bluuebunny/crossref_metadata_2025 huggingface dataset:
Low expression of the interleukin (IL)‐4 receptor alpha chain and reduced signalling via the IL‐4 receptor complex in human neonatal B cells
Authors: Tian Cuixia , Kron Grace K. , Dischert Kevin M. , Higginbotham James N. , Crowe James E.
Published: June 2006

Diminished neonatal antibody responses following infection or immunization may stem in part from intrinsic characteristics of neonatal B cells. In this study, we used B‐cell subset sorting combined with gene expression assays to investigate major differences in the expression of host genes in neonatal and adult naïve B cells. We discovered significantly reduced expression of the interleukin (IL)‐4 receptor alpha chain and reduced IL‐4‐induced signalling in neonatal B cells. Neonatal naïve B cells were susceptible to more rapid and more profound levels of apoptosis when cultured in vitro. They also exhibited a limited response to IL‐4 treatment compared with adult cells. The expression level of the IL‐13 receptor alpha 1 chain, a key component of the IL‐13 receptor/IL‐4 type II receptor, and the response to IL‐13 treatment for protection against apoptosis in neonatal B cells were similar to those of the adult B cells. These studies suggest a possible mechanism underlying the limited magnitude and durability of neonatal antibody responses.
Healthy participants in phase I clinical trials: the quality of their decision to take part
Authors: Rabin Cheryl , Tabak Nili
Published: June 2006

Aims and objective. This study was set out to test the quality of the decision‐making process of healthy volunteers in clinical trials.

Background. Researchers fear that the decision to volunteer for clinical trials is taken inadequately and that the signature on the consent forms, meant to affirm that consent was ‘informed’, is actually insubstantial.

Design. The study design was quasi‐experimental, using a convenience quota sample.

Methods. Over a period of a year, candidates were approached during their screening process for a proposed clinical trial, after concluding the required ‘Informed Consent’ procedure. In all, 100 participants in phase I trials filled out questionnaires based ultimately on the Janis and Mann model of vigilant information processing, during their stay in the research centre.

Results. Only 35% of the participants reached a ‘quality decision’. There is a definite correlation between information processing and quality decision‐making. However, many of the healthy research volunteers (58%) do not seek out information nor check alternatives before making a decision.

Conclusions. Full disclosure is essential to a valid informed consent procedure but not sufficient; emphasis must be put on having the information understood and assimilated. Research nurses play a central role in achieving this objective.
Swedish Registered Nurses’ incentives to use nursing diagnoses in clinical practice
Authors: Axelsson Lena , Björvell Catrin , Mattiasson Anne‐Cathrine , Randers Ingrid
Published: June 2006

Aims and objectives.  The purpose of this study was to describe Registered Nurses’ incentives to use nursing diagnoses in clinical practice.

Background.  The use of nursing diagnoses is scarce in Swedish patient records. However, there are hospital wards were all nurses formulate and use nursing diagnoses in their daily work. This leads to the question of what motivates these nurses who do use nursing diagnoses in clinical practice.

Design.  A qualitative descriptive design.

Methods.  A purposeful sampling of 12 Registered Nurses was used. Qualitative interviews to collect data and a content analysis were performed.

Results.  Five categories were identified: identification of the patient as an individual and as a whole, a working tool for facilitating nursing care, increasing awareness within nursing, support from the management and influence on the professional role. The principle findings of this study were: (i) that the Registered Nurses perceived that nursing diagnoses clarified the patient's individual needs and thereby enabled them to decide on more specific nursing interventions, (ii) that nursing diagnoses were found to facilitate communication between colleagues concerning patient care and thus promoted continuity of care and saved time and (iii) that nursing diagnoses were perceived to increase the Registered Nurses’ reflective thinking leading to a continuous development of professional knowledge.

Conclusions.  The present findings suggest that the incentives to use nursing diagnoses originate from effects generated from performing a deeper analysis of the patient's nursing needs. Further research is needed to test and validate the usability and consequences of using nursing diagnoses in clinical practice.

Relevance to clinical practice.  Motivating factors found in this study may be valuable to Registered Nurses for the use and development of nursing diagnoses in clinical care. Moreover, these factors may be of relevance in other countries that are in a similar situation as Sweden concerning application of nursing diagnoses.
Ecology of wildlife rabies in Europe
Authors: HOLMALA KATJA , KAUHALA KAARINA
Published: June 2006

The number of wildlife rabies cases has increased in Europe in recent years. We review the epizootiology of wildlife rabies in Europe, paying special attention to recent changes to the situation of two important vector species: the red fox and the raccoon dog. Red foxVulpes vulpeshas been the main vector of rabies since 1945, but the number and proportion of raccoon dogNyctereutes procyonoidescases has rapidly increased during the past few years, particularly in north‐eastern Europe.

The transmission rate (average number of susceptible animals infected by each rabid animal) is critical for rabies spread and is partly determined by population density. Both raccoon dogs and foxes live in pairs. Foxes also live in family groups. Pairs and groups share their territories. Home range size usually correlates negatively with population density. Fox home ranges are 50–1500 ha, those of raccoon dogs 150–700 ha. The threshold value for rabies spread among foxes is estimated to be 0.63 individuals/km2. Although fox density in eastern and northern Europe may be lower than this, the pooled density of foxes and raccoon dogs exceeds the threshold density.

Animal movements, especially dispersal of young, pose a risk for rabies spread. Although the likelihood of an epizootic is highest where fox and raccoon dog densities are highest, rabies may spread fastest where population densities are lower, because dispersal distances tend to correlate negatively with population density.

Oral vaccinations have been more effective in rabies control than culling foxes. Where two vector species exist, vaccination should be conducted twice a year, because most raccoon dogs disperse in autumn but some foxes do not disperse before mid‐ or late winter.

New rabies models, based on two vector species and their interaction, and which take into account the hibernation period of raccoon dogs, are needed for north‐eastern Europe.
Demography of three populations of American minkMustela visonin Europe
Authors: BONESI L. , HARRINGTON L. A. , MARAN T. , SIDOROVICH V. E. , MACDONALD D. W.
Published: June 2006

Demographic data on an invasive species of management concern, the American mink, are presented. Data were obtained on three feral mink populations in Europe distinguished by differences in the time elapsed since population establishment.

Demographic data are presented in the form of life tables, age–sex distributions and sex ratios. Mink lived a maximum of 6 years, and mortality of 1‐year‐olds and adults differed substantially between populations.

The data support the hypothesis that mink populations subject to culling have a higher proportion of young (less than 1 year old) to adults compared with non‐culled populations.
Ancient introductions of mammals in the Mediterranean Basin and their implications for conservation
Authors: GIPPOLITI SPARTACO , AMORI GIOVANNI
Published: June 2006

The importance of taxonomy to the determination of conservation priorities and actions is widely accepted. It should be not surprising therefore that the taxonomic treatment of mammal species that have been subject to human actions in antiquity may well influence the contemporary assessment of conservation priorities at various levels.

As a result of early extinctions caused by humans and protohistoric and historic introductions, we suggest that the Mediterranean Basin and its islands are particularly prone to misdirection of efforts towards biodiversity conservation.

The two main risks associated with the failure to use an evolutionary and palaeoecological approach to conservation efforts are (i) an underestimation of the conservation importance of distinctive continental taxa vs. the apparent endemicity of island taxa; and (ii) a serious risk for native and endemic island species when anthropochorous mammals, especially ungulates, misguidedly become the focus of conservation actions, particularly inside protected areas.

Urgent measures, including refinement of mammal taxonomy, the exclusion of known anthropochorous taxa from conservation lists and implementation of protective legislation, are necessary to maintain the uniqueness and richness of the Mediterranean biodiversity hotspot.
Parental violence and the occurrence of severe and acute malnutrition in childhood
Authors: Hasselmann Maria H. , Reichenheim Michael E.
Published: June 2006

Evidence from developed countries has linked family violence with severe acute malnutrition (SAM), yet no similar studies have been conducted in developing countries where the risk of SAM is higher. To redress this gap, the objective of this study was to explore the role of intimate partner violence (IPV) among caregivers as an independent risk factor for SAM. A hospital‐based case–control (n = 172 : 345) study was carried out in six paediatric hospitals of Rio de Janeiro (1995–99). Cases comprised children (1–24 months) admitted with SAM (weight‐for‐height z‐score < −2 SD). Controls were children of the same age admitted for non‐traumatic surgery. Couple violence was gauged through the Conflict Tactics Scales from two perspectives: (a) two ordinal variables characterising the intensity of verbal and physical aggression based on scores, and (b) a four‐level variable representing a pattern of increasing violence seriousness. Unconditional logistic regression analysis was performed to control for confounding factors.

Parents of SAM cases had higher Conflict Tactics scores than parents of controls, indicating more severe partner violence. The adjusted odds ratio for the comparison of the highest to the lowest scores (10 vs. 0) was 4.15 (95% confidence interval 1.55, 11.15). Using the four‐level variable for violence seriousness, a threefold SAM risk was found for children with parents reporting severe physical abuse, but not for those with parents reporting verbal aggression or more minor physical assaults. In addition to traditionally studied risk factors, the findings suggest that family violence may also play an important role in SAM among children. Moreover, these findings indicate that the risk for SAM is not associated with all types of IPV, but that children exposed to severe and recurrent events are more likely to be admitted for SAM. For the prevention or early detection of SAM, this result points to a specific population group requiring rigorous public health targeting, especially in terms of accurate detection of both SAM and IPV, as well as appropriate handling and follow‐up of violent families.
Primary immunodeficiencies and susceptibility to parasitic infections
Authors: SUBAUSTE C. S.
Published: June 2006

Primary immunodeficiencies are important disorders because they typically cause severe illness in affected patients. In addition, these diseases provide a unique glimpse at the underpinnings of the immune system in humans. Susceptibility to infections, including those caused by parasites, is a hallmark of these immune defects. Understanding the association between primary immunodeficiencies and parasitic infections will likely improve our grasp on the mechanisms of defense against these pathogens.
Reliability of the Australian Therapy Outcome Measures for Occupational Therapy Self‐care scale
Authors: Scott Fiona , Unsworth Carolyn A. , Fricke Janet , Taylor Nicholas
Published: June 2006

Background and Aims:  With the shift of health care towards evidence‐based practice, demonstrating outcomes of intervention has become an important component of occupational therapy practice. Outcome measures and assessment procedures with sound psychometric properties are necessary to demonstrate such therapy outcomes. This study investigated the interrater and intrarater reliability of one of the 12 scales from a newly developed outcome measure, the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs‐OT).

Method and Results:  Seven occupational therapists rated 15 written case studies on two occasions on the four domains (impairment, activity limitation, participation restriction and distress/well‐being) of the AusTOMs‐OT self‐care scale. The results showed that the AusTOMs‐OT self‐care scale had moderate to high interrater reliability with intraclass correlation coefficients (ICCs) of over 0.79 for the three domains: activity limitation, participation restriction and distress/well‐being, and over 0.70 for impairment. Intrarater reliability was also reported to be moderate to high, with ICCs of 0.88 for activity limitation, 0.81 for participation restriction, 0.94 for distress/well‐being, and 0.74 for impairment.

Conclusion:  The findings of this study support the reliability of the AusTOMs‐OT self‐care scale and suggest that it can be used to evaluate self‐care intervention outcomes, thus contributing to the evidence‐based practice of occupational therapy.
Acute segmental testicular infarction
Authors: DEBECK CHRISTIAN , GHASEMIAN REZA
Published: June 2006

Abstract  We report a case of segmental testicular infarction occurring in a patient with sickle cell trait. A 20‐year‐old African American man presented with a complaint of sudden onset, acute severe left testicular pain for 24 hours. Scrotal ultrasound revealed a hypo‐echoic mass in the left testicle. The hypo‐echoic area demonstrated no blood flow in Doppler mode. Because malignancy could not be excluded, the patient underwent a standard inguinal testicular exploration. A partial orchiectomy was performed with complete excision of the lesion. Pathology revealed infarcted testicular tissue with no malignancy present. Further evaluation revealed that the patient had sickle cell trait unbeknownst to him.
Is interstitial cystitis an allergic disorder?: A case of interstitial cystitis treated successfully with anti‐IgE
Authors: LEE JAECHUN , DOGGWEILER‐WIYGUL RAGI , KIM SOHYUNG , HILL BRANDON D , YOO TAI JUNE
Published: June 2006

Abstract  Interstitial cystitis (IC) is a chronic disorder diagnosed by symptomatology of pelvic pain and urinary frequency, which are extremely variable and unpredictable fluctuating among patients. IC has recently been found combined with some allergic disorders and histopathologic abnormalities resembling that of allergic disorders, including mast cell activation, histamine release and eosinophil infiltration. Therefore, it could be cautiously postulated that IC is one of the allergic disorders of the urogenital system. A 28‐year‐old Caucasian female patient, who was diagnosed with asthma and allergic rhinitis, suffered from bladder symptoms of frequency, urgency and pelvic pain for the past 3 years. The symptoms disturbed her every day and were intractable for treatment. Urologists concluded that she had interstitial cystitis. Specific immunotherapy (SIT) was recommended for her allergic symptoms. While taking specific immunotherapy, she had anaphylaxis. She still had the reaction even with the 1000‐fold diluted shot of SIT. Omalizumab was used for her allergic symptoms and possible prevention of anaphylactic reaction to SIT. Interestingly, she reported that her urogenital symptoms had subsided since omalizumab had been started. According to the published literature, we postulate that interstitial cystitis might be one of the IgE mediated, mast cell driven allergic disorders of the urogenital system. Therefore, in this case, the patient’s bladder symptoms are successfully controlled primarily by anti‐IgE therapy and the improvement could be maintained by SIT. We report, for the first time, a case of interstitial cystitis with allergic rhinitis and asthma, successfully treated by anti‐IgE therapy and specific immunotherapy.
Primary malignant melanoma of the bladder
Authors: PACELLA MAURO , GALLO FABRIZIO , GASTALDI CHRISTIAN , AMBRUOSI CARLO , CARMIGNANI GIORGIO
Published: June 2006

Abstract  Primary malignant melanomma of bladder is extremely rare: 18 cases are reported to date. An 82 year‐old man underwent trans‐urethral resection of bladder for a bleeding tumor of the posterior wall. Histological diagnosis was melanoma of the bladder. There was no history of previous or regressed cutaneous malignant melanoma. Margins of the bladder lesion contained atypical melanocytes similar to those commonly seen in the periphery of primary mucous membrane lesions. Clinical studies and radiological examinations were negative for other primary site of melanoma. The patient had a bladder recurrence that was consistent with primary tumor and died of widespread disease 9 months after diagnosis.
Blindness and vision impairment in the elderly of Papua New Guinea
Authors: Garap Jambi N , Sheeladevi Sethu , Shamanna BR , Nirmalan Praveen K , Brian Garry , Williams Carmel
Published: June 2006

Abstract

Background:  To estimate the magnitude and causes of blindness and vision impairment in Papua New Guinea for service delivery planning and ophthalmic education development.

Methods:  Using the World Health Organization standardized Rapid Assessment of Cataract Surgical Services protocol, a population‐based cross‐sectional survey was conducted in 2005. By systematic, two‐stage cluster random sampling, 39 clusters each of 30 people aged 50 years and over were selected from urban and rural locations. A cause of vision loss was determined for each eye with a presenting visual acuity worse than 6/18.

Results:  Of the 1191 people enumerated, 1174 were examined (98.6%). The 50 years and older age‐gender adjusted prevalence of vision impairment (presenting visual acuity less than 6/18 in the better eye) was 29.2% (95% Confidence Interval [CI]: 27.6, 35.1, Design Effect [deff] = 2.3). That of functional blindness (presenting visual acuity less than 6/60 in the better eye) was 8.9% (95% CI: 8.4, 12.0, deff = 1.2), and of World Health Organization blindness (but presenting, rather than best corrected, visual acuity of less than 3/60 in the better eye) was 3.9% (95% CI: 3.4, 6.1, deff = 1.0). Uncorrected refractive error (13.1%, 95% CI: 11.3, 15.1, deff = 1.2) and cataract (7.4%, 95% CI: 6.4, 10.2, deff = 1.3) were leading causes of vision impairment, age‐gender adjusted. Cataract was the most common (age‐gender adjusted 6.4%, 95% CI: 5.1, 7.3, deff = 1.1) cause of functional blindness. On bivariate analysis, increasing age (P < 0.001), illiteracy (P < 0.001) and unemployment (P < 0.001) were associated with functional blindness. Gender was not.

Conclusions:  The identification and treatment of refractive error and cataract need to be priorities for eye health services in Papua New Guinea if the burden of vision impairment and blindness is to be diminished. The education of community and hospital eye care providers, whether medical, nursing or other cadres, must emphasize these. Eye care services must be structured and provided to allow and encourage accessibility and uptake, with satisfactory treatment outcomes for these conditions.
Cyclosporin A inhibits eosinophilic infiltration into the conjunctiva mediated by type IV allergic reactions
Authors: Fukushima Atsuki , Yamaguchi Tomoko , Ishida Waka , Fukata Kazuyo , Liu Fu‐Tong , Ueno Hisayuki
Published: June 2006

Abstract

Background: Eosinophils are important effector cells in severe allergic conjunctivitis such as vernal keratoconjunctivitis. Infiltration of eosinophils into the conjunctiva is mediated by type I and type IV allergic reactions. Cyclosporin A (CsA) eye drops are administered therapeutically for severe allergic conjunctivitis, but the mechanism by which CsA acts, that is, by inhibiting type I, type IV or both types of allergic reactions, is not known. We investigated whether CsA eye drops inhibit type I, type IV or both types of allergic reactions in the conjunctiva.

Methods: Experimental immune‐mediated blepharoconjunctivitis (EC) was induced in BALB/c mice by either active immunization or passive immunization by transfer of ragweed (RW)‐primed splenocytes and RW‐specific IgE, followed by RW challenge to the conjunctiva. These mice were treated in eye drops with vehicle, 0.1% CsA, 0.5% CsA or 0.1% betamethasone five times (1 and 2 h before RW challenge and 1, 2 and 3 h after RW challenge). Twenty‐four hours after the challenge, the conjunctivas were harvested for histological analysis to evaluate eosinophilic infiltration. To evaluate effects of CsA eye drops on systemic immune responses, sera and spleens were collected from actively immunized mice at the time of sacrifice to examine serum IgE levels and cellular immune responses, respectively.

Results: CsA eye drops significantly inhibited eosinophilic infiltration into the conjunctiva in actively immunized EC‐developing mice compared with vehicle‐treated mice. The CsA‐induced inhibition was similar to inhibition induced by 0.1% betamethasone. Serum IgE levels and splenocyte responses in CsA‐treated mice were equivalent to those in vehicle‐treated mice. Betamethasone treatment inhibited eosinophilic infiltration into the conjunctiva induced by both splenocyte transfer and IgE transfer, while CsA treatment inhibited infiltration induced by splenocyte transfer.

Conclusions: CsA eye drops inhibited eosinophilic infiltration into the conjunctiva without affecting systemic immune responses. CsA predominantly inhibits eosinophilic infiltration by interfering with the type IV allergic reaction in the conjunctiva.
Retinal branch artery occlusion following injection of hyaluronic acid (Restylane)
Authors: Peter Silvia , Mennel Stefan
Published: June 2006

Abstract

The authors report a retinal branch artery occlusion occurring after facial injection of a dermal filler. The superior temporal artery showed occlusion due to a clearly visible long and fragmented embolus suggestive of gel and clearly distinguishable from calcific or cholesterol emboli. The authors suppose that hyaluronic acid gel was embolized in the patient. The embolized material is supposed to enter the ocular circulation through retrograde arteriolar flow after intra‐arterial injection into one of the peripheral branches of the ophthalmic artery. If there is any evidence of a visual problem after facial injection of a dermal filler, prompt consultation of an ophthalmologist is recommended.
Biologic therapies for inflammatory eye disease
Authors: Lim Lyndell , Suhler Eric B , Smith Justine R
Published: June 2006

Abstract

The era of biologic medical therapies provides new options for patients with treatment‐resistant inflammatory eye disease. In this review, the authors summarize current published experience in a rapidly progressing clinical field, including the use of biologics, such as the tumour necrosis factor blockers, daclizumab and rituximab, and related agents, interferons and intravenous immunoglobulin, for the treatment of uveitis, scleritis and orbital inflammation. Reports of dramatic recoveries in patients with recalcitrant ocular inflammation who have received such therapies must be balanced against the high cost of biologics and the potential for serious, and at times unanticipated, complications of this treatment.
Interferon α 2b treatment for residual ocular surface squamous neoplasia unresponsive to excision, cryotherapy and mitomycin‐C
Authors: Nemet Arie Y , Sharma Vidushi , Benger Ross
Published: June 2006

Abstract

Three patients had residual or recurrent tumour following excision of large ocular surface squamous neoplasia (OSSN) lesions, which did not resolve despite the use of adjunctive cryotherapy and topical mitomycin‐C therapy. The residual tumour was treated with topical or subconjunctival injectable interferon α 2b. All three eyes had complete resolution of the OSSN lesions after an average of 6 weeks (range 4–8 weeks) of treatment with interferon α 2b. No regrowth was seen during the follow‐up period of 22.7 ± 32.3 months (range 5–60 months). No adverse reactions or complaints were reported during and following interferon use, and previous symptoms from mitomycin‐C treatment resolved completely. In these patients subconjunctival or topical interferon was an effective and safe treatment for residual OSSN. Longer follow up is required to confirm the long‐term efficacy in prevention of recurrences.
Acute retinal necrosis post intravitreal injection of triamcinolone acetonide
Authors: Toh Tze’Yo , Borthwick James H
Published: June 2006

Abstract

Although few data exist on the complication of intravitreal injection of triamcinolone acetonide (IVTA) in human eyes, it is generally thought to be well‐tolerated. The commonest reported adverse events are raised intraocular pressure and progression of cataract. Acute retinal necrosis, as far as the authors are aware, has not been reported to be associated with IVTA in the literature before. The authors hereby report such a case in a patient who has IVTA as an adjunct to photodynamic therapy of choroidal neovascularization secondary to age‐related macular degeneration.
Agonist‐induced internalization of corticotropin‐releasing factor receptors in noradrenergic neurons of the rat locus coeruleus
Authors: Reyes Beverly A. S. , Fox Krysta , Valentino Rita J. , Van Bockstaele Elisabeth J.
Published: June 2006

Corticotropin‐releasing factor (CRF) acts within the locus coeruleus (LC), to modulate activity of the LC‐norepinephrine (NE) system. Combining molecular and cellular approaches, we demonstrate CRF receptor (CRFr) mRNA expression in Sprague–Dawley rat LC and provide the firstin vivoevidence for agonist‐induced internalization of CRFr. CRFr mRNA was detected in LC micropunches by RT‐PCR. In dual labelling immunofluorescence studies, tyrosine hydroxylase (TH) containing neurons exhibited CRFr labelling. At the ultrastructural level, immunogold‐silver labelling for CRFr was localized to the plasma membrane of TH‐immunoperoxidase labelled dendrites. CRF (100 ng) injection into the LC produced a robust neuronal activation that peaked 10–15 min after injection and was maintained for the duration of the recording. This was associated with CRFr internalization in LC neurons that was apparent at 5 and 30 min after injection. By 5 min after injection the ratio of cytoplasmic to total dendritic CRFr‐labelling was 0.81 ± 0.01 in rats injected with CRF and 0.59 ± 0.02 in rats injected with artificial cerebrospinal fluid (ACSF;P < 0.0001). Enhanced internalization of CRFr was maintained at 30 min after CRF injection, with the ratio being 0.86 ± 0.02 for CRF‐injected cases and 0.57 ± 0.03 for ACSF‐injected cases (P < 0.0001). Internalized CRFr was associated with early endosomes, indicative of degradation or recycling. Agonist‐induced CRFr internalization in LC neurons may underlie acute desensitization to CRF or stress. This process may be a pivotal target by which stressors or pharmacological agents regulate the sensitivity of the LC‐NE system to CRF and subsequent stressors.
Electrophysiological markers of voice familiarity
Authors: Beauchemin Maude , De Beaumont Louis , Vannasing Phetsamone , Turcotte Aline , Arcand Claudine , Belin Pascal , Lassonde Maryse
Published: June 2006

Our ability to discriminate and recognize human voices is amongst the most important functions of the human auditory system. The current study sought to determine whether electrophysiological markers could be used as objective measures of voice familiarity, by looking at the electrophysiological responses [mismatch negativity (MMN) and P3a] when the infrequent stimulus presented is a familiar voice as opposed to an unfamiliar voice. Results indicate that the MMN elicited by a familiar voice is greater than that elicited by an unfamiliar voice at FCz. The familiar voice also produced a greater P3a wave than that triggered by the unfamiliar voice at Fz. As both the MMN and the P3a were elicited as participants were instructed not to pay attention to incoming stimulation, these findings suggest that voice recognition is a particularly potent preattentive process whose neural representations can be objectively described through electrophysiological assessments.
The impact of tumour location on the histological subtype of renal cortical tumours
Authors: SCHACHTER LEE R. , BACH ARIADNE M. , SNYDER MARK E. , KATTAN MICHAEL W. , RUSSO PAUL
Published: June 2006

OBJECTIVE

To determine whether the location of renal cortical tumours (RCTs) is a possible factor affecting tumour behaviour, by investigating whether exophytic vs a central location is associated with a difference in histological subtype distribution, as recognized prognostic factors for RCTs include size, stage, grade, and histological subtype.

PATIENTS AND METHODS

Between 1 January 1996 and 1 June 2003, we evaluated 485 consecutive RCTs in 469 patients who had renal imaging studies and underwent either partial or radical nephrectomy at our institution. A radiologist and a urologist independently reviewed the imaging studies of all patients to determine exophytic vs central location. An exophytic lesion was defined as one that clearly both pushed out the renal contour and did not extend into the collecting system, hilum, or renal sinus. A lesion that did not meet these criteria was defined as a central lesion. Logistic regression analysis was used to determine if either type of lesion had a greater representation of any histological subtype. A two‐tailed P ≤ 0.05 was considered to indicate significance.

RESULTS

Of the 485 RCTs, 171 (35%) were exophytic and 314 (65%) were central, while 308 (64%) were clear cell and 177 (36%) were non‐clear cell tumour histology. Of the exophytic lesions, 52.0% were clear cell, while 69.7% of central lesions were clear cell (P < 0.001). Conversely, 71.1% of clear cell tumours were central, while 53.7% of non‐clear cell tumours were central (P = 0.003). After controlling for size and stage, tumour location remained associated with histological subtype (P = 0.003).

CONCLUSIONS

Exophytic lesions are significantly more likely than central lesions to be non‐clear cell tumours, and clear cell tumours are significantly more likely than non‐clear cell tumours to be central. As studies indicate that the clear cell histological subtype portends a worse prognosis than the non‐clear cell subtype, our results imply that tumour location affects the prognosis in RCTs, with exophytic lesions having a better prognosis than central lesions. This result may have important implications for physicians and patients when planning partial vs radical nephrectomy by either open or minimally invasive techniques.
Diagnostic difficulties in children with coexisting pelvi‐ureteric and vesico‐ureteric junction obstruction
Authors: ÇAY ALI , IMAMOGLU MUSTAFA , BAHAT ELIF , SARIHAN HALUK
Published: June 2006

OBJECTIVE

To assess the diagnosis of children with coexisting pelvi‐ureteric junction (PUJ) and vesico‐ureteric junction (VUJ) obstruction, and the management of such patients, as having these two anomalies in the same ureter creates serious diagnostic difficulties, but any delay in diagnosis might cause a deterioration of renal function and affect the success of surgery to correct either anomaly.

PATIENTS AND METHODS

We assessed the diagnostic difficulties and approach to 14 patients with coexistent PUJ and VUJ obstruction, who were treated surgically in our clinic between 1994 and 2005; we also review related published reports in English.

RESULTS

Surgery was used in all 14 patients over the 11‐year period; only five patients had an accurate diagnosis before surgery. Six patients were diagnosed with uroradiological techniques immediately after pyeloplasty; three were diagnosed on investigating an associated anomaly later.

CONCLUSION

In children with coexisting PUJ and VUJ obstruction there are serious diagnostic problems; to prevent any deterioration in renal function due to obstruction, these anomalies require early diagnosis and treatment. For an early and accurate diagnosis, the coexistence of these two anomalies in the same ureter should be considered.
A new bulking agent (polyacrylamide hydrogel) for treating stress urinary incontinence in women
Authors: LOSE GUNNAR , MOURITSEN LONE , NIELSEN JOHN BUGGE
Published: June 2006

OBJECTIVE

To evaluate the efficacy and safety of a transurethral injection with polyacrylamide hydrogel (PAHG) for treating stress urinary incontinence (SUI) in women.

PATIENTS AND METHODS

The study comprised 17 women with pure SUI and eight with mixed incontinence (age range 35–84 years). Between November 2001 and November 2003, the women were injected into the urethral wall with a PAHG (Aquamid®, Contura International A/S, Denmark), a homogenous, highly biocompatible, atoxic, nonresorbable sterile watery gel consisting of ≈2.5% cross‐linked polyacrylamide and 97.5% nonpyrogenic water. The women were followed prospectively (assessed at 1, 3 and 12 months after treatment) and their clinical outcome documented.

RESULTS

Four women did not complete the study, and of the remainder, eight (38%) were subjectively dry and a further nine (43%) improved. Objectively, urine leakage/24 h was decreased by 93% and the number of incontinence episodes by 87%. Quality‐of‐life measures improved significantly in all domains other than general health perception. There were no significant changes of urodynamic variables. Treatment‐related adverse events were recorded in 16 women. Urinary tract infection (10 cases) and urinary retention (five cases) were most common. There were no injection site reactions.

CONCLUSION

PAGH seems to be a promising new bulking agent for the treatment of SUI.
Urethral stricture assessment: a prospective study evaluating urethral ultrasonography and conventional radiological studies
Authors: GUPTA NITIN , DUBEY DEEPAK , MANDHANI ANIL , SRIVASTAVA ANEESH , KAPOOR RAKESH , KUMAR ANANT
Published: June 2006

Authors from India have found that sono‐urethrography is an accurate method of evaluating the length of anterior urethral strictures, being more accurate than retrograde urethrography, and that it gives additional information about spongiofibrosis.

OBJECTIVE

To evaluate the accuracy of urethral ultrasonography (sono‐urethrography, SUG) in determining the length of anterior urethral strictures, and for predicting the degree of spongiofibrosis.

PATIENTS AND METHODS

In all, 52 patients with anterior urethral strictures detected on retrograde urethrography (RUG) were also examined using SUG, to assess the stricture location, length and degree of spongiofibrosis. The findings of both procedures were then compared with the operative findings.

RESULTS

The mean (sd) stricture length on RUG, SUG and at surgery was 2 (0.8), 3.8 (1.4) and 3.5 (1.6) cm, respectively. The mean length on SUG was closer to that at surgery. Spongiofibrosis was detected by SUG with an overall accuracy of 42%, 56% and 83% for mild, moderate and severe degrees of fibrosis, respectively. There were no significant complications during the procedure.

CONCLUSION

SUG is more accurate for evaluating the length of anterior urethral strictures than RUG, and gives additional information about spongiofibrosis.
Comparison of the International Index of Erectile Function erectile domain scores and nocturnal penile tumescence and rigidity measurements: does one predict the other?
Authors: YANG CLAIRE C. , PORTER MICHAEL P. , PENSON DAVID F.
Published: June 2006

Associate Editor

Michael G. Wyllie

Editorial Board

Ian Eardley, UK

Jean Fourcroy, USA

Sidney Glina, Brazil

Julia Heiman, USA

Chris McMahon, Australia

Bob Millar, UK

Alvaro Morales, Canada

Michael Perelman, USA

Marcel Waldinger, Netherlands

OBJECTIVE

To describe the relationship between the International Index of Erectile Function (IIEF) erectile domain score, and nocturnal penile tumescence and rigidity values measured by RigiScan (Timm Medical Technologies, Eden Prairie, MN).

PATIENTS AND METHODS

In all, 73 men were evaluated with the IIEF and 2 nights of continuous penile monitoring with the RigiScan. Twenty‐six men were evaluated before and after prostatectomy, for a total of 99 pairs of data points. We dichotomized the RigiScan results as ‘adequate’ (no erectile dysfunction, ED), or ‘inadequate’ (having ED), based on the ‘best erectile event’ over the 2 nights of monitoring. Two separate criteria for adequate erectile function were used, one of >70% rigidity for ≥10 min, and the other >60% rigidity for ≥10 min. The erectile domain score of the IIEF was calculated in the standard fashion.

RESULTS

Using both the 70% and the 60% rigidity criteria, there was a statistically significant association between the IIEF erectile domain scores and the RigiScan data (r = 0.27, P = 0.008 and r = 0.29, P = 0.003, respectively). However, the sensitivity of the IIEF to predict ED based on RigiScan results using the 70% rigidity criteria was 68.9%, and the specificity was 57.1%. When the IIEF was used as a continuous predictor of RigiScan results, the area under the receiver‐operating characteristic (ROC) curve was 0.66. Using the 60% criteria, the sensitivity was 55.8% and the specificity was 73.2%; the area under the ROC curve was 0.72.

CONCLUSIONS

IIEF erectile domain scores and nocturnal penile tumescence and rigidity measurements are weakly associated, and the clinical utility of one test to predict the other is limited. However, because of the differences in the measured outcomes (perception of erectile function vs physiological capacity), a weak association does not disqualify either test’s individual utility.
Examination of the safety and use of apomorphine prescribed in general practice in England as a treatment for erectile dysfunction
Authors: MACLENNAN KARYN M. , BOSHIER ANDREW , WILTON LYNDA V. , SHAKIR SAAD A.W.
Published: June 2006

OBJECTIVES

To examine the safety and use of apomorphine as prescribed in general medical practice in England as a treatment for erectile dysfunction (ED).

PATIENTS AND METHODS

Apomorphine hydrochloride (marketed as Uprima®, Abbott Laboratories Ltd, UK) is licensed in the UK as a sublingual therapy for ED. It is the first treatment for ED with a central mode of action. This postmarketing observational cohort study was conducted using prescription‐event monitoring (PEM) methods. Exposure information was obtained from dispensed prescription data for patients first prescribed apomorphine between October 2001 and December 2002. Outcome data were derived from Green‐Form questionnaires posted to prescribing physicians ≥6 months after the date of the first apomorphine prescription for each patient. The study cohort comprised 11 185 patients, 99.3% (11 111) of whom were men, with a median (interquartile range) age of 61 (54–68) years.

RESULTS

The most frequently reported prescribing indication was ED and the most frequently reported reason for stopping apomorphine was that it was ‘not effective’. In addition, the percentage of patients for whom apomorphine was reported to have been effective was relatively low. Headache was the most commonly reported adverse drug reaction, and the most frequently reported clinical condition occurring in the first month of observation. A small number of events (24) were reported that were not listed in the current Summary of Product Characteristics (SPC) and were considered by the prescribing general practitioner (GP) to be associated with apomorphine use.

CONCLUSION

The proportion of patients for whom apomorphine was reported to be effective was low. Also, ‘not effective’ was the most frequently reported event and a high percentage of patients stopped apomorphine because it was ‘not effective’. The most frequently reported clinical adverse events (headache and nausea) were those listed in the SPC. A small number of reports for unlabelled events were thought by prescribers to be related to apomorphine use. The confounding factors of patient age and coexisting disease should be considered when assessing data from this study.
A prospective study of 100 cases of penile cancer managed according to European Association of Urology guidelines
Authors: HEGARTY PAUL K. , KAYES OLIVER , FREEMAN ALEX , CHRISTOPHER NIM , RALPH DAVID J. , MINHAS SUKS
Published: June 2006

OBJECTIVE

To prospectively assess the outcome of patients treated according to the European Association of Urology (EAU) guidelines on the management of penile cancer, a system originally based on retrospective series.

PATIENTS AND METHODS

Between 2002 and 2005, 100 consecutive patients (median age 62 years) with penile cancer were treated at one institution; all were categorized and treated according to EAU guidelines. Data were analysed using the z‐test, with significance defined as P < 0.05.

RESULTS

Survival curves were limited to those with >12 months of follow‐up (mean 29); the survival of the whole group was 92%. Of men with palpable nodes, 72% had lymph node involvement, whereas 18% of those with impalpable nodes who had lymphadenectomy according to the guidelines had lymph node disease. The grade of the primary tumour was more predictive than T stage for lymph node involvement and survival. The 3‐year disease‐specific survival for N0, N1 and N2 disease was 100%, 100% and 73%, respectively, and survival at 12 months for N3 disease was 67%. The median survival for those with metastases was 3 months.

CONCLUSION

The overall survival of men with penile cancer is high, with a clear benefit for early lymphadenectomy in men with positive nodal disease. However, the current EAU guidelines are limited in predicting those patients with micrometastatic disease, with the result that 82% of patients undergo unnecessary prophylactic lymphadenectomy. There is a need to identify more accurate molecular markers for predicting lymph node disease, or the role of novel staging techniques must be assessed.
To what extent does the prostate‐specific antigen nadir predict subsequent treatment failure after transrectal high‐intensity focused ultrasound therapy for presumed localized adenocarcinoma of the prostate?
Authors: UCHIDA TOYOAKI , ILLING ROWLAND O. , CATHCART PAUL J. , EMBERTON MARK
Published: June 2006

OBJECTIVE

To explore the association between the prostate‐specific antigen (PSA) nadir after transrectal high‐intensity focused ultrasound (HIFU) therapy for organ‐confined prostate cancer and subsequent treatment failure, as defined by the presence of residual disease at biopsy 6 months after treatment.

PATIENTS AND METHODS

Between January 1999 and January 2005, 115 patients in a Japanese hospital were treated using a transrectal HIFU system (SonablateTM, Focus Surgery, IN, USA) for presumed localized adenocarcinoma of the prostate. All treatments were primary and none of the patients had received hormone therapy. The PSA level was measured at 2‐monthly intervals and all patients had a transrectal prostate biopsy taken at 6 months. Multiple logistic regression was used to examine the relationship between PSA nadir and treatment failure, as defined by the presence of disease at biopsy.

RESULTS

The PSA nadir was strongly associated with treatment failure (P < 0.001). Patients with a PSA nadir of 0.0–0.2 ng/mL had a treatment failure rate of only 11% (four of 36), compared to 46% (17 of 37) in patients with a PSA nadir of 0.21–1.00 ng/mL and 48% (20 of 42) with a PSA nadir of >1.0 ng/mL. In addition, the PSA nadir was strongly associated with both preoperative PSA level and residual prostate volume.

CONCLUSION

There is a clear and intuitive association between the PSA nadir and the risk of treatment failure after HIFU. These data can be used to predict the risk of residual disease in patients with prostate cancer undergoing HIFU therapy. They can also be used to inform where the target PSA nadir should be set for this novel therapy.
The MTHFR C677T polymorphism confers a high risk for stroke in both homozygous and heterozygous T allele carriers with Type 2 diabetes
Authors: Hermans M. P. , Gala J.‐L. , Buysschaert M.
Published: June 2006

Objective  Individuals with Type 2 diabetes are at increased risk of stroke. Plasma homocysteine (tHcy) is an independent risk factor for cardiovascular (CV) disease. The methylene–tetrahydrofolate reductase (MTHFR) gene polymorphism (thermolabile variant C677T) is associated with CV risk, partly as a result of increased Hcy, especially in homozygous subjects.

Aim  To relate the occurrence of the MTHFR polymorphism with stroke prevalence by examining allelic frequency and genotype distribution in 165 subjects with Type 2 diabetes studied for the presence of thermolabile C677T MTHFR mutation.

Results  Mean age was 67.7 years, and tHcy 18.2 µmol/l. T allele frequency was 38.5%. MTHFR genotypes were: normal (CC) 40%; heterozygous (CT) 43%; homozygous (TT) 17%. Serum levels of folic acid and B12 vitamin were within normal limits. Stroke prevalence was 14%. Sixty‐four per cent of stroke‐free subjects had the normal C allele vs. 46% in stroke subjects. The frequencies of genotypes (CC‐CT‐TT) were (%): 44‐41‐15 in stroke‐free vs. 17‐57‐26 in stroke patients. Coronary (CAD) and peripheral artery disease (PAD) were common in all groups, with no differences according to genotypes. Stroke prevalence was markedly higher in genotypes CT and TT (18 and 21%) compared with CC (6%). Mean tHcy levels were higher in TT subjects.

Conclusion  The allelic frequency of C677T MTHFR mutation in Type 2 diabetes subjects with stroke is markedly different from that of subjects without stroke. Genotypic characteristics suggest that C677T MTHFR mutation confers a higher risk for stroke to both homozygous and heterozygous T allele carriers that cannot be ascribed solely to raised tHcy and/or lower folate status in CT subjects, nor to phenotypic expression of conventional risk factors for stroke. The impact of the MTHFR polymorphism on stroke may result from T allele‐linked deleterious effects, or C allele‐linked protection. Confirmatory studies are warranted, as this cohort was not randomly selected, and a type 1 error cannot be ruled out.
Weight gain is associated with improved glycaemic control but with adverse changes in plasma lipids and blood pressure isn Type 1 diabetes
Authors: Ferriss J. B. , Webb D. , Chaturvedi N. , Fuller J. H. , Idzior‐Walus B. ,   The EURODIAB Prospective Complications Group
Published: June 2006

Aims  To assess the effects of weight gain on metabolic control, plasma lipids and blood pressure in patients with Type 1 diabetes.

Methods  Patients in the EURODIAB Prospective Complications Study (n = 3250) were examined at baseline and 1800 (55%) were re‐examined a mean of 7.3 years later. Patients had Type 1 diabetes, defined as a diagnosis made before age 36 years and with a need for continuous insulin therapy within a year of diagnosis. Patients were aged 15–60 years at baseline and were stratified for age, sex and duration of diabetes.

Results  The change in HbA1c from baseline to follow‐up examination was significantly more favourable in those who gained 5 kg or more during follow‐up (‘marked weight gain’) than in patients who gained less or no weight or lost weight (‘less or no weight gain’). In those with marked weight gain, there was a significantly greater rise in plasma triglycerides and total cholesterol and significantly less favourable changes in low‐density lipoprotein and high‐density lipoprotein cholesterol compared with those with less or no weight gain, with or without adjustment for HbA1c. Systolic and diastolic blood pressure also rose significantly more in the group with marked weight gain.

Conclusion  Weight gain in patients with Type 1 diabetes has adverse effects on plasma lipids and blood pressure, despite a small improvement in glycaemic control.