 1505 patients. The outbreak was caused through ingestion of a dried squid snack contaminated with S. oranienburg. Such a large number of cases has not been previously recorded in Japan or other countries.

Methods
: A 9‐month‐old boy was admitted to our hospital with enteritis and bacteremia due to S. oranienburg. His older brother had eaten the contaminated snack. We detected S. oranienburg in the stools of five out of his six family members.

Results
: With the exception of the index case's brother, no other family members had eaten the contaminated snack. The S. oranienburg strain detected in the family was confirmed to be the same strain by pulse field gel electrophoresis. Therefore, we presumed there had been a series of household transmissions.

Conclusion
: Our observation of intrafamilial transmission suggests that S. oranienburg may be highly infectious.
Septic arthritis in patients followed‐up in neonatal intensive care unit
Authors: Kabak Sevki , Halici Mehmet , Akcakus Mustafa , Cetin Neside , Narin Nazmi
Published: March 2003

Background
: Septic arthritis is an uncommon, but serious disorder in neonates. Most patients survive with permanent handicaps. Due to the rarity of this condition in neonates and paucity of signs and symptoms, the diagnosis of septic arthritis in newborns is more difficult than in older children.

Methods
: Septic arthritis or suppurative arthritis is an infection of the joint by a variety of microorganisms, including bacteria, viruses, mycobacteria and fungi. Purulent synovial fluid, positive culture and positive Gram stain were accepted as a gold standard for exact diagnosis. Fourteen neonates who were followed‐up in a neonatal intensive care unit, with septic arthritis, were included in a study based on a review of medical reports and a long‐term clinical and radiological follow‐up. Clinical symptoms, bacteriology, risk factors and outcomes are discussed.

Results
: Staphylococcus aureus was the predominant causative organism. Risk factors for septic arthritis were prematurity (4/14), umbilical catheterization or venous catheterization (3/14), sepsis (3/14), perinatal asphyxia (2/14) and difficult birth (1/14). All cases of septic arthritis in neonates were improved without squealae except in two patients. One patient died and one patient had severe squealae. In these two patients, the duration of disease from clinical onset to initiation of therapy was long.

Conclusion
: The most important prognostic factor in predicting a favorable outcome in neonatal septic arthritis is early diagnosis and therapy. When appropriate treatment is delayed, catastrophic sequelae are inevitable. Early diagnosis of the condition and rapid removal of pus are mandatory for the survival of the joint. Long‐term follow‐up may reveal effects of epiphyseal damage, early degenerative changes and limitation of the range of motion.
Self‐esteem and student nurses: An account of a descriptive study
Authors: Burnard Philip , Hebden Una , Edwards Deborah
Published: March 2003

Abstract In this paper the authors describe a study of nursing students' self‐reported self‐esteem levels using a validated instrument: the Culture‐Free Self‐Esteem Inventory 2 (CFSEI‐2). The research question was: How do student nurses rate their own self‐esteem levels? The paper offers a short review of some of the literature, followed by a description of the sample (a convenience sample of 101 undergraduate nursing students), data collection and analysis methods and the findings. The self‐esteem components of CFSEI‐2 are general, personal and social and these terms are defined in the text of this paper. The findings indicated that the mean scores for this sample of nursing students fell within normal levels for all three components of self‐esteem. Younger students were found to have higher scores for the social subscale, which indicates that they had a higher perception of the quality of their relationships with their peers. The findings of this study indicate that these undergraduate student nurses' perceptions of their self‐esteem were comparable to the normal ranges of self‐esteem as assessed by the instrument.
Nursing home use for clinical rotations: Taking a second look
Authors: Chen Shu‐li , Melcher Pat , Witucki Janet , McKibben Mary Angela
Published: March 2003

Abstract Because of the high acuity level of hospitalized clients and the rapid increase in aging populations, the placement of beginning fundamental students in a nursing home setting should be taken into more serious consideration. Thus, the purpose of the present paper was to describe the advantages and disadvantages of using nursing homes as clinical sites for baccalaureate of science in nursing education based on a comprehensive review of the literature. The main advantages are the wide spectrum of health needs, stable census, and regularly scheduled treatments in nursing homes. The main disadvantages are lack of adequate role models, lack of preparation and interest of the nursing faculty in working with the elderly, and potential for creating negative attitudes toward the elderly and their care.
Aging: A body of resistance
Authors: Chater Keri
Published: March 2003

Abstract The present paper explores the language of aging used, often unthinkingly, by nurses and policy makers. Terms so often used when describing aging, such as ‘frailty’ and ‘dependence’, are used in a way that implies a common knowledge, a point of convergence. It will be argued, using data gathered from research, that these terms often are a point of departure and that they may not signify a common understanding at all. From a postmodern perspective, it will be argued that it is at this point that common knowledge comes up against corporeal or embodied knowledge. In conclusion, the author will argue for a clinical encounter in which intersubjective meanings can be elucidated.
Defining characteristics of expertise in Japanese clinical nursing using the Delphi technique
Authors: Nojima Yoshiko , Tomikawa Takako , Makabe Satsuki , Snyder Mariah
Published: March 2003

Abstract A four‐round Delphi technique was conducted on 127 experienced Japanese nurses to develop a consensus of opinion on the defining characteristics underlying expertise, and the prime requirements for the development of expertise in clinical nursing. Sixteen statements identified as the prime defining characteristics underlying expertise indicated that experienced Japanese nurses’ picture of expertise is general, comprehensive and focused on task expertise. Four prime requirements for the development of expertise identified indicated that neither experience nor accumulation of theoretical knowledge alone is sufficient to develop expertise; but that motivation and attitude do play an essential role in the development of expertise.
Proliferation and differentiation of rat dorsal prostatic epithelial cells in collagen gel matrix culture, focusing upon effects of adipocytes
Authors: Tokuda Yuji , Toda Shuji , Masaki Zenjiro , Sugihara Hajime
Published: March 2003

Abstract
Background
: Prostatic epithelial cells organize functional acinus structures under epithelial– extracellular matrix and epithelial–stromal cell interactions. Recently, the adipose tissue, which surrounds and even exists within the prostate, has been suggested to affect the differentiation and proliferation of some cell types. Therefore, tissue fragments, which consist mainly of epithelial and fibromuscular stromal cells, were cultured in three‐dimensional collagen gel matrix culture with adipocytes.

Methods
: Tissue fragments of rat dorsal prostate, including both epithelial and fibromuscular stromal components, were cultured in collagen gel with or without adipocytes. Epithelial cell differentiation was evaluated with the reconstruction of acinus‐like structures and with immuno‐histochemistry of rat dorsal prostate‐specific proteins, dorsal protein‐1 and probasin. The proliferation was examined by uridine uptake.

Results
: Under coculture of the fragments and adipocytes, epithelial cells reconstructed more differentiated acinus‐like structures surrounded by fibromuscular stromal cells than tissue fragment culture without adipocytes. Dorsal protein‐1 and probasin expressions of epithelial cells in this coculture system were the same as in rat prostate in vivo. In the coculture, epithelial cells had a higher proliferation activity.

Conclusion
: These results indicate that adipocytes promote proliferation and differentiation of prostatic epithelial cells. Our new culture model with adipocytes suggests the importance of cell–cell interactions, including those of epithelial cells and adipocytes.
Necessity of repeat biopsies in men for suspected prostate cancer
Authors: Noguchi Masanori , Yahara Junro , Koga Hiroshi , Nakashima Osamu , Noda Shinshi
Published: March 2003

Background: The indications for repeat prostate needle biopsy in men whose initial biopsy results revealed no evidence of cancer are not defined.

Methods: We retrospectively studied 218 consecutive cases of men undergoing prostate biopsies for suspected cancer. Men in whom cancer was found on repeat biopsy were compared with others with regard to age, digital rectal examination, serum prostate‐specific antigen (PSA) concentration, prostate volume, PSA density, PSA slope and the frequency of prostatic intraepithelial neoplasia (PIN) on initial prostate biopsy.

Results: Of the 114 cancers detected, 99 (87%) were diagnosed on initial biopsy and 15 (13%) were diagnosed on repeat biopsy. Mean PSA concentration and mean PSA density were significantly higher in patients with cancer on initial biopsy than on repeat biopsy (P < 0.05), but they were similar among patients with and without cancer on repeat biopsy. The PSA slope showed a more progressive increase in patients with cancer on repeat biopsy than in those patients without cancer at 6 month intervals. Of the 218 patients undergoing prostate biopsy, seven (3.2%) were identified with high grade PIN but without concurrent prostate cancer. Prostate cancers were detected in two of these seven patients (29%) on repeat biopsy.

Conclusions: Serum PSA levels and PSA density did not provide useful predictive information about the indications of repeat biopsy. We conclude that men with a more progressive increase in PSA levels at 6 months intervals and high grade PIN on prostate needle biopsy should undergo repeat sampling to exclude missed cancer.
Complete disruption of the female urethra
Authors: Takayama Tatsuya , Mugiya Soichi , Ohira Tomoaki , Un‐No Toshiyuki , Fujita Kimio
Published: March 2003

Purpose: We report a rare condition of complete rupture of the bladder neck with an anterior vaginal laceration secondary to blunt pelvic trauma in a 19‐year‐old woman.

Methods: Management consisted of a suprapubic cystostomy, followed by end‐to‐end anastomosis 3 days later.

Results/Conclusions: After 6 months, the patient is continent without any urinary disturbances.
Clinical outcome of microsurgery for obstructive azoospermia
Authors: INABA YOKO , FUJISAWA MASATO , OKADA HIROSHI , ARAKAWA SOICHI , KAMIDONO SADAO
Published: March 2003

Background: Recent technical advances in microscopy have greatly improved the reconstruction of the seminal tract in cases of obstructive azoospermia.

Methods: We evaluated the clinical outcome of 28 patients with obstructive azoospermia who underwent microsurgical reconstruction (i.e. vasovasostomy or unilateral epididymovasostomy). Diagnoses included postvasectomy (n = 9), childhood inguinal herniorrhaphy (n = 10) and cases of unknown cause (n = 9). Six of the unknown cases proved to be inoperable. We analyzed the outcome of the surgical reconstructions of operable cases according to the causes of obstruction, duration of obstruction, quality of the fluid obtained from the distal seminal tract (concentration, morphology and motility of sperm) and the histologic findings of the testis.

Results: The surgical outcome was analyzed with regard to the incidence of patency and pregnancy. The incidence of patency achieved in nine vasectomy cases was 89%, while the incidence of pregnancy was 44%. In contrast, the incidence of patency in the nine operable cases with herniorrhaphy was 44%, while the pregnancy rate was 0%. Of four cases of unknown cause who underwent epididymovasostomy, the incidence of patency was 100% and the incidence of pregnancy was 75%. The outcomes were worse in post‐vasectomy cases with long‐term obstruction of more than 10 years; however, this was not statistically significant. The outcome was significantly worse in cases with low sperm concentrations. There was no significant relationship between histologic findings and surgical outcome.

Conclusions: The surgical outcome of vasovasostomy of postherniorrhaphy cases was significantly worse than that of post‐vasectomy cases. With regard to epididymovasostomy, a unilateral repair was clinically evaluated.
Role of ejaculation in the treatment of chronic non‐bacterial prostatitis
Authors: YAVAŞÇAOĞLU ĮSMET , OKTAY BÜLENT , ŞIMŞEK ÜMIT , ÖZYURT MUSTAFA
Published: March 2003

Background: Chronic non‐bacterial prostatitis (NBP) is the most common prostatitis syndrome. Prevention and cure are not possible because the cause of NBP is unknown. However, patients may benefit from supportive measures. The impact of the frequency of ejaculation alone on the course of NBP was evaluated in the present study.

Methods: Thirty‐four single male patients who avoided masturbation and extramarital sexual intercourse for personal and/or religious beliefs and who did not respond to a clinical trial of doxycycline hydrochloride therapy (200 mg daily for 4 weeks) directed against mycoplasmas, chlamydiae and ureaplasmas were enrolled in the study. They were encouraged to masturbate regularly at least twice a week and were re‐evaluated at the end of a 6 month period, including a complete inquiry regarding their sexual function during this time. Response was assessed by a symptom severity index.

Results: Clinical and laboratory re‐evaluation could be performed in 28 patients. Of 18 patients who adhered to the recommendations, two (11%) experienced complete relief of symptoms, whereas six (33%) had marked improvement, six had moderate improvement and four (22%) did not benefit. In contrast, three of seven patients who masturbated less frequently reported partial improvement. Three patients who did not ejaculate other than during wet dreams had a worse prognosis.

Conclusions: Young men who are single and suffering from NBP must be informed about their illness in detail and, if they are not doing so, they should be encouraged to ejaculate regularly, for example by masturbation in the absence of a sexual relationship with a partner. We believe that normal sexual activity decreases the incidence of NBP in some cases.
Prognosis of patients with T4 prostate carcinoma
Authors: Furuya Yuzo , Akakura Koichiro , Ichikawa Tomohiko , Ito Haruo
Published: March 2003

Background: The clinical course of patients with T4 prostate carcinoma was examined in order to consider whether there are alternative treatment options besides androgen ablation therapy.

Methods: From 1986 to 1995 at Chiba University Hospital, there were 22 cases of T4 prostate carcinoma. Sixteen cases had no bone metastasis at initial diagnosis. Tumor grade and response of prostate‐specific antigen (PSA) to endocrine treatment were evaluated in these 16 cases.

Results: Four patients had moderately differentiated and 12 had poorly differentiated adenocarcinoma. For initial treatment, all patients received endocrine therapy. Anti‐androgen therapy was effective in 15 cases and the 5 year cause‐specific and progression‐free survival rates were 72.1 and 38.1%, respectively. Patients with moderately differentiated tumors tended to have a longer disease‐free period than those with poorly differentiated tumors (P = 0.047).

Conclusions: Endocrine therapy was effective in patients with T4 tumors. It was suggested that aggressive local treatment (i.e. radiotherapy) in combination with endocrine therapy may be considered if the patients had no distant metastases and had a long life expectancy.
Intra‐arterial infusion of 5‐fluorouracil, leucovorin and cisplatin for primary adenocarcinoma of the urinary bladder*
Authors: Awakura Yasuo , Yamamoto Masakazu , Fukuzawa Shigeki , Nonomura Mitsuo , Fukuyama Takuo
Published: March 2003

Background
: Primary invasive adenocarcinoma of the urinary bladder was diagnosed in a 59‐year‐old man with a 6‐month history of macrohematuria.

Methods
: He was treated with intra‐arterial infusion of 5‐fluorouracil, leucovorin and cisplatin and underwent radical cystectomy and construction of ileal conduit.

Results
: The pathologic examination of the specimen revealed no viable malignant cells.

Conclusion
: 5‐Fluorouracil combined with leucovorin and/or cisplatin has been used in the treatment of gastrointestinal adenocarcinoma and may be useful in primary adenocarcinoma of the bladder.