bluuebunny/crossref_metadata_2025 huggingface dataset:
Complete sequence of the IncP‐9 TOL plasmid pWW0 from Pseudomonas putida
Authors: Greated Alicia , Lambertsen Lotte , Williams Peter A. , Thomas Christopher M.
Published: March 2003

The TOL plasmid pWW0 (117 kb) is the best studied catabolic plasmid and the archetype of the IncP‐9 plasmid incompatibility group from Pseudomonas. It carries the degradative (xyl) genes for toluenes and xylenes within catabolic transposons Tn4651 and Tn4653. Analysis of the complete pWW0 nucleotide sequence revealed 148 putative open reading frames. Of these, 77 showed similarity to published sequences in the available databases predicting functions for: plasmid replication, stable maintenance and transfer; phenotypic determinants; gene regulation and expression; and transposition. All identifiable transposition functions lay within the boundaries of the 70 kb transposon Tn4653, leaving a 46 kb sector containing all the IncP‐9 core functions. The replicon and stable inheritance region was very similar to the mini‐replicon from IncP‐9 antibiotic resistance plasmid pM3, with their Rep proteins forming a novel group of initiation proteins. pWW0 transfer functions exist as two blocks encoding putative DNA processing and mating pair formation genes, with organizational and sequence similarity to IncW plasmids. In addition to the known Tn4651 and IS1246 elements, two additional transposable elements were identified as well as several putative transposition functions, which are probably genetic remnants from previous transposition events. Genes likely to be responsible for known resistance to ultraviolet light and free radicals were identified. Other putative phenotypic functions identified included resistance to mercury and other metal ions, as well as to quaternary ammonium compounds. The complexity and size of pWW0 is largely the result of the mosaic organization of the transposable elements that it carries, rather than the backbone functions of IncP‐9 plasmids.
Global features of the Pseudomonas putida KT2440 genome sequence
Authors: Weinel Christian , Nelson Karen E. , Tümmler Burkhard
Published: March 2003

The compositional bias of the G+C, di‐ and tetranucleotide contents in the 6 181 862 bp Pseudomonas putida KT2440genome was analysed in sliding windows of 4000 bp in steps of 1000 bp. The genome has a low GC skew (mean 0.066) between the leading and lagging strand. The values of GC contents (mean 61.6%) and of dinucleotide relative abundance exhibit skewed Gaussian distributions. The variance of tetranucleotide frequencies, which increases linearly with increasing GC content, shows two overlapping Gaussian distributions of genome sections with low (minor fraction) or high variance (major fraction). Eighty per cent of the chromosome shares similar GC contents and oligonucleotide bias, but 105 islands of 4000 bp or more show atypical GC contents and/or oligonucleotide signature. Almost all islands provide added value to the metabolic proficiency of P. putida as a saprophytic omnivore. Major features are the uptake and degradation of organic chemicals, ion transport and the synthesis and secretion of secondary metabolites. Other islands endow P. putida with determinants of resistance and defenceor with constituents and appendages of the cell wall. A total of 29 islands carry the signature of mobile elements such as phage, transposons, insertion sequence (IS) elements and group II introns, indicating recent acquisition by horizontal gene transfer. The largest gene carries the most unusual sequence that encodes a multirepeat threonine‐rich surface adhesion protein. Among the housekeeping genes, only genes of the translational apparatus were located in segments with an atypical signature, suggesting that the synthesis of ribosomal proteins is uncoupled from the rapidly changing translational demands of the cell by the separate utilization of tRNA pools.
Perchlorate reduction by a novel chemolithoautotrophic, hydrogen‐oxidizing bacterium
Authors: Zhang Husen , Bruns Mary Ann , Logan Bruce E.
Published: March 2003

Water treatment technologies are needed that can remove perchlorate from drinking water without introducing organic chemicals that stimulate bacterial growth in water distribution systems. Hydrogen is an ideal energy source for bacterial degradation of perchlorate as it leaves no organic residue and is sparingly soluble. We describe here the isolation of a perchlorate‐respiring, hydrogen‐oxidizing bacterium (Dechloromonas sp. strain HZ) that grows with carbon dioxide as sole carbon source. Strain HZ is a Gram‐negative, rod‐shaped facultative anaerobe that was isolated from a gas‐phase anaerobic packed‐bed biofilm reactor treating perchlorate‐contaminated groundwater. The ability of strain HZ to grow autotrophically with carbon dioxide as the sole carbon source was confirmed by demonstrating that biomass carbon (100.9%) was derived from CO2. Chemolithotrophic growth with hydrogen was coupled with complete reduction of perchlorate (10 mM) to chloride with a maximum doubling time of 8.9 h. Strain HZ also grew using acetate as the electron donor and chlorate, nitrate, or oxygen (but not sulphate) as an electron acceptor. Phylogenetic analysis of the 16S rRNA sequence placed strain HZ in the genus Dechloromonas within the β subgroup of the Proteobacteria. The study of this and other novel perchlorate‐reducing bacteria may lead to new, safe technologies for removing perchlorate and other chemical pollutants from drinking water.
The frequency and characteristics of highly thermophilic bacteria in cool soil environments
Authors: Marchant Roger , Banat Ibrahim M. , Rahman Thahira J. , Berzano Marco
Published: March 2003

Following enrichment at 70°C and 80°C, five highly thermophilic aerobic eubacteria have been isolated from cool soil environments. These organisms show a temperature range for growth of 40–80°C and have optimal and very high growth rates around 70°C with generation times less than 30 min. All isolates are narrow rods, which stain Gram‐negative, but have a Gram‐positive cell wall structure and only one of five isolates is a spore former. All cultures contain a small proportion of previously unreported extremely long flexuous rods, which can be seen to divide eventually. Biochemical testing of five strains reveals a significant ability to utilize alkanes and some aromatic hydrocarbons. Using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) of 16S rDNA the five strains were differentiated into three categories, which paralleled the biochemical results. 16S rDNA sequences showed high similarity with thermophilic Bacillus species now reclassified as Geobacillus. These bacteria are present in high numbers in apparently all soils and the question is raised of how these organisms, which are apparently unable to grow at the temperatures experienced in these cool soils, are so prominent.
Cultivation of globally distributed soil bacteria from phylogenetic lineages previously only detected in cultivation‐independent surveys
Authors: Sait Michelle , Hugenholtz Philip , Janssen Peter H.
Published: March 2003

The culturability of microorganisms in a 10 cm core of an Australian pasture soil was investigated using a minimal agar medium with xylan as the growth substrate. Culturability decreased with increasing depth, from a maximum of 19% of the total microscopically countable cells in the 0–2 cm section to 2.4% in the 8–10 cm section. Seventy‐one isolates from the core were identified by comparative 16S rRNA gene sequence analysis. Many of these isolates belong to groups of globally distributed soil bacteria, including well‐characterized families of the classes Alphaproteobacteria and Betaproteobacteria, and of the subclass Actinobacteridae. Other isolates belong to groups with few or no cultivated representatives: 10 isolates in two subdivisions of the phylum Acidobacteria, five isolates in a new order and nine isolates in a new family of the class Alphaproteobacteria, two isolates in a new order of the class Gammaproteobacteria, three isolates in two new families of the subclass Actinobacteridae, and two isolates in the subclass Rubrobacteridae. These new isolates represent the first laboratory cultures able to be assigned to some of these groups and greatly increase the number of cultivated strains known for others. This demonstrates that a minimal change in cultivation strategy (using a polymeric growth substrate and longer incubation times) can result in the isolation of globally distributed but previously uncultured phylogenetically novel soil bacteria.
Statistical analysis of denaturing gel electrophoresis (DGE) fingerprinting patterns
Authors: Fromin N. , Hamelin J. , Tarnawski S. , Roesti D. , Jourdain‐Miserez K. , Forestier N. , Teyssier‐Cuvelle S. , Gillet F. , Aragno M. , Rossi P.
Published: March 2003

Technical developments in molecular biology have found extensive applications in the field of microbial ecology. Among these techniques, fingerprinting methods such as denaturing gel electrophoresis (DGE, including the three options: DGGE, TGGE and TTGE) has been applied to environmental samples over this last decade. Microbial ecologists took advantage of this technique, originally developed for the detection of single mutations, for the analysis of whole bacterial communities. However, until recently, the results of these high quality fingerprinting patterns were restricted to a visual interpretation, neglecting the analytical potential of the method in terms of statistical significance and ecological interpretation. A brief recall is presented here about the principles and limitations of DGE fingerprinting analysis, with an emphasis on the need of standardization of the whole analytical process. The main content focuses on statistical strategies for analysing the gel patterns, from single band examination to the analysis of whole fingerprinting profiles. Applying statistical method make the DGE fingerprinting technique a promising tool. Numerous samples can be analysed simultaneously, permitting the monitoring of microbial communities or simply bacterial groups for which occurrence and relative frequency are affected by any environmental parameter. As previously applied in the fields of plant and animal ecology, the use of statistics provides a significant advantage for the non‐ambiguous interpretation of the spatial and temporal functioning of microbial communities.
Complete genome sequence and comparative analysis of the metabolically versatile Pseudomonas putida KT2440
Authors: Nelson K. E. , Weinel C. , Paulsen I. T. , Dodson R. J. , Hilbert H. , Martins dos Santos V. A. P. , Fouts D. E. , Gill S. R. , Pop M. , Holmes M. , Brinkac L. , Beanan M. , DeBoy R. T. , Daugherty S. , Kolonay J. , Madupu R. , Nelson W. , White O. , Peterson J. , Khouri H. , Hance I. , Lee P. Chris , Holtzapple E. , Scanlan D. , Tran K. , Moazzez A. , Utterback T. , Rizzo M. , Lee K. , Kosack D. , Moestl D. , Wedler H. , Lauber J. , Stjepandic D. , Hoheisel J. , Straetz M. , Heim S. , Kiewitz C. , Eisen J. , Timmis K. N. , Düsterhöft A. , Tümmler B. , Fraser C. M.
Published: March 2003

Pseudomonas putida is a metabolically versatile saprophytic soil bacterium that has been certified as a biosafety host for the cloning of foreign genes. The bacterium also has considerable potential for biotechnological applications. Sequence analysis of the 6.18 Mb genome of strain KT2440 reveals diverse transport and metabolic systems. Although there is a high level of genome conservation with the pathogenic Pseudomonad Pseudomonas aeruginosa (85% of the predicted coding regions are shared), key virulence factors including exotoxin A and type III secretion systems are absent. Analysis of the genome gives insight into the non‐pathogenic nature of P. putida and points to potential new applications in agriculture, biocatalysis, bioremediation and bioplastic production.
Persistence and cell culturability of biocontrol strain Pseudomonas fluorescens CHA0 under plough pan conditions in soil and influence of the anaerobic regulator gene anr
Authors: Mascher Fabio , Schnider‐Keel Ursula , Haas Dieter , Défago Geneviève , Moënne‐Loccoz Yvan
Published: March 2003

Certain fluorescent pseudomonads can protect plants from soil‐borne pathogens, and it is important to understand how these biocontrol agents survive in soil. The persistence of the biocontrol strain Pseudomonas fluorescens CHA0‐Rif under plough pan conditions was assessed in non‐sterile soil microcosms by counting total cells (immunofluorescence microscopy), intact cells (BacLight membrane permeability test), viable cells (Kogure's substrate‐responsiveness test) and culturable cells (colony counts on selective plates) of the inoculant. Viable but non‐culturable cells of CHA0‐Rif (106 cells g−1 soil) were found in flooded microcosms amended with fermentable organic matter, in which the soil redox potential was low (plough pan conditions), in agreement with previous observations of plough pan samples from a field inoculated with CHA0‐Rif. However, viable but non‐culturable cells were not found in unamended flooded, amended unflooded or unamended unflooded (i.e. control) microcosms, suggesting that such cells resulted from exposure of CHA0‐Rif to a combination of low redox potential and oxygen limitation in soil. CHA0‐Rif is strictly aerobic. Its anaerobic regulator ANR is activated by low oxygen concentrations and it controls production of the biocontrol metabolite hydrogen cyanide under microaerophilic conditions. Under plough pan conditions, an anr‐deficient mutant of CHA0‐Rif and its complemented derivative displayed the same persistence pattern as CHA0‐Rif, indicating that anr was not implicated in the formation of viable but non‐culturable cells of this strain at the plough pan.
The impact of grassland management on archaeal community structure in upland pasture rhizosphere soil
Authors: Nicol Graeme W. , Glover L. Anne , Prosser James I.
Published: March 2003

The community structure of rhizosphere soil Archaea from three grassland types, associated with different management practices, was examined at a site in the Borders region of Scotland, by analysis of 16S rRNA gene fragments amplified from 16S rDNA and from rRNA. Denaturing gradient gel electrophoresis (DGGE) and sequence analysis of amplified products indicated high relative abundance within the archaeal community of two distinct lineages of non‐thermophilic (group 1) Crenarchaeota. Grassland management practices influenced archaeal community structure, as characterized by both 16S rRNA‐ and 16S rDNA‐derived DGGE profiles. One band dominated DGGE profiles in all three grassland types examined, and reproducible differences in the presence and intensity of bands were observed between profiles from managed and natural grassland sites. Analysis of 16S rRNA‐derived amplicons from managed and natural grasslands at sites in the north of England and the north of Wales also indicated high relative abundance of non‐thermophilic crenarchaeotes within the archaeal community. The band dominating the Scottish grassland site also dominated DGGE profiles from the English and Welsh sites, and similar differences were seen between profiles derived from soils subjected to different management regimes. The study indicates that grassland archaeal communities are dominated by Crenarchaeota, with closely related members of this lineage ubiquitous in distribution in UK upland pasture, and indicate that management practices influence the nature of the crenarchaeotal community.
Quantification of cell‐specific substrate uptake by probe‐defined bacteria under in situ conditions by microautoradiography and fluorescence in situ hybridization
Authors: Nielsen Jeppe Lund , Christensen Dinna , Kloppenborg Marie , Nielsen Per Halkjær
Published: March 2003

A technique based on quantitative microautoradiography (QMAR) and fluorescence in situ hybridization (FISH) was developed and evaluated in order to determine the quantitative uptake of specific substrates in probe‐defined filamentous bacteria directly in a complex system. The technique, QMAR‐FISH, has a resolution of a single cell and is based on an improved fixation protocol and the use of an internal standard of bacteria with known specific radioactivity. The method was used to study the in situ ecophysiology of the filamentous bacteria ‘Candidatus Meganema perideroedes’ and Thiothrix sp. directly in an activated sludge system. The cellular uptake rate of tritium‐labelled substrates revealed an average cell‐specific uptake rate of 4.1 ¥ 10−15 mol of acetate cell−1 h−1 and 3.1 ¥ 10−15 mol of acetate cell−1 h−1 for the two filamentous species respectively. The two filamentous species had very similar activity in all cells along each filament. Surprisingly, the filaments within both probe‐defined populations had threefold variation in activity between the different filaments, demonstrating a large variation in activity level within a single population in a complex system. The substrate affinity (Ks) for uptake of acetate of the cells within the two filamentous bacteria was determined by incubation with variable concentrations of labelled acetate. The Ks values of the ‘Candidatus Meganema perideroedes’ and the Thiothrix filamentous bacteria were determined to be 1.8 µM and 2.4 µM acetate respectively.
What should the role of ACE inhibitors be in the treatment of diabetes? Lessons from HOPE and MICRO‐HOPE
Authors: Heinig Robert E.
Published: March 2003

Experimental and clinical evidence suggest that angiotensin converting enzyme (ACE) inhibition may reduce cardiovascular (CV) risk by directly affecting endothelial dysfunction, atherosclerosis and thrombus formation. These direct effects are in addition to effects on vascular tone or pressure. The Health Outcomes and Prevention Evaluation (HOPE) study assessed the role of an ACE inhibitor ramipril in reducing CV events in 9297 patients ≥ 55 years who were at high risk of CV events but did not have left ventricular dysfunction, heart failure, or high blood pressure at the time of study entry. In the overall HOPE population, the risk of the primary composite outcome (cardiovascular death, myocardial infarction, or stroke) was reduced by 22% (p < 0.001), and in patients with diabetes plus one other CV risk, it was reduced by 25% (p = 0.0004). Ramipril treatment achieved risk reduction in patients with mild renal insufficiency (serum creatinine ≥ 1.4 mg/dl). Ramipril treatment did not increase adverse events in patients with renal insufficiency. The Study to Evaluate Carotid Ultrasound changes in patients treated with Ramipril and Vitamin E (SECURE) demonstrated that ramipril 10 mg significantly reduced the rate of carotid intimal medial thickening, suggesting a direct effect on atherosclerotic progression.
Multiple CHD risk factors in type 2 diabetes: beyond hyperglycaemia
Authors: Reaven Gerald M.
Published: March 2003

Recent evidence from the United Kingdom Prospective Diabetes Study convincingly demonstrates that good glycaemic control is difficult to achieve and, despite its positive impact on microvascular complications, is not sufficient to reduce the risk of coronary heart disease (CHD). Syndrome X—a cluster of abnormalities associated with resistance to insulin‐mediated glucose uptake that have been implicated in accelerating atherogenesis—provides a useful clinical concept to prevent CHD in patients with type 2 diabetes. Components of syndrome X can include hypertension, hyperinsulinaemia, dyslipidaemia, and a procoagulant state, changes that contribute to the development of atherosclerosis. Low‐density lipoprotein cholesterol (LDL‐C) levels are usually close to normal, but the LDL‐C is present in abnormally small and dense particles. Triglyceride levels are elevated and are associated with an increase in postprandial accumulation of atherogenic, remnant lipoprotein particles. High‐density lipoprotein cholesterol levels are typically low. This particular dyslipidaemia, along with hyperinsulinaemia, induces expression of plasminogen activator inhibitor‐1, contributing to a prothrombotic state. In addition, plaque formation may be accelerated in insulin‐resistant subjects by increased expression of adhesion molecules on endothelial cells and increased rate of monocyte adhesion to cultured endothelial cells. Syndrome X and type 2 diabetes are associated with multiple abnormalities that enhance the atherosclerotic process. The opportunities for new therapeutic approaches to reduce cardiovascular risk will undoubtedly evolve along with our understanding of the complex factors responsible for insulin resistance, compensatory hyperinsulinaemia, and CHD.
Endoanal ultrasound or magnetic resonance imaging for preoperative assessment of anal fistula: a comparative study
Authors: Gustafsson U.‐M. , Kahvecioglu B. , Åström G. , Ahlström H. , Graf W.
Published: March 2003

Objective

To compare endoanal ultrasound (EUS) with a 10‐MHz probe vs. bodycoil magnetic resonance imaging (MRI) in the preoperative evaluation of anal fistula.

Subjects and methods

23 patients with fistula in the anal region underwent preoperative 0.5 T bodycoil MRI and 10 MHz EUS which included probing in 6 patients. The results of the EUS and MRI were compared against the surgical findings as a reference method.

Results

In classification of the primary tract there was agreement between EUS and surgical findings in 14 (61%) and between MRI and surgery in 11 (48%). Concerning the presence of an internal opening the corresponding figures were 17 (74%) and 10 (43%) and in judging the presence of an extension or an abscess 15 (65%) vs. 11 (48%), respectively. In three out of eight patients with nonhealing or recurrence after surgery preoperative imaging had shown an extension and/or an abscess that was not identified by the surgeon.

Conclusion

EUS, sometimes complemented with probing, is well comparable to bodycoil MRI in classifying and describing the topography of an anal fistula.
Circular stapled anopexy for haemorrhoidal disease: results
Authors: Lehur P.‐A. , Gravié J.‐F. , Meurette G.
Published: March 2003

Objective

Stapled anopexy is a new approach for haemorrhoids requiring surgical treatment. This study reviews the available information concerning the present results of this procedure.

Methods

Medline and hand search of the literature was conducted to identify available information on the procedure, with a special interest for the on‐going or published randomized clinical trials.

Results

The advantages of the stapled approach of haemorrhoids were analyzed in the different areas of concern, including postoperative pain reduction, length of hospital stay and sick‐leave, postoperative wound care and type and rate of complications. Continence status, symptom cure and patient satisfaction following stapled anopexy are also reported.

Conclusion

Stapled anopexy is probably less painful than conventional haemorrhoidectomy. Other advantages in the short term result from this new approach. Long term efficacy of the procedure is still unknown.
Untreatable faecal incontinence: colostomy or colostomy and proctectomy?
Authors: Catena F. , Wilkinson K. , Phillips R. K. S.
Published: March 2003

Purpose

To determine the frequency of rectal symptoms and secondary proctectomy in patients undergoing elective permanent end sigmoid colostomy for faecal incontinence and determine risk factors.

Methods

A retrospective chart review of patients undergoing elective end sigmoid colostomy for faecal incontinence at St Mark’s Hospital between January 1991 and December 1998. Patients were divided into three groups: A, symptoms leading to subsequent proctectomy; B, symptomatic but avoiding proctectomy; C, asymptomatic.

Results

There were 44 patients (80% women, average age 57 years): Group A 12 (27%); Group B 13 (30%); Group C 19 (43%). Group A were on average younger than Group C (45 years vs 64 years, P < 0.05). No other risk factor for symptoms or proctectomy was evident, and in particular a prior history of obstructed defaecation/anal digitation was not related. Only half the patients undergoing proctectomy had histological evidence of defunctioned proctitis in the resected rectum.

Conclusions

Data are insufficient presently to recommend primary proctectomy in this group of patients (even if it were to be performed laparoscopically).
Overlapping sphincteroplasty: does preservation of the scar influence immediate outcome?
Authors: Moscovitz I. , Rotholtz N. A. , Baig M. K. , Zhao R. H. , Lam D. T. Y. , Nogueras J. J. , Weiss E. G. , Singh J. J. , Wexner S. D.
Published: March 2003

Background  The importance of the overlapping scar in an anterior sphincteroplasty is often emphasized. The aim of this study was to identify the tissue type used in overlapping sphincter repair based upon ultrasound images, and to correlate these results with the immediate clinical outcome.

Methods  Data were collected prospectively on all patients with faecal incontinence who underwent anterior overlapping sphincteroplasty between June 1998 and May 1999. Continence was assessed by a standardized incontinence score ranging from 0 to 20. Pre‐operative ultrasound images were compared to intraoperative ultrasound findings for each patient. In each case the surgeon performed an overlap of what was grossly felt to represent scar after which a single blinded observer performed intraoperative ultrasound. The degree of overlap was measured and classified as hyperechoic over hyperechoic (muscle over muscle; Type 1), hyperechoic over or under hypoechoic (muscle over or under scar; Type 2), hypoechoic over hypoechoic (scar over scar; Type 3). The patient follow‐up included incontinence score that was obtained by telephone interview; suboptimal outcome was considered as an incontinence score ≥ 6. Statistical analysis was performed using the Mann–Whitney test and Wilcoxon matched‐pairs test.

Results  Fourteen female patients with a mean age of 51.6 (range 28–79) years were evaluated. The mean pre‐operative incontinence score was 17.1 (range 7–20) and 13 of the 14 (93%) patients had an incontinence score ≥ 15. All pre‐operative ultrasound images were hypoechoic which correlated with the surgeon's intraoperative findings of scar. The operative appearance included two Type 1, four Type 2, and eight Type 3 images. Larger pre‐operative ultrasound image defects were statistically significantly related to intraoperative Type 3 ultrasound images. At a mean follow up of 7.5 (range 2–16) months the mean postoperative incontinence score was 4.5 (range 0–12). In patients with Type 1 and Type 2 images, the mean postoperative score was 8.6 (range 4–12) whereas in patients with Type 3 it was 1.3 (range 0–5) (P < 0.003); 7 of the 8 patients in Type 3 (87.5%) had an incontinence score ≤ 2.

Conclusion  These preliminary results show a significant immediate benefit to the overlap of scar over scar, however, such overlapping may not always be achieved despite the surgeon's intent. Furthermore, larger pre‐operative defects may predispose to more extensive anterior scarring and thus a better chance of achieving this desired overlap.
Diverticular disease of the colon and concomitant abnormalities in patients undergoing endoscopic evaluation of the large bowel
Authors: Loffeld R. J. L. F. , Van Der Putten A. B. M. M.
Published: March 2003

Objective

To study the prevalence of diverticula and presence of concomitant pathology in consecutive patients undergoing endoscopic examination of the colon.

Methods

A cross‐sectional analysis of the endoscopy reports of all patients sent for endoscopic evaluation of the colon in a period of 8.5 years.

Results

A total of 9086 endoscopies were performed. Of these 2259 (24.7%) were undertaken for follow‐up. Diverticula were seen in 1849 patients (27%) (739 male, 1110 female, mean age 69 year). In 4978 patients (73%)(2162 male, 2816 female, mean age 52 year) no diverticula were seen, of these 2303 (46%) had no abnormalities in their colon. Patients with diverticula were significantly older, 69 vs 46.7 years (P < 0.001). No difference was present in gender. Colorectal cancer and inflammatory bowel disease were significantly more common in patients without diverticula, while polyps were more often seen in patient with diverticula. Patients with diverticula had a significantly lower incidence of colorectal cancer. In addition, the number of cancers located proximal to the splenic flexure was statistically higher in the group of patients presenting with diverticula (P < 0.001).

Conclusions

The overall prevalence of diverticular disease in patients undergoing endoscopy is 27%, and increases with age. Patients with diverticulosis have significantly lower incidence of colorectal cancer and if cancer is detected then it is more common proximal to the splenic flexure.
Safety of the temporary loop ileostomy
Authors: Hallböök O. , Matthiessen P. , Leinsköld T. , Nyström P.‐O. , Sjödahl R.
Published: March 2003

Objective To evaluate the complications of the temporary loop ileostomy.

Method A retrospective study of 222 consecutive patients with low anterior resection, ileal pouch‐anal anastomosis or continent ileostomy and a diverting loop ileostomy routinely fashioned during the primary operation. The loop ileostomy was closed in 213 patients (96%) during the minimum follow‐up period of 15 months.

Results Four patients (2%) required preterm closure of the ostomy due to stomal retraction (n = 3) or bowel obstruction (n = 1). Four patients were readmitted due to transient bowel obstruction that resolved without surgery. After closure of the loop ileostomy a total of 27 patients (13%) had complications. In 7 patients emergency re‐operation was done due to small bowel obstruction (n = 5) or intra‐abdominal abscess (n = 2). Elective re‐operation was done in 5 patients for hernia at the site of the previous stoma. Despite the use of a loop ileostomy there was 1 postoperative death after the initial operation in consequence of anastomotic leakage. There was 1 death in consequence of closure of the loop ileostomy after 3 weeks due to intra‐abdominal sepsis and heart failure.

Conclusion In this series closure of the ostomy wasassociated with one death (0.5%) and overall ostomy‐related morbidity included the need to re‐operate in 6%.
Effects of antihyperglycaemic therapies on proinsulin and relation between proinsulin and cardiovascular risk factors in type 2 diabetes
Authors: Hermann L. S. , Ranstam J. , Vaaler S. , Melander A.
Published: March 2003

Aim: To assess the effect of oral antihyperglycaemic therapy on fasting proinsulin and the relation between proinsulin levels and cardiovascular risk factors in type 2 diabetes.

Methods: One hundred and sixty‐five patients with type 2 diabetes, fasting blood glucose concentration (FBG) ≥ 6.7 mmol/l, were recruited from five diabetes outpatient clinics in primary health care. Diet and antihyperglycaemic medication, aiming at FBG <6.7 mmol/l, was maintained for 6 months after completed dose titration in a randomized, double‐blind, double‐dummy trial with metformin (M), glibenclamide (G) and primary combination of both drugs (MG). The study compared M, G and MG in low dose (MGL) and also different high‐dose regimens, i.e. G added to M (M/G), M added to G (G/M) and primary combination (MGH). Outcome measures were fasting proinsulin, glycaemia, body mass index, blood pressure, lipids, insulin and C‐peptide.

Results: Lower proinsulin levels were found when therapy was initiated with metformin (M vs. G, p = 0.013 and M/G vs. G/M, p = 0.033). M and G were equally effective on glucose levels. In the group as a whole FBG decreased from (mean ± s.d.) 10.2 ± 2.7 to 7.0 ± 1.2 mmol/l with no change in proinsulin. Proinsulin was associated with cardiovascular risk factors, linking high proinsulin to an atherogenic risk marker profile. Mean proinsulin change from baseline was inconsistently associated with markers of insulin resistance. Meal‐stimulated glucose (net AUC) decreased after treatment only in those with low baseline proinsulin levels.

Conclusion: It may be advantageous to initiate oral antihyperglycaemic therapy with metformin rather than with sulphonylurea. High proinsulin levels are associated with an atherogenic‐risk marker profile and an impaired therapeutic postprandial glucose response after treatment in patients with type 2 diabetes. Proinsulin change after therapy is inconsistently associated with markers of insulin resistance and unrelated to fasting blood glucose reduction.
A new air displacement plethysmograph for the determination of Japanese body composition
Authors: Miyatake N. , Nonaka K. , Fujii M.
Published: March 2003

A new device based on the plethysmographic measurement of body volume, named the BOD POD Body Composition System, was developed for the purpose of estimating body composition. The performance, reliability, validity, and clinical application of this system were evaluated in Japanese subjects. The coefficient variation (CV:%) in same‐day tests was 2.48, in three separate‐day tests it was 2.27, and for independent operators it was 4.53, respectively. There was a clear correlation between the results from BOD POD and those from dual energy X‐ray absorptiometry (DEXA) (r = 0.910, p < 0.01). Finally, the fat body composition of 4489 subjects (1499 men, 2990 women) was clinically measured by BOD POD. The findings indicate that the BOD POD is a highly reliable and valid method for determining body fat percentage. This new method has several advantages, e.g. it is quick, simple to operate and may accommodate wide populations.
The association between insulin resistance and endotheliopathy
Authors: Tooke J.
Published: March 2003

Summary. Vascular endothelium is involved in the regulation of vascular tone, vessel permeability, and angiogenesis. Vessel tone is determined by the balance of various paracrine vasodilatory and vasoconstrictor factors, most notably nitric oxide (NO) and endothelin‐1. Not surprisingly, endothelial dysfunction is believed to be crucial in the development of the chronic vascular complications of diabetes.

Endothelial dysfunction, which may be examined by studying endothelial‐dependent vasodilatation in humans, is also disturbed by many of the individual features of the insulin resistance syndrome including hypertension, dyslipidaemia, and hyperglycaemia. Therefore, it may be possible that endothelial dysfunction could be closely associated with, or even a common antecedent of, the insulin resistance syndrome (IRS). There is emerging evidence that impaired endothelial‐dependent vasodilatation is present in populations at future risk of diabetes and even in children of low birth weight, who may exhibit features of the insulin resistance syndrome in later life.

Endothelial dysfunction is an obvious therapeutic target if the vascular pathology associated with insulin resistance and type 2 diabetes is to be ameliorated.
Disturbed release of gastrointestinal peptides in anorexia nervosa and in obesity
Authors: Baranowska B. , Radzikowska M. , Wasilewska‐Dziubinska E. , Roguski K. , Borowiec M.
Published: March 2003

Aim: It is commonly accepted that some neuropeptides play an important role in the control of appetite and hormonal secretion. Several gastrointestinal peptides may affect on central control of appetite via vagal and spinal nerves. The aim of this study was to evaluate the release of gastrointestinal peptides in anorexia nervosa and in obesity, because in these diseases the disturbances in the control of appetite and hormonal secretion were found. Material consisted of 30 women with anorexia nervosa aged 16–29 years (mean 22 years) and 23 women with obesity aged 19–33 years (mean 29 years) and 25 lean women of control group.

Methods: In women with anorexia nervosa as compared with control group we observed a significant increase of plasma vasoactive intestinal peptide (VIP) levels (p < 0.0 1) and a significant decrease of leptin (p < 0.001), β‐endorphin (p >< 0.01), gastrin (p < 0.05), cholecystokinin (CCK; p < 0.05) and somatostatin (S‐S; p < 0.01). In obese women we found a significant increase of neuropeptide Y (NPY; p < 0.001), leptin (p> < 0.01), galanin (p < 0.001), β‐endorphin (p < 0.001), gastrin (p < 0.01), CCK (p < 0.001) and S‐S (p < 0.01) and a significant decrease of VIP concentrations (p < 0.001) as compared with control group.

Conclusion: Our results indicate that the release of gastrointestinal peptides is disturbed in obesity and in anorexia nervosa. These findings suggests that dysfunction of brain–gut axis may be also an important factor in the abnormal control of appetite axcept of hypothalamic dysfunction.
Effect of four‐week metformin treatment on plasma and erythrocyte antioxidative defense enzymes in newly diagnosed obese patients with type 2 diabetes
Authors: Pavlović D. , Kocić R. , Kocić G. , Jevtović T. , Radenković S. , Mikić D. , Stojanović M. , Djordjević P. B.
Published: March 2003

The principal metabolic effect of metformin–an oral antihyperglycaemic agent–is the improvement in the sensitivity of peripheral tissues and liver to insulin. This study examined the effect of metformin monotherapy on antioxidative defence system activity in erythrocytes and plasma in diabetic patients. We studied the effect of metformin treatment on the activities of Cu, Zn‐superoxide dismutase (EC 1. 15. 1. 1.), catalase (EC 1. 11. 1. 6.) and glutathione peroxidase (EC 1. 11. 1. 9.) in relation to lipid peroxidation products and reduced glutathione level in plasma and erythrocytes. In this study we also examined erythrocytes' susceptibility to H2O2‐induced oxidative stress during metformin therapy. Although metformin monotherapy ameliorated the imbalance between free radical‐induced increase in lipid peroxidation (by reducing the MDA level in both erythrocytes and plasma) and decreased plasma and cellular antioxidant defences (by increasing the erythrocyte activities of Cu, Zn, SOD, catalase and GSH level) and decreased erythrocyte susceptibility to oxidative stress, it had negligible effect to scavenge Fe ion‐induced free radical generation in a phospholipid‐liposome system.
Effects of chronic treatment with acarbose on glucose and lipid metabolism in obese diabetic Wistar rats
Authors: Carrascosa J. M. , Molero J. C. , Fermín Y. , Martínez C. , Andrés A. , Satrústegui J.
Published: March 2003

Aims  The effect of chronic treatment with acarbose on fasting plasma glucose, insulin, triglyceride, cholesterol and free fatty acid (FFA) concentrations, as well as on the glucose and insulin excursions during oral glucose tolerance test (OGTT), in obese diabetic Wistar (WDF) rats was investigated.

Methods  Forty‐five mature male WDF rats were randomly distributed to one of the three treatment groups (no acarbose, 20 mg and 40 mg of acarbose/100 g of chow, respectively). After 3.5, 7.5 and 11.5 months, animals were tested for glucose tolerance by means of an OGTT, and their respective metabolic profiles were determined. Control determinations were done in obese and age‐matched lean animals before the start of the trial.

Results  The WDF rats exhibit higher body weight and fasting blood glucose, insulin, triglyceride and cholesterol concentrations compared to lean animals. Moreover, they show marked glucose intolerance as indicated by the glucose and insulin excursions during OGTT. Interestingly, in both treated and untreated animals, a reversion of the hyperglycaemic state as well as an improvement of the glucose tolerance is observed. However, whereas in the group receiving no acarbose this is accounted for by dramatic increases in fasting plasma insulin concentrations and insulin secretion during OGTT (as indicated by the ΔInsulin area), in rats treated with acarbose the reversion of the diabetic state takes place without increments in hormone concentration. In addition, rats treated with acarbose for 3.5 and 7.5 months show lower plasma triglyceride and FFA concentrations, and the same was observed for cholesterol at the highest dosage of the drug.

Conclusions  Chronic treatment with acarbose of WDF rats improves the glycaemic and lipidic control as well as the glucose tolerance, with a lower demand of pancreatic insulin than in untreated rats. This data suggests that the long‐term modulation of glucose and insulin excursions after meals improves the insulin sensitivity in this rat strain.
Dyslipidaemia in African Americans, Hispanics and Whites with type 2 diabetes mellitus and hypertension
Authors: Sharma M. D , Pavlik V. N
Published: March 2003

Summary

Aim

To study the pattern of dyslipidaemia in African American, Hispanic, and White patients with type 2 diabetes mellitus and/or hypertension.

Methods

The data were collected retrospectively on 6450 patients followed in the Harris County Hospital District Community Clinics. The information collected from review of the charts included each patient's age, sex, race, body mass index (b.m.i.), duration of type 2 diabetes mellitus and hypertension, medications, fasting plasma glucose, haemoglobin A1c, and fasting lipid profile. Mean lipid and haemoglobin A1c levels in the three ethnic groups were compared. The risk of abnormal cholesterol and triglyceride levels was assessed with logistic regression analysis.

Results

The results show that in patients with type 2 diabetes mellitus after correcting for age, sex and b.m.i., African Americans have the lowest serum triglyceride concentrations and Whites have the highest values. This trend holds true even in patients with hypertension and in patients with both hypertension and type 2 diabetes mellitus. The risk of having abnormal triglycerides is 74% lower in African Americans, and 42% lower in Hispanics than Whites based on logistic regression model. Despite better glycaemic control, Whites have a greater increase in serum triglyceride concentrations than Hispanics and African Americans.

Conclusions

Although African Americans are known to be at higher risk for cardiovascular complications than Whites or Hispanics, they appear to have lower triglyceride concentrations than Whites or Hispanics in the presence of type 2 diabetes mellitus. This suggests that an increased prevalence of other adverse factors must contribute to their heightened cardiovascular risk.
Hormone replacement therapy for postmenopausal women with diabetes
Authors: Palin S. L. , Kumar S. , Sturdee D. W. , Barnett A. H.
Published: March 2003

SUMMARY

Background  Recent studies have shown only 17% of postmenopausal women in the UK receive prescriptions for hormone replacement therapy (HRT), with diabetic women being prescribed HRT 30% less often than non‐diabetic women. Up to 80% of women experience menopausal symptoms, however, so it is expected that by using HRT many would gain benefit from symptom relief, in addition to benefiting from its effects in disease prophylaxis.

Methods  We conducted a questionnaire survey of the attitudes to HRT prescribing of 178 local general practitioners (GPs) and 47 hospital doctors, working in diabetes and gynaecology.

Results  Responses were received from 98 (55%) GPs and 39 (83%) hospital doctors. One hundred and thirty‐six (99%) would advise HRT for menopausal symptoms, with 133 (97%) advising HRT for a spontaneous premature menopause and 126 (92%) for a surgically induced menopause. One hundred and thirty‐four (98%) would advise HRT for diabetic women with menopausal symptoms, with 122 (89%) indicating that HRT had no adverse effect on glycaemic control. For disease prophylaxis, all hospital doctors and 93 (95%) GPs would advise HRT for prevention of osteoporosis, although only 91 (93%) GPs would advise HRT to diabetic women for this indication. Thirty‐three (85%) hospital doctors would advise HRT as prophylaxis against cardiovascular disease compared with 66 (67%) of GPs. For this indication in diabetic women, 32 (82%) hospital doctors and 67 (68%) GPs would advise HRT. Oral HRT was the most widely recommended preparation although GPs also frequently recommended patches. Topical gel, implants and other preparations were less commonly advised. Hospital doctors predominantly advised HRT for menopausal symptoms to be continued for between 1 and 5 years, although more GPs recommended HRT to be continued for longer than 5 years. The majority of doctors from both groups advised that HRT used for disease prophylaxis be continued for more than 5 years.

Conclusion  More doctors than anticipated indicated they would recommend HRT, especially to diabetic women. Concerns among doctors about the side‐effects of HRT and, in particular, the metabolic effects of HRT, do not appear to deter them from advising HRT. Willingness to prescribe a drug, however, is different from actually prescribing it and responses to questionnaires tend to be those regarded as being acceptable. Low patient demand for HRT due to fear or lack of awareness may also be contributing. Organizational change with the development of more menopause clinics may facilitate wider use of HRT.
Comparative accuracy of cardiovascular risk prediction methods in patients with diabetes mellitus
Authors: Game F. L. , Bartlett W. A. , Bayly G. R. , Jones A. F.
Published: March 2003

SUMMARY

Objective  To compare the accuracy of cardiovascular risk prediction methods based on equations derived from the Framingham Heart Study in a cohort of patients with diabetes mellitus.

Research design and methods  Risk factor data was collected prospectively from 906 patients with diabetes mellitus. Absolute cardiovascular risks were calculated using the Framingham equation, and estimated with the currently available Framingham‐based risk tables and charts. The sensitivity, specificity, positive and negative predictive values of the tables and charts to assess cardiovascular risk were assessed using calculation of risk from the full Framingham equation as the reference method.

Results  In all, 146 subjects (16.1%) had calculated 10‐year coronary heart disease (CHD) risks ≥ 30%, and 585 (64.6%) had risks ≥ 15%. For identification of those at 10‐year CHD risk ≥ 30%, the original Sheffield tables had a sensitivity of 43% (95% confidence intervals (CI) 19.9–61.7%) and specificity of 94% (CI 90.8–96.7%). Modifications of the Sheffield tables improve sensitivity (95% CI 93.9–97%) but reduce specificity (90% CI 85.6–95.7%). The Joint British Guidelines' charts have a moderate sensitivity (69.5% CI 51.8–81.9%) and high specificity (99.7% CI 98.9–100%). For identification of individuals at a 10‐year CHD risk ≥ 27%, the Framingham categorical tables had a sensitivity of 95% (CI 91.6–97.8%), but a specificity of only 83% (95% CI 79.1–85.5%).

Conclusions  The Joint British charts appear to have the best performance in a cohort of patients with diabetes mellitus, however, calculation of CHD/CVD (cardiovascular disease) risks with personal or laboratory computers using the full Framingham equation remains the most accurate way to assess cardiovascular risk in a primary prevention setting.
Metabolic and hormonal effects of tacrolimus (FK506) or cyclosporin immunosuppression following renal transplantation
Authors: Dmitrewski J. , Krentz A. J. , Mayer A. D. , Buckels J. A. C. , Barnes A. D. , Smith J. , Nattrass M.
Published: March 2003

Twelve renal transplant recipients randomised to receive immunosuppression with either tacrolimus (FK506) or cyclosporin underwent oral glucose tolerance tests (OGTT) a median of 8 months (range 7–9) after transplantation. Six healthy subjects acted as controls. Compared with the controls, both transplant groups had significantly elevated fasting (p < 0.05 for both groups) and postprandial (p < 0.001 for tacrolimus and p < 0.05 for cyclosporin) blood glucose concentrations. Fasting hyperinsulinaemia was observed in both transplant groups (p < 0.05) relative to the control subjects. Glucose‐stimulated plasma immunoreactive insulin concentrations in the tacrolimus‐treatment group were significantly higher than in the cyclosporin group (p < 0.05) and the controls (p < 0.001). Postprandial blood alanine concentrations were also significantly elevated in the tacrolimus group compared with both the controls (p < 0.001) and cyclosporin‐treated patients (p < 0.001). The raised insulin concentrations with normal or increased blood glucose concentrations after renal transplantation suggests that insulin resistance was more marked in patients receiving tacrolimus‐based immunosuppression.