bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatric Morbidity and Burnout in the Medical Profession: An Italian Study of General Practitioners and Hospital Physicians
Authors: Grassi Luigi , Magnani Katia
Published: April 2003

Background: Burnout and psychological stress symptoms represent a major problem among health care professionals. The aim of this study was to investigate the prevalence of and the relationship between psychiatric morbidity and burnout among a convenience sample of Italian primary care physicians (GPs) and hospital physicians (HPs). Method: The sample consisted of 328 physicians (182 GPs and 146 HPs) who completed the 12-item version of the General Health Questionnaire and the Maslach Burnout Inventory (MBI). Results: The global prevalence of psychiatric morbidity was 22.3% (20.3% among GPs and 24.6% among HPs). Symptoms of emotional exhaustion were reported by 27.5% of the participants (GPs: 32.4%; HPs: 21.2%), depersonalization by 25.6% (GPs: 27.4%; HPs: 22.6%) and low personal accomplishment by 12.8% (GPs: 13.1%; HPs: 12.3%). No significant difference was found between the two groups, except higher levels of emotional exhaustion among GPs. Female GPs reported lower scores on MBI depersonalization and female HPs lower scores MBI personal accoplishment than male GPs and HPs, respectively. Conclusions: The study underscores the significant problem of stress among physicians and indicates the need for supporting health professionals in order to improve their psychological well-being and, possibly, the quality of their relationship with the patients.
Could Long-Term Alimentary Iron Overload Have an Impact on the Parameters of Oxidative Stress?
Authors: Rehema Aune , Zilmer Mihkel , Zilmer Kersti , Kullisaar Tiiu , Vihalemm Tiiu
Published: April 2003

The effects of long-term alimentary (drinking water) iron overload on the parameters of oxidative stress were evaluated. The study group (n = 35) from a village in southern Estonia was 37.1 ± 13.3 years old, and the mean period of drinking water iron overload was 20.6 ± 9.3 years. The serum iron content was significantly higher than normal. The total iron-binding capacity of serum tended to be lowered. There was no change in the transferrin content. The parameters of lipid peroxidation like conjugated dienes and thiobarbituric acid reactive substances showed also significant differences. In addition, the red blood cell glutathione content was also decreased. The total antioxidant capacity of serum was not changed. It can be concluded from our results that a long-term alimentary iron overload results in a positive serum iron balance, which, in turn, yields an increased oxidative stress.
Dietary Fat Level and Short-Term Effects of a High-Fat Meal on Food Intake and Metabolism
Authors: Silberbauer Christa J. , Jacober Bettina , Langhans Wolfgang
Published: April 2003

After determining the dietary fat intake in 40 subjects based on a 7-day recording period, the effects of a high-fat breakfast (52% of metabolizable energy from fat) on postprandial fat and carbohydrate metabolism as well as on subsequent lunch intake were investigated in 28 lean, male subjects with habitual dietary fat intakes between 21 and 44% (of daily energy intake). Correlational analysis and comparisons between a low-fat group (LF; fat intake ≤35%, n = 10) and a high-fat group (HF; fat intake ≥40%, n = 11) with a similar body mass index (LF: 22.7, HF: 22.4) and a low body fat content (LF and HF: 10.7) demonstrated that the fat level of the habitual diet did not affect the baseline values and the postprandial changes in the respiratory quotient and in the plasma levels of glucose, insulin, lactate, free fatty acids, β-hydroxybutyrate, and triglycerides induced by the high-fat breakfast. Only the area under the curve for insulin was higher, and the lactate/insulin ratio was lower in the HF group than in the LF group. Moreover, hunger and satiety ratings and lunch intake (amount, duration, microstructure of eating) after the high-fat breakfast were similar in all subjects. Thus, the habitual level of dietary fat did not alter the acute effects of a fat-rich breakfast on whole-body and hepatic fatty acid oxidation and eating behavior at lunch under the present test conditions. Yet, a long-term high fat intake appears to have subtle effects on postprandial metabolism which are consistent with early signs of a developing insulin resistance.
Effect of the Source of Dietary Fat on Postweaning Lipogenesis in Lean and Fat Pigs
Authors: Freire J.P.B. , Mourot J. , Cunha L.F. , Almeida J.A.A. , Aumaitre A.
Published: April 2003

Twenty-four male piglets weaned after 21 days, 12 of the Large White lean breed (LW) and 12 of the Alentejano fat breed (AL), have been used to compare the effects of genotype and source of dietary fat on the activities of enzymes involved in lipogenesis and on the composition of selected fatty tissues. During 4 weeks the piglets were fed isoenergetic and isonitrogenous experimental diets, containing 5% of either olive oil or tallow. In AL piglets the acetylcoenzyme A carboxylase activity was three- and ninefold higher, the malic enzyme activity six- and fivefold, and the glucose-6-phosphate dehydrogenase activity was four- and fivefold higher in the dorsal subcutaneous and in the perirenal fat, respectively, than in LW piglets. In general, fatty tissues of the AL piglets contained a higher proportion of saturated fatty acids. Olive oil induced a significant increase in the activities of malic enzyme and glucose-6-phosphate dehydrogenase in both tissues, but only slightly increased the acetylcoenzyme A carboxylase activity in perirenal fatty tissues (p < 0.05). The fatty acid profile of the subcutaneous and of the perirenal fat was strongly affected by the composition of dietary fat. These observations showed that the source of dietary fat influenced markedly lipid metabolism and body composition since a very early age.
Glycosylphosphatidylinositol-Anchored Proteins in Human and Pig’s Milk
Authors: Kunz Clemens , Rudloff Silvia , Gundlach Kai , Schuler Frank , Egge Heinz
Published: April 2003

Glycosylphosphatidylinositols (GPIs) are a recently discovered class of glycoconjugates that anchor either proteins, polysaccharides or small oligosaccharides to cellular membranes via a covalent linkage. To investigate the presence of soluble GPIs, individual human milk samples and mature pig’s milk were defatted and casein removed by acid precipitation and ultracentrifugation. Soluble proteins were subjected to FPLC gel filtration (Superdex 200) and high molecular weight proteins were separated into fractions I–V. Immunological studies have been performed using Western blotting of whole milk, casein and whey fractions, and Superdex fractions I–V followed by incubation with a monoclonal antibody against the purified GPI anchor of the variant surface glycoprotein from Trypanosoma brucei brucei. We found that significant amounts of GPI-anchored proteins are secreted into human milk and pig’s milk. The antibody which reacted only with components in the whey fractions bound to 5 different human milk proteins with a molecular weight of ≥200 (at least 3 components), 90 and 80 kD. In pig’s milk, the staining pattern was found to be different from human milk. Similar to other GPI-anchored cell structures the functions of GPI-containing proteins in human milk and pig’s milk as well as the specific components carrying these anchors remain to be investigated.
Apolipoproteins A-I and B in Kuwaiti Children
Authors: Moussa Mohamed A.A. , Shaltout Azza A. , Nkansa-Dwamena David , Mourad Mohammad
Published: April 2003

To assess the relation of apolipoproteins (Apos) A-I and B (the carrier proteins for high and low density lipoprotein cholesterol, respectively) with the degree of obesity, body fat distribution, serum lipids, glucose and insulin levels, a case-control study was carried out and included 460 Kuwaiti obese children, 6–13 years old, matched by age and sex to 460 normal-weight controls. Obese children were ascertained in a representative cross-sectional study of 2,400 school children. The Apo A-I levels were not different between obese and non-obese boys, while they were significantly lower in obese girls (p < 0.01). The Apo B mean concentrations were significantly higher in obese boys and girls (p < 0.001), while the Apo A-I:B ratio was significantly lower in obese children (p < 0.001). Apo A-I levels were positively correlated with total cholesterol, high- and low-density lipoprotein cholesterol, but were not correlated with very low-density lipoprotein cholesterol, triglycerides, insulin, glucose or insulin:glucose ratio. Apo B levels were negatively correlated with high-density lipoprotein cholesterol and positively correlated with insulin and insulin:glucose ratio (p < 0.01) in obese children. The study documented an adverse Apo profile in obese Kuwaiti children. Since Apo changes are correctable through management of obesity, their identification in childhood offers prospects for prevention of early onset atherogenesis in adulthood.
Effects of Consumption of Oat Milk, Soya Milk, or Cow’s Milk on Plasma Lipids and Antioxidative Capacity in Healthy Subjects
Authors: Önning G. , Åkesson B. , Öste R. , Lundquist I.
Published: April 2003

A drink based on oats has been developed with new technology. In this study the effects of this oat milk, soya milk and cow’s milk on plasma lipid, glucose, insulin, and antioxidant status (measured as the ability of serum to suppress the formation of the radical cation ABTS·+) were compared in 24 healthy men and women. Half of the subjects (group A) consumed 0.75–1 liters/day of oat milk and soya milk for 4 weeks each, and the other half (group B) consumed oat milk and cow’s milk for two 4-week periods. In the combined groups A plus B the oat milk regimen resulted in decreased plasma cholesterol (4%) and low-density lipoprotein (LDL) cholesterol (9%) levels as compared with baseline, but no changes in high-density lipoprotein cholesterol (HDL) and triglyceride values were observed. Also soya milk consumption resulted in decreased LDL cholesterol concentrations. The only significant plasma lipid change observed during consumption of cow’s milk was an increase in HDL cholesterol. No consistent changes in body weight, fasting blood glucose, serum insulin, and antioxidant status occurred after consumption of any milk regimen. A significant correlation between baseline antioxidant status and total plasma cholesterol was found (r = –0.56). It is proposed that the high content of β-glucans in oat milk was responsible for the decreased plasma cholesterol and LDL cholesterol concentrations, but the effect could also be due to a replacement of saturated fat in the customary diet by unsaturated fat. It is concluded that oat milk can be used as an alternative to other milk drinks by subjects who would benefit from reduced LDL cholesterol values.
Inclusion of a Legume in a Saturated Fat-Rich Diet Affects the Cholesterol Status but not the Expression of Triiodothyronine and Retinoic Acid Receptors in Rat Liver
Authors: Bonilla Stéphane , Noël-Suberville Catherine , Higueret Paul , Puy Portillo Maria , Macarulla Maria Teresa , Martinez Alfredo , Garcin Henri
Published: April 2003

In a previous study, we showed that a high-fat diet, rich in saturated fatty acids and cholesterol, induced hypercholesterolemia and, in rat liver, a decreased expression of TR and RAR, nuclear receptors which are transcription factors for genes involved in cell growth, differentiation and cellular homeostasis. The aim of this study was to determine whether hypercholesterolemia plays a role in the onset of this decreased expression. Rats were fed a high-fat diet, rich in saturated fatty acids and cholesterol, for 3 weeks and then received in addition Vicia faba for 2 weeks. The inclusion of the legume induced a decrease in hypercholesterolemia (in agreement with numerous data) but did not affect the underexpression of TR or RAR (expression evaluated as the maximum binding capacity of receptors and as the abundance of mRNA of these receptors). Thus, it is suggested that, at least in this experimental model, hypercholesterolemia plays a minor role in the decreased expression of nuclear receptors in rat liver.
Colitis-Induced Changes in the Level of Trace Elements in Rat Colon and Other Tissues
Authors: Al-Awadi F.M. , Khan I. , Dashti H.M. , Srikumar T.S.
Published: April 2003

Trace elements constitute important prosthetic groups in a number of antioxidant enzymes which neutralize free radicals generated during inflammatory conditions such as colitis. However, the status of trace elements in colitis remains to be found. In the present study the concentrations of zinc, copper, manganese and selenium in the colon, liver and serum of rats with acetic acid (HAc)- or trinitrobenzenesulfonic acid (TNBS)-induced colitis were measured using atomic absorption spectrophotometer. Myeloperoxidase and glutathione peroxidase activities were measured spectrophotometrically. Our results show that the selenium concentration was significantly decreased by 33 and 37.5% in the colon and 69 and 78% in liver by HAc and TNBS treatment, respectively. Similarly the zinc concentration in the colon was decreased by 21 and 28% by HAc- and TNBS-induced colitis as compared to the controls, but manganese and copper, remained unaltered. The serum concentrations of copper, zinc and selenium also remained unaltered during colitis. The weight of HAc-treated rats did not decrease while there was a significant weight loss in the TNBS-treated rats. Myeloperoxidase activity was increased, whereas glutathione peroxidase activity was significantly decreased in the colon inflamed by HAc or TNBS as compared to the controls. These findings suggest that colitis induces a reduction in the tissue levels of trace elements which is independent of the way colitis is induced. Our findings of a reduction in Se and glutathione peroxidase activity together suggest that the reduction in the trace element concentrations is not due to dietary factors or malabsorption. The decrease may severely affect the antioxidant potential of the colon and therefore is a putative factor for the progression of disease.
Galacto-Oligosaccharides Relieve Constipation in Elderly People
Authors: Teuri Ulla , Korpela Riitta
Published: April 2003

The aim of the study was to investigate whether galacto-oligosaccharides (GOS) relieve constipation in elderly people. The final study population consisted of 14 female subjects, mean age 79.6 (69–87) years, who suffered from constipation. The study was a double-blind two-period cross-over study. Both study periods lasted 2 weeks. The subjects ingested either 2 control yoghurts or 2 GOS-containing yoghurts daily. The yoghurts were otherwise similar, but the daily dose of GOS (Elix’or, BWP, Holland) from the GOS yoghurt was 9 g. The regular use of laxatives was stopped during the study periods and laxatives were used only when necessary. All the subjects reported the function of their intestines daily in a questionnaire. The defecation frequency per week (mean, range) was higher during the GOS period (7.1, 3–15) than during the control period (5.9, 1–14). GOS had no statistically significant effect on the use of laxatives, the consistency of feces or the ease of defecation, although GOS seemed to make defecation easier (p = 0.07). The adverse gastrointestinal symptoms were similar during both the control and the GOS periods. GOS seem to relieve constipation in most elderly people but the responses differ individually.
Effect of Cholesterol Feeding on DNA Damage in Male and Female Syrian Hamsters
Authors: Turley E. , Armstrong N.C. , Wallace J.M.W. , Gilmore W.S. , McKelvey-Martin V.J. , Allen J.M. , Strain J.J.
Published: April 2003

Cholesterol oxides are cytotoxic and have been implicated in many disease processes; however, it has been proposed that cholesterol oxides result from cholesterol acting as a sacrificial antioxidant. In this study, the effect of dietary cholesterol on DNA damage, assessed by the alkaline comet assay, was examined in male and female Syrian hamsters. Animals were fed ad libitum a modified AIN-76 diet (control) or a diet with 0.5% cholesterol for 10 weeks. Following the 10-week feeding period, there was no significant difference in body weight between cholesterol-fed and control animals. Cholesterol feeding resulted in significant liver hypertrophy, and increased plasma total and HDL cholesterol in both male and female animals compared with controls. There was no difference in liver cell DNA damage levels as measured by the comet assay. Heart cells from cholesterol-fed hamsters, however, showed a significant decrease in tail DNA (p = 0.050) indicating decreased damage compared with controls and a possible protective effect of cholesterol against DNA damage.
Effects of Guar Gum and Cellulose on Cecal Enzyme Activity and Cecal Short-Chain Fatty Acids in Young and Aged Mice
Authors: Tamura Motoi , Hirayama Kazuhiro , Itoh Kikuji
Published: April 2003

The effects of cellulose or guar gum on cecal enzyme activity and cecal short-chain fatty acids (SCFAs) in young and aged mice were studied. Male Crj:CD-1 (ICR) mice were fed an MF diet for 4 (young mice) or 23 months (aged mice). The MF diet was then replaced with a semisynthetic diet supplemented with 5% guar gum or 5% cellulose. The mice were fed the guar gum or cellulose diet for 3 weeks. There was no significant difference in cecal content between the two diet groups. There were no significant differences in total short-chain fatty acid production between the young mice fed the cellulose and those fed the guar gum diet, and between the aged mice fed the cellulose and guar gum diet. There were significant differences in cecal enzyme activity between the young mice fed the cellulose and those fed the guar gum diet. β-Glucuronidase activity was significantly higher in the young mice fed the guar gum diet than in those fed the cellulose diet. There were also significant differences in cecal enzyme activity between the aged mice fed the cellulose diet and those fed the guar gum diet. β-Glucuronidase activity was significantly higher in the aged mice fed the guar gum diet than in these fed the cellulose diet. β-Glucosidase activity was significantly lower in the aged mice fed the guar gum diet than in those fed the cellulose diet. The effect of cellulose on the microflora between the young and aged mice might be different from the effect of guar gum. The degree of adaptation to the diet of microflora in young and aged mice fed the cellulose diet might differ from that in those fed the guar gum diet. The higher enzyme activities of microflora in aged animals compared to young animals, might have some relation with the incidence of colon cancer in aged animals.
Sodium Transport Kinetics, Cell Membrane Lipid Composition, Neural Conduction and Metabolic Control in Type 1 Diabetic Patients
Authors: Stiefel Pablo , Ruiz-Gutierrez Valentina , Gajón Esther , Acosta Domingo , García-Donas Miguel A. , Madrazo Juan , Villar José , Carneado Joaquín
Published: April 2003

Background:  A decreased content of n–3 fatty acids in erythrocyte membrane of type 1 diabetic patients, which is inversely related to plasma levels of HbA1c, has been reported previously. Our aim in this study was to observe the changes after a low-dose n–3 fatty acid (330 mg/day docosahexaenoic acid and 630 mg/day eicosapentanoic acid) dietary intervention in the lipid composition of cell membrane and metabolic control (measured according to plasma HbA1c levels). Since changes in both parameters may alter transmembrane sodium transport or influence parameters measuring target organ damage, we also studied the neural conduction quality and activity of four sodium transporters. Methods: Eighteen type 1 diabetic patients were randomly assigned to continue their usual diet (control group) or to supplement their diet with a daily low dose of n–3 fatty acids (supplemented group). The changes between baseline and end values of the following parameters were compared: HbA1c, lipid and phospholipid composition of cell membrane, activity of four ion carriers and neural conduction quality. Results: The dietary supplementation caused statistically significant changes in membrane lipid composition, particularly an increase of C22:6 (n–3) and the total n–3 fatty acid (respectively +0.90 ± 1.14% vs. –0.44 ± 1.23% and +1.36 ± 1.62% vs. –0.5 ± 1.80%, p < 0.05). After the dietary supplementation, we also observed a significant decrease of HbA1c (–2.00 ± 1.9% vs. –0.13 ± 0.48%, p < 0.05), without significant changes in the dose of insulin required, an increase in the motor conduction velocity by the median nerve (+2.12 ± 1.35 m/s vs. –0.8 ± 2.34 m/s, p < 0.05) and a decrease of the Vmax of the Na+-Li+ countertransport (–96.6 ± 111.2 vs. +58.1 ± 81.3 μmol/l cell/h–1, p < 0.01). Conclusion: A low-dose omega–3 fatty acid dietary supplementation may change the fatty acid composition of the cell membrane and improve the metabolic control of diabetes. Using this dose, we also observed a decrease of the maximal rate of Na+-Li+ countertransport and a slight improvement of neural conduction.
Replacing Saturated Fat with PUFA-Rich (Sunflower Oil) or MUFA-Rich (Rapeseed, Olive and High-Oleic Sunflower Oil) Fats Resulted in Comparable Hypocholesterolemic Effects in Cholesterol-Fed Hamsters
Authors: Trautwein Elke A. , Rieckhoff Dörte , Kunath-Rau Angelika , Erbersdobler Helmut F.
Published: April 2003

Recent studies have suggested that monounsaturated fatty acid (MUFA)-rich dietary fats do not have the same plasma cholesterol-lowering effects whereby rapeseed oil was more effective than olive oil. This phenomenon could be explicable by the content of other fatty acids or plant sterols. To further evaluate the effects of different MUFA-rich oils (18:1-rich sunflower oil, rapeseed oil, olive oil) in comparison to polyunsaturated (PUFA)-rich oils (18:2-rich sunflower oil) and saturated fat (palm stearin) on cholesterol and bile acid metabolism, male Syrian golden hamsters were fed semipurified diets containing 5% fat and 0.2% cholesterol for 5 weeks. To test whether oil refining would have an impact on the cholesterol-lowering potential, unrefined and refined varieties of rapeseed and olive oil were included. After 5 weeks, plasma total cholesterol (TC) was highest with palm stearin (10.0 ± 2.6 mmol/l) while the MUFA- or PUFA-rich fats significantly lowered TC. The lowest TC concentrations were found with refined rapeseed, cold pressed rapeseed and 18:2-rich sunflower oil (6.7 ± 1.2; 7.1 ± 0.7 and 7.1 ± 0.7 mmol/l, respectively), whereas TC was 10–15% higher (not significant) with 18:1-rich sunflower, virgin and refined olive oil. Liver cholesterol concentrations were lowest in hamsters fed palm stearin or 18:2-rich sunflower oil while MUFA-rich fats increased hepatic cholesteryl ester accumulation, especially of cholesteryl oleate. There were no significant differences in the fecal neutral sterol and bile acid excretion. These data demonstrate that MUFA-rich dietary fats, e.g. rapeseed, olive and 18:1-rich sunflower oil, are comparable in their hypocholesterolemic potential and cause similar effects on plasma cholesterol as 18:2-rich sunflower oil in hamsters when the dietary cholesterol intake is moderate.
Effect of Glycemic Control and Vitamin E Supplementation on Total Glutathione Content in Non-Insulin-Dependent Diabetes mellitus
Authors: Sharma Anjali , Kharb Simmi , Chugh S.N. , Kakkar Rajesh , Singh G.P.
Published: April 2003

Thirty patients with non-insulin-dependent diabetes mellitus were selected for the study. 15 age-matched healthy volunteers served as controls. Serum malonaldehyde, total glutathione, and vitamin E levels were estimated before and after glycemic control and after 4 weeks of vitamin E supplementation. Both total glutathione and vitamin E levels increased after glycemic control and showed an increase after vitamin E supplementation. Malonaldehyde levels lowered after glycemic control, but remained higher than controls. Since vitamin E supplementation significantly decreased oxidative stress in the present study, it may play a role in reducing free-radical-induced oxidant injury in diabetes mellitus.
Dietary Habits and Cardiovascular Risk in the Spanish Population: The DRECE Study (II) Micronutrient Intake
Authors: Ballesteros-Pomar M.D. , Rubio-Herrera M.A. , Gutiérrez-Fuentes J.A. , Gómez-Gerique J.A. , Gómez-de-la-Cámara A. , Pascual O. , Gárate I. , Montero R. , Campiña S.
Published: April 2003

Objective: To evaluate the dietary micronutrient intake in the adult Spanish population participating in the DRECE study. Methods: The cross-sectional study was performed in two stages in 1991 and 1996 in 43 primary care clinics. One thousand two hundred people ‘with cardiovascular risk’ and 600 ‘without risk’ answered a food frequency questionnaire. Results: Significant increases in vitamin C, retinol, lycopenes, β-cryptoxanthin and vitamin E intakes were found. Vitamin A, α-carotenoid and lutein intakes decreased. Vitamin B12, B6 and folic acid intakes increased in people with cardiovascular risk, whereas only the last two increased in the control group. Nearly 100% of the people consumed the recommended dietary allowances for vitamins B12 and B6 and >70% for folic acid. Calcium, iron, and zinc intake increased in both groups, but magnesium and selenium intake increased only in people at risk. Vitamin A, B1 and zinc intakes have decreased, and >50% of the people do not consume the recommended dietary allowance. Conclusion: Antioxidant vitamins and vitamin B12, B6 and folic acid intakes seem to be adequate in the adult Spanish population, no significant differences appear regarding their cardiovascular risk status. Vitamin A, B1 and zinc intakes are not appropriate.
Serum β2-Microglobulin Levels in Patients Chronically Dialyzed with CA-210 versus CT-190 Dialysis Membranes
Authors: DeFranco Penny , Farrell John , Gellens Mary , Bastani Bahar
Published: April 2003

β2-Microglobulin (B2M) amyloidosis (dialysis-related amyloidosis), manifested primarily by carpal tunnel syndrome and destructive osteoarthropathy, is a major sequel of long-term dialysis. Previous investigators have shown that high-flux biocompatible synthetic membranes (e.g., polyacrylonitrile) lower β2M levels when compared to cellulosic membranes (e.g., cuprophane). To date, however, no study has compared β2M levels of patients dialyzed with the two more biocompatible cellulosic membranes CA-210 (cellulose acetate) and CT-190 (cellulose triacetate; high flux, more biocompatible). We retrospectively compared the serum β2M levels in two chronic hemodialysis populations: 22 patients on CT-190 and 21 patients on CA-210. There was no difference between the two groups with regard to age, sex, or duration of dialysis. The patients on the CA-210 membrane had significantly higher serum β2M levels (mean ± SE; 53.6 ± 4.7 vs. 36.8 ± 2.6 mg/l, CA-210 vs. CT-190, respectively, p = 0.003). Subsequently we switched 13 patients dialyzed with a CA-210 membrane to a CT-190 membrane and followed serum β2M levels for 14 months. We found a significant decrease in serum β2M levels within 1 month which was maintained over 14 months of follow-up (47.4 ± 4.4 vs. 62.8 ± 6.7 mg/l, CT-190 at 14 months vs. CA-210 at baseline, respectively, p < 0.01).
Parathyroidectomy Does Not Correct Hypertension in Patients on Maintenance Hemodialysis
Authors: Ifudu Onyekachi , Matthew Jocelyn J. , Macey Leila J. , Hong Joon S. , Sumrani Nabil , Sommer Bruce G. , Friedman Eli A.
Published: April 2003

Both hypertension and secondary hyperparathyroidism (2° HPT) are common features of the uremic syndrome. It has been suggested that 2° HPT causes hypertension in end-stage renal disease (ESRD). We compared predialysis blood pressure (BP), weight and dose of antihypertensive medications (AHM) prescribed in 19 hemodialysis patients 1 month before total parathyroidectomy (PTx), during the first month after PTx, and long-term (mean 16 months) in 12 of 19 patients.At the time of PTx, study patients had a mean age of 47 ± 9 years, mean duration of ESRD was 112 ± 57 months, and mean intact parathyroid hormone (PTH) level of 1,181 ± 552 pg/ml. Mean BP and predialysis weight were equivalent during the month before and the month after PTx.Of 12 patients followed long term, 8 (67%) were receiving AHM before PTx; after PTx; 3 (36%) of 8 discontinued AHM within 1 year, 2 (25%) of 8 required more AHM, while 2 (25%) of 8 continued on their original AHM, and 1 patient who was not on AHM prior to PTx required initiation of AHM after PTx.There was a clinically significant increase in predialysis weight at 1 year after PTx (median 13 lb) and over time (r = 0.7; slope = 0.5; p = 0.07). However, there was neither a clinically nor statistically significant change in either systolic (r = –0.18; slope = –0.01; p = 0.61) or diastolic (r = –0.6; slope = –0.24; p = 0.12) BP over time. We conclude that PTx fails to correct hypertension in hemodialysis patients with 2° HPT.
Urinary Excretion of Podocytes Reflects Disease Activity in Children with Glomerulonephritis
Authors: Hara Masanori , Yanagihara Toshio , Takada Tsuneo , Itoh Michio , Matsuno Masatomo , Yamamoto Tadashi , Kihara Itaru
Published: April 2003

The significance of the presence of podocytes in the urine was studied in various renal diseases in children. The podocytes were detected by immunofluorescence using monoclonal antibodies against the podocalyxin that is present on the surface of podocytes which serves as a glycocalyx. They were scored according to the numbers per partitioned area on cytospun urine sediments. Urine podocytes were absent in normal control, nonglomerular diseases such as urinary tract infection and nonglomerular hematuria, and glomerular, noninflammatory diseases such as minimal change nephrotic syndrome and membranous nephropathy. Conversely, the excretion of podocytes in the urine were detected in various glomerular, inflammatory diseases. A significantly higher level of the podocyte score was found in the acute state of glomerular diseases which was defined as within 6 months after disease onset. Positive correlations were obtained between the presence of urinary podocytes and the histological features of active extracapillary changes and mesangial proliferation. Urinary podocytes were examined monthly for 12 months in 7 cases with IgA nephropathy and 2 cases with Henoch-Schönlein purpura nephritis, and a consistently higher urinary podocyte score was observed in the patients with histological progression. The scoring of urinary podocytes was found to be useful clinically, as a diagnostic tool for glomerular or nonglomerular diseases, inflammatory or noninflammatory diseases, a marker for the estimation of the severity of active glomerular injury and also as a predictor of disease progression.
Minimal-Change Nephropathy and Malignant Thymoma
Authors: Zinger Carlos , Ben-Itzhak Ofer , Szylman Pedro , Green Jacob , Nakhoul Farid
Published: April 2003

A 69-year-old woman presented with persistent dyspnea and continuous coughing and mediastinal mass. The mass was found to be a malignant thymoma and was resected incompletely. A full-blown nephrotic syndrome appeared 1 year after removal of the thymoma. Renal biopsy revealed minimal-change glomerulonephritis. There was no evidence of other autoimmune diseases or causes of the minimal-change glomerulonephritis.
Cancer in End-Stage Renal Disease: Potential Factors Involved
Authors: Vamvakas Spiros , Bahner Udo , Heidland August
Published: April 2003

Increased incidence of cancer at various sites is observed in patients with end-stage renal disease (ESRD). In particular, lymphomas and carcinomas of the kidney, prostate, liver and uterus show an enhanced prevalence in these subjects compared with the general population. A multitude of factors directly or indirectly associated with the renal disease and the treatment regimens may contribute to the increased tumor formation in these patients. Impaired function of the immune system and of DNA repair mechanisms as well as reduced antioxidant defense, accumulation of carcinogenic compounds partly due to reduced renal elimination as well as chronic infections and inflammations are found more frequently in patients with ESRD compared with the general population and may act in concert to accelerate malignant transformation and tumor formation.
A Patient with Thrombotic Microangiopathy Accompanied by Glomerular Subendothelial Electron Dense Deposits
Authors: Kimura Masato , Fujigaki Yoshihide , Ohtake Takayasu , Furuya Ryuichi , Hishida Akira , Kaneko Eizo
Published: April 2003

A 50-year-old woman presented with thrombocytopenia, microangiopathic hemolytic anemia, and nephrotic syndrome. Although a high level of circulating immune complexes, mild hypocomplementemia, and the antinuclear antibody also were present, the criteria for collagen disease were not fulfilled. Renal biopsy demonstrated a typical thrombotic microangiopathy (TMA) involving glomeruli. There also were electron-dense deposits located just beneath the original glomerular basement membrane in the dilated subendothelial space, thought to be immune complexes following positive IgG, C1q and C3 staining on an immunofluorescent study. Corticosteroid therapy rapidly ameliorated her hematologic abnormalities and proteinuria and normalized the immunologic data. These findings strongly suggest that the TMA in this patient was induced by immune complex-associated mechanisms.
Nephrotic Syndrome Associated with Diffuse Mesangial Hypercellularity: Is It a Heterogeneous Disease Entity?
Authors: Joh Kensuke , Matsuyama Norimasa , Kanetsuna Yukiko , Usui Nobuo , Hattori Motofumi , Yumura Wako , Aizawa Shigeo
Published: April 2003

Diffuse mesangial hypercellularity (DMH) is a rare primary mesangial proliferative glomerulonephritis associated with idiopathic nephrotic syndrome (INS). We conducted this study on 15 patients, including 5 patients with repeated specimens, with a follow-up of 0.9–17.5 years and evaluated the clinical course and pathological findings. Seven patients were male. Ten patients were under 14 years of age. All specimens had INS and were diagnosed morphologically with primary diffuse mesangial proliferative glomerulonephritis at initial biopsy; 4 were diagnosed with focal segmental glomerulosclerosis (FSGS) within 3 years by the second biopsy. The remaining 11 patients included 8 initial responders and 3 initial nonresponders to 8 weeks’ steroid therapy and had the histologic variant of the minimal-change nephrotic syndrome (MCNS). Ten of the 11 patients had normal renal function during the investigation period. One patient with the MCNS variant who was refractory to steroid therapy developed end-stage renal disease (ESRD) within 6 years. Four patient with the histologic variant of FSGS included 1 initial responder, 2 late responders, and 1 steroid-refractory case. One patient with the FSGS variant developed ESRD within 4 years. The follow-up biopsies documented that the severity of mesangial hypercellularity was associated with the severity of proteinuria or hematuria. We conclude that DMH may be divided into heterogeneous disease entities, whereas morphologic changes in initial biopsies were similar. Each variant as well as the degree of DMH should be recognized routinely by follow-up biopsy, because they are prognostic indicators.
Persistent High Prevalence of Thyroid Antibodies after Immunosuppressive Therapy in Subjects with Glomerulonephritis
Authors: Westman Kerstin W.A. , Bygren Per G. , Ericsson Ulla-Britt , Høier-Madsen Mimi , Wieslander Jörgen , Erfurth Eva-Marie
Published: April 2003

The prevalence of thyroid antibodies, indicating an autoimmune thyroiditis, has been shown to be significantly increased in patients with autoimmune diseases. A 3-year prospective follow-up study of 42 patients with biopsy-confirmed glomerulonephritis is presented. Although the majority of patients had been treated with immunosuppressants, the prevalence of thyroid peroxidase antibodies was unchanged in both females and males, 47 and 15% respectively, at follow-up. Likewise, the prevalence of thyroglobulin antibodies was unaffected as was that of antinuclear antibodies (ANA) when analysing males and females together. However, for males there was a trend to higher prevalence for ANA at follow-up. On the other hand, the prevalence of antineutrophil cytoplasmic antibodies declined. Furthermore, thyroid antibodies were not restricted to membranous nephropathy, and notably found in 4 out of the 8 patients with vasculitis.
Can Total Urinary Protein Measurements Predict Microalbuminuria?
Authors: Stankeviciute Nijole , Sabah Siama , Singh Ashok , Shaykh Mashouf , Bakir Asad A. , Arruda Jose A.L. , Dunea George
Published: April 2003

We re-addressed the question of whether routine total urinary protein determinations can be used to predict the presence of microalbuminuria by studying 61 patients who attended a diabetic clinic and tested negative or had one positive protein by dipstick. Total urinary protein was measured by the Biorad dye-binding method in undialyzed urine (UND), in dialyzed urine (DIAL), and in dialyzed urine in which albumin and globulins were separated, measured separately with albumin and globulin standards and the results added together to obtain total urinary protein (A + G). The results were compared with albumin measurements obtained by radioimmunoassay (RIA). Compared to DIAL, urinary protein measurements were 43% higher with A + G and 22% higher with UND. Microalbuminuria correlated moderately with UND (r = 0.81) and better with the other methods (r = 0.87 for DIAL, r = 0.91 for A + G). None of the methods predicted microalbuminuria reliably. Taking a protein-to-creatinine ratio of 0.15 and an albumin-to-creatinine ratio of 0.03 as upper limits of normal, we found that UND had a 72% positive predictive value (28% false positives) and 85% negative predictive value (15% false negatives). DIAL had 90% positive predictive value (10% false positives) and 78% negative predictive value (22% false negatives). A + G had 65% positive predictive value (35% false positives) but 91% negative predictive value (9% false negatives). A + G, which uses the correct standards, would be the most suitable method for screening, having the least number of false negatives, but has more false positives because it is more sensitive. In practice, most routine chemical laboratories find it expedient to use only UND, but physicians interpreting the results of this method should be aware of its limitations.
A Simple Assessment of Peritoneal Transport in Stable Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Lai Kar Neng , Szeto Cheuk Chun , Ho Kelvin K.L. , Yu Alex W.Y. , Mak Tony W. , Lam Christopher W.K.
Published: April 2003

We studied the peritoneal transport properties in 175 stable continuous ambulatory peritoneal dialysis (CAPD) patients seeking a simple and handy assessment of peritoneal permeability to small solutes. Measurement of creatinine in biological fluid was known to suffer from interference by high glucose concentration in the sample. Furthermore, the interference is also affected by the creatinine concentration of the specimen. Peritoneal transport properties were studied by determining the dialysate to plasma ratio of creatinine concentration (D/P) at the fourth hour of the peritoneal equilibration test, and the mass transfer area coefficient of creatinine (MTACCr) or glucose (MTACGlu). The ratio of glucose concentration in peritoneal dialysate effluent (PDE) at 4 and 0 h (G4/G0) was examined and compared with various peritoneal parameters. There were significant logarithmic correlations between D/P or G4/G0 with MTACCr (r = 0.96 and 0.79, respectively, p < 0.0001). The correlation between G4/G0 and D/P was linear (r = –0.82, p < 0.0001). A fairly good agreement was present between G4/G0 and D/P by Bland and Altman’s method. The bias was –0.93% with 95% confidence interval –23.29% to 21.43% of the measured value. Systematic error was found when D/P or G4/G0 were compared with MTACCr. D/P under estimated MTACCr in the high range. The reverse happened for G4/G0. Net ultrafiltration (NUF) also correlated with MTACCr, D/P and G4/G0 (r = –0.32, p < 0.001; –0.26, p < 0.01; and 0.16, p < 0.05, respectively.In conclusion, the use of G4/G0 as a measure of peritoneal transport in CAPD is an acceptable alternative to D/P. It is highly reproducible and avoids correction of interference when creatinine transport parameters are measured. Because of the logarithmic relations of G4/G0 (or D/P) with MTACCr, the former should not be directly converted to MTACCr. Such a simple measure of peritoneal permeability is, however, most convenient for serial monitoring and can be useful to detect early loss of ultrafiltration or solute clearance.
Pseudo-Normal Osmolal and Anion Gaps following Simultaneous Ethanol and Methanol Ingestion
Authors: Haviv Yosef S. , Rubinger Dvora , Zamir Ehud , Safadi Rifaat
Published: April 2003

Methanol, ethylene glycol, and isopropyl alcohol are associated with acute intoxication. The diagnosis is dependent upon high anion-gap metabolic acidosis, and an osmolal gap between the calculated and the measured osmolality. Normal anion gap has been reported in some cases of concomitant methanol and ethanol ingestion, where the high serum levels of ethanol inhibited the metabolism of methanol by alcohol dehydrogenase. The osmolal gap in these cases was higher than expected for methanol, and served as a constant marker for a metabolic derangement. Herewith, we present a patient who presented with normal osmolal and anion gaps 36 h after ethanol and methanol ingestion, yet progressively developing ocular toxicity. Normal anion and osmolal gaps should not rule out earlier methanol poisoning.
A Case of IgA Nephropathy in Three Sisters with Thin Basement Membrane Disease
Authors: Yoshida Kazuo , Suzuki Junzo , Suzuki Shigeo , Kume Kazunari , Suzuki Hitoshi , Hujiki Tomoo
Published: April 2003

IgA nephropathy associated with thin basement membrane disease is reported in a 9-year-old female. The diagnosis of IgA nephropathy was made by means of an immunofluorescence investigation, which showed generalized diffuse mesangial deposits. Thin basement membrane disease was identified by electron-microscopic investigations, which disclosed thinning of the basement membrane of several capillary loops and prominence of the lamina densa. Her father, elder sister and younger sister were also found to have hematuria and her sisters were diagnosed as having thin basement membrane disease by renal biopsy. Patients with IgA nephropathy have focal thinning of the glomerular basement membrane, but we consider that urinalysis of the family needs to be done for the diagnosis of familial thin basement membrane disease, when diffuse thinning of the glomerular basement membrane is detected in such patients.
IgA Nephropathy in Psoriasis
Authors: Ahuja Tejinder S. , Funtanilla Marjorie , de Groot John J. , Velasco Ariel , Badalamenti John , Wilson Stephen
Published: April 2003

IgA nephropathy (IGAN) was first described by Berger and Hinglais in 1968. It is now the most common glomerular disease worldwide. IGAN has been associated with several diseases. Its association with psoriasis has been rarely described. We report a case of IGAN with crescentic changes, associated with psoriasis vulgaris. We review the literature on the association of IGAN with psoriasis and discuss the likely pathogenetic linkage.
Anti-Glomerular Basement Membrane Nephritis after Extracorporeal Shock Wave Lithotripsy
Authors: Iwamoto Ichiro , Yonekawa Satoru , Takeda T oshiya , Sakaguchi Mika , Ohno Takashi , Tanaka Hisao , Hasegawa Hirofumi , Imada Akio , Horiuchi Atsushi , Umekawa Tohru , Kurita Takashi
Published: April 2003

Rapidly progressive glomerulonephritis was observed in a 37-year-old woman following the administration of extracorporeal shock wave lithotripsy (ESWL) for a single stone in her right kidney. The renal biopsy specimen showed diffuse cellular crescents in all glomeruli, with linear deposits of immunoglobulin G and complement component C3 along the glomerular basement membrane (GBM). Circulating anti-GBM antibodies were detected by enzyme-linked immunosorbent assay. Thus, the patient was diagnosed with anti-GBM nephritis. It is suggested that ESWL produced an alteration in the GBM leading to the production of anti-GBM antibodies.
Interleukin-4 Cooperates with Interleukin-10 to Inhibit Vascular Permeability Factor Release by Peripheral Blood Mononuclear Cells from Patients with Minimal-Change Nephrotic Syndrome
Authors: Matsumoto Koichi , Ohi Hiroyuki , Kanmatsuse Katsuo
Published: April 2003

Increased production of a vascular permeability factor (VPF) from peripheral blood mononuclear cells (PBMC) in patients with minimal-change nephrotic syndrome (MCNS) has been reported. Interleukin-4 (IL-4) and interleukin-10 (IL-10), both produced by T-helper type-2 cells, are cytokines with the capacity to downregulate proinflammatory responses. To gain insight into the immunoregulatory properties of these cytokines, we analyzed the effects of recombinant human IL-4 and IL-10 on VPF release in MCNS patients. In the present study we show that the regulatory cytokines IL-4 and IL-10 are potent inhibitors of the VPF activity of concanavalin A-activated MCNS PBMC. Each cytokine was found to suppress VPF release in a dose-dependent manner. Moreover, when used at suboptimal concentrations, a combination of the two cytokines resulted in enhanced suppression of VPF release. Neutralization of endogenously produced IL-4 and IL-10 by both anti-IL-4 and anti-IL-10 antibodies resulted in an increased release of VPF. These data demonstrate that IL-4 acts in concert with IL-10 to inhibit VPF release and suggest that they are effective biologic regulators of the VPF responses in vitro.
Living-Related-Donor Kidney Transplantation Outcome in Recipients with Primary Focal-Segmental Glomerulosclerosis
Authors: Refaie Ayman , Sobh Mohamed , Moustafa Fatma , Bakr Mohamed A. , El-Mekresh M. , Farahat S. , Ghoneim Mohamed A.
Published: April 2003

We studied the outcome of renal transplantation in 30 patients with primary focal-segmental glomerulosclerosis (FSGS) and in 30 controls in whom renal failure was secondary to nonglomerular renal diseases. All patients received living-related-donor kidneys, and the majority had one-haplotype HLA matching. Within the follow-up period, the mean serum creatinine values were significantly higher in FSGS recipients as compared with the control group (p = 0.02). However, the frequency of acute rejection episodes and the mean blood pressure values were not significantly different between the two groups. There was a tendency of a higher incidence of proteinuria among FSGS recipients in comparison with the controls. Moreover, nephrotic-range proteinuria occurred only in 3 recipients of the FSGS group. Recurrence of FSGS was morphologically documented in 2 recipients 7 and 18 months, respectively, after transplantation. It is concluded that FSGS as the primary disease has a negligible impact on the living-related-donor kidney transplantation in the Egyptian population. Therefore, this disease should not discourage transplantation for this group of patients.
Exorcisms Used for Treatment of Urinary Tract Diseases in Greece during the Middle Ages and Renaissance
Authors: Diamandopoulos Athanasios
Published: April 2003

Using an unpublished 16th century manuscript as a pilot case, we examined the role of the formal Christian rituals and of hybrid semi-Christian semi-pagan exorcistic writings in curing renal ailments. It was found that in spite of the changing religious and cultural orthodoxy in the lands around the Eastern Mediterranean Basin, people did adhere to their belief in divine intervention when they were suffering from renal and/or other afflictions. We traced the origin of these beliefs at least to the preclassical period, and its continuation well beyond the Renaissance. The same practice applied both to nephrological diseases of humans (clergy and laymen alike) and of animals. We also present several interesting works of art from the palaeo-Christian to the post-Byzantine era supporting our theses.