bluuebunny/crossref_metadata_2025 huggingface dataset:
Should children with a history of anaphylaxis to foods undergo challenge testing?
Authors: Vlieg‐Boerstra B. J. , Duiverman E. J. , Van Der Heide S. , Bijleveld C. M. A. , Kukler J. , Dubois A. E. J.
Published: September 2008

Background
Data on the frequency of resolution of anaphylaxis to foods are not available, but such resolution is generally assumed to be rare.

Objective
To determine whether the frequency of negative challenge tests in children with a history of anaphylaxis to foods is frequent enough to warrant challenge testing to re‐evaluate the diagnosis of anaphylaxis, and to document the safety of this procedure.

Methods
All children (n=441) who underwent a double‐blind, placebo‐controlled food challenge (DBPCFC) between January 2003 and March 2007 were screened for symptoms of anaphylaxis to food by history. Anaphylaxis was defined as symptoms and signs of cardiovascular instability, occurring within 2 h after ingestion of the suspected food.

Results
Twenty‐one children were enrolled (median age 6.1 years, range 0.8–14.4). The median time interval between the most recent anaphylactic reaction and the DBPCFC was 4.25 years, range 0.3–12.8. Twenty‐one DBPCFCs were performed in 21 children. Eighteen of 21 children were sensitized to the food in question. Six DBPCFCs were negative (29%): three for cows milk, one for egg, one for peanut, and one for wheat. In the positive DBPCFCs, no severe reactions occurred, and epinephrine administration was not required.

Conclusions
This is the first study using DBPCFCs in a consecutive series of children with a history of anaphylaxis to foods, and no indications in dietary history that the food allergy had been resolved. Our study shows that in such children having specific IgE levels below established cut‐off levels reported in other studies predicting positive challenge outcomes, re‐evaluation of clinical reactivity to food by DBPCFC should be considered, even when there are no indications in history that anaphylaxis has resolved. DBPCFCs can be performed safely in these children, although there is a potential risk for severe reactions.
Changes in adiponectin multimer distribution in response to atorvastatin treatment in patients with type 2 diabetes
Authors: Von Eynatten M. , Liu D. , Bluemm A. , Schuster T. , Baumann M. , Lutz J. , Heemann U. , Dugi K. A. , Nawroth P. P. , Bierhaus A , Humpert P. M.
Published: September 2008

Objective  Multimeric high molecular weight (HMW) forms of adiponectin were previously shown to be inversely associated with the extent of atherosclerosis in males and are down‐regulated in patients with the metabolic syndrome and type 2 diabetes. In this study, potential influences of atorvastatin therapy on adiponectin multimer distribution were studied in patients with type 2 diabetes.

Design, patients and measurements  The effect of 40 mg atorvastatin on HMW, medium molecular weight (MMW), and low molecular weight (LMW) isoforms of adiponectin were investigated in 75 patients (23 females; 52 males) with type 2 diabetes in an 8‐week‐long, placebo‐controlled and randomized study. Adiponectin multimeric isoforms were detected by Western blot analysis.

Results  After atorvastatin therapy the median serum concentration of HMW adiponectin increased significantly by 42·3% (1·68 vs. 2·39 µg/ml; P < 0·001), while concentrations of MMW adiponectin and LMW adiponectin significantly decreased by 20·8% and 23·2%, respectively (MMW: 3·31 vs. 2·62 µg/ml, P = 0·047; LMW: 0·56 vs. 0·43 µg/ml, P = 0·033). Median total adiponectin levels were not significantly altered by atorvastatin treatment (6·0 vs. 6·2 µg/ml, P = 0·898). Consequently, the HMW : total‐adiponectin ratio significantly increased by 25·0% (0·40 vs. 0·50; P = 0·013).

Conclusions  Atorvastatin therapy is associated with significant changes in adiponectin multimer distribution in patients with type 2 diabetes. Since total adiponectin levels were not affected by intervention, atorvastatin may shift adiponectin size towards the HMW form.
Characterization of the recognition and functional heterogeneity exhibited by cytokine‐induced killer cell subsets against acute myeloid leukaemia target cell
Authors: Linn Yeh C. , Lau Siew Kee J. , Liu Bee H. , Ng Lee H. , Yong Hao X. , Hui Kam M.
Published: September 2008

The polyclonal cytokine‐induced killer (CIK) cells exhibit potent cytotoxicity against a variety of tumour cells including autologous and allogeneic acute myeloid leukaemic (AML) targets. At maturity, three lymphocyte subsets: CD3− CD56+, CD3+ CD56− and CD3+ CD56+, constitute the bulk of the CIK cell culture. The CD3− CD56+ subset behaves like classical natural killer (NK) cells where cytotoxicity is potentiated by blocking the human leucocyte antigen Class I molecules in the AML targets. Both the CD3+ CD56+ and CD3+ CD56− subsets, though known to kill autologous and allogeneic targets to a comparable degree and therefore non‐major histocompatibility complex (MHC)‐restricted, nevertheless require the presence of the MHC molecule on the target, which interacts with their CD3–T‐cell receptor complex. Although CIK cells are often termed ‘NK‐like’ T cells, we have demonstrated that the well‐characterized NK receptors KIR, NKG2C/E, NKG2D and DNAM‐1 are not involved in the process of AML recognition for the CD3+ CD56− and CD3+ CD56+ subsets. The CD3+ CD56+ and CD3+ CD56− subsets express a polyclonal and comparable TCRVβ repertoire in a Gaussian distribution. The CD3+ CD56+ subset kills AML targets more efficiently than its CD3+ CD56− counterpart because of the presence of a higher proportion of CD8+ cells. The CD3+ CD56+ subset comprise more terminally differentiated late effector T cells that bear the CD27+ CD28− or CD27− CD28− phenotype, with a higher granzyme A content. In comparison, the phenotype of the CD3+ CD56− subset is consistent with early effector T cells that are CD27+ CD28+ and CD62L+, known to be less cytotoxic but possess greater proliferative potential.
Toll‐like receptor ligand activation of murine bone marrow‐derived dendritic cells
Authors: Dearman Rebecca J. , Cumberbatch Marie , Maxwell Gavin , Basketter David A. , Kimber Ian
Published: September 2008

Dendritic cells (DCs) are required for the initiation of primary immune responses. The pattern of Toll‐like receptor (TLR) expression on various subsets of these cells has been shown to differ, suggestive of distinct roles in influencing immune responses. We have examined here the responses of immature DCs derived from murine bone marrow (BMDCs) to a range of TLR ligands. BMDCs cultured for 6 days in the presence of granulocyte–macrophage colony‐stimulating factor were stimulated for 24 hr with ligands to TLR1‐2 [Pam3Cys‐Ser‐(Lys)4 (PAM)], TLR2‐6 (macrophage‐activating lipopeptide‐2 (MALP‐2); zymosan or peptidoglycan (PG)], TLR3 (polyinosinic‐polycytidylic acid), TLR4 [lipopolysaccharide R515 (LPS)], TLR5 (flagellin), TLR7 (polyuridylic acid) and TLR9 [CpG ODN2395 (CpG)]. DC activation was monitored using membrane marker expression and analysis of culture supernatants for cytokine/chemokine release. Ligands to TLR3 and TLR7 failed to activate BMDCs. All other TLR ligands caused elevated expression of membrane markers. PAM, MALP‐2 and LPS induced high‐level expression of proinflammatory cytokines and chemokines. Treatment with CpG was associated with a preferential type 1 cytokine and chemokine profile. Zymosan and PG were proinflammatory but also skewed towards a type 2 pattern of cytokines and chemokines. In contrast, flagellin did not cause marked secretion by BMDCs of cytokines or chemokines. These data for BMDCs are largely consistent with the reported TLR repertoire of freshly isolated murine Langerhans cells. In addition, murine BMDCs show selective responses to TLR ligands with respect to general activation, with differentiated cytokine patterns suggestive of potential priming for divergent immune responses.
Milrinone and theophylline act as lower oesophageal sphincter relaxing agents: a comparative pharmacodynamic study in the rabbit
Authors: KOUTSOVITI‐PAPADOPOULOU M. , PSARRA T. A. , BATZIAS G. C.
Published: September 2008

This study demonstrates that the inotropic agent milrinone and the bronchodilator drug theophylline exert a relaxing effect on the rabbit lower oesophageal sphincterin vitro. The relaxing effect of milrinone and theophylline, which is concentration‐dependent, involves a second messenger 3′,5′‐cyclic adenosine monophosphate pathway and most probably it is accomplished through inhibition of phosphodiesterase (PDE) type III, as according to the obtained results it is not significantly modified either by nicotinic acid, an inhibitor of adenylate cyclase, or by the inhibitor of nitric oxide‐synthetaseNω‐nitro‐l‐arginine methylester and the purinergic antagonist suramin; moreover, it persists under non‐adrenergic non‐cholinergic conditions and it is both hexamethonium‐ and tetrodotoxin‐insensitive. Both milrinone and theophylline display equal efficacy, comparable to that of the calcium blocker verapamil and the non‐selective PDE inhibitor papaverine, but milrinone appears 50 times more potent than theophylline and three times less potent than verapamil, as, according to the pIC50values the potency rank of order is found to be verapamil (5.56) > milrinone (5.12) > theophylline (3.42). The here obtained pharmacodynamic profiles of the drugs suggest that both milrinone and theophylline may be considered as potent relaxing agents of the lower oesophageal sphincter.
Polymorphism of HLA‐DRB1, ‐DQB1 and ‐DPB1 genes in Bai ethnic group in southwestern China
Authors: Hu W. , Tang L. , Wang J. , Wang B. , Li S. , Yu H. , Tang W. , Li H. , Tan S. , Shou W. , Xiao C.
Published: September 2008

In this work, polymorphism of human leukocyte antigen (HLA)‐DRB1, ‐DQB1 and ‐DPB1 genes was detected using polymerase chain reaction–sequence‐based typing method in 128 healthy unrelated volunteers from the Bai ethnic group of Yunnan province of southwest China. Among all the 28 alleles detected for the DRB1 gene, the most common allele was DRB1*120201 with a frequency of 16.41%, followed by DRB1*090102, DRB1*080302, DRB1*1404, DRB1*150101, DRB1*140101 and DRB1*160201, with frequencies of 10.16%, 9.77%, 9.38%, 8.98%, 8.59% and 8.21%, respectively. Among 19 DQB1 alleles detected, the most frequent allele was DQB1*030101/0309 (35.94%), followed by DQB1*050201 (11.33%), DQB1*060101/060103 (10.54%) and DQB1*0401 (10.16%). For the DPB1 locus, the most common alleles were DPB1*0501 (42.19%), DPB1*1301 (13.28%), DPB1*020102 (10.93%) and DPB1*040101 (9.77%). The comparison of HLA class II allele frequencies of Bais with those of other Chinese populations suggested that the Bai ethnic group belonged to the southern group of Chinese.
A new HLA‐DR4 allele, DRB1*0474, with an unusual residue at position 77
Authors: Desaules C. , Villard J. , Tiercy J.‐M.
Published: September 2008

We report here a new DR4 allele, DRB1*0474, identified in a volunteer hematopoietic stem cell donor of the Swiss National Registry. DRB1*0474 differs from DRB1*040701 by two nucleotide residues resulting in a single Thr → Asn substitution at codon 77.
Influences on medical students' decisions to study at a rural clinical school
Authors: Spencer Ryan J. , Cardin Anthony J. , Ranmuthugala Geetha , Somers George T. , Solarsh Barbara
Published: September 2008

Objective:  To identify factors that influenced medical students at Monash University to undertake their first year of clinical training (third year of the medical course) at a rural clinical school (RCS).

Design:  Third‐year Monash University medical students undertaking clinical placements at a RCS were surveyed in 2005. A semistructured questionnaire was used to ask students to rate the influence of a list of factors on their decision to undertake their year‐long placement at a RCS.

Results:  Under half (48%) of students studying at an RCS reported that they were of rural background. All surveyed items were identified as having had a positive influence. Greater clinical experience, learning opportunities and patient access were identified as having the greatest positive influence followed closely by free accommodation and other financial and supportive incentives. Future rural career intention was eight times more likely to be a positive influence in rural compared with urban background students.

Conclusion:  The most important positive influence on Monash third‐year medical students' decision to study at an RCS is the perception of high‐quality clinical experiences and education. This perception arises from rural exposure during pre‐clinical years.
Geographical variation of incidence of cutaneous melanoma in Queensland
Authors: Buettner Petra Gertraud , MacLennan Robert
Published: September 2008

Objective:  The study investigated geographical differences and time trends of incidence rate and body site distribution of cutaneous melanoma in Queensland.

Design:  Analysis of data recorded by Queensland Cancer Registry.

Patients:  Analysis included 34 021 patients with invasive and 10 710 patients with in situ melanoma diagnosed between 1982 and 2002.

Main outcome measures:  Age‐standardised incidence rates (world standard population) per 100 000 inhabitants of cutaneous melanoma and annual percentage change (APC).

Results:  Yearly age‐standardised incidence rates of invasive melanoma averaged over the 21 years of observation were highest in the south‐eastern part of the state, notably in the statistical division Moreton for men (54.2) and in Fitzroy for women (51.4). Inland divisions had on average lower rates than coastal areas. For both men and women, age‐standardised incidence rates of invasive and of in situ melanoma increased between 1982 and 2002 for Queensland as a whole and for almost all its statistical divisions. For invasive cancer, the increase was strongest for Moreton (APC men: 5.4%; women: 4.5%; P < 0.001, respectively). APCs were higher for in situ melanoma compared with invasive melanoma for all statistical divisions and both genders. In both genders, the increase in invasive rates was most pronounced for the trunk (APC men: 3.2%, P = 0.040; women: 2.3%; P = 0.306).

Conclusions:  The south‐eastern corner of Queensland endured the main burden of melanoma. Behavioural and lifestyle choices might create the observed differences between statistical divisions. The increase in trunk melanomas is discussed with respect to aetiology.
IgG subclass distribution, affinity of anti‐myeloperoxidase antibodies in sera from patients with Wegener's granulomatosis and microscopic polyangiitis
Authors: LIU LI‐JUN , CHEN MIN , YU FENG , ZHAO MING‐HUI , WANG HAI‐YAN
Published: September 2008

Aim:  Our previous study suggested that patients with MPO‐ANCA (myeloperoxidase antineutrophil cytoplasmic autoantibodies)‐positive Wegener's granulomatosis (WG) were common in Chinese, indicating that patients with MPO‐ANCA could manifest as either WG or microscopic polyangiitis (MPA). The aim of this study was to compare the immunological characteristics of MPO‐ANCA in patients with WG and MPA.

Methods:  Fifteen patients with WG and 21 patients with MPA were enrolled in the current study. Anti‐MPO IgG subclasses and their titres were detected by antigen‐specific enzyme‐linked immunosorbent assays (ELISA); affinity was assessed by antigen‐inhibition ELISAs. The sera from all patients were employed to inhibit biotin conjugated affinity‐purified human anti‐MPO antibodies (Probe‐biotin), from plasma exchange of a patient with MPA, in a competitive inhibition ELISAs system.

Results:  All four anti‐MPO subclasses could be detected in sera from patients with WG and MPA. The titres of anti‐MPO IgG4 subclass in patients with WG were significantly higher than those with MPA (1:1878 vs 1:218, P < 0.005). The affinity constants of MPO‐ANCA were comparable between patients with WG and MPA (0.3–70/M vs 0.3–140/M respectively). Eleven out of the 15 sera and 18 out of the 21 sera could inhibit the binding of the Probe‐biotin in patients with WG and MPA respectively. The average inhibition rate was 47.7% ± 11.5% and 61.7% ± 14.5% respectively (P < 0.05).

Conclusion:  MPO‐ANCA IgG4 subclass might play a role in the development of WG. The MPO‐ANCA in WG and MPA might recognize overlapping but different epitopes on native MPO molecule. The difference in immunological characteristics of MPO‐ANCA might contribute to different disease entities.
Facial wrinkles as a predictor of decreased renal function
Authors: PARK BYUNG‐HYUN , LEE SIK , PARK JIN‐WOO , KIM KYUNG‐AH , KIM HAN‐UK , LEE JU‐HYUNG , KOH DAI‐HA , YOUM JUNG‐HO , YOO NINA , PARK SUE‐KYUNG , KWON KEUN‐SANG
Published: September 2008

Aims:  Oxidative stress generated either by exogenous or endogenous sources can lead to progressive organ damage and skin ageing over a long period of time. Moreover, some dermatological signs are independent of chronological ageing, and may reflect the long‐term redox state of internal organs. Therefore, we hypothesized that there might be an association between facial wrinkles and decreased renal function, an oxidative stress‐related disease.

Methods:  A cross‐sectional study was carried out in a Korean population of 264 adults aged 30 years and older. Facial wrinkle scores in the crow's‐foot area were estimated using a standardized form of visual assessment. As an index of renal function, we determined estimated glomerular filtration rate (eGFR). Lipid hydroperoxide (LPO) assay was performed to measure the levels of oxidative stress.

Results:  After adjusting for possible confounders, lower eGFRs and higher LPO levels were found in those with severe facial wrinkles.

Conclusion:  We conclude that severe facial wrinkles might be used as a predictive marker of decreased renal function, independently of age, gender and other established risk factors.
Molecular analysis of the SMN and NAIP genes in Iranian spinal muscular atrophy patients
Authors: Omrani Omid , Bonyadi Morteza , Barzgar Mohammad
Published: September 2008

Background:  Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder characterized by degeneration of spinal cord anterior horn cells, leading to muscular atrophy. SMA is clinically classified into three subgroups based on the age of onset and severity. The majority of patients with SMA have homozygous deletions of exons 7 and 8 of the survival motor neuron (SMN) gene. The purpose of the present study was to determine the frequency of SMN and neuronal apoptosis inhibitory protein (NAIP) gene deletions in Iranian SMA patients. Experience in prenatal diagnosis of SMA in this population is also reported.

Methods:  To study the frequency of deletions of SMN and NAIP genes in an Iranian sample group, 75 unrelated SMA patients (54 type I, eight type II and 13 type III) were analyzed according to the methods described by van der Steege et al and Roy et al.

Results:  Homozygous deletion of SMN1 exons 7 and/or 8 were identified in 68 out of 75 patients (90%). Deletion of exon 5 of the NAIP gene was found in 40/54 of type I, 2/8 of type II and 1/13 of type III patients.

Conclusions:  Deletion of the SMN1 gene is a major cause of SMA in Iran, and NAIP gene deletions were common in the present patients with type I SMA. Also, the incidence of NAIP deletion is higher in more severe SMA.
Retrospective multi‐institutional study on hemangiopericytoma in Polish children
Authors: Bien Ewa , Stachowicz‐stencel Teresa , Godzinski Jan , Balcerska Anna , Izycka‐swieszewska Ewa , Kazanowska Bernarda , Madziara Wojciech , Perek‐polnik Marta , Mankowski Przemysław , Nurzynska‐flak Joanna , Rybczynska Aleksandra , Prokurat Andrzej ,   Oncological Centers of the Polish Pediatric Solid Tumors Study Group
Published: September 2008

Background:  Pediatric hemangiopericytoma (HPC) is an extremely rare vascular tumor with little data available on its clinical course and management.

Methods:  Fourteen children with HPC registered in Polish Pediatric Rare Tumors and Polish Pediatric Soft‐tissue Sarcomas Studies between 1992 and 2002 are reported.

Results:  Seven patients (F/M: 5/2, age 2–10 months) had infantile HPC, four of whom had primary tumors affecting superficial tissues of the trunk and upper limbs. No child had initial nodal or organ metastases. Primary excision (PE) was performed only in three patients with superficial lesions. They received no supplemental treatment. The remaining four children responded well to chemotherapy (CHT), entering complete remission after CHT alone (n= 2) or after delayed resection (n= 2). No relapses occurred and all patients were alive 48–146 months after treatment. Seven patients (F/M: 2/5, age 3.2–16.5 years) had adult‐type HPC, five of whom had tumors localized in superficial tissues of the lower limbs or head/neck. All patients presented with locally advanced disease. PE was performed in five children (complete in four); all patients were alive at follow up of 40–127 months. Three patients died of recurrence after incomplete PE despite supplemental chemo‐ and radiotherapy.

Conclusions:  Complete surgical excision remains the mainstay of treatment for both HPC types. In unresectable adult‐type HPC adjuvant chemo‐ and radiotherapy should be administered in macro‐ and microscopic tumor residues, but the prognosis is poor despite supplemental treatment. High chemo‐responsiveness of infantile‐type HPC produces a favorable outcome even in cases of unresectable, life‐threatening tumors.
MORE ACCURATE PREDICTION OF POST‐ERCP PANCREATITIS BY 4‐H SERUM LIPASE LEVELS THAN AMYLASE LEVELS
Authors: Nishino Takayoshi , Toki Fumitake , Oyama Hiroyasu , Shiratori Keiko
Published: September 2008

Background:  The aim of the present study was to evaluate and compare 4‐h post‐endoscopic retrograde cholangiopancreatography (ERCP) hyperamylasemia and hyperlipasemia as predictors of post‐ERCP pancreatitis.

Methods:  We reviewed 1631 consecutive cases consisting of 910 cases of diagnostic ERCP and 721 cases of therapeutic ERCP. Pancreatitis was diagnosed when abdominal pain persisted for 24 h after ERCP and the pain was associated with high serum amylase level and/or lipase level.

Results:  Pancreatitis developed in 69 (4.2%) of the 1631 cases. The receiver‐operator characteristic (ROC) curve of both the 4‐h amylase level and the 4‐h lipase level after diagnostic ERCP showed good test performance, with area under the curve of 0.88 (95% CI: 0.85–0.91) and 0.94 (95% CI: 0.92–0.96), respectively. The ROC of both the 4‐h amylase level and the 4‐h lipase level after therapeutic ERCP also showed good test performance, with an area under the curve of 0.92 (95% CI: 0.90–0.93) and 0.96 (95% CI: 0.94–0.97), respectively. The optimal cut‐off value for lipase after both diagnostic and therapeutic ERCP was 10‐fold the upper limit of the normal range. The serum lipase value after both diagnostic ERCP (P = 0.025) and therapeutic ERCP (P = 0.035) was a more effective predictor of post‐ERCP pancreatitis based on the areas under the ROC curve than was the serum amylase value.

Conclusions:  The 4‐h post‐ERCP lipase value is more useful for predicting pancreatitis after both diagnostic and therapeutic ERCP.
COMPARISON OF ENDOSCOPIC DETECTION RATE OF EARLY GASTRIC CANCER AND GASTRIC ADENOMA USING TRANSNASAL EGD WITH THAT OF TRANSORAL EGD
Authors: Yoshida Yukiya , Hayami Yoko , Matuoka Masaki , Nakayama Satoshi
Published: September 2008

Background:  To investigate the influence of the reduced image quality of transnasal esophagogastroduodenoscopy (EGD) with the ultrathin endoscope (transnasal EGD) on endoscopic diagnoses, we compared the detection rate (DR) of early gastric cancer and gastric adenoma by transnasal EGD with that of transoral EGD using a standard endoscope.

Methods:  Transnasal EGD was carried out in 2791 examinations for the purposes of screening or other reasons. Controls were examined by transoral EGD and numbered 3591 examinations. The transnasal endoscope used was an EG530N. Lesions graded C‐3 or higher by Kimura‐Takemoto's classification were regarded as endoscopic atrophy.

Results:  (i) DR in all subjects and those with atrophy were not different between transnasal and transoral EGD. (ii) Multivariate analysis of DR in subjects with atrophy was carried out using five variables: gender, age, purposes of endoscopy, endoscopic insertion route and the four endoscopists. DR was significantly higher in males or subjects ≥60 years. No difference was noted between the endoscopic insertion routes (transnasal vs transoral). (iii) The subjects analyzed in (ii) were divided into the transnasal and transoral groups, and multivariate analysis of DR was carried out using four variables. DR was not different among the endoscopists in the transoral group. However, in the transnasal group, DR increased as the years of endoscopic experience was prolonged.

Conclusions:  Multivariate analysis detected no significant difference in DR between transnasal and transoral EGD. However, a significant difference in DR by transnasal EGD among the endoscopists is detected. Transnasal EGD should be carefully carried out by experienced endoscopists.
NEWLY DEVELOPED OPTIMAL BAND IMAGING SYSTEM FOR THE DIAGNOSIS OF EARLY GASTRIC CANCER
Authors: Yoshizawa Mitsuyo , Osawa Hiroyuki , Yamamoto Hironori , Satoh Kiichi , Nakano Hidetoshi , Tsukui Mamiko , Sugano Kentaro
Published: September 2008

Background:  Magnifying narrow band imaging system is useful for the diagnosis of early gastric cancer. However, it is difficult for the operator of the scope to maintain the correct distance between the tip of the endoscope and the gastric mucosa for appropriate visualization. The newly developed optimal band imaging system can reconstruct good spectral images derived from ordinary endoscopic images and enhance the mucosal surface without magnification as well as with low magnification. This imaging technique is based on narrowing the bandwidth of the conventional image arithmetically, using spectral estimation technology.

Methods:  We evaluated endoscopic features of 30 lesions with elevated‐type, 32 lesions with depressed‐type and two lesions with flat‐type early gastric cancer using this new system.

Results:  We found the best images in all cases of early gastric cancers by using a specific combination of the following three wavelengths available in this system: 470 nm for blue, 500 nm for green and 550 nm for red. The optimal band images showed the depressed‐type early gastric cancer as reddish lesions distinct from the surrounding yellowish non‐cancerous area, leading to a clear demarcation line between the cancerous and non‐cancerous mucosa without magnification. Moreover, 30–40‐fold magnified optimal band images showed a clearly irregular microvascular pattern or a microstructure pattern of the mucosal surface in all types of gastric cancers.

Conclusion:  This new system can provide useful information for diagnosing various types of early gastric cancers without and with low magnification.
NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY FOR PREOPERATIVE STAGING IN A PANCREATIC CANCER PATIENT
Authors: Kitano Seigo , Yasuda Kazuhiro , Shibata Kohei , Yoshizumi Fumitaka , Kawaguchi Koji , Suzuki Kosuke , Ohta Masayuki , Inomata Masafumi , Shiraishi Norio
Published: September 2008

Background:  Many experimental studies have shown the technical feasibility of natural orifice translumenal endoscopic surgery (NOTES). We report the first clinical application of natural orifice transgastric endoscopic peritoneoscopy in Japan for preoperative staging in a patient with pancreatic cancer.

Methods:  A submucosal tunnel was created for safe peritoneal access and secure closure of the gastric‐incision site.

Results:  Transgastric peritoneoscopy provided an excellent view and allowed approach to various areas of the abdominal cavity. After confirmation of operative curability, the patient underwent an open standard operation without complication.

Conclusions:  Natural orifice transgastric endoscopic peritoneoscopy for cancer staging using the submucosal tunnel technique appears to be feasible and safe.
ABDOMINAL PAIN AFTER MIGRATION OF A BILIARY ENDOPROSTHESIS
Authors: Ruinemans Gerjan MF , Van Zanten Reynaldus AA , Rakic Srdjan , Van Den Hout Jan WH , Veneman Thiemo F
Published: September 2008

The use of endoprostheses in cases of obstruction of the biliary tract is common practice. We describe a case in which repetitive displacement of endoprostheses caused severe complications.
CHARACTERISTIC INTRADUCTAL ULTRASONOGRAPHIC FEATURES OF PORTAL BILIOPATHY
Authors: Ikeura Tsukasa , Matsushita Mitsunobu , Sakao Masayuki , Kawamura Rinako , Shimatani Masaaki , Okazaki Kazuichi
Published: September 2008

The term ‘portal biliopathy’ is used to describe cholangiographic abnormalities seen in patients with extrahepatic portal vein obstruction. Portal biliopathy is mainly composed of extrinsic compression of the bile duct caused by enlarged venous collaterals. Herein we report a case of asymptomatic portal biliopathy caused by idiopathic extrahepatic portal vein obstruction. In the present case, intraductal ultrasonography showed normal anatomic layers of the distal common bile duct wall, surrounded by numerous tubular structures which were suspected to be collateral vessels. We suggest that intraductal ultrasonography may be a helpful imaging procedure for detection of this pathological condition.
Treatment options and strategies for acute severe pulmonary embolism
Authors: Hamilton‐Craig C. R. , McNeil K. , Dunning J. , Walters D. L. , Slaughter R. , Kermeen F.
Published: September 2008

Pulmonary thromboembolism (PE) is the third most frequent cause of cardiovascular death after ischaemic heart disease and stroke. In fatal PE, 2/3 of patients die within first hour of presentation. There is a clinical impetus to rapidly recognize, risk‐stratify and appropriately treat patients with acute severe PE. Current recommendations present conflicting classification systems, and there is often some confusion in the clinical evaluation and management of patients with acute severe PE. This review presents a series of real clinical cases, which illustrate the available treatment options, ranging from conservative therapy to thrombolysis through to percutaneous catheter fragmentation and open surgical embolectomy. We evaluate the evidence for the various strategies and propose an algorithm for clinicians with a focus on early risk stratification and timely referral. This is particularly relevant to regional and remote centres, as well as secondary and tertiary institutions.
Ecological fitting by phenotypically flexible genotypes: implications for species associations, community assembly and evolution
Authors: Agosta Salvatore J. , Klemens Jeffrey A.
Published: September 2008

Ecological fitting is the process whereby organisms colonize and persist in novel environments, use novel resources or form novel associations with other species as a result of the suites of traits that they carry at the time they encounter the novel condition. This paper has four major aims. First, we review the original concept of ecological fitting and relate it to the concept of exaptation and current ideas on the positive role of phenotypic plasticity in evolution. Second, we propose phenotypic plasticity, correlated trait evolution and phylogenetic conservatism as specific mechanisms behind ecological fitting. Third, we attempt to operationalize the concept of ecological fitting by providing explicit definitions for terms. From these definitions, we propose a simple conceptual model of ecological fitting. Using this model, we demonstrate the differences and similarities between ecological fitting and ecological resource tracking and illustrate the process in the context of species colonizing new areas and forming novel associations with other species. Finally, we discuss how ecological fitting can be both a precursor to evolutionary diversity or maintainer of evolutionary stasis, depending on conditions. We conclude that ecological fitting is an important concept for understanding topics ranging from the assembly of ecological communities and species associations, to biological invasions, to the evolution of biodiversity.
Anatomy and systematics of the minute syrnolopsine gastropods from Lake Tanganyika (Caenogastropoda, Cerithioidea, Paludomidae)
Authors: Strong Ellen E. , Glaubrecht Matthias
Published: September 2008

The minute syrnolopsine gastropods endemic to Lake Tanganyika have been allied to a number of freshwater, marine and terrestrial groups as a consequence of superficial conchological similarity. Although early anatomical studies confirmed the cerithioid organization of this clade, their close relationship to other lake species was not consistently recognized. In several recent cladistic analyses based on molecular data, the higher taxonomic placement and sister group relationships of syrnolopsines have been unstable. The present analysis confirms that syrnolopsines possess a spermatophore‐forming organ – a synapomorphy of the Paludomidae – corroborating their placement in this family. Consistent with the molecular data, syrnolopsine monophyly is supported by two characters that occur exclusively in this group (salivary gland ducts that bypass the nerve ring and a linear albumen gland). Several characters inMartelia tanganyicensis– the most diminutive syrnolopsine – are only evident in the smallest lake species thus far investigated (Bridouxia,Stormsia) namely reduction of ctenidial leaflets, sorting area, intestine length and number of statoconia. These features are interpreted as being correlated with reduction in size. Nevertheless, close examination reveals differences in detail that allow more refined hypotheses of homology and are consistent with their independent origin.
Eyes and vision in Arion rufus and Deroceras agreste (Mollusca; Gastropoda; Pulmonata): What role does photoreception play in the orientation of these terrestrial slugs?
Authors: Zieger Marina V. , Vakoliuk Irina A. , Tuchina Oksana P. , Zhukov Valery V. , Meyer‐Rochow Victor Benno
Published: September 2008

This paper deals with the orientational behaviour in the two terrestrial slugs Arion rufus and Deroceras agreste. It presents anatomical details of their eyes and provides an appraisal of the eyes’ optical system. In both species the retinae contain two principal types of cell: photoreceptive and pigmented supportive cells. While only the eye of A. rufus apparently contains neurosecretory neurones, that of D. agreste is the only one equipped with a small additional retina with its own separate lens. Lens shapes vary between ovoid (A. rufus) and spherical (D. agreste). Our results demonstrate that the camera‐type eyes in A. rufus and D. agreste have optical systems that do not allow the production of a sharp image on the retina. The slugs demonstrate negative visually mediated phototactic behaviour, but no polarization sensitivity. Only one aspect of the visual environment, namely the overall distribution of light and dark, seems to be important for these slugs. As the main role of the slugs’ photoreceptors is to monitor environmental brightness and to assist the animal in orientating towards dark places, we conclude that these slugs do not need to perceive sharp images.
The relationship between preoperative prostate‐specific antigen and biopsy Gleason sum in men undergoing radical retropubic prostatectomy: a novel assessment of traditional predictors of outcome
Authors: Pierorazio Phillip , Desai Manisha , McCann Tara , Benson Mitchell , McKiernan James
Published: September 2008

OBJECTIVE

To investigate the relationship between prostate‐specific antigen (PSA) level and Gleason sum, and its impact on biochemical failure (persistent PSA level of >0.2 ng/mL) after radical prostatectomy (RP), as the PSA, Gleason sum and clinical stage are commonly used preoperative predictors of outcome in men with localized prostate cancer.

PATIENTS AND METHODS

The Columbia Urologic Oncology Database was reviewed (1988–2006); 3460 had undergone RP. Patients who received neoadjuvant/adjuvant therapy or had incomplete data were excluded, yielding 1932 in the analysed sample. Analysis of variance (anova) methods were used to assess differences in PSA level (on a log scale) among three different groups of patients, categorized by their Gleason sum scores, as <7, 7 and >7. To account for full penetrance of PSA screening, surgery before 1998 was considered as a potential confounder. anova was used to determine whether the association of Gleason score and PSA levels differed before and after 1998. The effect of PSA level on biochemical failure was examined for variance among the three Gleason score groups using a Cox proportional hazards model with time to biochemical failure as the outcome, logPSA, Gleason sum (<7, 7 and >7), their interaction, and clinical stage as the predictors. Concordance indices (c‐index) were calculated for the model with and without the interaction term between PSA and Gleason sum to determine its significance.

RESULTS

Of 1932 patients, 1190 (61.6%) had a Gleason sum of <7, 595 (30.8%) of 7 and 146 (7.6%) of >7. The median PSA level was 5.9, 6.1 and 7.8 ng/mL, respectively (P < 0.001). After adjusting for clinical stage, there was no significant interaction effect (P = 0.34) between Gleason sum and time of surgery on PSA level, implying that the relationship between Gleason sum and PSA levels has not changed over these two periods, despite changes in PSA screening. Results from the Cox model showed that PSA level, Gleason sum, their interaction term and clinical stage were significant predictors of biochemical failure. The c‐index for the model without the interaction term was 0.70 and increased to 0.72 when including it, indicating an increase in the predictive ability of the model when including the interaction term.

CONCLUSION

PSA level and Gleason sum are highly interrelated variables, although they each carry additional information that significantly contributes to the prediction of biochemical failure. This study shows that, for an individual patient, the higher the initial PSA level the higher the risk of having poorly differentiated prostate cancer. Also, predictive models of biochemical failure can be improved by considering the interaction between PSA and Gleason sum.
The thermo‐expandable metallic ureteric stent: an 11‐year follow‐up
Authors: Agrawal Sachin , Brown Christian T. , Bellamy Elizabeth A. , Kulkarni Ravi
Published: September 2008

OBJECTIVE

To review our long‐term use of the thermo‐expandable metallic ureteric stent, (model 051, PNN Medical, Denmark) for ureteric obstruction, and review current reports on its use.

PATIENTS AND METHODS

Data were collected prospectively on all patients who had a Memokath 051 ureteric stent inserted between November 1996 and November 2007. The standard stent, and wide and dual expansion versions were used. The stricture characteristics were recorded in a standard way. All stents were inserted by one surgeon in the UK and internationally, following a standard protocol.

RESULTS

In all, 74 stents were inserted into 55 patients in the study period (mean age 60 years, range 11–90). The indications for metallic stenting included primary stenting for malignancy, failed conventional open and endoscopic techniques, palliation, and where significant comorbidity limited repetitive stent changes. In 28 patients the obstruction was caused by malignancy, whereas in 27 it was caused by recurrent benign disease. The mean (range) hospital stay was 1.43 (0–7) days. Imaging after insertion showed normal or improved functional drainage in all but three patients, with immediate complications including urinary extravasation (one), poor thermo‐expansion (one) and equipment failure (locking assembly) (one). Late complications included migration (13), encrustation (two) and fungal infections (three). In all, 14 patients needed reinsertion (mean of 7.1 months, range 1–14) after insertion for migration (eight), encrustation (two), stricture progression (three) and incorrect stent length (one). Overall, 29 patients have died with the stents in‐situ. The mean (range) follow‐up was 16 (4–98) months.

CONCLUSIONS

The thermo‐expandable metallic Memokath 051 ureteric stent offers effective and durable long‐term relief from ureteric obstruction, and is a safe alternative to conventional JJ stenting. In addition there is an emerging role in palliation and the primary management of ureteric strictures.
How do individual transferable quotas affect marine ecosystems?
Authors: Branch Trevor A
Published: September 2008

Published papers were reviewed to assess ecosystem impacts of individual transferable quotas (ITQs) and other dedicated access systems. Under ITQs, quota shares increase with higher abundance levels, thus fishers may request lower total allowable catches (TACs) and pay for monitoring and research that improves fishery sustainability. Mortality on target species generally declines because catches are closer to TACs and because ghost fishing through lost and abandoned gear decreases. High‐grading and discarding often decline, but may increase if landings (and not catches) count against ITQs and when there is little at‐sea enforcement. Overall, ITQs positively impact target species, although collapses can occur if TACs are set too high or if catches are routinely allowed to exceed TACs. Fishing pressure may increase on non‐ITQ species because of spillover from ITQ fisheries, and in cases where fishers anticipate that future ITQ allocations will be based on catch history and therefore increase their current catches. Ecosystem and habitat impacts of ITQs were only sparsely covered in the literature and were difficult to assess: ITQs often lead to changes in total fishing effort (both positive and negative), spatial shifts in effort, and fishing gear modifications. Stock assessments may be complicated by changes in the relationship between catch per unit effort, and abundance, but ITQ participants will often assist in improving data collection and stock assessments. Overall, ITQs have largely positive effects on target species, but mixed or unknown effects on non‐target fisheries and the overall ecosystem. Favourable outcomes were linked to sustainable TACs and effective enforcement.
Inquiries into Malaysia's socio‐technical disasters: recommendations and lessons learnt
Authors: Said Aini Mat , Ahmadun Fakhru'l‐Razi , Kadir Razali Abdul , Daud Mohamed
Published: September 2008

Most democratic countries hold inquiries into disasters. One of their key functions is to establish the cause of an event and to learn lessons in order to prevent a recurrence. In addition, they offer an opportunity for communal catharsis, permitting the public to vent anger, distress and frustration and to exert pressure for policy changes. Malaysia has experienced six landmark socio‐technical disasters since 1968, which resulted in the proposal or amendment of various safety/emergency acts and regulations. The authors used a grounded theory approach utilising a constant comparative method to analyse the recommendations made by the inquiries into these events. Data indicate that social and technical recommendations comprise 85 and 15 per cent, respectively, of the total recommendations made by the inquiry committees. This paper offers suggestions for improving the management of inquiry tribunals, as they will remain a valuable source of information for society and corporations to learn from past incidents.
RATS, We Should Have Used Clinton: Subliminal Priming in Political Campaigns
Authors: Weinberger Joel , Westen Drew
Published: September 2008

Political strategists decide daily how to market their candidates. Growing recognition of the importance of implicit processes (processes occurring outside of awareness) suggests limitations to focus groups and polling, which rely on conscious self‐report. Two experiments, inspired by national political campaigns, employed Internet‐presented subliminal primes to study evaluations of politicians. In Experiment 1, the subliminal word “RATS” increased negative ratings of an unknown politician. In Experiment 2, conducted during former California Governor Gray Davis's recall referendum, a subliminal photo of Clinton affected ratings of Davis, primarily among Independents. Results showed that subliminal stimuli can affect ratings of well‐known as well as unknown politicians. Further, subliminal studies can be conducted in a mass media outlet (the Internet) in real time and supplement voter self‐report, supporting the potential utility of implicit measures for campaign decision making.
Authoritarianism without Dominant Ideology: Political Manifestations of Authoritarian Attitudes in Hungary
Authors: Todosijević Bojan , Enyedi Zsolt
Published: September 2008

Since the publication of Adorno, Frenkel‐Brunswik, Levinson, and Sanford's (1950) classic study, considerable debate has developed concerning the political and ideological correlates of authoritarianism. This paper examines relationships between authoritarianism, on the one hand, and self‐identification with ideological labels, attitudes toward political extremists, and party preferences, on the other hand. The survey data have been collected in Hungary between 1994 and 2002. Findings indicate that it is the center‐right ideology and political orientation that attracts most authoritarians, yet authoritarian extreme‐left also survives. The findings also show that liberal orientation and center‐left identification constitute the political counter‐pole of authoritarianism. Extreme‐right supporters are found to be attracted only to particular aspects of authoritarianism.
Towards the End of a Long Transition? Bipolarity and Instability in Italy's Changing Political System
Authors: Carbone Maurizio , Newell James L.
Published: September 2008

This article analyses the significance of the 2008 general election for the prospects of an early conclusion to Italy's transition from a First to a Second Republic. The election saw not only the return of Berlusconi to power, but also a radical simplification of Italian politics, with a considerable reduction in the number of parliamentary groups and the emergence of much more straightforward and clear-cut governing and opposition roles. The likelihood of a successful conclusion to the transition was increased by the agreement of governing and opposition forces in the immediate aftermath of the campaign to search actively for mutually acceptable institutional reforms.
Moderate Secularism and Multicultural Equality
Authors: Lægaard Sune
Published: September 2008

Tariq Modood argues that European states are only ‘moderately secular’ and that this kind of secularism is compatible with public accommodation of religious groups and provides a model of Muslim integration appropriate for European states. Although attention to the fact of moderate secularism provides a response to a prominent argument against multicultural accommodation of religious minorities, what is really at stake in discussions of multiculturalism and secularism are political principles. Modood's case for accommodation of Muslims along the lines of moderate secularism presupposes a normative conception of equality, but his characterisation of multicultural equality is inadequate in several respects.
Liberalism Ex Nihilo: Joseph Ratzinger on Modern Secular Politics
Authors: Paskewich J. Christopher
Published: September 2008

Joseph Ratzinger – now Pope Benedict XVI – has a rich body of political writings that has gone largely unnoticed by political scientists. A renowned theologian, even outside the Catholic Church, he has sensitively explored the impact of secularism and religion on liberal democracy. In public and in print, he even debated the philosopher Jürgen Habermas on these topics. This article explores his novel contribution to the study of the liberal state: a secularised, religious foundation for the state will balance autonomy for the citizens with a needed moral orientation for the political realm.