bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Reverse gear’ cellular movement mediated by chemokines
Authors: Zlatopolskiy Andrey , Laurence Jeffrey
Published: March 2003

We sought to model the mechanism by which leucocytes may be actively repulsed by a β‐chemokine signal. This model is used to interpret an apparent paradox in chemokine biology, whereby high levels of a T‐cell chemoattractant, stromal cell derived factor‐1 (SDF‐1), are present in bone marrow and thymic tissues despite a paucity of mature T lymphocytes in these areas. We postulate the differential involvement in cell migration of the two binding sites on SDF‐1 for its sole receptor, CXCR4, depending on whether high or low concentrations of SDF‐1 are encountered by the cell. Site choice would be mediated by divergent affinities of the two binding interactions. We also propose differential signalling following SDF‐1/CXCR4 interactions on the plasma membrane versus ligand/receptor complexes in endocytic vesicles. Preliminary data showing divergent susceptibility to kinase inhibitors depending on whether a cell is attracted to or repulsed by SDF‐1, are consistent with this model. In terms of physical movement toward or away from a chemokine gradient, we compare the cycling of surface receptors during migration to the caterpillar drive of a tractor, which can change direction simply by altering the direction of rotation of its threads. Finally, the potential clinical implications of concentration‐dependent, chemokine‐based cell attraction and repulsion are discussed.
B lymphocytes not required for progression from insulitis to diabetes in non‐obese diabetic mice
Authors: Charlton Brett , Zhang Ming Da , Slattery Robyn M
Published: March 2003

Previous studies have implicated B lymphocytes in the pathogenesis of diabetes in the non‐obese diabetic (NOD) mouse. While it is clear that B lymphocytes are necessary, it has not been clear at which stage of disease they play a role; early, late or both. To clarify when B lymphocytes are needed, T lymphocytes were transferred from 5‐week‐old NOD female mice to age‐matched NOD/severe combined immunodeficiency (SCID) recipient mice. NOD/SCID mice, which lack functionally mature T and B lymphocytes, do not normally develop insulitis or insulin‐dependent diabetes melitus (IDDM). The NOD/SCID mice that received purified T lymphocytes from 5‐week‐old NOD mice subsequently developed insulitis and diabetes even though they did not have detectable B lymphocytes. This suggests that while B lymphocytes may be essential for an initial priming event they are not requisite for disease progression in the NOD mouse.
Hepatoimmunology: A perspective
Authors: Mackay Ian R
Published: March 2003

Premises for the subspecialty of hepatoimmunology include the recognition that the liver is a lymphoid organ with unique immunological properties. These properties ensure efficient innate defence against intestinal microbes and toxins, confer a particular capacity for induction of tolerance, and provide for apoptotic disposal of redundant lymphocytes. Pathological responses within the liver are elicited when: (i) hepatotropic viruses (hepatitis virus B and C) escape immune elimination and reside in hepatocytes; (ii) the liver becomes the site of autoimmune responses directed against either hepatocytes (autoimmune hepatitis) or biliary ductules (primary biliary cirrhosis); or (iii) the liver in the course of disposal of drugs generates neoantigens that provoke adverse allergic responses. Recent advances in the understanding of the immunopathogenesis of these entities are reviewed.
The experience of nursing home life
Authors: Fiveash Barb
Published: March 2003

Fiveash B. International Journal of Nursing Practice 1998; 4: 166–174

The experience of nursing home life

This study explored the articulate resident’s experience of nursing home living. Using an ethnographic approach, data was collected through progressive, in‐depth, open‐ended interviews and participant observation from two 80‐bed nursing homes in New South Wales. Employing purposeful sampling, eight key informants were selected concurrent with data collection and analysis according to the adequacy of information and appropriateness of subjects. Four major themes emerged from the data: (i) against my will, (ii) living in a public domain, (iii) cultural implications of living with others, and (iv) the impact of nursing home residency. Findings indicate that whilst some residents find the experience acceptable, for others the experience is both constraining and dehumanising.
On reflection in action: Unaddressed issues in refocusing the debate on reflective practice
Authors: Clinton Michael
Published: March 2003

Clinton M. International Journal of Nursing Practice 1998; 4: 197–202

On reflection in action: Unaddressed issues in refocusing the debate on reflective practice

Reflective practice is now widely debated as a means of improving nursing practice. However, assumptions about reflective practice are rarely clarified and seldom subjected to critique. Therefore, the purpose of this paper is to take up Clarke, James & Kelly’s suggestion that limits to the scope and depth of reflection be considered. This is achieved by reflecting on what these authors claim it means to reflect in action. Four arguments are presented: (i) that nurses cannot be conscious of all aspects of nursing practice because there are aspects of practice that cannot be represented in consiousness, (ii) that those aspects of practice that can be represented in consciousness can be so only imperfectly, (iii) that all such representations are not reflexive, and (iv) that any representation in the form of an internal dialogue that could be regarded as reflection is overdetermined. Implications for reflexivity are then considered.
Leisure or therapeutics? Snoezelen and the care of older persons with dementia
Authors: Burns Ian , Cox Helen , Plant Helen
Published: March 2003

Snoezelen is the registered tradename for a multisensory environment approach initially established for purposes of leisure or therapeutics in the special education arena, but now expanding into a variety of client groups and settings, most notably in the care of older persons. Snoezelen is making its way into Australia at a rapid rate despite a lack of evidence‐based research. This paper looks at the Snoezelen phenomenon and searches the literature to review the history and contemporary use of this multisensory environmental work. While most articles indicate positive outcomes Snoezelen is not without its critics, some of whom focus on the lack of rigorous research while others critique the artificiality. As a leisure approach Snoezelen appears to add quality to the culture of the care environment.
Vivian Bullwinkel: Sole survivor of the 1942 massacre of Australian nurses
Authors: M Norman Elizabeth , Angell Dorothy
Published: March 2003

This article describes the series of tragedies 65 Australian Army Nursing Service (AANS) women suffered during the fall of Singapore in February 1942, until their rescue from a prisoner‐of‐war camp in September 1945. The story unfolds through the experiences of one nurse, Sister Vivian Bullwinkel, who was the sole survivor of the massacre of a number of these women on Bangka Island; the article examines her immediate and enduring reaction to this incident.
Case study approach to removing physical restraint
Authors: Koch Susan , Lyon Cheryl
Published: March 2003

The pathway to discarding the use of restraints on older people with a dementing illness is cluttered with misinformation. While exploring the reasons restraints are used as an intervention on an older person with a dementing illness, we find duty of care is an important aspect. This paper presents the process that occurred when an aged care facility used an education and consultation approach in an attempt to remove the need for physical and chemical restraint. This case involved the family of an older person with a dementing illness and staff of the aged care facility.
Identifying and transforming dysfunctional nurse–nurse relationships through reflective practice and action research
Authors: Rn Bev Taylor
Published: March 2003

This project facilitated reflective practice processes in experienced Registered Nurses (RNs) in order to raise critical awareness of practice problems, work systematically through problem‐solving processes to uncover constraints, and improve the quality of care given by nurses in light of the identified constraints and possibilities. Twelve experienced female RNs working in a large Australian rural hospital shared their experiences of nursing during three action research cycles. A thematic concern of dysfunctional nurse–nurse relationships was identified, as evidenced by bullying and horizontal violence. The negotiated action plan was put into place and participants reported varying degrees of success in attempting to improve nurse–nurse relationships.
Blueschist‐facies metamorphism during Paleozoic orogeny in southwestern Japan: Phengite K–Ar ages of blueschist‐facies tectonic blocks in a serpentinite melange beneath early Paleozoic Oeyama ophiolite
Authors: Tsujimori Tatsuki , Itaya Tetsumaru
Published: March 2003

Blueschist‐bearing Osayama serpentinite melange develops beneath a peridotite body of the Oeyama ophiolite which occupies the highest position structurally in the central Chugoku Mountains. The blueschist‐facies tectonic blocks within the serpentinite melange are divided into the lawsonite–pumpellyite grade, lower epidote grade and higher epidote grade by the mineral assemblages of basic schists. The higher epidote‐grade block is a garnet–glaucophane schist including eclogite‐facies relic minerals and retrogressive lawsonite–pumpellyite‐grade minerals. Gabbroic blocks derived from the Oeyama ophiolite are also enclosed as tectonic blocks in the serpentinite matrix and have experienced a blueschist metamorphism together with the other blueschist blocks. The mineralogic and paragenetic features of the Osayama blueschists are compatible with a hypothesis that they were derived from a coherent blueschist‐facies metamorphic sequence, formed in a subduction zone with a low geothermal gradient (~ 10°C/km). Phengite K–Ar ages of 16 pelitic and one basic schists yield 289–327 Ma and concentrate around 320 Ma regardless of protolith and metamorphic grade, suggesting quick exhumation of the schists at ca 320 Ma. These petrologic and geochronologic features suggest that the Osayama blueschists comprise a low‐grade portion of the Carboniferous Renge metamorphic belt. The Osayama blueschists indicate that the ‘cold’ subduction type (Franciscan type) metamorphism to reach eclogite‐facies and subsequent quick exhumation took place in the northwestern Pacific margin in Carboniferous time, like some other circum‐Pacific orogenic belts (western USA and eastern Australia), where such subduction metamorphism already started as early as the Ordovician.
Pb, Nd, and Sr isotopic constraints on the origin of Miocene basaltic rocks from northeast Hokkaido, Japan: Implications for opening of the Kurile back‐arc basin
Authors: Ikeda Yasuo , Stern Robert J. , Kagami Hiroo , Sun Chih‐Hsien
Published: March 2003

Late Miocene (7–9 Ma) basaltic rocks from the Monbetsu‐Kamishihoro graben in northeast Hokkaido have chemical affinities to certain back‐arc basin basalts (referred to herein as Hokkaido BABB). Pb‐, Nd‐ and Sr‐isotopic compositions of the Hokkaido BABB and arc‐type volcanic rocks (11–13 Ma and 4–4.5 Ma) from the nearby region indicate mixing between the depleted mantle and an EM II‐like enriched component (e.g. subducted pelagic sediment) in the magma generation. At a given 87Sr/86Sr, Hokkaido BABB have slightly lower 143Nd/144Nd and slightly less radiogenic 206Pb/204Pb compared with associated arc‐type lavas, but both these suites are difficult to distinguish solely on the basis of isotopic compositions. These isotopic data indicate that while generation of the Hokkaido BABB involves smaller amounts of the EM II‐like enriched component than do associated arc lavas, Hokkaido BABB are isotopically distinct from basalts produced at normal back‐arc basin spreading centers. Instead, northeast Hokkaido BABB are more similar to basalts erupted during the initial rifting stage of back‐arc basins. The Monbetsu‐Kamishihoro graben may have developed in association with extension that formed the Kurile Basin, suggesting that opening of the basin continued until late Miocene (7–9 Ma).
Global carbonate accumulation rates from Cretaceous to Present and their implications for the carbon cycle model
Authors: Nakamori T.
Published: March 2003

Abstract Global carbonate accumulation rates on the surface of the earth, including not only platforms but also continental margin slopes and deep‐sea from the Cretaceous to Present, are estimated by compiling previous geologic studies. These rates are revised, taking account of the erosional effect of the sediments on the platform and deep‐sea. Long‐term model carbonate fluxes from the ocean to the crust are calculated on the basis of the carbon cycle model (GEOCARB of Berner 1991). The rates based on the actual geologic data indicate much lower values than model fluxes, excluding the Pliocene and Quaternary. The discrepancy could be attributed to the two misunderstandings, namely an overestimate of carbonate accumulation rate for the Quaternary and an incorrect use of the higher Quaternary rate for a boundary condition of the model. The carbonate accumulation rate for the Pliocene to Quaternary is lowered from 29.8 × 1018 mol/Ma (modified from Opdyke & Wilkinson 1988) to 14.8 × 1018 mol/Ma in the present study, assuming that the rate from Quaternary to Pliocene is almost the same as the Miocene value. New model fluxes are recalculated with the new boundary condition in the Quaternary (14.8 × 1018 mol/Ma). Revised model fluxes show general trends of high rates in 120 Ma or 130 Ma, and a low rate in 0 Ma, and are in agreement with the accumulation rate pattern.
Geochemical and Sr–Nd–Pb isotopic investigation of Triassic granitoids and basement rocks in the northern Gyeongsang Basin, Korea: Implications for the young basement in the East Asian continental margin
Authors: Cheong Chang‐Sik , Kwon Sung‐Tack , Sagong Hee
Published: March 2003

Abstract We present chemical and Sr–Nd–Pb isotopic compositions of three Triassic (226–241 Ma) calc‐alkaline granitoids (the Yeongdeok granite, Yeonghae diorite and Cheongsong granodiorite) and basement rocks in the northern Gyeongsang basin, south‐eastern Korea. These plutons exhibit typical geochemical characteristics of I‐type granitoids generated in a continental magmatic arc. The Yeongdeok and Yeonghae plutons have similar initial Sr, Nd and Pb isotope ratios (87Sr/86Srinitial = 0.7041 ~ 0.7050, ɛNd(t) = 2.3 ~ 4.0, 206Pb/204Pbfeldspar = 18.22 ~ 18.34), but distinct rare earth element patterns, suggesting that the two plutons formed from partial melting of a similar source material at different depths. The Cheongsong pluton has slightly more enriched Sr–Nd–Pb isotopic compositions (87Sr/86Srinitial = 0.7047 ~ 0.7065, ɛNd(t) = 3.9 ~ 2.8, 206Pb/204Pbfeldspar = 18.24 ~ 18.37) than the other two plutons. The Nd model ages of the basement rocks (1.1 ~ 1.4 Ga) are slightly older than those of the plutons (0.6 ~ 1.0 Ga). The initial Sr and Nd isotopic ratios of the plutons can be modeled by the mixing between the mid‐oceanic ridge basalt‐like depleted mantle component and the crustal component represented by basement rocks, which is also supported by Pb isotope data. The Sr and Nd isotope data from granitoids and basement rocks suggest that the Gyeongsang basin, the Hida belt and the inner zone of south‐western Japan share relatively young basement histories (middle Proterozoic), compared with those (early Proterozoic to Archean) of the Gyeonggi and Yeongnam massifs and the Okcheon belt. The Nd isotope data of basement rocks suggest that the Hida belt might be better correlated with the basement of the Gyeongsang basin than the Gyeonggi massif, the Okcheon belt or the Yeongnam massif, although it may represent an older continental margin of East Asia than the Gyeongsang basin considering its slightly older Nd model ages.
Geochemistry of peridotite xenoliths in alkali basalts from Jeju Island, Korea
Authors: CHOI SEONG HEE , LEE JONG IK , PARK CHUNG‐HWA , MOUTTE JACQUES
Published: March 2003

Abstract  Ultramafic xenoliths in alkali basalts from Jeju Island, Korea, are mostly spinel lherzolites with subordinate amounts of spinel harzburgites and pyroxenites. The compositions of major oxides and compatible to moderately incompatible elements of the Jeju peridotite xenoliths suggest that they are residues after various extents of melting. The estimated degrees of partial melting from compositionally homogeneous and unfractionated mantle to form the residual xenoliths reach 30%. However, their complex patterns of chondrite‐normalized rare earth element, from light rare earth element (LREE)‐depleted through spoon‐shaped to LREE‐enriched, reflect an additional process. Metasomatism by a small amount of melt/fluid enriched in LREE followed the former melt removal, which resulted in the enrichment of the incompatible trace elements. Sr and Nd isotopic ratios of the Jeju xenoliths display a wide scatter from depleted mid‐oceanic ridge basalt (MORB)‐like to near bulk‐earth estimates along the MORB–oceanic island basalt (OIB) mantle array. The varieties in modal proportions of minerals, (La/Yb)N ratio and Sr‐Nd isotopes for the xenoliths demonstrate that the lithospheric mantle beneath Jeju Island is heterogeneous. The heterogeneity is a probable result of its long‐term growth and enrichment history.
Geochemical evolution of the Dras–Kohistan Arc during collision with Eurasia: Evidence from the Ladakh Himalaya, India
Authors: CLIFT PETER D. , HANNIGAN ROBYN , BLUSZTAJN JERZY , DRAUT AMY E.
Published: March 2003

Abstract  The Dras 1 Volcanic Formation of the Ladakh Himalaya, India, represents the eastern, upper crustal equivalent of the lower crustal gabbros and mantle peridotites of the Kohistan Arc exposed in Pakistan. Together these form a Cretaceous intraoceanic arc now located within the Indus Suture zone between India and Eurasia. During the Late Cretaceous, the Dras–Kohistan Arc, which was located above a north‐dipping subduction zone, collided with the south‐facing active margin of Eurasia, resulting in a switch from oceanic to continental arc volcanism. In the present study we analyzed samples from the pre‐collisional Dras 1 Volcanic Formation and the postcollisional Kardung Volcanic Formation for a suite of trace elements and Nd isotopes. The Kardung Volcanic Formation shows more pronounced light rare earth element enrichment, higher Th/La and lower ɛNd values compared with the Dras 1 Volcanic Formation. These differences are consistent with an increase in the reworking of the continental crust by sediment subduction through the arc after collision. As little as 20% of the Nd in the Dras 1 Volcanic Formation might be provided by sources such as the Karakoram, while approximately 45% of the Nd in the Kardung Volcanic Formation is from this source. However, even before collision, the Dras–Kohistan Arc shows geochemical evidence for more continental sediment contamination than is seen in modern western Pacific arcs, implying its relative proximity to the Eurasian landmass. Comparison of the lava chemistry in the Dras–Kohistan Arc with that in the forearc turbidites suggests that these sediments are partially postcollisional, Jurutze Formation and not all pre‐collisional Nindam Formation. Thus, the Dras–Eurasia collision can be dated as Turonian–Santonian (83.5–93.5 Ma), older than it was previously considered to be, but consistent with radiometric ages from Kohistan.
Predictors of surgical outcomes
Authors: NELSON HEIDI
Published: March 2003

The foundation of surgical decision‐making has always been the risk‐to‐benefit ratio. Traditionally, the risks of complications and death, predicted by comorbid conditions, have been balanced against the benefits of disease management; that is, relief of symptoms or prevention of disease‐related complications. Increasingly, patient preference and quality‐of‐life outcomes are entering into the decision‐making process even at the price of modest increases in risk. In addition, the role of the surgeon as a predictor of outcomes has come under close scrutiny and has been demonstrated as having an effect on a number of important surgical outcomes. In the future, our methods for analyzing and reporting surgical outcomes will have to accommodate new predictors.
Plasma levels of mevalonate and 7α‐hydroxy‐4‐cholesten‐3‐one in chronic liver disease
Authors: Yoshida Tadashi , Honda Akira , Matsuzaki Yasushi , Shoda Junichi , Abei Masato , Tanaka Naomi , Osuga Toshiaki
Published: March 2003

Background and Aims: Cholesterol levels in blood tend to be preserved despite hepatic impairment, in contrast to albumin levels and other markers of liver function in patients with liver cirrhosis (LC). We reported previously that the levels of plasma mevalonate (MVA) and 7α‐hydroxy‐4‐cholesten‐3‐one (7α3one) closely reflect hepatic synthetic rates of cholesterol and bile acids. The aim of this study was to examine the association between hepatic cholesterogenesis and bile acid synthesis in hepatocellular impairment using these indices.

Methods: The plasma indices were measured in patients with LC (n = 38) or chronic hepatitis (CH; n = 11) and in normal controls (n= 22). The severity of LC was assessed by the Child–Pugh score.

Results: There were no significant differences in plasma MVA levels between CH, LC and control groups. However, plasma 7α3one levels were significantly lower in LC than in CH and control groups (P < 0.01). While MVA levels did not correlate with the Child–Pugh score, there was a significant correlation between 7α3one level and Child–Pugh score (P < 0.005). The plasma 7α3one level in controls correlated positively with MVA levels (P< 0.01); however, there was no significant correlation between these indices in CH and LC.

Conclusion: In chronic liver disease, there was a tendency for hepatic cholesterogenesis to be sustained in the face of hepatocellular impairment, while bile acid synthesis declined in parallel with the severity of impairment.
Findings and benefit of liver biopsies in 46 patients infected with human immunodeficiency virus
Authors: Piratvisuth Teerha , Siripaitoon Pisud , Sriplug Hutcha , Ovartlarnporn Bancha
Published: March 2003

Aims: The aim of this work is to evaluate the role of liver biopsy and to determine the histological findings in patients infected with the human immunodeficiency virus (HIV) who have abnormal liver function tests (LFT).

Methods: We performed a percutaneous liver biopsy in 46 HIV‐seropositive patients with abnormal LFT. Parts of biopsied tissue were used for bacterial and fungal culture and the rest was processed for histological examination including special staining.

Results: Of these 46 patients, 41 patients were males and five were females. The median age was 31 ± 6 years. Mycobacterium tuberculosis was the most common histological finding (15 cases). Of 15 tuberculosis patients, 11 (73.3%) had lymphadenopathy and positive acid‐fast bacilli (AFB) in node aspiration or biopsy. The other findings included AFB‐negative granuloma (eight cases), histoplasmosis (six cases), cryptococcosis (six cases), penicillosis (four cases), viral hepatitis: hepatitis C virus (HCV; one case), hepatitis B virus and HCV infection (one case), fatty liver (two cases), drug‐induced hepatitis (one case) and non‐specific changes (five cases). There were double infections in three patients. We were able to demonstrate opportunistic infections in 41 cases (89.3%).

Conclusions: Mycobacterium tuberculosis was the most common histological finding in HIV patients with abnormal LFT in Thailand. Liver biopsy was a useful procedure in evaluating abnormal LFT in HIV patients.
Genotyping as a diagnostic aid in genetic haemochromatosis
Authors: Rossi Enrico , Henderson Sandra , Chin Christine , Olynyk John , Beilby John , Reed William , Jeffrey Gary
Published: March 2003

Background: Two mutations in a newly described gene, HFE, have been proposed as genetic markers for the inherited iron overload disease, genetic haemochromatosis.

Methods: We assessed the frequency of both mutations in a cohort of genetic haemochromatosis patients and compared these with a control population. The patients were genetic haemochromatosis patients from Western Australia whose diagnosis met strict criteria for phenotypic expression. Control patients had other liver disease where iron overload was excluded.

Results: Genomic DNA of 72 genetic haemochromatosis patients and 69 controls was examined for the C282Y and H63D mutations of the HFE gene using polymerase chain reaction amplification and restriction enzyme digestion. In genetic haemochromatosis patients, the C282Y mutation was homozygous in 64 of 72, giving a sensitivity of 89% (95% confidence interval 82–96%), heterozygous in five (7%) and absent in another three (4%), whereas none of the control subjects were homozygous. The H63D mutation was present in one genetic haemochromatosis patient and was not useful as a diagnostic marker. In this cohort of Western Australian patients with phenotypic expression of genetic haemochromatosis, the specificity of a homozygous C282Y mutation for genetic haemochromatosis was 100%.

Conclusions: The results indicate that genotyping for the C282Y mutation is a useful test for the diagnosis of genetic haemochromatosis in clinical practice.
CASE REPORT: Hepatocellular carcinoma in type 1a glycogen storage disease with identification of a glucose‐6‐phosphatase gene mutation in one family
Authors: Nakamura Toshifumi , Ozawa Takachika , Kawasaki Tsunehisa , Yasumi Kazuhiko , Wang Dong‐Yu , Kitagawa Mutsuo , Takehira Yasunori , Tamakoshi Katsutoshi , Yamada Masami , Kida Hideo , Sugie Hideo , Nakamura Hirotoshi , Sugimura Haruhiko
Published: March 2003

Abstract A 40‐year‐old man with glycogen storage disease type 1a (von Gierke disease, GSD1a) developed hepatocellular carcinoma (HCC). Cold single‐strand conformation polymorphism (SSCP) with 12% glycerol identified the G727T mutation in the glucose‐6‐phosphatase (G6Pase) gene, which has been reported to be the most common mutation in Japanese GSD1a patients. This case report is the first documentation of HCC in a case with G727T mutation. Given the prevalence of HCC in GSD1a with various germline mutations, analysis is needed to confirm that the germline mutation in this case is really related to hepatocarcinogenesis. DNA analysis of the family pedigree of this case, revealed three individuals with GSD1a and seven heterozygous carriers of the G727T mutation. As the diagnosis of GSD1a in this family was made only after these three patients reached adulthood, DNA diagnosis may help early identification of GSD1a patients and prevention of the progression of the disease. This DNA‐based diagnosis permits prenatal diagnosis in at‐risk patients and may facilitate screening and counselling of patients clinically suspected of having this disease.

© 1999 Blackwell Science Asia Pty Ltd
Cardiopulmonary dysfunction in cirrhosis
Authors: Liu Hongqun , Lee Samuel
Published: March 2003

Abstract Cirrhosis is associated with several circulatory abnormalities. These include hyperkinetic systemic and splanchnic circulation, hepatopulmonary syndromes including pulmonary hypertension, and cirrhotic cardiomyopathy. Hepatopulmonary syndrome generally refers to hypoxaemia seen in patients with chronic liver disease and appears to be relatively common, although often subclinical. However, significant pulmonary hypertension occurs in 0.2–0.7% of cirrhotic patients. Nitric oxide and/or other vasodilators appear to be involved in the pathogenesis of hepatopulmonary syndrome through induction of pulmonary capillary dilatation which increases the alveolar‐arterial oxygen gradient. Cirrhotic cardiomyopathy refers to abnormal left ventricular function which is manifested under conditions of physiological or pharmacological stress. The emergence of liver transplantation as an effective treatment for end‐stage liver disease has led to recognition of previously subclinical cardiomyopathy and congestive heart failure accounts for significant morbidity and mortality after this procedure. Diminished myocardial β‐adrenergic receptor function has been shown to play an important role in the pathogenesis of this condition. The contributions of other factors including nitric oxide, catecholamines and membrane fluidity changes are under investigation. Cirrhotic patients also have an increased incidence of other cardiac abnormalities, such as endocarditis and pericardial effusions.

© 1999 Blackwell Science Asia Pty Ltd
Plasma human hepatocyte growth factor concentrations in patients with biliary obstruction
Authors: Kimura Fumio , Miyazaki Masaru , Suwa Toshikazu , Sugiura Toshiyuki , Shinoda Tokuzou , Itoh Hiroshi , Ambiru Satoshi , Shimizu Hiroaki , Nakagawa Kouji
Published: March 2003

Background: It has been suggested that human hepatocyte growth factor (hHGF) maintains the growth and viability of hepatocytes and biliary epithelial cells. The purpose of this study was to determine plasma hHGF concentrations in patients with obstructive jaundice and to correlate these findings with clinical outcome.

Methods: The study included 22 patients who had biliary obstruction and underwent percutaneous transhepatic biliary drainage. The plasma concentrations of hHGF, standard liver function tests, daily bile flow and the half‐life of serum total bilirubin were measured following the drainage.

Results: Plasma hHGF concentrations were significantly higher in patients with biliary obstruction compared with a control group (P< 0.01). The plasma hHGF concentrations correlated with white cell count, prothrombin time and bilirubin half‐life (P< 0.05), but not with the values from other liver function tests. Seven patients who died within 3 months after biliary drainage had significantly higher concentrations of plasma hHGF than the 15 patients who survived for at least 3 months (P< 0.05). The patients who experienced a poor outcome also had lower bile flows and prolonged bilirubin half‐lives compared with the survivors (P< 0.05). The plasma hHGF concentrations decreased significantly after biliary drainage in the survivors (P< 0.01), but not in the patients with a poor outcome.

Conclusions: These results suggest that systemic inflammation and the hepatic dysfunction caused by obstructive jaundice cause an increase in the plasma concentrations of hHGF. In addition, the plasma concentrations of hHGF may be a predictor of poor outcome in jaundiced patients.
Public health measures to control hepatitis B virus infection in the developing countries of the Asia–Pacific region
Authors: Chen Ding‐Shinn
Published: March 2003

Hepatitis B virus (HBV) infection is prevalent in the Asia–Pacific region and the disease burden caused by chronic HBV infection has been enormous. Although vaccination programmes have been implemented in the past decade, and there are extremely successful countries in the region, many countries still cannot afford a control program. These countries are often populous and highly endemic for HBV infection. To overcome this, aid from developed countries or private foundations should be actively sought. In the developing countries of this region, HBV infection in early childhood is the main cause of chronic HBV status, and thus universal vaccination of all infants is the best way to control HBV infection. Because of the expense and extra costs of screening pregnant women, the use of hepatitis B immune globulin may not be essential. To achieve the goal of universal infant vaccination, public education should be done in parallel with education of health professionals and control measures. The Asia–Pacific region has more people with chronic hepatitis B than any other part of the world, and control of HBV infection in this region will no doubt be the most important and challenging task to be taken in the beginning of the new millennium.
A 15‐minute [13C]‐urea breath test for the diagnosis of Helicobacter pylori infection in patients with non‐ulcer dyspepsia
Authors: Peng Nan‐Jing , Hsu Ping‐I , Lee Shui‐Cheng , Tseng Huei‐Hwa , Huang Wen‐Keui , Tsay Daw‐Guey , Ger Lu‐Ping , Lo Gin‐Ho , Lin Chiun‐Ku , Tsai Chi‐Chang , Lai Kwok‐Hung
Published: March 2003

Background
: Non‐ulcer dyspepsia (NUD) accounts for the majority of dyspeptic patients and studies on the epidemiology of Helicobacter pylori infection in NUD depend on a non‐invasive and rapid diagnostic test. This study was performed to determine the sensitivity and specificity of a 15‐min simplified protocol of the [13C]‐urea breath test ([13C]‐UBT) for the diagnosis of H. pylori infection in patients with NUD.

Methods
: One hundred and thirty‐six patients with a clinical and endoscopic diagnosis of NUD were included. The [13C]‐UBT was modified from the European standard protocol. The baseline breath sample was collected 5 min after the patient took a test meal and the 13CO2 was collected 15 min after the patient drank 100 mg [13C]‐urea. The gold standard used for comparison was either a positive culture or positive histology + positive rapid urease test sampled on upper gastrointestinal endoscopy.

Results
: The prevalence of H. pylori infection in NUD by the gold standard was 59.6%, whereas that calculated by the [13C]‐UBT was 60.3%. The sensitivity and specificity of [13C]‐UBT was 93.8 and 89.1% compared with the gold standard. The shortened collection time and simplification of the procedure may have led to a decline in specificity.

Conclusion
: The 15‐min [13C]‐UBT is a rapid but less specific protocol for detecting the presence of H. pylori infection in patients with NUD.

© 2000 Blackwell Science Asia Pty Ltd
Interaction between hyaluronan and CD44 in the development of dimethylnitrosamine‐induced liver cirrhosis
Authors: Satoh Tomomi , Ichida Takafumi , Matsuda Yasunobu , Sugiyama Motoya , Yonekura Kenji , Ishikawa Tohru , Asakura Hitoshi
Published: March 2003

Background
: A significant increase in serum hyaluronan (HA) levels has been reported in patients with liver cirrhosis. This mechanism is not yet clear, and receptors for HA have not been characterized. In this study, we examined the expression of both HA and its receptors, CD44 and intercellular adhesion molecule‐1 (ICAM‐1), in dimethylnitrosamine‐induced liver cirrhosis.

Methods and Results
: Using biotinylated HA binding protein, HA was detected in the area of periportal fibrosis and around the sinusoidal wall where hepatic fibrosis was developing. Electron microscopy revealed that HA was localized on Ito cells and sinusoidal endothelial cells (SEC). Conversely, CD44, which was only expressed weakly in normal liver, was present in large amounts in cirrhotic liver. The distribution pattern of CD44 was similar to that of HA, however, CD44 was mainly localized on the infiltrating lymphocytes and Kupffer cells. Moreover, CD44 was detected on part of factor VIII‐positive SEC. intercellular adhesion molecule‐1, another receptor for HA, was detected on the surface of hepatocytes and around the sinusoidal wall in cirrhotic liver, but its distribution was not accompanied by expression of HA. With respect to CD44 isoforms, the standard form m‐RNA predominated in both normal and cirrhotic liver. Variant pMeta‐1 mRNA was detected at low levels.

Conclusions
: An interaction between HA and CD44 may play a role in the recruitment of numerous infiltrating cells and HA accumulation in hepatic sinusoids. Together with phenotypic changes in the SEC, these results may lead to a disturbance in the elimination of HA during the progression of liver cirrhosis.
Temporary use of an accuflex stent for unextractable common bile duct stones
Authors: Mizukami Yusuke , Saito Hiroya , Obara Takeshi , Arisato Satoshi , Nakano Yasuhiro , Sakurai Yasuo , Izawa Tsutomu , Kohgo Yutaka
Published: March 2003

Endoscopic management has become the main therapeutic approach for the extraction of common bile duct (CBD) stones, and successful removal can be achieved in 80–90% patients using conventional balloon and basket techniques. However, if it is difficult to completely fragment a stone, or to clear the CBD, which may occur for a variety of reasons, the therapeutic problem will remain. When bile duct stones can not be removed, a viable management option is to place a biliary stent to ensure drainage. However, recent studies of long‐term biliary stenting, with a plastic stent, showed a relatively high rate of morbidity and mortality. We report an alternative, unique treatment for unextractable common bile duct stones, using the temporal placement of an expandable metallic stent (EMS) to facilitate passage of fragments through the papilla.
Iron excretion in iron‐overloaded rats following the change from an iron‐loaded to an iron‐deficient diet
Authors: Oates Phillip S , Jeffrey Gary P , Basclain Kerrie A , Thomas Carla , Morgan Evan H
Published: March 2003

Background
: Iron stores in the body are thought to be regulated by a mechanism associated with the rate of iron absorption from the diet, with no significant role played by iron excretion. We report the existence of an iron excretory process that results in the loss of significant amounts of liver iron.

Methods and Results
: Rats were fed 3% carbonyl iron for 9 weeks, which resulted in a 20‐fold increase in liver non‐haem iron. When the rats on this iron‐loaded diet were switched to a low iron diet for 2 and 7 days, liver non‐haem iron levels fell 30% and 45%, respectively. A similar fall in transferrin‐bound plasma iron was also seen. As the liver iron had not redistributed to other body compartments, it was concluded that the iron had been excreted and that the excreted iron represented a loss of 22% and 28% in total body non‐haem iron over 2 and 7 days, respectively. Ligation of the common bile duct in iron loaded rats that had been switched to the iron‐deficient diet was accompanied by a similar loss of liver iron and also hepatocellular damage. In addition, measurement of enterocyte iron levels showed that only approximately 5% of the total iron excreted was found in these cells.

Conclusion
: Neither bile nor enterocytes play a significant role in iron excretion. The similarity in the degree of fall in transferrin‐bound iron levels with a change in diet suggests that iron excretion involves the uptake and excretion of transferrin bound‐iron, possibly by goblet cells. The observed hypertrophy of the intestinal mucosa associated with carbonyl iron feeding may facilitate hypersecretion of mucous and the excretion of this iron.
Cardiac tamponade caused by spontaneous rupture of mediastinal lymph node metastasis of hepatocellular carcinoma
Authors: Seki Shuichi , Kitada Takuya , Sakaguchi Hiroki , Nakatani Kazuki , Kamino Toshio , Nakamura Kenji , Yamada Ryusaku
Published: March 2003

Rupture of a hepatocellular carcinoma (HCC) is a well‐known cause of death in patients with HCC. This report describes a rare case of HCC presenting as cardiac tamponade caused by a spontaneous rupture of mediastinal lymph node metastasis into the pericardial space. A transcatheter arterial embolization (TAE) of internal thoracic artery successfully controlled the bleeding, and the patient was rescued from cardiac tamponade. Although there was no rebleeding, the patient died from liver failure 2 months later. An autopsy revealed a poorly differentiated HCC in the liver, lung and mediastinal lymph nodes.
Coagulation profile and platelet function in patients with extrahepatic portal vein obstruction and non‐cirrhotic portal fibrosis
Authors: Bajaj Jasmohan S , Bhattacharjee J , Sarin Shiv‐Kumar
Published: March 2003

Background and Aims:

Coagulation disorders commonly develop in patients with cirrhosis of the liver. They have also been reported in patients with non‐cirrhotic portal fibrosis (NCPF) and extra‐hepatic portal venous obstruction (EHPVO); the two conditions with portal hypertension and near‐normal liver functions. The spectrum and prevalence of coagulation abnormalities and their association with the pathogenesis of these diseases and with hypersplenism was prospectively studied.

Methods:

Eighteen EHPVO patients that included an equal number of NCPF patients and 20 healthy controls were prospectively studied. The coagulation parameters assessed included: international normalized ratio, partial thromboplastin time, and fibrinogen and fibrinogen degradation products. Platelet aggregation and malondialdehyde levels were measured.

Results:

Both EHPVO (83%) and NCPF (78%) patients had a significantly prolonged international normalized ratio and a decrease in fibrinogen and platelet aggregation. The EHPVO patients had a significant prolongation in partial thromboplastin time (67% patients), with increased levels of fibrinogen degradation product levels occurring in all patients; these were normal in NCPF patients. Platelet malondialdehyde levels were normal in both groups. Hypersplenism was present in four EHPVO and seven NCPF patients. It did not significantly influence the coagulation profile in either NCPF or EHPVO patients.

Conclusions:

Coagulation anomalies are common and significant in both NCPF and EHPVO patients, suggestive of a mild disseminated intravascular coagulation disorder. These imbalances could be caused by chronic subclinical endotoxemia and cytokine activation after the initial portal thromboembolic event. The persistence of these abnormalities in adolescent patients indicates an ongoing coagulation derangement.
Hepatic steatosis in chronic hepatitis C virus infection: Prevalence and clinical correlation
Authors: Hwang Shinn‐Jang , Luo Jiing‐Chyuan , Chu Chen‐Wei , Lai Chiung‐Ru , Lu Ching‐Liang , Tsay Shyh‐Haw , Wu Jaw‐Ching , Chang Full‐Young , Lee Shou‐Dong
Published: March 2003

Background and Aims: Hepatic steatosis is a histological characteristic in patients with chronic hepatitis C virus (HCV) infection. The aim of this study was to evaluate the prevalence of hepatic steatosis in Chinese patients with chronic hepatitis C, and to look for possible correlation with various histopathological changes and to look for possible correlation with various clinical and pathologic variables.

Methods: One hundred and six patients were enrolled, and patients with alcoholism or diabetes mellitus were excluded. Clinical, biochemical and virologic data, including HCV genotype and serum HCV‐RNA titer and histological findings, were compared between patients with and without hepatic steatosis.

Results: Fifty‐five (52%) of the 106 patients with chronic hepatitis C had hepatic steatosis. Patients with hepatic steatosis had significantly higher mean serum levels of triglyceride and γ‐glutamyl transpeptidase, higher body mass index, and a higher incidence of obesity compared with patients without hepatic steatosis. No significant differences in serum HCV‐RNA titer and HCV genotype or the response to interferon therapy were noted between the two groups. Histological analysis showed patients with hepatic steatosis had a significantly higher mean fibrotic score than patients without hepatic steatosis (1.9 ± 1.2 vs 1.3 ± 1.0; P = 0.016). There were no significant differences in the severity of necroinflammation, the presence of lymphoid aggregation/follicle or bile duct damage between the two groups. Multivariate logistic regression analysis showed that independent predictors associated with hepatic steatosis were obesity or a histology fibrotic score of ≥ 2.

Conclusion: It was found that 52% of Chinese patients with chronic hepatitis C had hepatic steatosis. Patients with hepatic steatosis were more frequently obese and had more severe hepatic fibrosis.
Comparison of clinical, virologic and pathologic features in patients with acute hepatitis B and C
Authors: Chu Chen‐Wei , Hwang Shinn‐Jang , Luo Jiing‐Chyuan , Wang Yuan‐Jen , Lu Rei‐Hwa , Lai Chiung‐Ru , Tsay Shyh‐Haw , Wu Jaw‐Ching , Chang Full‐Young , Lee Shou‐Dong
Published: March 2003

Background and Aims:The clinical outcomes of adult‐acquired acute infection of hepatitis C virus (HCV) and hepatitis B virus (HBV) are quite different. In order to compare the clinical, biochemical, virologic and pathologic pictures in these two groups of patients, we enrolled 22 adult patients with acute hepatitis C and 16 adult patients with acute hepatitis B, on whom liver biopsies were performed within 3 months of acute onset of the illness.

Results:The results showed that a significantly younger age, a higher ratio of the clinical symptoms of jaundice, nausea, vomiting, and poor appetite, a higher mean serum level of alanine transaminase, aspartate transaminase, and total bilirubin were present in patients with acute hepatitis B patients than in those with acute hepatitis C (P< 0.05). There was a significantly higher degree of periportal inflammation and total necro‐inflammatory activity in the acute hepatitis B patients (P= 0.002 and 0.049, respectively). Fifteen (68.2%) of the 22 patients with acute hepatitis C had detectable serum HCV‐RNA, but only two (14.3%) of the 14 tested patients with acute hepatitis B had detectable serum HBV‐DNA, detected by using the branched DNA signal amplification assay. Eighteen (82%) of the 22 acute hepatitis C patients and none of the 16 acute hepatitis B patients progressed into a chronic hepatitis stage (P< 0.001).

Conclusion:The manifestations of mild clinical symptoms, lower mean serum transaminases and bilirubin levels, a lesser degree of histological periportal necroinflammation, and more patients with a high circulatory viral load among the acute hepatitis C patients, may lead to more of that group developing chronicity than patients with acute hepatitis B.
Rapid response of severe refractory metastatic Crohn’s disease to infliximab
Authors: Miller Ashley M , Elliott Peter R , Fink Roy , Connell William
Published: March 2003

AbstractA case is described of a middle‐aged female who developed an aggressive form of biopsy‐proven metastatic Crohn’s disease involving the inguinal, perineal and submammary areas. Her condition had been unresponsive to topical and systemic corticosteroids, antibiotics, immunosuppressives, and repeated surgical debridement. Administration of infliximab resulted in a rapid clinical response with subjective improvements in pain and general well‐being, and an objective decline in exudate, erythema and size of the lesions. Infliximab may be a suitable therapeutic option in patients with metastatic Crohn’s disease.