bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of retinoic acid in experimental diabetic nephropathy
Authors: Han Sang‐Youb , So Gyeong‐A , Jee Yi‐Hwa , Han Kum‐Hyun , Kang Young‐Sun , Kim Hyoung‐Kyu , Kang Shin‐Wook , Han Dae‐Suk , Han Jee‐Young , Cha Dae‐Ryong
Published: November 2004

Although the pathogenetic mechanism of diabetic nephropathy has not been elucidated, an inflammatory mechanism has been suggested to contribute to its progression. Monocyte chemoattractant peptide (MCP)‐1 attracts macrophages and T cells, and ultimately injures renal tissue. In early diabetic nephropathy, urinary excretion of MCP‐1 was elevated, and increased as renal damage became more severe. Podocytes are expected to have an inflammatory role in diabetic nephropathy, as the surface expression of chemokine receptors such as CCR and CXCR on these cells has been recently reported. Although retinoid (retinal), a known anti‐inflammatory agent, has been reported to be beneficial in some experimental models of renal disease, it has not been determined to prevent disease progression in diabetic nephropathy. We investigated the effects of all‐trans retinoic acid on the production of MCP‐1 under high glucose conditions in cultured mouse podocytes. We also evaluated whether all‐trans retinoic acid inhibits inflammatory changes and improves renal function during the early stages of diabetic nephropathy in streptozotocin‐induced diabetic rats. In cultured podocytes, high glucose stimuli rapidly upregulated the MCP‐1 mRNA transcript and protein release. Treatment with retinoic acid tended to suppress the MCP‐1 gene transcript, and significantly inhibited MCP‐1 protein synthesis induced by high glucose stimulation. Urinary protein excretion and the urinary albumin : creatinine ratio (ACR) were significantly higher in diabetic rats 4 weeks after the induction of diabetes mellitus compared with control rats, and retinoic acid treatment markedly decreased both proteinuria and urinary ACR (proteinuria: 1.25 ± 0.69 vs 0.78 ± 0.72 mg/mgCr, P = 0.056; urinary ACR: 0.47 ± 0.25 vs 0.21 ± 0.06 mg/mgCr, P = 0.088). Urinary excretion of MCP‐1 was rapidly increased 2 days after induction of diabetes mellitus in diabetic rats, and further increased until rats were 4 weeks of age, compared with control rats. Retinoic acid treatment resulted in 30% reduction of the urinary level of MCP‐1 compared with vehicle‐treated diabetic rats (119.3 ± 74.2 vs 78.1 ± 62.7 pg/mgCr, P = 0.078). Immunohistochemistry revealed a significant increase in staining for MCP‐1 and anti‐monocyte/macrophage (ED‐1) protein in the diabetic kidney, and retinoic acid treatment significantly suppressed intrarenal MCP‐1 and ED‐1 protein synthesis. In conclusion, podocytes are involved in the inflammatory reaction under diabetic circumstances, and these reactions were suppressed by retinoic acid. Retinoic acid also suppressed inflammatory changes in the diabetic rat kidney, and decreased proteinuria in diabetic rats. These results suggest that retinoic acid may have renoprotective effects in the early stages of diabetic nephropathy through an anti‐inflammatory activity.
Suffering related to health care: A study of breast cancer patients’ experiences
Authors: Arman Maria , Rehnsfeldt Arne , Lindholm Lisbet , Hamrin Elisabeth , Eriksson Katie
Published: November 2004

A previous study indicated that patient narratives include experiences of suffering caused or increased by health‐care encounters. The aim of this study was to interpret and understand the meaning of patients’ experiences of suffering related to health care from an ethical, existential and ontological standpoint. Sixteen women with breast cancer in Sweden and Finland took part in qualitative interviews analysed with a hermeneutic, interpretive approach. The outcome showed that suffering related to health care is a complex phenomenon and constitutes an ethical challenge to health‐care personnel. The women's experiences of suffering related to health care tended to be of similar seriousness as their experiences of suffering in relation to having cancer. In an ethical, existential and ontological sense, suffering related to health care is basically a matter of neglect and uncaring where the patient's existential suffering is not seen and she is not viewed as a whole human being.
Combination therapy of thymalfasin (thymosin‐alpha 1) and peginterferon alfa‐2a in patients with chronic hepatitis C virus infection who are non‐responders to standard treatment
Authors: RUSTGI VINOD
Published: November 2004

Abstract  The worldwide spread of hepatitis C virus is enormous; chronic hepatitis C virus infection is a leading cause of liver cirrhosis and hepatocellular carcinoma. While treatment options have improved substantially over the last decade, responses are still disappointing, particularly in certain difficult‐to‐treat groups such as patients who are immunosuppressed or have decompensated disease. Preliminary studies have indicated that combined treatment strategies may provide effective approaches for the future. The combination of thymalfasin with pegylated interferon is currently a promising option for the treatment of patients with chronic hepatitis C virus infection. An ongoing phase 3 study in the USA should provide much needed data to improve the outcome for these patients.

© 2004 Blackwell Publishing Asia Pty Ltd
Principles for the development of the guidelines
Authors:   The committee for The Japanese Respiratory Society guidelines in management of respiratory infections
Published: November 2004

Principles for the development of the guidelines

The committee for The Japanese Respiratory Society guidelines in management of respiratory infections. Respirology 2004; 9: S1–S2
Ventilator‐associated pneumonia
Authors:   The committee for The Japanese Respiratory Society guidelines in management of respiratory infections
Published: November 2004

Ventilator‐associated pneumonia

The committee for The Japanese Respiratory Society guidelines in management of respiratory infections. Respirology 2004; 9: S30–S34
Aspiration pneumonia
Authors:   The committee for The Japanese Respiratory Society guidelines in management of respiratory infections
Published: November 2004

Aspiration pneumonia

The committee for The Japanese Respiratory Society guidelines in management of respiratory infections. Respirology 2004; 9: S35–S37
Appendix I: Nursing‐home acquired pneumonia
Authors:   The committee for The Japanese Respiratory Society guidelines in management of respiratory infections
Published: November 2004

Appendix I: Nursing‐home acquired pneumonia

The committee for The Japanese Respiratory Society guidelines in management of respiratory infections. Respirology 2004; 9: S51–S55
Redescription ofDixella humeralis(Tonnoir) with notes on the immature stages (Diptera: Dixidae)
Authors: Ogawa Joshua R , Miller Kelsey L , Judd Darlene D
Published: November 2004

Abstract The adult male ofDixella humeralisis redescribed and adult female and immature life stages are described for the first time. Originally described from the Blue Mountains, New South Wales, the current range is extended to include the pasture lands of the Dorrigo Plateau. Larval and pupal chaetotaxy are illustrated and their putative homology with the Culicidae is discussed. Adult and larval characters are presented that separate the known endemic AustralianDixellaspecies.
Constraints to community groups monitoring plants and animals in rainforest revegetation sites on the Atherton Tablelands of far north Queensland
Authors: Freeman Amanda N. D.
Published: November 2004

Summary  Many revegetation projects throughout Australia are implemented by community organizations and are often heavily reliant on volunteers. These community organizations are also often recipients of Natural Heritage Trust (NHT) funds from the federal government and, as part of meeting funding obligations, are expected to monitor their revegetation projects. There is, however, no minimum prescription for the level of monitoring required. Six community organizations undertaking rainforest revegetation projects on the Atherton Tablelands of far north Queensland were surveyed concerning the plant and animal monitoring techniques they employ. Of 10 distinct projects funded through the Bushcare programme of the NHT between 1997 and 2002, only three projects received any systematic monitoring apart from photography to record changes in vegetation cover and condition. Fauna monitoring was only undertaken where a community group was able to obtain assistance from a government agency, researchers, or call on the expertise of local naturalists. Reasons given for these community organizations not undertaking systematic monitoring of plants and animals in their revegetation sites included: lack of personnel, money and expertise; negative perceptions of the value of monitoring; and, lack of interest among the group's membership. As this survey was very small and localized, results may not be applicable to community groups as a whole. However, this survey suggests that although some of the constraints to community group monitoring can be overcome, doubt regarding the efficacy of monitoring and lack of time/interest in monitoring relative to other volunteer activities cannot easily be resolved. Over‐reliance on such groups and their volunteers to conduct monitoring places an inappropriate expectation on these community organizations.
Reliability of X‐rays and bone scans for the assessment of changes in skeletal metastases from breast cancer
Authors: Shackleton M. , Yuen K. , Little A. F. , Schlicht S. , McLachlan S.‐A.
Published: November 2004

Aims:  To examine the level of agreement among observers regarding changes between serial images of bone metastases.

Methods:  Thirty‐five pairs of bone X‐rays and 30 pairs of bone scans were selected from the files of patients with breast cancer involving the skeleton. All images in a pair were of the same site and had been taken at least 12 weeks apart. Thirteen radiologists and 14 nuclear medicine physicians examined the X‐ray and bone scan pairs, respectively. Each assessed whether the changes between sequential films represented improvement, stability or worsening. Inter‐observer agreement was analysed using the kappa statistic (κ).

Results:  There was only fair overall agreement among radiologists regarding changes between X‐rays (κ = 0.23), but there was substantial agreement among nuclear medicine physicians for bone scan assessments (κ = 0.62). Neither the experience of the observers nor the time between images had a significant effect on agreement. For X‐rays, agreement was poorer if the response category was ‘improvement’ and if the type of bone lesion was mixed lytic/sclerotic.

Conclusions:  Evaluation of serial X‐rays is unreliable for determining the response of bone metastases. Scintigraphic evaluation has a higher internal validity for the determination of response, but it should not be used in isolation from other clinical data. (Intern Med J 2004; 34: 615−620)
‘Is she experiencing any pain?’: disability and the physician−patient relationship
Authors: Toombs S. K.
Published: November 2004

In this essay, I reflect on my experience as a multiple sclerosis patient in order to identify some of the unique challenges that chronic disability poses in the physician−patient relationship. I suggest that it is important to broaden the goals of the clinical encounter to incorporate personal (as opposed to simply bodily) well‐being, to be aware of the manner in which chronic disability affects decisions regarding treatment, to recognize the import of physical and attitudinal barriers and to acknowledge that patients with chronic disabilities have an ‘expert’ knowledge of bodily experience. I also suggest that chronic disability provides an exceptional opportunity with respect to the relationship between doctors and patients. (Intern Med J 2004; 34: 645−647)
Five cases of non‐typhoidal Salmonella endovascular infection
Authors: Drinković D. , Taylor S. L. , Lang S.
Published: November 2004

The incidence of human non‐typhoidal Salmonella (NTS) infection has increased in many countries. Endovascular infection is one of the most serious forms of extraintestinal infection. Five patients with NTS endovascular infection treated at Middlemore Hospital, Auckland, New Zealand, are presented here. All persons with NTS bacteraemia who are older than 50 years and have a risk of atherosclerosis should be evaluated for possible endovascular infection. (Intern Med J 2004; 34: 641−645)
Optical imaging of the spatiotemporal dynamics of cerebral blood flow and oxidative metabolism in the rat barrel cortex
Authors: Weber B. , Burger C. , Wyss M. T. , Von Schulthess G. K. , Scheffold F. , Buck A.
Published: November 2004

Oxidative metabolism and cerebral blood flow (CBF) are two of the most important measures in neuroimaging. However, results from concurrent imaging of the two with high spatial and temporal resolution have never been published. We used flavoprotein autofluorescence (AF) and laser speckle imaging (LSI) in the anaesthetized rat to map oxidative metabolism and CBF in response to single vibrissa stimulation. Autofluorescence responses reflecting oxidative metabolism demonstrated a fast increase with a delay of 0.1 s. The sign‐reversed speckle contrast reflecting CBF started to rise with a delay of 0.6 s and reached its maximum 1.4 s after the stimulation offset. The fractional signal changes were 2.0% in AF and 9.7% in LSI. Pixelwise modelling revealed that CBF maps spread over an area up to 2.5‐times larger than metabolic maps. The results provide evidence that the increase in cerebral oxidative metabolism in response to sensory stimulation is considerably faster and more localized than the CBF response. This suggests that future developments in functional imaging concentrating on the metabolic response promise an increased spatial resolution.
Tracheal administration of atropine in children—effect on heart rate
Authors: JØRGENSEN BENT , ØSTERGAARD DORIS
Published: November 2004

Forty‐one ASA I patients, aged 2–6 years, anaesthetized for elective ear, nose and throat surgery, were studied in a double blind and randomized fashion in order to examine the effect of tracheally administered atropine 0.02 mg·kg−1 or saline 0.9% on heart rate. In patients receiving atropine heart rate increased 8.8 beats·min−1 (8.7%) and 16.2 beats·min−1 (16.0%) after 3 and 5 min respectively. No increase in heart rate was seen in the saline group. Because of the late onset of action and only moderate increase in heart rate it is concluded that tracheal administration of atropine 0.02 mg·kg−1 to children is insufficient in emergency situations.
Perioperative anaesthetic morbidity in children: a database of 24 165 anaesthetics over a 30‐month period
Authors: Murat Isabelle , Constant Isabelle , Maud'huy Hélène
Published: November 2004

Background : This study reports the practices and morbidity of 24 165 anaesthetics performed over a 30‐month period in a paediatric teaching hospital.

Methods : Data describing practices and adverse events during anaesthesia and in the postanaesthesia care unit (PACU) were collected prospectively from 1 January 2000 to 30 June 2002 on an audit form as a part of the Quality Assurance Program. All surgical specialties are covered except for open heart surgery and neurosurgery.

Results : A total of 724 adverse events were reported during anaesthesia and 1105 in PACU. Respiratory events represented 53% of all intraoperative events. They were more frequent in infants compared with older children, in ENT surgery compared with other surgery, in children in whom the trachea was intubated and in children with ASA status 3–5 compared with those with ASA score 1 or 2. Cardiac events accounted for 12.5% of intraoperative events and were mainly observed in children with ASA score 3–5. In PACU, vomiting was the most frequent adverse event with an overall incidence of 6%. Vomiting was more frequent in older children compared with infants and young children and more frequent after ENT surgery compared with other surgery. Only one death was reported in a premature newborn infant and was not anaesthesia‐related.

Conclusions : This observational study confirms previous reports, and indicates that there is still a relative higher rate of adverse events in infants compared with older children even in a teaching paediatric hospital with a high annual caseload.
Management of urethral stricture disease: developing options for surgical intervention
Authors: Peterson Andrew C. , Webster George D.
Published: November 2004

Urethral strictures demand careful surgical management, and the authors from North Carolina describe the developing art of urethral surgery in the first of the mini‐reviews in this issue. The non‐surgical oncologists’ role in managing advanced and metastatic TCC is of great importance, and as urologists increasingly adopt a multi‐disciplinary approach to cancer, the next two mini‐reviews in this section should be of considerable interest. Finally, what is a prostasome? The possible importance of its role in prostate disease is described in the fourth paper.
Evaluation of urinary extravasation and results after continence‐preserving radical retropubic prostatectomy
Authors: Varkarakis John , Wirtenberger Walter , Pinggera Germar‐Michael , Berger Andreas , Harabayashi Toru , Bartsch Georg , Horninger Wolfgang
Published: November 2004

Two of the papers in this section refer to surgical technique in cancer operations. In the first, authors from Innsbruck examine their rates of urinary extravasation after removing the catheter 10 days after radical retropubic prostatectomy; the rate was very low, the continence rates were excellent, and the rate of anastomic stricture was low. This is a large and well‐studied group of patients.

In the second of these papers, authors from Paris describe a technique of radical cystectomy where there is sparing of the prostate capsule and of the seminal vesicles, to preserve potency and improve continence. They found very little positive support in their results in favour of this technique, and felt it should have only a limited role.

A study from Sacramento assesses a modified yeast assay as an aid to detect p53 gene mutations in localized prostate cancer. They found it to be superior to other methods, and felt that p53 mutations carried important prognostic implications.

OBJECTIVE

To evaluate the feasibility of urinary catheter removal 10 days after a radical retropubic prostatectomy (RRP) by assessing the incidence of urinary extravasation and its effect on postoperative stricture and continence rates.

PATIENTS AND METHODS

During a 4.5‐year period, 619 patients undergoing RRP were evaluated. If no extravasation was detected on gravity cystography, the urinary catheter was removed 10 days after RRP. In patients with significant extravasation the catheter was left in place for 3 weeks. Overall stricture and continence rates were recorded in patients at 3, 6 and 12 months after surgery.

RESULTS

There was extravasation during cystography in 29 patients (4.6%). At 3, 6 and 12 months, continence rates after catheter removal at 10 days were 74.9%, 87.9%, and 93.6%, respectively, while in the late‐removal group they were 72.4%, 84.6% and 90.9%, respectively, with no significant difference between the groups. At 3 months the overall continence rate was 74.8% and at 12 months up to 93.5%. There was no difference in stricture rates between the groups, with an overall stricture rate of 0.7%.

CONCLUSIONS

Catheter removal 10 days after RRP is feasible, giving excellent early and late continence rates, with low anastomotic stricture rates obtained using good surgical technique. Extravasation at 10 days was rare and with proper management did not influence the final results.
Transurethral microwave thermotherapy vs transurethral resection for treating benign prostatic hyperplasia: a systematic review
Authors: Hoffman Richard M. , MacDonald Roderick , Monga Manoj , Wilt Timothy J.
Published: November 2004

Technology has been used in the management of BPH, sometimes without much evidence to support its use. The first manuscript is a systematic review of the literature comparing transurethral microwave therapy to TURP. This shows that although microwave therapy is safe and effective in the short term, it is not as effective as TURP.

Authors from London report on their long‐term (up to 12‐years of follow‐up) results when using the Urolume wallstent for urethral stricture. They describe the results in detail, and conclude that the stent should only be used in patients who are unfit for or who refuse urethroplasty.

OBJECTIVE

To conduct a systematic review of randomized controlled trials evaluating the efficacy and safety of transurethral microwave thermotherapy (TUMT) compared with transurethral resection of the prostate (TURP) in treating men with symptomatic benign prostatic hyperplasia (BPH).

METHODS

We searched Medline, the Cochrane Library and reference lists of retrieved studies to identify randomized trials of ≥ 6 months duration with ≥ 10 patients in each treatment arm. Data were extracted on study design, patient and treatment characteristics, urinary symptoms, urinary flow, adverse events and repeat treatment for BPH.

RESULTS

Six studies were evaluated, involving 540 patients. The mean age (67.8 years), baseline symptom score (19.5), and peak urinary flow (PUF, 8.6 mL/s) did not differ by treatment group. The pooled mean urinary symptom score decreased by 65% with TUMT and 77% with TURP. The weighted mean (95% confidence interval) difference for the symptom score at the follow‐up was −1.83  (−3.09 to −0.58) points, favouring TURP. The pooled mean PUF increased by 70% with TUMT and 119% with TURP. The weighted mean difference for the PUF at the follow‐up was 5.37 (4.22–6.51) mL/s, favouring TURP. Retrograde ejaculation (57.6% vs 22.2%), transfusions (5.7% vs 0%) and re‐treatment for strictures (relative hazard 9.76) were all significantly more common after TURP, but re‐treatment for BPH was significantly more common after TUMT (relative hazard 10.0).

CONCLUSIONS

TUMT techniques are effective and safe short‐term alternatives to TURP for treating BPH. However, TURP provided greater symptom and urinary flow improvements and fewer subsequent BPH treatments than TUMT.
Treatment of stress urinary incontinence using a copolymer system: impact on quality of life
Authors: Van Kerrebroeck Philip , Ter Meulen Flip , Larsson Gregor , Farrelly Elisabeth , Edwall Lena , Fianu‐Jonasson Aino
Published: November 2004

OBJECTIVE

To investigate the effect on quality of life (QoL) of a novel system for treatment of stress urinary incontinence (SUI).

PATIENTS AND METHODS

In an open, prospective, multicentre study, 42 women not previously treated by invasive therapy and with urodynamically verified SUI received 4 × 1.0 mL or 4 × 0.7 mL of non‐animal stabilized hyaluronic acid/dextranomer copolymer injected transurethrally into the urethra via the ImplacerTM device (ZuidexTM system, Q‐Med AB, Uppsala, Sweden). QoL was assessed using the King's Health Questionnaire. The patients’ perception of treatment benefit and the number of incontinence episodes/24 h were also investigated.

RESULTS

There were significant improvements over baseline in seven of 10 domains of the King's Health Questionnaire at 3 months, and these improvements were sustained at 1 year. For the change from baseline to 1 year, eight of 10 domains showed a significant positive correlation with the number of incontinence episodes/24 h. In terms of treatment benefit, most of the women perceived an improvement at 1, 3, 6 and 12 months. Of the 18 women requiring re‐treatment, most perceived an improvement at 3, 6 and 12 months.

CONCLUSION

Treatment with the Zuidex system produced significant improvements over a year in both subjective QoL and objective incontinence measures, with a significant positive correlation between them.
A pilot randomized double‐blind placebo‐controlled trial on the use of antibiotics on urinary catheter removal to reduce the rate of urinary tract infection: the pitfalls of ciprofloxacin
Authors: Wazait Hassan D. , Patel Hitenddra R. , Van Der Meulen Jan H.P. , Ghei Maneesh , Al‐Buheissi Salah , Kelsey Michael , Miller Ronald A. , Emberton Mark
Published: November 2004

OBJECTIVE

To assess if a short course of antibiotics starting at the time of the removing a short‐term urethral catheter decreases the incidence of subsequent urinary tract infection (UTI).

PATIENTS AND METHODS

Patients across specialities with a urethral catheter in situ for ≥ 48 h and ≤ 7 days were recruited at the time of catheter removal. Patients were excluded if they had had recent genitourinary surgery or were on antibiotics. Eligible patients were randomly assigned to a 48‐h course of either ciprofloxacin or placebo tablets starting 2 h before catheter removal. A catheter specimen of urine was obtained before the start of the trial medication. The follow‐up was at 7 and 14 days after catheter removal, with a questionnaire for UTI symptoms, and a mid‐stream urine sample was taken.

RESULTS

Forty‐eight patients were recruited and had a complete follow‐up (25 received ciprofloxacin and 23 placebo). Of the ciprofloxacin group, four patients (16%) had a UTI at the follow‐up after catheter removal, and two were symptomatic. The UTI in two patients (including one of those symptomatic) was newly developed after catheter removal; the other two UTIs were a result of failure to resolve a catheter‐associated UTI. All these UTIs in the ciprofloxacin group were resistant to ciprofloxacin. Of the placebo group, three patients (13%) had a UTI at the follow‐up after removal, and one patient was symptomatic. The UTI, newly developed after catheter removal, was resistant to ciprofloxacin. The other two patients were asymptomatic; their UTIs were a result of failure to resolve a catheter‐associated UTI, and one was resistant to ciprofloxacin.

CONCLUSIONS

The risk of UTI (both symptomatic and asymptomatic) after removing a urethral catheter is real, even in absence of catheter‐associated UTI before removal. UTIs occurring after removing a short‐term urinary catheter had a high rate of resistance to ciprofloxacin. There was no detectable significant benefit in using prophylactic ciprofloxacin to reduce the UTI rate after catheter removal.
Anatomical studies of the neurovascular bundle and cavernosal nerves
Authors: Costello Anthony J. , Brooks Matthew , Cole Owen J.
Published: November 2004

OBJECTIVE

To accurately define the anatomy of the neurovascular bundle (NVB) in men.

MATERIALS AND METHODS

The NVB was microdissected in detail bilaterally in 12 fixed human male adult cadavers. The anatomy of the NVB and its relationship to surrounding pelvic structures was ascertained in each specimen.

RESULTS

Previous reports of the anatomy of the NVB have not mentioned its levator ani and anterior rectal component. The anatomy of the cavernosal nerves is such that accurate graft anastomosis to proximal and distal cavernosal nerve segments is extremely difficult.

CONCLUSION

The current anatomical description of the cavernosal nerve and NVB is inaccurate.
The Lahey clinic experience with continent urinary diversion
Authors: Crivellaro Simone , Michaels Mike J. , Kocjancic Ervin , Libertino John A.
Published: November 2004

The authors from the Lahey Clinic describe that institution's experience with continent urinary diversion. In a large series of patients, they compared morbidity, mortality and clinical outcome of continent urinary diversion with orthotopic neobladder.

OBJECTIVE

To compare the morbidity, mortality and clinical outcome of catheterizable continent urinary reservoirs (CUR) with orthotopic neobladders (ONB) at our institution.

PATIENTS AND METHODS

Between September 1985 and October 2001, 238 patients (84 women and 154 men) had a continent urinary diversion, including 125 ONBs and 113 CURs. The charts of these patients were reviewed retrospectively and the patients interviewed by telephone when possible (for continence data and overall satisfaction). Over the 16 years the relative frequency of ONB diversion increased steadily and thus the mean follow‐up was significantly longer for the CUR (9.4 years) than for the ONB group (5.2 years) (P < 0.001). This bias was addressed by comparing these large groups for the early outcome only. Separately, the long‐term outcome was analysed, comparing the 40 most recently constructed CURs with all 113 ONBs; this gave a mean follow‐up of 5.2 years for ONB and 5.9 years for CUR (not significant, P = 0.23).

RESULTS

Of the 238 continent diversions, 125 were ONBs and 113 CURs; most patients had a diagnosis of transitional cell carcinoma before surgery. The mean age at surgery was 59.1 years for the ONB and 54.8 years for the CUR group (P < 0.001). Men were significantly more likely than women to have had an ONB. There were two deaths after surgery in the ONB and none in the CUR group. The hospital stay was significantly longer for the CUR than for the ONB group; the likelihood of an intensive care unit stay, estimated blood loss and reoperation rate were higher in the CUR group. There was no significant difference in the rates of short‐term (<30 days) complications. The analysis of the time‐controlled groups showed significantly more long‐term (>30 days) complications and of reoperation in the CUR group. Fifty‐one patients with ONB and 19 with CURs were contacted by telephone; of those with an ONB, 43 (84%) had daytime continence (<1 pad/day) while 13 (25%) were continent at night (<1 pad). Fifteen of 19 with a CUR reported full day and night‐time continence. From separate telephone interviews, overall satisfaction was high for both groups (mean 4.5, scale 0–5), expectations were met in 92% for both, and 94% in both would choose the same procedure again if confronted with the same set of circumstances.

CONCLUSIONS

Both ONB and CUR offer an excellent functional outcome, as reflected by patient satisfaction and continence rates.
Comparative study of dartos fascia and tunica vaginalis pedicle wrap for the tubularized incised plate in primary hypospadias repair
Authors: Chatterjee Uday S. , Mandal Manas K. , Basu Supriyo , Das Ranjit , Majhi Tapas
Published: November 2004

OBJECTIVES

To report a prospective comparative study on using dartos fascia, i.e. subcutaneous tissue of penile skin and tunica vaginalis pedicled wrap (TVPW) from the parietal layer of the tunica vaginalis of the testis, for a one‐stage tubularized incised‐plate (TIP) repair for hypospadias.

PATIENTS AND METHODS

Forty‐nine patients (mean age 4.6 years, range 1–22) with hypospadias of different types (varying from coronal to penoscrotal) were repaired in one of three hospitals over 3 years. All patients were repaired using the TIP technique, with dartos fascia wrap used in 20 and TVPW in 29, without using a loupe or microscope during surgery. Urinary diversion and splinting were provided by a urethral catheter. The operative duration for both groups was similar at ≈ 2 h.

RESULTS

In the dartos fascia group there were three (15%) fistulae, but there were none in the TVPW group.

CONCLUSIONS

Although the dissection for TVPW seems to be cumbersome theoretically, it is not difficult. The combination of TIP and TVPW in primary repair may be a good alternative to other techniques.
Involvement of 5‐hydroxytryptamine (HT)7 receptors in the 5‐HT excitatory effects on the rat urinary bladder
Authors: Palea Stefano , Lluel Philippe , Barras Martine , Duquenne Chantal , Galzin Anne‐Marie , Arbilla Sonia
Published: November 2004

OBJECTIVE

To investigate the in vitro and in vivo effects of 5‐hydroxytryptamine (5‐HT) on the rat urinary bladder and to characterize the receptors involved in mediating these pharmacological effects by using selective antagonists.

MATERIALS AND METHODS

Female Wistar rats (250–350 g) were used for all studies. In vitro, detrusor muscle strips were mounted between two platinum electrodes in organ baths filled with a modified Krebs’ solution bubbled with 95% O2 and 5% CO2 at 37 °C. After equilibration and a contraction to 80 mmol/L KCl, strips were exposed to electrical field stimulation for 30 min and incubated with the antagonist or vehicle for a further 30 min, then a 5‐HT concentration‐response curve (CRC) was obtained. In vivo, rats were anaesthetized with pentobarbital, and the ureters and urethra ligated, the bladder catheterized and infused with saline. 5‐HT (3–100 µg/kg intravenous) dose‐dependently increased intravesical pressure (IVP). After administering 5‐HT at 30 µg/kg three times at 10 min intervals (controls), one dose of antagonist was perfused for 5 min and, after a further 5 min, 30 µg/kg 5‐HT was tested again. This cycle was repeated four times using increasing doses of the antagonist to be tested.

RESULTS

In vitro, 5‐HT (0.01–100 µmol/L) induced a concentration‐dependent enhancement of the neurogenic response, with a mean (sd) pEC50 of 6.36 (0.15) and Emax of 41.1 (4.6)% KCl (eight rats). In unstimulated tissues, 5‐HT induced no contractile effect. Selective 5‐HT4, 5‐HT3 and 5‐HT1A receptor antagonists had no effect on the 5‐HT potentiating effects. The potentiating effect of 5‐HT was antagonized by mesulergine at 0.3 µmol/L, R(+)lisuride at 0.3 µmol/L and the selective 5‐HT7 receptor antagonist SB‐258741 at 0.3 µmol/L. In vivo, in anaesthetized rats, IVP increases induced by repeated doses of 30 µg/kg 5‐HT were reproducible. R(+)lisuride (3–100 µg/kg) dose‐dependently inhibited the 5‐HT‐induced increase of IVP. At the maximum dose tested, R(+)lisuride almost totally inhibited the 5‐HT effect.

CONCLUSIONS

In rat isolated detrusor muscle the 5‐HT7 receptor antagonists SB‐258741, R(+)lisuride and mesulergine blocked the 5‐HT potentiating effect with the expected potency. Moreover, in anaesthetized rats, R(+)lisuride abolished 5‐HT effects on IVP at doses that antagonize physiological effects known to be mediated by 5‐HT7 receptor activation in several animal species. These results suggest the involvement of 5‐HT7 receptors in the modulation of rat bladder contraction both in vitro and in vivo.
Foods derived from animals: the impact of animal nutrition on their nutritive value and ability to sustain long‐term health
Authors: Givens D. I. , Shingfield K. J.
Published: November 2004

Summary Foods derived from domestic animals are a significant source of nutrients in the UK diet. However, certain aspects of some animal‐derived foods, notably levels of saturated fatty acids, have given rise to concerns that these foods may contribute to the risk of cardiovascular disease, the metabolic syndrome and other conditions. However, the composition of the many animal‐derived foods is not constant and can often be enhanced by manipulating the nutrition of the animal. This paper reviews these possibilities with particular attention to lipids, and draws attention to the fact that milk in particular, contains a number of compounds which may, for example, exert anti‐carcinogenic effects. It is clear that the role of animal nutrition in creating foods closer to the optimum composition for long‐term human health will not only be more relevant in the future, but will be vital in attempts to improve the health of the human population.
Current Issues in the Economics of Groundwater Resource Management
Authors: Koundouri Phoebe
Published: November 2004

Abstract.  The issue of groundwater management remains a practical concern in many regions throughout the world, while water managers continue to grapple with the question of how to manage this resource. In this article, we attempt to bring the most advanced and appropriate tools to bear on the issue of resource allocation involving groundwater. Our objective is to demonstrate the state of the art in the literature on ways to think about this complex resource and to deal with the important economic issues emanating from its complexity. We present the conceptual framework within which economists examine the elements interacting in the management of groundwater resources, indicate why the role of the market is limited with respect to the price of this very complex resource, and point to the mechanisms that can pull competitive groundwater price and quality‐graded quantity of groundwater in line with their equilibrium levels. In particular, we critically review economic models of groundwater use, examine the potential for groundwater management, discuss the difficulties encountered in the estimation of the relevant control variables of such models, and identify the advantages and limitations of the instruments devised for the efficient use (allocation) of this resource. Finally, we argue that devised regulatory schemes usually ignore the information and knowledge needed for their implementation, and we suggest a core of conditions necessary for successful groundwater management reforms.
Getting Marx and Foucault into Bed Together!
Authors: Hunt Alan
Published: November 2004

This article is a contribution to the occasional series dealing with a major book that influenced the author. Previous contributors include Stewart Macaulay, John Griffith, William Twining, Carol Harlow, Geoffrey Bindman, Harry Arthurs, and André‐Jean Arnaud.
Growth, institutions and knowledge: a review and reflection on the historiography of 18th–20th century China
Authors: Ma Debin
Published: November 2004

This article surveys major themes on the latest revisionist thesis of economic growth in China during the eighteenth and nineteenth centuries. With an emphasis on the role of informal and formal institutions to economic growth, this article reviews the traditional legal system and its impact on the organizational evolution of major Chinese merchant groups. It argues that, to understand the distinctive path of long‐term economic growth or stagnation in China, we need to go beyond the study of resource endowments or technologies, to also incorporate an economic analysis of China’s traditional social and political institutions and their associated ideologies.
The historical origins of the Philippine economy: a survey of recent research of the Spanish colonial era
Authors: Fradera Josep M.
Published: November 2004

This article surveys recent research of the Spanish colonial era in the Philippines since the late eighteenth century. While highlighting imperfections in our understanding, the article establishes the parameters with which the Philippine economy entered the twentieth century. It outlines the intensification of Spanish colonial rule through changes in the taxation system, particularly the expansion of forced tobacco cultivation until its abolition in 1882. Since then, the Spanish set out to further change and intensify colonial rule but contradictions in the system of colonial rule caused the effort to come to an abrupt end in 1898.
INVESTMENT PATTERNS AND THE COMPETITIVENESS OF GREEK REGIONS
Authors: Filippaios Fragkiskos , Kottaridi Constantina
Published: November 2004

This paper aims at mapping and analyzing the determinants of industrial activity in Greek regions in order to assess current investment patterns. For this purpose, we estimate a conditional logit model of 226 new established firms for 1996 and 1997. Results give interesting insights that are likely of particular importance to regional policy makers. Noteworthy is the spatial concentration of firms in different prefectures while the large metropolitan cities, Athens and Thessalonica, although with declining shares, prevail as the dominant hosts. European regional policy seems to enhance firms’entry via its effect on economic development variables, in contrast with the Greek Development Law, which turns out non‐influential.
What happens to precocious readers' performance by the age of eleven?
Authors: Stainthorp Rhona , Hughes Diana
Published: November 2004

This paper reports on the progress made by a small group of fourteen 11‐year‐old children who had been originally identified as being precocious readers before they started primary school at the age of five. The data enable comparisons to be made with the performance of the children when they were younger so that a six‐year longitudinal analysis can be made. The children who began school as precocious readers continued to make progress in reading accuracy, rate and comprehension, thereby maintaining their superior performance relative to a comparison group. However, their progress appeared to follow the same developmental trajectory as that of the comparison group. Measures of phonological awareness showed that there are long‐term, stable individual differences that correlated with all measures of reading. The children who were reading precociously early showed significantly higher levels of phonological awareness than the comparison children. In addition, they showed the same levels of performance on this task as a further group of high achieving young adults. A positive effect of being able to read at precociously early age was identified in the significantly higher levels of receptive vocabulary found amongst these children. The analyses indicated that rises in receptive vocabulary resulted from reading performance rather than the other way round.
Compatible Prior Distributions for Directed Acyclic Graph Models
Authors: Roverato Alberto , Consonni Guido
Published: November 2004

The application of certain Bayesian techniques, such as the Bayes factor and model averaging, requires the specification of prior distributions on the parameters of alternative models. We propose a new method for constructing compatible priors on the parameters of models nested in a given directed acyclic graph model, using a conditioning approach. We define a class of parameterizations that is consistent with the modular structure of the directed acyclic graph and derive a procedure, that is invariant within this class, which we name reference conditioning.
Power Transformations to Induce Normality and their Applications
Authors: Chen Willa W. , Deo Rohit S.
Published: November 2004

Random variables which are positive linear combinations of positive independent random variables can have heavily right-skewed finite sample distributions even though they might be asymptotically normally distributed. We provide a simple method of determining an appropriate power transformation to improve the normal approximation in small samples. Our method contains the Wilson–Hilferty cube root transformation for χ2 random variables as a special case. We also provide some important examples, including test statistics of goodness-of-fit and tail index estimators, where such power transformations can be applied. In particular, we study the small sample behaviour of two goodness-of-fit tests for time series models which have been proposed recently in the literature. Both tests are generalizations of the popular Box–Ljung–Pierce portmanteau test, one in the time domain and the other in the frequency domain. A power transformation with a finite sample mean and variance correction is proposed, which ameliorates the small sample effect. It is found that the corrected versions of the tests have markedly better size properties. The correction is also found to result in an overall increase in power which can be significant under certain alternatives. Furthermore, the corrected tests also have better power than the Box–Ljung–Pierce portmanteau test, unlike the uncorrected versions.
Never Give up on the Good Times: Student Attrition in the UK*
Authors: Johnes Geraint , McNabb Robert
Published: November 2004

The determinants of students’ propensity to drop out of university are analysed using individual records of all students passing through the central applications process in 1993. The data set comprises about 100,000 individuals and allows a much more thorough analysis of student wastage than has been possible in the past. The main reasons for attrition, academic failure (‘involuntary’ attrition) and ‘voluntary’ dropout, are modelled. The results highlight, inter alia, the importance of matching and peer group effects, both of which have been found to be important determinants of student outcomes in the US but which have been subject to little empirical scrutiny for the UK.
Forecast Pooling for European Macroeconomic Variables*
Authors: Marcellino Massimiliano
Published: November 2004

We compare alternative forecast pooling methods and 58 forecasts from linear, time‐varying and non‐linear models, using a very large dataset of about 500 macroeconomic variables for the countries in the European Monetary Union. On average, combination methods work well but single non‐linear models can outperform them for several series. The performance of pooled forecasts, and of non‐linear models, improves when focusing on a subset of unstable series, but the gains are minor. Finally, on average over the EMU countries, the pooled forecasts behave well for industrial production growth, unemployment and inflation, but they are often beaten by non‐linear models for each country and variable.
The Limits of Conceptual Analysis
Authors: SCHROETER LAURA
Published: November 2004

Abstract: A priori conceptual analysis is once again part of the philosophical mainstream. Unlike their verificationist predecessors, modern conceptual analysts deny that we have armchair access to the essential nature of the objects and properties we think about. Instead, they claim we have access to how the reference of our words and thoughts is fixed. This position seems to resolve the apparent tension between semantic externalism and privileged access to one's own meanings. However, I argue that our grasp of reference‐fixing conditions is as fallible as our understanding of essences.
Restoration of CD4 T‐cell responses to cytomegalovirus is short‐lived in severely immunodeficient HIV‐infected patients responding to highly active antiretroviral therapy
Authors: Keane NM , Price P , Lee S , Almeida CA , Stone SF , James I , French MA
Published: November 2004

Objectives

To define the level of pathogen‐specific immune reconstitution persisting over 3 to 5 years of highly active antiretroviral therapy (HAART) in HIV‐infected patients who began therapy with CD4 T‐cell counts below 50 cells/μL.

Methods

Cytomegalovirus (CMV)‐specific T‐cell responses were analysed in adult HIV‐1‐infected patients with nadir CD4 T‐cell counts below 50 cells/μL before HAART. CMV‐specific CD4 T‐cell responses were measured by interferon‐γ enzyme‐linked immunospot assay (ELISpot assay), lymphoproliferation and interferon‐γ levels in cell culture supernatants.

Results

CD4 T‐cell responses to CMV were low in untreated patients and remained low during the first year on HAART, but increased progressively to levels similar to those found in HIV‐seronegative CMV‐seropositive controls at 3 years. Responses then declined markedly and at 5 years were lower than controls. This could not be explained by changes in CD4 or CD8 T‐cell counts or plasma HIV RNA levels. Interferon‐γ and interleukin‐5 responses to a mitogen were maintained or elevated.

Conclusions

CMV‐specific CD4 T‐cell responses were found to decline after 3–5 years on HAART and may provide inadequate long‐term protection against CMV disease in patients who are severely immunodeficient prior to treatment.