bluuebunny/crossref_metadata_2025 huggingface dataset:
HELICOBACTER PYLORI INFECTION AND TREATMENT OUTCOME IN AN URBAN AUSTRALIAN POPULATION
Authors: Lam Vincent W. T. , Trinh Linh K. , Wilson Robert B.
Published: August 2006

Background:  To examine the rate of Helicobacter pylori infection in a group of symptomatic patients using rapid urease test and antral histology and report on their treatment outcomes.

Methods:  From a single‐surgeon series in a tertiary teaching hospital, 200 consecutive symptomatic patients undergoing their first diagnostic upper gastrointestinal endoscopy during 2003–2004 were included in this retrospective audit. Campylobacter‐like organism (CLO) test results were compared with the results of conventional histological examination plus Giemsa staining. Eradication rates and demographic data were collected.

Results:  One hundred and seventy‐nine of 200 (89.5%) patients had antral biopsies for histology and for CLOtest. The CLOtest was positive in 31% (56/179) of patients. Thirty‐two of 56 (57%) patients had an early‐positive CLOtest (<24 h). The remaining 43% (24/56) of patients had a late‐positive CLOtest (>24 h). Histological examination of the antral biopsy showed evidence of H. pylori in 28/56 (50%) patients with a positive CLOtest. H. pylori eradication therapy was prescribed in 51/56 (91%) patients with a positive CLOtest. Forty‐five of 51 (88%) of these patients had a subsequent urea breath test. Urea breath test was positive in 17/45 (29%) patients after H. pylori eradication therapy was prescribed.

Conclusion:  Rate of H. pylori in this series of symptomatic patients was 31%. As nearly half of the CLOtests became positive after 24 h, we suggest that the CLOtest should be re‐examined 24 h after gastroscopy. Standard antral histology and CLOtest were in agreement in only 50% of cases, suggesting that the CLOtest is a more sensitive test. The failure rate of 29% for initial H. pylori eradication therapy reinforces the need for follow up after treatment.
RANDOMIZED, CONTROLLED STUDY COMPARING SITZ‐BATH AND NO‐SITZ‐BATH TREATMENTS IN PATIENTS WITH ACUTE ANAL FISSURES
Authors: Gupta Pravin J.
Published: August 2006

Background:  To determine the efficacy and safety of sitz baths in the management of acute anal fissures.

Methods:  Individual patients were randomized to either receive sitz baths or no sitz baths for 4 weeks in addition to oral psyllium husk. Patients were asked to soak their hips and buttocks in a tub containing plain lukewarm water for 10 min, once after defecation in the morning and again at bedtime. Each week, the patients were called to assess pain scores and healing of fissures, whereas the level of satisfaction was recorded at the end of 4 weeks. Main outcome measures were validated pain scores and levels of satisfaction.

Results:  Fifty‐eight subjects were recruited for this study. In all, 52 of them completed the trial (27 in the sitz bath group and 25 in the control group). Although the pain score was lesser in the sitz bath group than in the control group, it failed to reach statistical significance. There were no significant differences in fissure healing between the two groups over the 4‐week study period. However, patients in the sitz bath group reported better satisfaction levels than the control group (P < 0.01). Although no serious adverse effects were observed, two patients from sitz bath group developed perianal skin rash.

Conclusion:  This study suggests that sitz baths improve patient satisfaction in acute anal fissures. However, the healing and overall pain relief was not significant enough to attract attention. It was also found to be associated with adverse effects in few patients.
TRAUMA RECEPTION AND RESUSCITATION
Authors: Fitzgerald Mark C. , Bystrzycki Adam B. , Farrow Nathan C. , Cameron Peter A. , Kossmann Thomas , Sugrue Michael E. , Mackenzie Colin F.
Published: August 2006

The hospital reception phase of major trauma management requires a great number of expedient decisions. However, despite widely taught programmes advocating a standardized, algorithmic approach to decision‐making, there is an ongoing rate of human errors contributing to adverse outcomes. It is now time for a fundamental change in our approach to trauma resuscitation. Point‐of‐care computer technology linked to real‐time decision‐making and trauma team coordination may achieve error reduction through standardized decision‐making and a corresponding reduction in preventable mortality and morbidity.
TRAUMATIC ADRENAL HAEMORRHAGE IN CHILDREN
Authors: Soundappan S. V. S. , Lam Albert H. , Cass Daniel T.
Published: August 2006

Background:  Adrenal injuries following blunt abdominal trauma is uncommon. Recent increased detection of traumatic adrenal haemorrhage (TAH) prompted this study.

Methods:  Cases were identified from retrospective search of the trauma and medical imaging database for the period 1998–2004. Medical records were reviewed and data analysed to identify mechanism of injury, imaging findings, associated injuries, presence of hypotension, length of stay and follow up.

Results:  Eleven children were identified with TAH. Right adrenal was commonly injured. Motor vehicle injury was the commonest mechanism. All injuries were identified on initial computed tomography, and all but one had associated abdominal injuries. There were no deaths. Ultrasound showed resolution within 3 months in six patients.

Conclusion:  TAH is an uncommon injury that is rarely isolated. Although initial diagnosis is made on computed tomography, ultrasound appears adequate for follow up. TAH appears to be an incidental finding that resolves on follow‐up imaging.
Value of B‐type natriuretic peptide in diagnosing left ventricular dysfunction in dialysis‐dependent patients
Authors: Zeng C. , Wei T. , Jin L. , Wang L.
Published: August 2006

Background: B‐type natriuretic peptide (BNP) is elevated in patients with end‐stage renal failure. The reported accuracy of BNP in diagnosing left ventricular dysfunction in these patients has been inconsistent.

Aim: To investigate the diagnostic values of BNP for left ventricular dysfunction in patients undergoing haemodialysis for chronic renal failure.

Methods: We measured plasma BNP before and at 10 min and 3, 6 and 24 h after haemodialysis in 56 patients.

Results: The average plasma BNP before haemodialysis was 284 ± 369 pg/mL, which was higher than that of healthy subjects (37 ± 37 pg/mL; n = 32, P < 0.01). The average plasma BNP in patients with left ventricular dysfunction (n = 21) was substantially higher than that in those with normal ventricular function before and at 10 min and 3, 6 and 24 h after haemodialysis (P < 0.001). The area under the receiver operating characteristic curves was greater than 0.895 before and at the four time points after haemodialysis (P < 0.01). Using 152 pg/mL as a cut‐off value, predialysis BNP has 81% sensitivity and 83% specificity in diagnosing left ventricular dysfunction in these patients.

Conclusion: We concluded that plasma BNP offers a good sensitivity and specificity in diagnosing left ventricular dysfunction in patients with dialysis‐dependent renal failure.
Critical review of complementary therapies in haemato‐oncology
Authors: Joske D. J. L. , Rao A. , Kristjanson L.
Published: August 2006

There is evidence of the increasing use of complementary and alternative medicine by Australians diagnosed with cancer. Given the increasing desire of cancer patients to use complementary and alternative medicine, it is important that clinicians have a good understanding of the evidence available in this field. This critical review aims to provide an overview of the current evidence pertaining to a range of complementary therapies that are used in a supportive role in the treatment of cancer patients. Treatment methods considered are acupuncture, music therapy, massage and touch therapies and psychological interventions. The efficacy of these complementary therapies in terms of improvement in symptoms and quality of life is examined. Evidence that relates to an effect on immune function and survival is also investigated.
Diversity of phototrophic bacteria in microbial mats from Arctic hot springs (Greenland)
Authors: Roeselers Guus , Norris Tracy B. , Castenholz Richard W. , Rysgaard Søren , Glud Ronnie N. , Kühl Michael , Muyzer Gerard
Published: August 2006

We investigated the genotypic diversity of oxygenic and anoxygenic phototrophic microorganisms in microbial mat samples collected from three hot spring localities on the east coast of Greenland. These hot springs harbour unique Arctic microbial ecosystems that have never been studied in detail before. Specific oligonucleotide primers for cyanobacteria, purple sulfur bacteria, green sulfur bacteria and Choroflexus/Roseiflexus‐like green non‐sulfur bacteria were used for the selective amplification of 16S rRNA gene fragments. Amplification products were separated by denaturing gradient gel electrophoresis (DGGE) and sequenced. In addition, several cyanobacteria were isolated from the mat samples, and classified morphologically and by 16S rRNA‐based methods. The cyanobacterial 16S rRNA sequences obtained from DGGE represented a diverse, polyphyletic collection of cyanobacteria. The microbial mat communities were dominated by heterocystous and non‐heterocystous filamentous cyanobacteria. Our results indicate that the cyanobacterial community composition in the samples were different for each sampling site. Different layers of the same heterogeneous mat often contained distinct and different communities of cyanobacteria. We observed a relationship between the cyanobacterial community composition and the in situ temperatures of different mat parts. The Greenland mats exhibited a low diversity of anoxygenic phototrophs as compared with other hot spring mats which is possibly related to the photochemical conditions within the mats resulting from the Arctic light regime.
Diversity and expression of nitrogenase genes (nifH) from ectomycorrhizas of Corsican pine (Pinus nigra)
Authors: Izumi Hironari , Anderson Ian C. , Alexander Ian J. , Killham Ken , Moore Edward R. B.
Published: August 2006

The diversity of bacterial nitrogenase genes (nifH) and their mRNA transcription in ectomycorrhizas of Corsican pine (Pinus nigra) were examined. DNA and RNA were extracted from surface‐sterilized and non‐sterilized Corsican pine roots colonized by the ectomycorrhizal (ECM) fungi, Suillus variegatus and Tomentellopsis submollis. DNA‐derived nifH polymerase chain reaction (PCR) products were obtained from all samples, but only a few reverse transcription PCRs for nifH mRNA were successful, suggesting that nitrogenase genes were not always transcribed. Several different nifH sequences were detected and the bacteria actively transcribing nifH were different from those whose genes were detected through DNA‐based PCR. Putative nitrogenase amino acid sequences revealed that more than half of the nifH products were derived from methylotrophic bacteria, such as Methylocella spp. The next most frequent sequence types were similar to those from Burkholderia.
‘Pressure of life’: ethnicity as a mediating factor in mid‐life and older peoples’ experience of high blood pressure
Authors: Higginbottom Gina Marie Awoko
Published: August 2006

Hypertension is a common condition which disproportionately affects African Caribbean people in England, yet this experience is rarely reported in the literature. Whilst a body of literature exists that explores chronic illness experience, little attention is paid to hypertension, nor to ethnicity as a mediating concept in chronic illness experience. This paper explores the meaning and consequences of hypertension for African Caribbean people residing in England. The study conducted was a qualitative study, informed by the ethnographic tradition. The study methods included the conduct of two focus group interviews (10 participants), 21 in‐depth interviews and five vignette interviews. Thirty‐six people in total participated in the study, both men and women, aged between 37 and 82 years (median age = 59.5 years) in two English cities. The sample was generated by contacting GP surgeries, community groups and associations and included economically active and retired people. The narrative accounts provided illuminate the personal biographies of the mid‐life and older participants in the study, providing evidence as to how issues such as ethnicity, migration, cultural adaptation, racism and discrimination may impact upon the chronic illness experience. Participants’ understandings of their self‐defined condition of high blood pressure differed greatly from medical conceptualisations of the condition of hypertension. The implications of the study are that in order to provide effective health and social care for individuals of African Caribbean origin with hypertension, care‐providers require insight into how migration and cultural adaptation may create major disruption to an individual's life trajectory, to which the subsequent diagnoses of chronic illness are relative in terms of the individual's response and adaptation.
Breaking the ceremonial order: patients’ and doctors’ accounts of removal from a general practitioner's list
Authors: Stokes Tim , Dixon‐Woods Mary , Williams Simon
Published: August 2006

The removal of patients from general practitioners’ (GPs) lists in the UK offers important sociological insights into what happens when the doctor‐patient relationship ‘goes wrong’. An interactionist analysis shows how removers (doctors) and removed (patients) strategically invoke ‘rules of conduct’ to account for difficulties in the doctor‐patient relationship and for GPs’ decisions to end their relationships with patients. In this paper we extend this analysis through recourse to Bourdieu's theory of practice, by juxtaposing ‘paired’ accounts of the same removal event by both remover and removed. Our analysis demonstrates the unthinking or non‐reflective nature of people's understanding of the rules governing social interactions, but also demonstrates how apparent rule violations make the rules explicit and expose patterns of power distribution. We argue that removal of patients amounts to a strategic exercise of symbolic power by GPs, and that this is experienced as an overtly violent symbolic act by patients. A theoretical reconciliation of interactionist theories of the doctor‐patient relationship with Bourdieu's theory of practice is both possible and profitable, providing a micro‐macro link in which issues of capital and power within the health (care) field are brought to the fore.
iPod Shuffle not Random
Authors: Holmes Peter
Published: August 2006

This article discusses the behaviour of a sequence of events under random choice and under a restriction of randomness. Outline lesson plans at three different levels are suggested.
High Moment Partial Sum Processes of Residuals in ARMA Models and their Applications
Authors: Yu Hao
Published: August 2006

Abstract. In this article, we study high moment partial sum processes based on residuals of a stationary autoregressive moving average (ARMA) model with known or unknown mean parameter. We show that they can be approximated in probability by the analogous processes which are obtained from the i.i.d. errors of the ARMA model. However, if a unknown mean parameter is used, there will be an additional term that depends on model parameters and a mean estimator. When properly normalized, this additional term will vanish. Thus the processes converge weakly to the same Gaussian processes as if the residuals were i.i.d. Applications to change‐point problems and goodness‐of‐fit are considered, in particular, cumulative sum statistics for testing ARMA model structure changes and the Jarque–Bera omnibus statistic for testing normality of the unobservable error distribution of an ARMA model.
Matrix metalloproteinase gene expression in oral lichen planus: erosive vs. reticular forms
Authors: Mazzarella N , Femiano F , Gombos F , De Rosa A , Giuliano M
Published: August 2006

Background  Oral lichen planus (OLP) is an autoimmune disease of unknown aetiology. The pathogenesis is characterized by apoptosis of basal keratinocytes, triggered by contact between CD8+‐activated lymphocytes and an unknown antigen expressed on the surface of the basal cells. Basement membrane (BM) degradation, which allows lymphocytes to migrate, involves proteolytic enzymes known as matrix metalloproteinases (MMPs).

Objectives  This study aimed to evaluate the expression of a series of MMPs in biopsies from OLP patients, to reveal correlations with different clinical forms of OLP.

Methods  Twenty‐six patients diagnosed with OLP (14 reticular and 12 erosive) were studied, together with seven healthy patients as negative controls.

Results  Reverse transcriptase polymerase chain reaction (RT‐PCR) showed that the overall levels of expression of MMP mRNAs were higher in erosive lichen planus (E‐OLP) than in the reticular forms (R‐OLP). Moreover, MMP‐1 and MMP‐3 may be principally associated with erosion development. The expression of specific tissue inhibitors of metalloproteinases (TIMPs) was also evaluated.

Conclusions  The different clinical appearances of OLP are associated with significant differences in MMP mRNA levels.
Effects of repetitive superficial chemical peels on facial sebum secretion in acne patients
Authors: Lee SH , Huh CH , Park KC , Youn SW
Published: August 2006

Background  Glycolic acid and Jessner's solution are popular superficial chemical peel agents for the treatment of facial acne, and increased sebum secretion is one of the major aetiological factors of acne.

Objective  To compare the effects of 30% glycolic acid peels and Jessner's solution peels on sebum secretion in facial acne patients.

Methods  Thirty‐eight patients with mild to moderate facial acne were included. Twenty‐seven patients were treated with 30% glycolic acid peels and 11 patients with Jessner's solution peels. Each peel was performed twice with an interval of 2 weeks. Before and 2 weeks after each peel, sebum levels of forehead, nose, chin and cheeks were measured by using a Sebumeter® (SM810 Courage & Khazaka, Cologne, Germany).

Results  The sebum levels were not significantly changed by two peels treatments of 30% glycolic acid peels or Jessner's solution peels on the facial skins of patients with facial acne.

Conclusions  The two types of peels, 30% glycolic acid peels and Jessner's solution peels, did not affect sebum secretion of the facial skins of patients with facial acne after the two peels treatments. The accumulative effects of more than two peels treatments using these modalities need further evaluation.
Anurans as prey: an exploratory analysis and size relationships between predators and their prey
Authors: Toledo L. F. , Ribeiro R. S. , Haddad C. F. B.
Published: August 2006

The vertebrate predators of post‐metamorphic anurans were quantified and the predator–prey relationship was investigated by analysing the relative size of invertebrate predators and anurans. More than 100 vertebrate predators were identified (in more than 200 reports) and classified as opportunistic, convenience, temporary specialized and specialized predators. Invertebrate predators were classified as solitary non‐venomous, venomous and social foragers according to 333 reviewed reports. Each of these categories of invertebrate predators was compared with the relative size of the anurans, showing an increase in the relative size of the prey when predators used special predatory tactics. The number of species and the number of families of anurans that were preyed upon did not vary with the size of the predator, suggesting that prey selection was not arbitrary and that energetic constraints must be involved in this choice. The relatively low predation pressure upon brachycephalids was related to the presence of some defensive strategies of its species. This compounding review can be used as the foundation for future advances in vertebrate predator–prey interactions.
Activity of a specialized insectivorous mammal (Myrmecophaga tridactyla) in the Pantanal of Brazil
Authors: Mourão G. , Medri Í. M.
Published: August 2006

The purpose of this study was to correlate the activity and habitat use of a large and ecologically specialized mammal (Myrmecophaga tridactyla) with the time of day and minimum daily temperature in Brazil's Pantanal wetland. Seven giant anteaters were fitted with very high frequency (VHF) radio transmitters and monitored from March to December 2001. The animal's state of activity or rest, time and ambient temperature were recorded in different patches of the study site, which were covered by a mosaic of vegetation types and several ponds. Whenever a giant anteater was inside a forest patch, the temperature inside and outside of the patch was also recorded. The temperatures throughout the day were recorded by the meteorological station at the study site. The period of greatest activity of giant anteaters started at 18:00 h on hot days, but whenever the daily minimum temperature declined, the species' activity began earlier. Giant anteaters use predominantly forest habitats for rest and open habitats for activity. The forest patches work as a temperature buffer, because they are cooler than the matrix of open habitats during the hot hours of the day and warmer than the matrix during the cold hours. Although the giant anteater is known to be associated with open habitats, this study indicates the need of preserving forest patches for the conservation of this species.
LH responses to single doses of exogenous GnRH in the Cape mole rat (Georychus capensis): the pituitary potential for opportunistic breeding
Authors: Oosthuizen M. K. , Bennett N. C.
Published: August 2006

The Cape mole rat Georychus capensis is a solitary mole rat that inhabits the winter rainfall region of the Western Cape Province of South Africa. Circulating basal concentrations of luteinizing hormone (LH) were found to be significantly higher in the breeding season in both sexes. During both the breeding and non‐breeding season, administration of exogenous gonadotropin‐releasing hormone (GnRH) increased circulatory LH levels. The magnitude of the LH response to an overdose of exogenous GnRH both in and out of the breeding season in males and females was not significantly different. Typically, seasonally breeding species exhibit a down‐regulation of the pituitary and reproductive functions out of the breeding season. It appears that there is no down‐regulation of GnRH receptors at the level of the pituitary out of the breeding season, because the pituitary responds to an exogenous GnRH challenge equally both in and out of the breeding period. The Cape mole rat exhibits the potential for opportunistic breeding out of the breeding period, provided that environmental factors are favourable. This finding questions whether this mole rat is actually a seasonal breeder or whether reproduction is hindered by the ecological constraint of the lack of opportunities to burrow and find mates at certain times of the year.
Quantifying the influence of topographic position on cougar (Puma concolor) movement in southern California, USA
Authors: Dickson B. G. , Beier P.
Published: August 2006

Large carnivores are frequently used as focal species for landscape‐level planning and conservation purposes. Information on cougars Puma concolor, for example, is being used to predict movement corridors and linkage areas in habitats influenced by rapid urbanization. However, animal movement through habitat terrain is a function of multiple factors, including complex topographic features. To assess the use of topographic position during movements by cougars in the Santa Ana Mountain Range of southern California, we analyzed the travel paths of 10–17 radio‐tagged individuals monitored during 44 overnight sessions. We examined selection for canyon bottom, gentle slope, steep slope and ridgeline topography at the scale of the movement session and at the scale of the home range. At both scales of selection, our results suggest that traveling or hunting cougars discriminated in their use of topographic position, that canyon bottoms and gentle slopes (<6°) ranked highest in compositional analyses of selection, and that these patterns were not highly confounded by the presence of preferred vegetation types. Ridgelines were used significantly less often than other positions. Our novel method of quantifying availability and use of topographic positions permits the assessment of terrain features, such as canyon bottoms, in facilitating cougar movements. For complex landscapes, models of animal movement should consider the topographic context that motivates patterns of habitat use, and should be developed using data obtained and analyzed at the appropriate spatial and temporal scales.
Measuring the Effects of Exchange Rate Changes on Investment in Australian Manufacturing Industry*
Authors: SWIFT ROBYN
Published: August 2006

This paper examines the relationship between exchange rates and investment in Australian manufacturing between 1988 and 2001. The effects of exchange rates on investment are found to vary positively with the export share of sales and negatively with the share of imported inputs into production, with lower price‐over‐cost mark‐ups increasing the response. For Australian manufacturing, a 10 per cent real appreciation of the Australian dollar leads to an average 8.0 per cent decrease in total investment through the export share channel, and an average 3.8 per cent increase through the imported input share channel, with most of the response occurring through investment in equipment, plant and machinery.
The Displacement Effect of Labour‐Market Programs: MONASH Analysis*
Authors: DIXON PETER B. , RIMMER MAUREEN T.
Published: August 2006

A key question concerning labour‐market programs is the extent to which they generate jobs for their target group at the expense of others. This effect is measured by displacement percentages. We describe a version of the MONASH model designed to quantify the effects of labour‐market programs. Our simulation results suggest that: (i) labour‐market programs can generate significant long‐run increases in employment; (ii) displacement percentages depend on how a labour‐market program affects the income trade‐off faced by target and non‐target groups between work and non‐work; and (iii) displacement percentages are larger in the short run than in the long run.
Terms‐of‐Trade Shocks and Exchange Rate Regimes in a Small Open Economy*
Authors: CHIA WAI‐MUN , ALBA JOSEPH D.
Published: August 2006

We examine the impact of terms‐of‐trade shocks on key macroeconomic variables by numerically solving a dynamic stochastic general equilibrium model of a small open economy. The model considers nominal price rigidity under different exchange rate regimes. The numerical solutions obtained are consistent with the empirical regularities documented by Broda (2004), in which output responses to shocks are smoother in floats than in pegs; in moving from pegs to floats, the rise in nominal exchange rate volatility is coupled by the rise in real exchange rate volatility; and in both exchange rate regimes, net foreign assets is the most volatile variable.
Decreased expressions of hepsin in human hepatocellular carcinomas
Authors: Chen Chien‐Hung , Su Kang‐Yi , Tao Mi‐Hua , Lin Shu‐Wha , Su Ying‐Hui , Tsai Yu‐Chiu , Cheng Kuang‐Chun , Jeng Yung‐Ming , Sheu Jin‐Chuan
Published: August 2006

Abstract: Background/Aims: Hepsin is a type II transmembrane protein predominantly expressed in the liver and has been implicated in participation in blood coagulation pathway and epithelial carcinogenesis. The aim of this current study is to investigate the role of hepsin in hepatocarcinogenesis.

Methods: Quantitative real‐time RT‐PCR was used to investigate the expression levels of hepsin in a total of 50 paired hepatocellular carcinomas (HCCs) and the corresponding non‐tumor liver tissues. Hepsin was transfected to the hepsin‐non‐expressing SK‐HEP‐1 cells to study the change of cell proliferation.

Results: In 62% (31/50) patients, the expression levels of hepsin in non‐tumor liver tissues are at least twofold higher than those in the corresponding HCC tissues. Positive hepatitis B surface antigen was more often detected in patients with hepsin underexpressed in the HCC tissues (74.2% vs. 31.6%, P=0.007). Patients with hepsin underexpressed in the HCC tissues survived shorter time than those without hepsin underexpression in the HCC tissues. The cell proliferation and for a colony formation of SK‐HEP‐1 HCC cells were inhibited by hepsin.

Conclusions: Most HCC patients had hepsin underexpressed in the HCC tissues. These patients survived for a shorter time compared with those without hepsin underexpression in the HCC tissues. Hepsin expression could inhibit cell proliferation and colony formation of HCC cells.
Increased angiogenesis and permeability in the mesenteric microvasculature of rats with cirrhosis and portal hypertension: an in vivo study
Authors: Geerts Anja M. , De Vriese An S. , Vanheule Eline , Van Vlierberghe Hans , Mortier Siska , Cheung Kin‐Jip , Demetter Pieter , Lameire Norbert , De Vos Martine , Colle Isabelle
Published: August 2006

Abstract:
Background: In vivo evidence for angiogenesis in the splanchnic vasodilation in portal hypertension (PHT) and cirrhosis is lacking. Vascular endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOS) are mediators of angiogenesis. The present study visualises in vivo structural changes (angiogenesis and vascular hyperpermeability) and examines the presence of VEGF and eNOS in the mesenteric microvasculature of animal models of PHT with and without cirrhosis.

Methods: Portal hypertension was induced by partial portal vein ligation (PPVL) and cirrhosis was induced by common bile duct ligation (CBDL) in rats. The mesenteric microcirculation was examined by intravital microscopy. Expression of VEGF, eNOS and CD31 in mesenteric tissue were studied by immunohistochemistry.

Results: An increased mesenteric angiogenesis was observed in PPVL and CBDL rats compared with Sham‐operated and control rats, as shown by intravital microscopy and CD 31 staining. VEGF and eNOS expression was higher in CBDL and PPVL rats compared with control groups and correlated positively with vascular density. Macromolecular leakage was increased in cirrhotic rats compared with control and PPVL rats.

Conclusion: Our study provides in vivo evidence of an increased angiogenesis in the mesenteric microvasculature of animal models of PHT and cirrhosis. Increased VEGF and eNOS expression in the mesentery of PPVL and CBDL rats may suggest their contribution. Microvascular permeability in the mesenteric vessels was only increased in cirrhotic rats.
Clinical features of hepatitis C virus‐related hepatocellular carcinoma and their association with α‐fetoprotein and protein induced by vitamin K absence or antagonist‐II
Authors: Yano Yoichi , Yamashita Fumihiko , Kuwaki Kotaro , Fukumori Kazuta , Kato Osamu , Yamamoto Hiroshi , Ando Eiji , Tanaka Masatoshi , Sata Michio
Published: August 2006

Abstract: Purpose: We investigated the differences in clinical features between α‐fetoprotein (AFP)‐predominant hepatocellular carcinoma (HCC) and protein induced by vitamin K absence or antagonist‐II (PIVKA‐II)‐predominant HCC, especially regarding host factors thought to contribute to hepatocarcinogenesis in chronic hepatitis C virus (HCV) infection.

Methods: HCV‐related HCC patients (n=306) were divided into four groups according to median AFP (48.1 ng/ml) and PIVKA‐II (60 mAU/ml). Host factors, tumor factors, survival, and risk factors affecting survival were compared.

Results: Aspartate aminotransferase (AST; IU/L), alanine aminotransferase (ALT; IU/L), and platelet count (× 104/ml) were, respectively, 81, 67, and 8.2 in AFP‐predominant HCC (group A; n=66) vs. 50, 42, and 11.4 in PIVKA‐II‐predominant HCC (group P; n=52). Tumor sizes (mm) in groups A and P were 20 and 37, respectively. Significant differences were evident. Survival was identical between the two groups. Factors affecting survival were total bilirubin, portal tumor thrombus and number of nodule in group A, and albumin and tumor distribution in group P.

Conclusions: PIVKA‐II‐predominant HCC had a milder hepatitis and a better‐preserved platelet count compared with AFP‐predominant HCC. Considering the strong relation between hepatocarcinogenesis and hepatic inflammation with chronic HCV infection, these differences indicate that hepatocarcinogenic mechanisms in PIVKA‐II‐predominant HCC may differ from those in AFP‐predominant HCC.
Non‐invasive markers to predict the liver fibrosis in non‐alcoholic fatty liver disease
Authors: Lydatakis Helen , Hager Ieronymos Philippos , Kostadelou Eyaggelia , Mpousmpoulas Stavros , Pappas Stavros , Diamantis Ioannis
Published: August 2006

Abstract: Background/Aim:The aim of this study was to find a non‐invasive marker, which could predict liver fibrosis without the need of liver biopsy in non‐alcoholic steatohepatitis (NASH).

Patients/Methods:Fifty patients were included. All patients had one or more conditions that characterize the metabolic syndrome and histological proven NASH. Hyaluronic acid (HA), leptin (LT) and laminin (LN) were determined from serum withdrawn at the day of biopsy.

Results:Patients were divided into two groups according to the histological findings. The first group consisted of 23 patients with NASH and fibrosis and the second group had 27 patients with NASH,ballooned cells, without fibrosis. Subjects with NASH and fibrosis had statistically significantly higher HA and LN than those with NASH without fibrosis,P<0.001, respectively. In contrast, there was no statistically significant difference between the levels of serum LT in the two groups. The stage of liver fibrosis in the 23 patients of group 1 was related only to the values of hyaluronic acid (P<0.001) and not to the ones of LT and LN.

Conclusion:Measurement of hyaluronic acid could be a predictive factor of the presence and stage of liver fibrosis in NASH. LN could be used to diagnose liver fibrosis but has no value in staging.
Quality of life in hepatitis C
Authors: Strauss Edna , Dias Teixeira Maria Cristina
Published: August 2006

Abstract:A number of different studies have shown a clear reduction in the quality of life of hepatitis C virus (HCV)‐related liver‐disease patients. Quality of life can be assessed by means of both generic and specific instruments, depending on the aim of the study and the population being studied. The application of a specific instrument to patients with liver diseases provides a broader assessment of different parameters related to hepatic disorders. In hepatitis C, alterations such as the stigma of liver disease, concerns about the disease and symptoms of the disease could be demonstrated with this type of instrument. The impact of the diagnosis of hepatitis C, a potentially serious disease, and the presence of comorbidities such as alcohol and drugs may lead to lower quality of life. Longitudinal studies have proved that, following diagnosis, the stigma of liver disease becomes more apparent over time. Women report worse quality of life than men, supporting that gender differences in hepatitis are also important when assessing quality of life. Alterations in the quality of life of patients submitted to treatment are mainly related to the somatic side effects of Interferon and Ribavirin and are most noticeable in the first weeks of therapy. Early improvement in the quality of life of patients who become HCV‐RNA negative suggests that the virus itself plays a biological role. There is no doubt that liver transplantation leads to an improvement in quality of life. Nevertheless, a major concern is the relapse of HCV, with the associated lower quality of life.
Association Between Mild Anemia and Executive Function Impairment in Community‐Dwelling Older Women: The Women's Health and Aging Study II
Authors: Chaves Paulo H. M. , Carlson Michelle C. , Ferrucci Luigi , Guralnik Jack M. , Semba Richard , Fried Linda P.
Published: August 2006

OBJECTIVES: To evaluate the relationship between mild anemia and executive function in community‐dwelling older women.

DESIGN: Cross‐sectional.

SETTING: Community‐based.

PARTICIPANTS: High‐functioning subjects participating in the baseline assessment of the Women's Health and Aging Study (WHAS) II, Baltimore, Maryland, 1994 to 1996. WHAS II eligibility criteria included aged 70 to 80, a Mini‐Mental State Examination score of 24 or greater, and absence of advanced disability (difficulty in no more than 1 domain of physical function). Included in this study were 364 subjects with a hemoglobin concentration 10 g/dL or greater and known executive function status.

MEASUREMENTS: Trail Making Test (TMT) Parts B and A. Tertiles of time to complete each test were used to define best (bottom), intermediate, and worst (top) performance. Tertiles of the difference TMT‐B minus TMT‐A were calculated. Anemia defined as hemoglobin concentration less than 12 g/dL.

RESULTS: The percentage of subjects in the worst TMT‐B, TMT‐A, and TMT‐B minus TMT‐A performance tertile was highest for those with anemia. Prevalent anemia substantially increased the likelihood of performing worst (as opposed to best) on the TMT‐B (odds ratio (OR)=5.2, 95% confidence interval (CI)=1.3–20.5), TMT‐A (OR=4.8, 95% CI=1.5–15.6), and TMT‐B minus TMT‐A (OR= 4.2, 95% CI=1.0–17.2), even after controlling for age, education, race, prevalent diseases, and relevant physiological and functional parameters.

CONCLUSION: This study provides preliminary evidence in support of the hypothesis that mild anemia might be an independent risk factor for executive function impairment in community‐dwelling older adults. Whether such an association is causal or noncausal remains to be determined.
Dissemination of the Hospital Elder Life Program: Implementation, Adaptation, and Successes
Authors: Inouye Sharon K. , Baker Dorothy I. , Fugal Patricia , Bradley Elizabeth H. ,   for the HELP Dissemination Project
Published: August 2006

OBJECTIVES: To describe the Hospital Elder Life Program (HELP) across dissemination sites, to detail adaptations, and to summarize advantages across sites.

DESIGN: Cross‐sectional survey.

SETTING: HELP sites in acute care hospitals.

PARTICIPANTS: Thirteen sites that enrolled 11,344 patients.

MEASUREMENTS: Seventy‐five closed‐ and open‐ended questions describing details of the HELP site, procedures, staffing, outcomes tracked, and advantages.

RESULTS: As of July 1, 2005, HELP had been fully implemented in 13 sites, with a median duration of 24 months (range 6.0–38.0). Although a high degree of fidelity to the original model was maintained, variations existed in staffing patterns, outcome tracking, and recommended HELP procedures. Adaptations were made across multiple domains, including enrollment criteria at 15.4% of sites, screening and assessment tools at 61.5%, and individual intervention protocols at 15.4% to 30.8%. Local circumstances drove these adaptations, with the most common reasons being lack of adequate staffing and logistical constraints. All sites conducted regular HELP staff meetings; other recommended quality assurance procedures were conducted at 46.2% to 92.3% of sites. Reported advantages of HELP included providing an educational resource at 100% of sites, improving hospital outcomes (e.g., delirium and functional decline) at 100%, providing nursing education and improving retention at 100%, enhancing patient and family satisfaction with care at 92.3%, raising visibility for geriatrics at 92.3%, and improving quality of care at 84.6%.

CONCLUSION: This report describes the real‐world implementation of HELP across 13 sites, documents their local adaptations and successes, and provides insight into how motivated institutions can create change to improve quality of care for older persons.
Histomorphometry of Fragmented Medial Coronoid Process in Dogs: A Comparison of Affected and Normal Coronoid Processes
Authors: DANIELSON KELSON C. , FITZPATRICK NOEL , MUIR PETER , MANLEY PAUL A.
Published: August 2006

Objective— To determine if fatigue microdamage is associated with fragmented medial coronoid process (FMCP).

Study Design— Prospective study.

Animals— Thirty‐eight dogs were admitted for subtotal coronoid ostectomy as treatment for FMCP. Surgical specimens of medial coronoid process (MCP) were retrieved from treated dogs. Normal MCP were collected from 5 age‐ and breed‐matched dogs and 2 age‐matched research beagles that were euthanatized for reasons other than elbow disease.

Methods— MCP specimens from affected elbows were classified into 4 groups based on disease severity. Specimens were bulk‐stained for microdamage using 1% basic fuchsin, embedded in polymethylmethacrylate and sectioned at 130 μm. Specimens were evaluated using epifluorescent microscopy (425–440 excitation, 475 nm barrier filter) for diffuse damage (D.DX), osteocyte loss, and porosity. Cartilage thickness was evaluated using bright field microscopy. Qualitative observations were also made.

Results— MCP specimens from affected elbows had increased D.Dx, increased osteocyte loss, and greater porosity than normal groups. Specimens classified as severe FMCP (Classes 3, 4) had the most fatigue microdamage. Some Class 1 specimens, defined as having no visible fissuring of the articular cartilage (AC), had large microcracks in trabecular bone.

Conclusions— Accumulation of subchondral fatigue microdamage, is associated with MCP fragmentation. Fissuring occurs in the subchondral bone before gross fibrillation of articular cartilage develops.

Clinical Relevance— Accumulation of fatigue microdamage in the MCP is important in the pathogenesis of FMCP. The underlying cause of this microdamage accumulation must be identified before treatment plans that will prevent further osteoarthritis of the elbow joint can be designed.
Cortical Allograft and Endoprosthesis for Limb‐Sparing Surgery in Dogs with Distal Radial Osteosarcoma: A Prospective Clinical Comparison of Two Different Limb‐Sparing Techniques
Authors: LIPTAK JULIUS M. , DERNELL WILLIAM S. , EHRHART NICOLE , LAFFERTY MARY H. , MONTEITH GABRIELLE J. , WITHROW STEPHEN J.
Published: August 2006

Objective—To compare surgical and oncologic outcome in dogs with osteosarcoma (OSA) of the distal aspect of the radius treated with limb‐sparing surgery, using either a cortical allograft or endoprosthesis, and postoperative chemotherapy; and to evaluate predictive factors for outcome.

Study Design—Prospective cohort study.

Animals—Dogs (n=20) with spontaneous, non‐metastatic OSA of the distal aspect of the radius.

Methods—Dogs were prospectively randomized for limb‐sparing surgery with either a cortical allograft (n=10) or endoprosthesis (10) and full‐course adjuvant chemotherapy using single or dual agent protocols of cisplatin, carboplatin, and/or doxorubicin. Surgical (intraoperative findings, postoperative infection, construct failure) and oncologic (local tumor recurrence, metastasis, survival) outcomes were compared. The influence of intraoperative and postoperative variables on surgical and oncologic outcome were evaluated.

Results—No clinically significant differences in surgical and oncologic outcome were detected between groups. The percentage of radius replaced by the implant was significantly greater in the endoprosthesis group (60.9% compared with 48.6%,P=.008). Median survival time (MST) for dogs with construct failure, regardless of implant type, was 685 days and significantly greater than MST of dogs without construct failure (322 days,P=.042; hazard ratio [HR] 16.82). Median metastasis‐free interval and MST (685 days versus 289 days;P=.034, HR 24.58) were significantly greater in dogs with postoperative infection. Disease‐free and overall limb‐salvage rates were 70% and 85%, respectively. Overall MST was 430 days.

Conclusions—For dogs with OSA of the distal aspect of the radius, a cortical allograft or endoprosthesis can be used for limb‐sparing surgery. Construct failure and postoperative infection significantly improve survival time regardless of implant type.

Clinical Relevance—An endoprosthesis is an attractive alternative to cortical allografts for limb‐salvage of the distal aspect of the radius in dogs because surgical and oncologic outcomes are similar, but the endoprosthesis is an immediately available off‐the‐shelf implant which is not complicated by the bone harvesting and banking requirements associated with cortical allografts. Mechanisms whereby postoperative infection improves survival time requires further investigation and, if elucidated, may provide the opportunity to improve the outcome of dogs and humans with OSA.
Radiographic Evaluation of the Zurich Cementless Total Hip Acetabular Component
Authors: HANSON STEVEN P. , PECK JEFFREY N. , BERRY CLIFFORD R. , GRAHAM JOHN , STEVENS GARY
Published: August 2006

Objective—To radiographically evaluate the Zurich cementless total hip (ZCTH) cup and correlate lucency with clinical signs of implant instability, time since surgery, and implant generation, using zonal analysis.

Study Design—Retrospective study.

Animals—Client‐owned dogs (n=53).

Methods—Radiographs of dogs that had ZCTH arthroplasty (>1 year) were evaluated using zonal analysis, for lucency surrounding the cup–bone interface (number of zones, length, area). Dogs were examined for clinical signs of implant instability (lameness, hip pain). Lucency was correlated with lameness, time after surgery, and implant generation.

Results—Radiographs of 68 implants (18 generation I, 50 generation II) were evaluated. Eight dogs were lame (11.8%). Dogs with lameness were more likely to have lucency in ≥2 zones of analysis (per view), have >2 times the average curvilinear length of lucency, and have >4 times the average area of lucency surrounding the implant compared with non‐lame dogs. A weak relationship was observed between time after surgery and implant generation; however, there was no relationship between time after surgery and lucency.

Conclusions—Dogs with lameness after ZCTH arthroplasty were more likely to have lucency at the cup–bone interface. Lucency was better evaluated by radiographic projection than zonal analysis. Temporal progression of lucency was weakly correlated with implant generation.

Clinical Relevance—Dogs with lucency in ≥2 zones of analysis should be evaluated more frequently for clinical signs of implant loosening. Further investigation of serial radiographs after ZCTH arthroplasty is warranted.
Complications Associated with Corrective Surgery for Patellar Luxation in 109 Dogs
Authors: ARTHURS GARETH I. , LANGLEY‐HOBBS SORREL J.
Published: August 2006

Objective— To review surgical techniques and postoperative complications associated with correction of patellar luxation in dogs.

Study design— Retrospective study.

Animals— Dogs (n=109) with patellar luxation (n=131).

Methods— Medical records of dogs that had corrective surgery for patellar luxation were reviewed. Signalment, history, grade and direction of patellar luxation, operative technique and clinical outcomes were retrieved.

Results— Overall frequency of postoperative complications was 18%. Frequency of major (requiring revision surgery) complications was 13%. Frequency of patellar reluxation was 8%. Frequency of overall, major, and patellar reluxation complications was higher for dogs weighing ≥20 kg compared with those <20 kg. Frequency of overall and major complications was higher for dogs with higher grades of patellar luxation. Femoral trochlear sulcoplasty resulted in lower frequency of patellar reluxation. Tibial tuberosity transposition (TTT) resulted in lower frequency of major complications and patellar reluxation. Retinacular/capsular release resulted in higher frequency of major complications. Patient age, gender, medial versus lateral patellar luxation, left versus right hindlimb, capsular/retinacular imbrication, use of anti‐rotational sutures, and whether stifle surgery had been performed previously did not significantly influence frequency of complications.

Conclusion— TTT and femoral trochlear sulcoplasty minimize the risk of postoperative patellar reluxation and major complications.

Clinical Relevance— Information derived from this study can be used to estimate the likelihood of postoperative complications for canine patients undergoing corrective surgery for patellar luxation.