bluuebunny/crossref_metadata_2025 huggingface dataset:
Six years’ (1992–1997) evolution of phytoplankton communities after recovery by liming in Lake Orta, northern Italy
Authors: Morabito Giuseppe
Published: March 2003

Lake Orta became heavily polluted in 1926 by ammonium sulphate and copper. After a couple of years the biological communities became extremely simplified and were composed of a few resistant species. This acute copper pollution was followed by a chronic acidification of the water, brought about by in‐lake biochemical oxidation of ammonium. Since the 1960s, heavy metals discharged from some plating factories became an additional source of pollution. After the reduction of ammonium discharge in 1982 and from May 1989 to June 1990 the lake was limed: the pH at overturn increased from pH 4.4 to 5.9, the metals’ concentration decreased and the number of planktonic taxa rapidly increased.

The present paper deals with the recent (1992–1997) evolution of the phytoplankton communities analysed by sample clustering: the cluster analysis indicates the separation of two large groups of samples (1992–1993 and 1995–1997). Such clustering is because of the gradual decline of the chlorophytes (for a long period the most important group in Lake Orta) between 1992 and 1994, followed by their marked decrease between 1995 and 1997, during which they were replaced by blue–green algae.

Also noticeable was the increase in diatoms, which had disappeared from the phytoplankton community from the 1930s until 1994, but during spring and summer 1997 they amounted to 40% of community abundance. Although it is now possible to describe a phytoplanktonic seasonal succession in Lake Orta, the dissimilarities shown by the cluster analysis seem to indicate the existence of a certain year‐to‐year variability inside the dominant species assemblage, meaning that the phytoplankton community is still evolving.

In spite of the phytoplankton’s fast recovery after liming, it is only since 1994 that the algal community started to change toward a phytoplankton assemblage more typical of deep subalpine lakes.
Institutional arrangements for managing the great lakes of the world: Results of a workshop on implementing the watershed approach
Authors: Borre Lisa , Barker David R. , Duker Laurie E.
Published: March 2003

The conceptual framework for lake management has evolved at an accelerating rate in recent years to include the basic principles of a watershed approach: (i) citizen and stakeholder involvement is important throughout the planning and management process; (ii) the geographic focus for management activities includes the lake and its entire watershed; and (iii) mechanisms need to be in place to promote cooperation among different government jurisdictions and organizations in the watershed. Creating effective institutional arrangements for implementing this watershed approach in lake regions is perhaps the most challenging and important issue facing the world’s lakes. LakeNet organized a workshop at the 8th International Conference on the Conservation and Management of Lakes in May 1999. This article is a synthesis of the results of the workshop and the eight case reports prepared by the workshop participants published in this special issue. Seven major threats to lakes were identified: (i) accelerated eutrophication; (ii) invasive species; (iii) toxic contamination; (iv) overfishing; (v) water diversion, (vi) acidification; and (vii) climate change. Institutions and institutional arrangements for addressing these issues and for implementing a watershed approach are just beginning to emerge on lakes around the world. All of the institutions described in the case reports were established or formalized during the 1980s and 1990s. The legal mechanisms creating these institutions range from cooperative agreements among jurisdictions for purposes of policy and planning to national laws and international treaties with full regulatory powers. The knowledge base, political will and financial resources for these activities were very small in comparison with the complexity of the task at hand.
Role of catchment area in the transport of nutrients to lakes in the Wielkopolska National Park in Poland
Authors: Szyper Halina , Gołdyn Ryszard
Published: March 2003

The external loading of 14 lakes in the Wielkopolska National Park was calculated, including nitrogen and phosphorus loads from point, diffuse and dispersed sources, precipitation and recreation. The basic source of nitrogen and phosphorus for most lakes in the Park is the export of diffuse pollution from the catchment area. Only four lakes are contaminated by sewage, which accounts for 0.1–61.2% of total nutrient loading. Annual unit area loads of phosphorus and nitrogen estimated for each lake were 2–51 times higher than Vollenweider’s critical loading levels. Estimated mass loading and annual unit area loads of nutrients for each lake were compared with lake water quality, expressed as the trophic state index. Analysis of the physico‐geographical structure of the catchment area and natural resistance of lakes to external input of nutrients allowed us to assess the role of the catchment in the deterioration of water quality and to indicate the protective measures required.
Development and use of a wetlands information system for assessing wetland functions
Authors: Wolfson Lois , Mokma Del , Schultink Ger , Dersch Eckhart
Published: March 2003

A wetlands information management system was developed to assess various wetland functions and values in two townships in Michigan, USA. The goals of the study were to determine the effectiveness of a wetland‐assessment method integrated with a geographical information system (GIS) to assess appropriate environmental criteria, potential effects of wetland size and type on function, and to develop a user–friendly interface that local officials might use in decision‐making related to wetland preservation and land‐use planning. In order to assess seven wetland functions and two values, quantitative measures were incorporated using GIS techniques to derive some of the needed information from existing spatial databases. However, on‐site investigation was required for all assessments. Of 65 wetlands evaluated through the system, no significant difference (P > 0.05) was found between wetland size and its ability to perform a given function. No single wetland type (e.g. forested, shrub/scrub, emergent, open water) had a higher probability of performing all wetland functions or values significantly more than another type. However, the combined application of on‐site evaluation and GIS technology might offer a more efficient method to assess wetland functions and values, with the latter providing an educational tool for local wetland planning and management.
Bacterioplankton production in a water column of Lake Biwa
Authors: Gurung Tek Bahadur , Urabe Jotaro , Nozaki Kentaro , Yoshimizu Chikage , Nakanishi Masami
Published: March 2003

Seasonal production of bacterioplankton in a water column of Lake Biwa was examined based on cell‐specific growth rates at above (surface layer) and below the thermocline (deep layer). The growth rates were estimated by incubating bacterioplankton in situ with a dilution technique. The rates ranged from 0.05 per day in winter to 0.89 per day in summer, generally with much higher rates in the surface layer than in the deep layer. In an entire water column, bacterial production (in terms of carbon [C]) ranged from 0.217 to 0.811 gC/m2 per day with a mean of 0.451 gC/m2 per day, which, on average corresponded to 43% of primary production. However, no significant correlation was detected between bacterial production and primary production rates. Although the bacterial production rate correlated positively to water temperature, surface and deep layer rates were comparative for some dates because the deep layer shared a large fraction of the water column. These results suggest that, although specific bacterial activity was low in the deep layer due to the low temperature, bacteria in that layer play substantial roles in consumption of organic matter and material flows in Lake Biwa.
Forecasting and assessing the impact of urban sprawl in coastal watersheds along eastern Lake Michigan
Authors: Pijanowski Bryan C. , Shellito Bradley , Pithadia Snehal , Alexandridis Konstantinos
Published: March 2003

The Land Transformation Model (LTM), which has been developed to forecast urban‐use changes in a grid‐based geographical information system, was used to explore the consequences of future urban changes to the years 2020 and 2040 using non‐urban sprawl and urban‐sprawl trends. The model was executed over a large area containing nine of the major coastal watersheds of eastern Lake Michigan. We found that the Black‐Macatawa and Lower Grand watersheds will experience the most urban change in the next 20–40 years. These changes will likely impact the hydrological budget, might reduce the amount of nitrogen exported to these watersheds, result in a significant loss of prime agricultural land and reduce the amount of forest cover along the streams in many of these watersheds. The results of this work have significant implications to the Lake Michigan Lake Area Management Plan (LaMP) that was recently developed by the United States Environmental Protection Agency.
Angiomatous variant of pleomorphic xanthoastrocytoma in a patient with a 20‐year history of epilepsy
Authors: Sugita Yasuo , Hayashi Itsurou , Aoki Takachika , Shigemori Minoru , Morimatsu Minoru , Okamoto Yuji , Kajiwara Kazunori
Published: March 2003

The angiomatous variant of the pleomorphic xantho‐astrocytoma (PXA) is a morphological subtype of PXA that is characterized by the presence of large numbers of tiny blood vessels with variable wall thicknesses. A case of an angiomatous variant of PXA occurring in the temporal lobe of a 43‐year‐old man is presented. The patient had a 20‐year history of seizures. Considering the clinical course and intra‐operative electro‐encephalography findings, it appears that this tumor was the epileptic focus in this patient and that it had been present for 20 years. Histopathologically, various degenerative changes, such as microcystic changes, calcification and hyaline thickening of vessel walls were seen in the tumor. In particular, obvious vascularity in the tumor and secondary vascular degenera‐tion should be related to gradual growth and benign clinical course of an angiomatous variant of PXA.
Systemic hypothermia following compression injury of rat spinal cord: An immunohistochemical study on the expression of vimentin and GFAP
Authors: Yu Wen Ru , Westergren Hans , Farooque Mohammad , Holtz Anders , Olsson Yngve
Published: March 2003

The objective of the present study was to determine whether systemic hypothermia up‐regulated vimentin and glial fibrillary acidic protein (GFAP) expression in the spinal cord as a result of trauma in normothermic rats. Experimental rats underwent thoracic laminectomy alone or laminectomy plus severe spinal cord compression, with or without reduction of core temperature. In hypothermic rats without trauma, vimentin was expressed in ependymal cells and a few intramedullary vessels but not in capillaries. Normothermic rats with trauma exhibited a marked up‐regulation of vimentin in the capillaries and in reactive astrocytes in all thoracic segments of the spinal cord. Expression of vimentin was significantly reduced in hypothermic rats with trauma. Expression of GFAP was reduced in hypothermic rats without trauma. However, trauma induced up‐regulation of GFAP in astrocytes in all thoracic segments. Hypothermia reduced this response in rats with trauma but to a lesser extent than vimentin. These results suggest that systemic hypothermia reduces the up‐regulation of vimentin in capillaries and reactive astrocytes in injured normothermic rats and support the hypothesis that systemic hypothermia influences microvascular and astrocyte responses in the peri‐injury zones following spinal cord compression trauma.
Clinicopathological studies on diffuse Lewy body disease
Authors: Kosaka Kenji , Iseki Eizo
Published: March 2003

With reports of dementia cases with numerous cortical Lewy bodies and our proposal that this be named ‘diffuse Lewy body disease’ (DLBD), this condition has received a great deal of attention, first in Japan and subsequently in Europe and North America. In the early 1990s, similar types of nomenclature were considered, and at the First International Workshop in 1995, it was proposed that ‘dementia with Lewy bodies’ be used as a generic term for Lewy body dementia, including the DLBD form. We review our previous clinicopathological findings and describe our recent immunohistochemical studies on DLBD.
Effects of macrophage‐colony‐stimulating factor deficiency on the maturation of microglia and brain macrophages and on their expression of scavenger receptor
Authors: Sasaki Atsushi , Yokoo Hideaki , Naito Makoto , Kaizu Chikako , Shultz Leonard D , Nakazato Yoichi
Published: March 2003

Macrophage‐colony‐stimulating factor (M‐CSF) regulates the survival, proliferation and differentiation of the mononuclear phagocyte lineage. Osteopetrotic (op/op) mice defective in producing functional M‐CSF were used in order to investigate the role of M‐CSF on the development of microglia and brain macrophages and the expression of scavenger receptor (SR). Adult op/op and littermate mice at 10–47 weeks of age were investigated by immunohistochemistry with a panel of monoclonal antibodies (F4/80, Mac‐1, anti‐major histocompatibility complex (MHC) class II and anti‐SR), electron microscopy and reverse transcriptase–polymerase chain reaction (RT‐PCR). Microglia were weakly immunolabeled with F4/80 and Mac‐1 in op/op and littermate mice, but the number of microglia in op/op mice was reduced in the cerebrum, cerebellum and brainstem compared with that of normal littermates. The numbers of Mac‐1‐positive microglia in op/op mice was 39% (pons) and 30% (cerebellar cortex) lower than that in normal littermates (P< 0.05). In addition, the microglia cell processes in op/op mice were often shorter than those in control mice. In op/op and littermate mice, both MHC class II and SR were present in perivascular cells and macrophages of the leptomeninx and choroid plexus. Ultrastructurally, perivascular cells appeared to be immature, since their cytoplasm was narrow and contained few inclusion bodies compared with those of control mice. Reverse transcriptase–polymerase chain reaction showed a weak expression for SR mRNA in the brains of op/op mice as well as littermate mice. These results indicate that microglia are partly dependent on M‐CSF for their proliferation and differentiation and that M‐CSF has no significant effect on the expression of SR in the physiological brain. The study also suggests that M‐CSF affects the maturation of perivascular cells at the ultrastructural level.
Widespread calcium deposits, as detected using the alizarin red S technique, in the nervous system of rats treated with dimethyl mercury
Authors: Mori Fumiaki , Tanji Kunikazu , Wakabayashi Koichi
Published: March 2003

It has been reported that the alizarin red S technique may be used to visualize both intracellular and extracellular calcium deposits. Using this method histologic observations of the nervous system were made in rats that were given dimethyl mercury at 5 mg/kg per day for 12 consecutive days, and killed on days 1, 4, 7, 10, 12, 24, 32, 49, 100 and 140 (day 0 was the day that the final dose was administered). Neuronal degeneration with calcium deposition was found in the nervous system from day 4 onward. In the cerebellum alizarin red S‐positive granules became gradually larger with time after dimethyl mercury administration, and large calcospherites were observed from day 32 onward. In contrast, the visualization of calcium deposits in the cerebral cortex was restricted to days 10–12. Calcium deposits were found in the ascending axons of the dorsal root ganglion neurons (dorsal fascicles of the spinal cord), but not in their perikarya. These findings suggest that widespread calcium deposition could occur in the nervous system following dimethyl mercury exposure, and that in the rat the mechanism of calcium deposition differs depending upon the brain region.
Cyclin D1 expression in normal oligodendroglia and microglia cells: Its use in the differential diagnosis of oligodendrogliomas
Authors: Bosone Ivana , Cavalla Paola , Chiadò‐Piat Loredana , Vito Nicoletta Di , Schiffer Davide
Published: March 2003

Cyclin D1 regulates G1–S progression. In many carcinomas it is overexpressed and it might even correlate with prognosis. However, the amplification of CCND1 contributes to the loss of cell cycle control only in a small fraction of malignant gliomas. Cyclin D1 can be immunohistochemically demonstrated by DCS‐6 mAb. In astrocytic gliomas the fraction of tumor cells with positive nuclei is almost null in well differentiated tumors and increases with the increase of proliferation rate that occurs in anaplasia. The correct evaluation of this fraction is hindered by the positive staining of normal oligodendrocytes and microglia cells. The cyclin D1‐positive staining of normal oligodendrocytes and microglia cells has been studied in a series of 20 oligodendrogliomas, five diffuse astrocytomas and five oligoastrocytomas and in 10 samples of normal cortex and white matter, using cyclin D1 DCS‐6 mAb, Feulgen reaction and CR3.43 mAb for microglia cells. As well as microglial nuclei, the nuclei of normal oligodendrocytes of the cortex and white matter, including peri‐neuronal satellites and pericapillary cells, were immunostained by DCS‐6 mAb. In infiltrative areas of oligodendrogliomas, normal, cyclin D1‐positive oligodendrocytes and cyclin D1‐negative tumor cells coexisted. In anaplastic oligodendrogliomas, cycling tumor oligodendrocytes may regain the capacity to express cyclin D1, which is thus positive in some tumor cells. The occurrence of positive oligodendrocytes in the peripheral parts of tumors can be useful in distinguishing astrocytomas from oligoastrocytomas.
Meshy meningioma: A potential novel variant
Authors: Yamanouchi Hideo , Yokoo Hideaki , Yoshida Takatomo , Kamiya Makoto , Sasaki Atsushi , Hirato Junko , Nakazato Yoichi
Published: March 2003

A potential novel variant of meningioma is reported. The tumor was solid, hard, white‐colored, well circumscribed in a fibrous capsule and fixed to the dura, showing no invasion into the brain parenchyma. Histopathological study presented a sparsely cellular tumor composed of cells with fine reticular or mesh‐like cytoplasm, each containing an oval nucleus. Mitotic figures were rarely seen. Immunohistochemical studies of tumor cells showed positive immunoreactivity for vimentin and epithelial membrane antigen but were negative for GFAP, desmin, neurofilament, keratin, S‐100, CD34 and CEA. Bipolar neoplastic cells and long processes were noted on ultrastructural observation; these were attached side by side to each other by desmosomes, resulting in a mesh‐like configuration. Perinuclear cytoplasm and processes were rich in intermediate filaments and rough endoplasmic reticulum. These microscopic and ultrastructural features have never before been reported among the variants of meningioma. The name ‘meshy meningioma’ is proposed for this novel variant.
Overexpression of mdm2 and p53 and association with progesterone receptor expression in benign meningiomas
Authors: Das Asha , Tan Wan‐Loo , Teo Jennifer , Smith Duncan R.
Published: March 2003

The progesterone receptor is frequently found expressed in meningiomas at robust levels. As several studies of breast and endometrial tumors have shown an inverse correlation between progesterone receptor expression and p53 overexpression, we sought to determine if a similar relationship existed in meningiomas. As p53 may also be inactivated by the overexpression of mdm2, we examined a cohort of 90 benign meningiomas immunohistochemically for the presence of the progesterone receptor as well as overexpression of p53 and mdm2. The progesterone receptor was detected in 67% (61/90) of cases, while p53 and mdm2 overexpression were detected in 14% (13/90) and 46% (42/90) of cases, respectively. An absolute correlation was observed between the overexpression of nuclear mdm2 and overexpression of the progesterone receptor, with nuclear mdm2 overexpression being confined to progesterone receptor‐positive tumors (P = 0.001). While p53 overexpression was not associated with progesterone receptor expression, a combination of mdm2 overexpression and/or p53 overexpression was significantly associated with the presence of the progesterone receptor (P = 0.025). These results suggest the existence of a novel relationship between p53 (and its regulatory control) and the presence of the progesterone receptor and, as such, may have fundamental consequences in developing progesterone receptor‐targeted therapies for meningiomas.
Neuropathology of experimental autoimmune encephalomyelitis modified by retroviral infection
Authors: Fukumitsu Hidefumi , Takase‐Yoden Sayaka , Watanabe Rihito
Published: March 2003

The A8 virus is a molecular clone of the neuropathogenic FrC6 virus derived from the Friend murine leukemia virus (F‐MuLV). To elucidate the effects of A8 virus‐infection on immune‐mediated diseases in the central nervous system, we investigated the development of acute and monophasic experimental autoimmune encephalomyelitis (EAE) in A8 virus‐infected Lewis rats. In EAE rats after A8 virus infection (A8‐EAE), many inflammatory cells were found in the gray matter including the frontal lobe, where almost no inflammatory cells were found in rats with EAE alone. The modified distribution of inflammatory cells was not dependent on the ages of A8 virus‐infected rats, although the frequency of the modified distribution was reduced in older rats. The chimeric virus Rec2, which contains the pol and env genes of 57 virus on the background of A8 and does not induce spongiform degeneration in the CNS, caused the same distributional modification of inflammatory cells in the rats with EAE as in A8‐EAE rats. Furthermore, the incidence and intensity of spongiform degeneration, thymoma and splenomegaly caused by A8 virus were reduced by the induction of EAE.
Atypical teratoid/rhabdoid tumor of the central nervous system: Clinico‐pathological study
Authors: Lee Min‐Cheol , Park Seung‐Kyu , Lim Joon‐Sup , Jung Shin , Kim Jae‐Hyoo , Woo Young‐Jong , Lee Ji‐Shin , Kim Hyung‐Ihl , Jeong Myung‐Ja , Choi Ha‐Young
Published: March 2003

Atypical teratoid/rhabdoid tumor (AT/RT) is a new entity among malignant pediatric brain tumors. This study was performed to investigate the clinicopathologic and cytogenetic features of the tumor. Five cases from a series of the brain tumors were studied. Clinical features of the patients were assessed with age, sex, location of the tumors, treatments and survival periods. Histopathologic features were analyzed by routine HE stain and immunohistochemical stains for epithelial membrane antigen, cytokeratin, vimentin, smooth muscle actin, desmin, GFAP, S‐100 protein, neurofilament protein, synaptophysin and α‐feto protein. Cytogenetic studies for karyotype analysis and fluorescent in situ hybridization were available in three cases. Mean age of patients was 5.6 years, and maximal survival periods were less than 13 months despite surgical and radiation therapy. The tumors were located in infratentorial and supratentorial areas. Histopathologically, the tumors were chiefly composed of rhabdoid cells, modified rhabdoid cells and undifferentiated small cells, mixed with epithelial, mesenchymal, and neural tumor‐like areas. These polyphenotypic features of the tumor cells were supported by diverse immunoreaction. Monosomy of chromosome 22 was demonstrated in two cases of the tumor. These results suggest that AT/RT may be a unique clinicopathologic entity, and histopathologic diagnosis of it should be made judiciously by differentiating other polymorphous tumors of the brain.
Hypercalcaemia following renal transplantation: A common problem of limited clinical consequence?
Authors: Walker Patrick C , Bannister Kym M , Clarkson Anthony R , Faull Randall J
Published: March 2003

SUMMARY:

Tertiary hyperparathyroidism, manifesting as hypercalcaemia, is common after renal transplantation. It often resolves within the first few years, but in previous studies has been associated with bone, renal and cardiovascular pathology. There have been no large studies in the last 10 years, or in patients treated predominantly with Cyclosporin A, that have examined the long‐term effect of this condition on patient or transplant outcomes. A retrospective analysis was conducted of 171 consecutive renal transplant recipients with at least 1 year of graft survival from 1984 to 1996. Measurement was made of current and past incidence of hypercalcaemia, the natural history of post‐transplant hypercalcaemia, and its effect on graft survival and function, and patient mortality. The incidence of hypercalcaemia was 26% and did not change significantly during the time frame of the study. The average serum calcium increased until 6 months post‐transplantation, and then steadily decreased over the next 7 years. There was a significant variation in the rate of decrease between subjects. No long‐term effect on patient or graft survival or function was detected. Post‐transplant hypercalcaemia usually represents a benign condition that resolves with time. A conservative approach is recommended in the management of most patients in this group.
Renal disease and the environment: lessons from Aboriginal Australia*
Authors: Hoy Wendy , Vanbuynder Paul , Mathews John D , Pugsley David J , Wang Zhiqiang
Published: March 2003

Aborigines in remote Australia are living in profound socio‐economic disadvantage and epidemiological transition. They are also experiencing an epidemic of cardiovascular disease, with deaths increased > threefold and renal failure increased > 20‐fold. Dialysis costs pose a crisis, but premature death is the greater human catastrophe. In one high‐risk group, we identified renal disease through the urinary albumin/creatinine ratio and assessed it distribution, its correlations, its associations with other morbidities and overall mortality and its natural history. We later introduced systematic antihypertensive and renal‐protective treatment for afflicted persons. Albuminuria was detected in 55% of adults. It was inversely correlated with glomerular filtration rate (GFR) and generally progressed over time. It was strongly correlated with cardiovascular risk, and its intensity predicted not only renal failure but also all‐cause natural death. Factors correlated with renal disease included increasing age, low birthweight and infant malnutrition, adult weight gain and its syndrome X metabolic accompaniments, skin infections, post‐streptococcal glomerulonephritis, heavy drinking, multiparity and a family history of renal disease. Nephron endowment probably also influences risk, with birthweight being one important driving force. Ironically, improved health services have probably contributed to the epidemic of renal failure in at least two ways: increased survival of low‐birthweight infants and increased longevity in adults, allowing the full progression or renal disease to its terminal state. The treatment programme was associated with swift and massive reductions in end‐stage renal failure, overall mortality and costs. Renal disease is multideterminant, with the simultaneous operation of several risk factors amplifying the increase in albuminuria and decrease in GFR that accompany increasing age. While many risk factors and mechanisms remain to be identified, our findings provide ample grounds for immediate intervention in similarly afflicted communities, with expectation of excellent outcome. Improved services will probably result in additional ascertainment of disease and more opportunity for its expression, so that disease prevention and modification become even more pressing obligations. Major shifts in our political, social, academic and clinical priorities are needed to effectively address these issues for all Aboriginal communities.
Cost‐effectiveness of using angiotensin‐converting enzyme inhibitors to slow nephropathy in normotensive patients with diabetes type II and microalbuminuria
Authors: Sakthong Phantipa , Tangphao Oranee , Eiam‐Ong Somchai , Kamolratanakul Pirom , Supakankunti Siripen , HIMATHONGKAM6 Thep , YATHAVONG7 Kitima
Published: March 2003

SUMMARY:We assessed the cost‐effectiveness of prescribing angiotensin‐converting enzyme (ACE) inhibitors to delay progression of diabetic nephropathy in normotensive patients with type II diabetes and microalbuminuria. The Markov models determined byDATATreeAGEsoftware were used to calculate the lifetime medical costs and life expectancy in patients treated with or without ACE inhibitors. The incremental cost‐effectiveness ratio (ICER), defined as the change in medical costs divided by the change in life expectancy, was the main outcome parameter. The ICER for ACE inhibitor therapy was US$788.37 per life‐year saved. Sensitivity analysis showed that ACE inhibitor therapy had no cost‐effectiveness value when the cost of ACE inhibitors was increased for more than 90% or when the cost of haemodialysis was decreased for greater than 48%, or when the efficacy of the treatment was reduced until the cumulative incidence of macroalbuminuria was increased from 18 to 48%.
Complement in renal disease
Authors: Charlesworth John A , Peake Philip W , Pussell Bruce A , Erlich Jonathan H
Published: March 2003

SUMMARY: The complement system consists of a series of plasma and membrane‐based proteins that participate in a wide range of biological events. These may be advantageous or damaging to the host. Most complement‐mediated effects involve sequential enzymatic activity or specific receptor–ligand interactions. Many tissues synthesize complement proteins, and substantial evidence suggests that these molecules contribute to local organ function. There is a long‐established link between complement and various forms of renal disease, including glomerulonephritis (GN), tubulointerstitial inflammation and transplant rejection. Among the glomerulonephritides, significant changes in plasma complement concentration are observed most commonly in acute post‐streptococcal disease, mesangiocapillary GN and lupus nephritis. The pattern of abnormality may predominantly affect the classical or alternative pathway, and these changes are of diagnostic importance and, to a lesser extent, assist in monitoring disease activity. Complement deposition is demonstrable in a wide range of renal diseases, but convincing evidence of its involvement in the pathogenesis of specific diseases is quite limited. Complement reactivity also occurs during haemodialysis, and the generation of biologically active by‐products has been demonstrated, to a variable extent, with different dialysis membranes. More recently, complement's involvement in the acute rejection of xenografts has been examined extensively, and attempts to modify its participation in these processes have been partially successful in experimental models. The long‐term efficacy and practical value of therapeutic complement inhibition is currently under examination in a variety of human and experimental immunological disorders.
Long‐term change of glomerular gelatinolytic activity in rats with streptozotocin‐induced diabetes
Authors: Fukudome Keiichi , Fujimoto Shouichi , Kinoshita Hiroshi , Hara Seiichirou , Hisanaga Shuichi , Eto Tanenao
Published: March 2003

SUMMARY: In diabetic nephropathy, a decrease in the activity of matrix metalloproteinase (MMP) might contribute to the build‐up of extracellular matrix protein in the mesangium and the glomerular basement membrane (GBM). Levels of MMP activity were measured as gelatinolytic activity in glomerular homogenates isolated from rats 1, 4, 12, 24 and 48 weeks after inducing diabetes mellitus (DM) with streptozotocin. The level of glomerular gelatinolytic activity after 1 week in DM rats was significantly increased compared with that in controls (224.8% of control; DM vs. control, 13.58 vs. 6.04 mU/glomerulus; P < 0.05), then decreased by 48 weeks (week 4, 92.8% of control; week 12, 81.9% of control; week 24, 31.8% of control; week 48, 47.3% of control). Glomerular metalloproteinase migrated on gelatin zymography at positions representing molecular weights of approximately 97, 80, 70 and 65 kDa. The intensity of these lytic bands was increased at 1 week but decreased at 24 and 48 weeks. Light microscopy revealed hypercellularity in the mesangial area at 1 week, followed by mild and marked mesangial expansion with GBM thickening at 12 and 48 weeks respectively. These data suggest that the persistent decrease in glomerular gelatinolytic activity during the chronic phase contributes to mesangial expansion and GBM thickening in DM rats. Moreover, the activity may play different roles at the time of onset and during the progression of diabetic nephropathy.
Positive and negative hepatitis B virus in renal biopsies of IgA nephropathy: an 85‐case clinicopathological analysis
Authors: Wu Zhao‐Long , Wang Nian‐Song , Xu Xun‐Hui , Qiu Lian‐Qun , ZHOU1 Qin , ZHANG3 Yue‐E
Published: March 2003

SUMMARY: The aetiological role of hepatitis B virus (HBV) antigens in IgA nephropathy remains uncertain. In a clinicopathological study, we examined 85 patients with primary IgA nephropathy divided into two groups depending on whether renal biopsy specimens were positive or negative for HBV antigens (HBsAg, HBcAg and HBeAg) using immunohistochemical methods. Compared with patients in the negative group (n = 59), those in the positive group (n = 26) had more obvious gross haematuria, proteinuria, hypertension and renal impairment. Their haemoglobin level, serum IgA concentration and creatinine clearance were also significantly abnormal. Immunofluorescence microscopy indicated that immunoglobulins deposited were mainly found in the combination of IgA + IgG + IgM. Consistent with the clinical manifestations, the pathological lesions revealed more glomerular sclerosis, tubular epithelial degeneration and necrosis and interstitial inflammation and fibrosis (P < 0.05). Thus, we concluded that the presence or absence of HBV in renal tissue from patients with IgA nephropathy results in significant differences in the clinical features, types and severity of pathological lesions and, consequently, prognosis. Tissue deposition of HBV might play an aetiological role in the pathogenesis of IgA nephropathy and may be an exacerbating factor in renal progressive deterioration. Antiviral therapy could be an important intervention in HBV antigen‐positive patients.
Nephropathy in type 2 diabetes: current therapeutic strategies
Authors: Gilbert Richard E. , Kelly Darren J.
Published: March 2003

Diabetic nephropathy is currently the commonest cause of end‐stage renal failure in most countries with a Western lifestyle. In addition to progressing to end‐stage renal disease, patients with type 2 diabetes and nephropathy are at especially high risk of cardiovascular death. A multifaceted approach, aiming not only to slow the progression of renal dysfunction but also to reduce the risk of associated complications, particularly cardiovascular disease, is advocated. Current evidence‐based guidelines serve a useful adjunctive role in providing target levels for therapeutic intervention.
Management of bacterial peritonitis and exit‐site infections in continuous ambulatory peritoneal dialysis*
Authors: THOMAS Merlin C , HARRIS David CH
Published: March 2003

SUMMARY: Peritonitis and exit‐site infections remain the most important limitations to the delivery of continuous ambulatory peritoneal dialysis (CAPD). Contamination of the peritoneum, from endogenous or exogenous sources, is responsible for most peritonitis episodes. Patients usually present with a cloudy bag, although other causes should be distinguished. Clinical suspicion of peritonitis should be followed rapidly by microbiological examination and empirical treatment. Microbiological confirmation allows for subsequent treatment based on sensitivities. Other interventions such as catheter removal may be appropriate in some patients. Exit‐site infections should also be identified and treated early. Peritonitis may be further prevented by adequate exit‐site care, hygienic methods, and techniques to minimise early contamination of the exit site. Mupirocin may also have a role in preventing infections caused by Staphylococcus aureus.
Advances in anaemia management: Current evidence
Authors: MCMAHON Lawrence P
Published: March 2003

SUMMARY: Simplicity and sufficiency in the management of renal anaemia were first envisaged with the development and production of recombinant human erythropoietin (epoetin). Recent years, however, have seen the publication of several studies examining the optimal administration of epoetin, the emergence of a new erythropoietic agent (Novel Erythropoietic Stimulating Protein, NESP), recognition of the need for supraphysiological iron levels, and the possible use of many potential adjuvant agents. Together, these factors have made the management of renal anaemia substantially more complex, perhaps even to the point of confusion. the purpose of this review, therefore, is to examine the evidence relating to these factors in order to offer a summary of their known effects on anaemia management, hopefully with some progress towards the initial goals.
Prednisolone‐loaded liposome decreases the accumulation of glomerular extracellular matrix and glomerular injury of immunoglobulin A nephropathy in ddY mice
Authors: LIAO Jie , HAYASHI Kayo , HORIKOSHI Satoshi , USHIJIMA Hideto , KIMURA Junji , TOMINO Yasuhiko
Published: March 2003

SUMMARY: Morphometric, immunofluorescent and electron microscopic analyses were performed to determine the glomerular changes of ddY mice after treatment with the prednisolone‐loaded liposome (PSL‐liposome) in the present study. A morphometric analysis including the extracellular matrix areas (ECMA), number of intraglomerular cell nuclei (NIGCN), and the ratio of glomerular tuft area (GTA) to the whole glomerular area (WGA) (GTA/WGA), or the ratio of glomerular Bowman's space (GBS) to GTA (GBS/GTA) was performed by image analysis using light microscopy. Extracellular matrix case, NIGCN and GTA/WGA of PSL‐liposome‐treated ddY mice were significantly decreased compared with those of ordinary prednisolone (PSL)‐treated and saline control ddY mice. Glomerular Bowman's space/GTA was markedly increased in the PSL‐liposome‐treated ddY mice. the mean intensity of immunoglobulin (Ig)A, IgG, complement C3 or intercellular adhesion molecule‐1 (ICAM‐1) staining in glomeruli of the PSL‐liposome treated ddY mice was also significantly decreased compared with those of ordinary PSL‐treated and saline control ddY mice. Electron dense deposits in glomeruli were decreased after treatment with PSL‐liposome in 61‐week‐old ddY mice. It appears that PSL‐liposome therapy might reduce glomerular expansion, and intraglomerular cell proliferation and infiltration in IgA nephropathy of ddY mice.
Regulation of the apoptosis‐related genes, Bax and Bcl‐2, in the early stage of diabetes mellitus
Authors: KIKUCHI Yuichi , NONOGUCHI Hiroshi , MACHIDA Kenji , WAKAMATSU Shiho , KOGA Hiroko , TOMITA Kimio
Published: March 2003

SUMMARY: Apoptosis is related to a particular phase of the pathogenesis of diabetic nephropathy. the aim of the study is to investigate if (and if so where in the kidney) apoptotic changes occur during the early stage of diabetes mellitus. the incidence of renal cell apoptosis and its related Bcl‐2 proteins was investigated in the early stage of streptozotocin‐induced diabetic rats, using histological sections as well as isolated nephron segments and high glucose treatments in vitro. Modulation of the induced changes with the angiotensin‐converting enzyme (ACE) inhibitor, temocapril, was also analysed. Reverse transcription (RT)‐competitive polymerase chain reaction and western blot analysis were used. Glucose caused an increase of Bax mRNA expression in glomeruli and in the proximal straight tubule (PST), but not in the inner medullary collecting duct (IMCD). Glucose induced a decrease (40%) of Bcl‐2 mRNA expression in PST but not in glomeruli or in IMCD. Western blotting showed an increase of Bax protein expression in PCT, PST, and medullary thick ascending limb (MAL), and a decrease of Bcl‐2 protein expression in PST in diabetic rats. the ratio of Bcl‐2 to Bax decreased in PCT and PST in diabetic rats. the terminal deoxynucleotidyl transferase‐mediated dUTP‐biotin nick end‐labelling (TUNEL) method revealed the presence of apoptotic cells in proximal tubules in diabetic rats. Short‐term administration of temocapril did not affect Bax and Bcl‐2 protein expression in PCT or PST of diabetic rats. In conclusion, high ambient glucose could directly induce apoptotic changes in proximal tubules but not in glomeruli or in distal tubules at the early stage of diabetes mellitus.
Increased frequency of the apolipoprotein E2 allele in maintenance haemodialysis patients in Taiwan
Authors: HSIEH Ming‐Chia , LIN Shiu‐Ru , LO Chao‐Sheng , HSIN Shih‐Chieh , CHEN Hung‐Chun , SHIN Shyi‐Jang
Published: March 2003

SUMMARY: Apolipoprotein E (apo E) regulates the metabolism of lipoproteins. Three different apo E alleles (ε2, ε3 and ε4) produce the apo E isoproteins, apo E2, apo E3 and apo E4. Previous studies had revealed that lipid abnormalities might contribute to the development and progression of kidney diseases. Thus, the apo E gene polymorphism may be associated with end‐stage renal disease. to investigate the distribution of apo E genotype in patients under haemodialysis in Taiwan, we examined 205 dialysis patients and 103 age‐matched normal controls. the apo E gene polymorphism was analysed by the use of polymerase chain reaction. Our study revealed that the frequency of apo E2 allele was significantly higher in dialysis patients (8.0%) than in normal controls (1.9%; P<0.01). the E3 and E4 allele frequencies were not significantly different between the groups. Our findings indicate that apo E polymorphism was apparently associated with the development of end‐stage renal disease in Taiwan.
‘It comes together at the end’: the impact of a one‐year subject in Nursing Inquiry on philosophies of nursing
Authors: Francis Dawn , Owens Jan , Tollefson Joanne
Published: March 2003

‘It comes together at the end’: the impact of a one‐year subject in Nursing Inquiry on philosophies of nursing

This paper reframes an interpretive study as critical inquiry as the researchers interrogate their roles and authority in the ‘reading’ of what is valued as reflective. Working from data collected in written philosophies and interviews within the context of a one‐year subject aimed at developing reflective practice and an appreciation of ways of knowing, this paper examines the change in philosophies of nursing perceived by three university‐based educators and their students. The study reveals a growing appreciation of the complexity of nursing but a limited consideration of the dialectic of critical theorising and everyday engagement necessary to critical reflection and reconstruction of action. More importantly, the process of research collaboration raises questions of the soul‐searching necessary for university educators to act against the institutionalised political context that determines what is seen to be of value in student learning.
Understanding change in clinical nursing practice
Authors: Parker Judith , Copnell Beverley
Published: March 2003

The present paper employs a poststructural framework to explore the construction of change in clinical nursing practice, as portrayed in nursing literature. In it a critique of two specific bodies of literature is offered: that which deals with the ‘abstract’ conception of change (but which is heavily influenced by organizational discourses) and that which describes changes in the clinical setting of critical care nursing practice. It is argued that the discursive constitution of change that is revealed in this analysis disadvantages clinical nurses. Because the context in which change occurs is largely unacknowledged, clinical nursing practice, as experienced and understood by nurses, is also marginalized. Change in clinical practice is under‐researched, and such inquiry should be undertaken from the perspective of nurses themselves, and requires an exploration of the discursive context of nursing work.
Privileged position: preparing nurses to work in the community
Authors: Carberry Clare
Published: March 2003

Privileged position: preparing nurses to work in the community

Nurses nurse, end of story, but is it? Is nursing any one thing? Nursing is many things and the positions that nurses occupy in any particular setting are multiple. In an educational project aimed at facilitating student learning, I set out to expose the multipositionality of community nursing and to acknowledge that discursive pressures shape and limit practice.

A set of resources using story method was produced for use in educational settings. Story method was chosen as an emancipatory vehicle for learning. A worrisome question that arose from reflection on the project was that although the educational aim of the project was emancipatory, did the singularity of the professional voice offered through the stories sabotage that goal?
Nursing leadership and health sector reform
Authors: Borthwick Chris , Galbally Rhonda
Published: March 2003

Nursing leadership and health sector reform

The political, technological and economic changes that have occurred over the past decade are increasingly difficult to manage within the traditional framework of health‐care, and the organisation of health‐care is seen to need radical reform to sweep away many of the internal barriers that now divide one form of health‐care, and one profession, from another. Nursing must equip itself with skills in advocacy and political action to influence the direction the system will take. Nursing currently suffers from a weakness in self‐concept that goes hand in hand with a weakness in political status, and nursing leadership must build the foundations for both advocacy for others and self‐advocacy for the nursing movement.

The profession faces tensions between different conceptions of its role and status, its relationship to medicine, and its relationship to health. Health indices are tightly linked to status, and to trust, hope, and control of one’s own life. Can nurses help empower others when they are not particularly good at empowering themselves? What will the role of the nurse be in creating the information flows that will guide people toward health? Nursing’s long history of adaptation to an unsettled and negotiated status may mean that it is better fitted to make this adaptation than other more confident disciplines.
Study of the measurement of defense style using Bond's Defense Style Questionnaire
Authors: NISHIMURA
Published: March 2003

Two hundred and seventy healthy university students were surveyed in December 1995 using Bond's Defense Style Questionnaire (DSQ) to measure the subjects' defense mechanisms. At the same time, a survey using Byrne's R‐S Scale (Repression–Sensitization Scale) of the MMPI (Minnesota multiphasic personality inventory) and five psychiatric symptom indexes (anxiety, sense of inadequacy, sensitivity, depression and impulsive anger) selected from the CMI (Cornell Medical Index‐Health Questionnaire) was conducted. Three factors were extracted from the DSQ through factor analysis: immature defenses, neurotic defenses, and mature defenses. The results of analysis of variance revealed the following: (i) for anxiety and anxiety related symptoms, both immature defenses and neurotic defenses indicated principal effect; (ii) for impulsive anger and depression, immature defenses presented principal effect; and (iii) for sensitivity and impulsive anger, interaction between a mature defense style and neurotic defense style was noted. The relationship between defense styles and psychiatric symptoms in healthy people is studied in this paper.