bluuebunny/crossref_metadata_2025 huggingface dataset:
A preliminary study of the use of peripheral quantitative computed tomography for investigating root canal anatomy
Authors: Sberna M. T. , Rizzo G. , Zacchi E. , Capparè P. , Rubinacci A.
Published: September 2008

Aim  To evaluate the use of peripheral quantitative computed tomography (pQCT) for qualitative and quantitative analysis of root canal anatomy and for assessing the extent of canal enlargement during root canal instrumentation.

Summary  The volume variation achieved by S1 ProTaper instruments in the coronal third of the root canals was analysed using peripheral computed tomography. The tooth was scanned in the horizontal plane producing 36 consecutive cross‐sectional images. All images were the result of 360 projections with a section thickness of 250 μm, a distance between slices of 0.5 mm and an in‐plane pixel size of 70 × 70 μm. The evaluation was completed before and after S1 ProTaper instrumentation (with or without circumferential filing) of one root canal of a freshly extracted maxillary first premolar tooth. The acquired images were realigned geometrically and processed using a 3D visualization software. pQCT scanning allowed 3D reconstruction of the root canal anatomy and the assessment of the extent of canal enlargement during root canal instrumentation with lateral displacement of canal walls and hence volume change being greater than the coefficient of variation. The densitometry evaluation showed uniform density along the root canal wall.

Key learning points • pQCT scanning allowed 3D reconstruction of the root canal anatomy and the assessment of the extent of canal enlargement during root canal instrumentation.

• pQCT shows promise for allowing qualitative and quantitative analysis of endodontic procedures.
Are medical students socially exclusive? A comparison with economics students
Authors: Blakey Hannah , Blanshard Eve , Cole Helen , Leslie Fiona , Sen Rosamund
Published: September 2008

Context  Medical students have long been perceived as socially segregated from other students. However, the evidence for this is mainly anecdotal. This study investigates this issue by comparing medical students with economics students.

Methods  Questionnaires measuring objective and subjective social life patterns were completed by 149 medical and 149 economics students at a campus‐based university in the UK.

Results  Medical students drew significantly more of their close friends and housemates from among students on the same course than economics students. Significantly more medical than economics students had a partner on the same course, participated in departmental sports clubs and societies, and felt separated from the rest of university life. Commonly reported reasons for this separation among medical students were high workloads, that the medical school was located outside the main campus, and high numbers of contact hours, some of which took place at sites outside the university.

Discussion  Medical students are more socially exclusive than economics students, which may lead to ‘in‐group’ attitudes and behaviours. This is educationally important and may affect their future professionalism. Universities should be aware of the issues involved when planning curricula, timetables, welfare initiatives and campus design. Prospective medical students should be informed of the social consequences of studying medicine.
Nitric oxide‐induced bacteriostasis and modification of iron‐sulphur proteins in Escherichia coli
Authors: Ren Binbin , Zhang Nianhui , Yang Juanjuan , Ding Huangen
Published: September 2008

The nitric oxide (NO) cytotoxicity has been well documented in bacteria and mammalian cells. However, the underlying mechanism is still not fully understood. Here we report that transient NO exposure effectively inhibits cell growth of Escherichia coli in minimal medium under anaerobic growth conditions and that cell growth is restored when the NO‐exposed cells are either supplemented with the branched‐chain amino acids (BCAA) anaerobically or returned to aerobic growth conditions. The enzyme activity measurements show that dihydroxyacid dehydratase (IlvD), an iron‐sulphur enzyme essential for the BCAA biosynthesis, is completely inactivated in cells by NO with the concomitant formation of the IlvD‐bound dinitrosyl iron complex (DNIC). Fractionation of the cell extracts prepared from the NO‐exposed cells reveals that a large number of different protein‐bound DNICs are formed by NO. While the IlvD‐bound DNIC and other protein‐bound DNICs are stable in cells under anaerobic growth conditions, they are efficiently repaired under aerobic growth conditions even without new protein synthesis. Additional studies indicate that l‐cysteine may have an important role in repairing the NO‐modified iron‐sulphur proteins in aerobically growing E. coli cells. The results suggest that cellular deficiency to repair the NO‐modified iron‐sulphur proteins may directly contribute to the NO‐induced bacteriostasis under anaerobic conditions.
Carbon monoxide enhances salt tolerance by nitric oxide‐mediated maintenance of ion homeostasis and up‐regulation of antioxidant defence in wheat seedling roots
Authors: XIE YANJIE , LING TENGFANG , HAN YI , LIU KAILI , ZHENG QINGSONG , HUANG LIQIN , YUAN XINGXING , HE ZIYI , HU BING , FANG LEI , SHEN ZHENGUO , YANG QING , SHEN WENBIAO
Published: September 2008

Salt stress induced an increase in endogenous carbon monoxide (CO) production and the activity of the CO synthetic enzyme haem oxygenase (HO) in wheat seedling roots. In addition, a 50% CO aqueous solution, applied daily, not only resulted in the enhancement of CO release, but led to a significant reversal in dry weight (DW) and water loss caused by 150 mm NaCl treatment, which was mimicked by the application of two nitric oxide (NO) donors sodium nitroprusside (SNP) and diethylenetriamine NO adduct (DETA/NO). Further analyses showed that CO, as well as SNP, apparently up‐regulated H+‐pump and antioxidant enzyme activities or related transcripts, thus resulting in the increase of K/Na ratio and the alleviation of oxidative damage. Whereas, the CO/NO scavenger haemoglobin (Hb), NO scavenger or synthetic inhibitor methylene blue (MB) or NG‐nitro‐l‐arginine methyl ester hydrochloride (l‐NAME) differentially blocked these effects. Furthermore, CO was able to mimic the effect of SNP by strongly increasing NO release in the root tips, whereas the CO‐induced NO signal was quenched by the addition of l‐NAME or cPTIO, the specific scavenger of NO. The results suggested that CO might confer an increased tolerance to salinity stress by maintaining ion homeostasis and enhancing antioxidant system parameters in wheat seedling roots, both of which were partially mediated by NO signal.
Root of edaphically controlled Proteaceae turnover on the Agulhas Plain, South Africa: phosphate uptake regulation and growth
Authors: SHANE MICHAEL W. , CRAMER MICHAEL D. , LAMBERS HANS
Published: September 2008

The influence of phosphorus (P) availability on growth and P uptake was investigated in South African Proteaceae: (1) Protea compacta R.Br., endemic on severely nutrient‐impoverished colluvial sands; (2) Protea obtusifolia Bueck ex Meissner; and (3) Leucadendron meridianum I. J. Williams, the latter both endemic on comparatively fertile limestone‐derived soils. Plants were grown hydroponically in 1000 L tanks at 0.01, 0.1 or 1.0 µm P for 14 weeks. Biomass accumulation was influenced by P availability, doubling as [P] increased from 0.1 to 1.0 µm. Total biomass was greatest for P. compacta, but L. meridianum and P. obtusifolia had two to four times greater relative biomass accumulation at 0.1 and 1.0 µm[P]. Proteoid root clusters developed at both 0.01 and 0.1 µm[P], but were suppressed at 1.0 µm[P]; this was a 10‐fold lower [P] than previously reported to inhibit cluster root formation. Rates of net P uptake at 5 µm P decreased in response to increased P availability from 0.01 to 1.0 µm P. Significant between‐species differences in rates of P uptake and capacity to down‐regulate P uptake were observed: P. compacta < P. obtusifolia < L. meridianum. The species responses are discussed in terms of adaptation to mosaics in soil P availability and the high beta diversity in the natural habitat.
The role of ultraviolet radiation, photosensitizers, reactive oxygen species and ester groups in mechanisms of methane formation from pectin
Authors: MESSENGER DAVID J. , MCLEOD ANDY R. , FRY STEPHEN C.
Published: September 2008

Ultraviolet (UV) radiation has recently been demonstrated to drive an aerobic production of methane (CH4) from plant tissues and pectins, as do agents that generate reactive oxygen species (ROS)in vivoindependently of UV. As the major building‐blocks of pectin do not absorb solar UV found at the earth's surface (i.e. >280 nm), we explored the hypothesis that UV radiation affects pectin indirectly via generation of ROS which themselves release CH4from pectin. Decreasing the UV absorbance of commercial pectin by ethanol washing diminished UV‐dependent CH4production, and this was restored by the addition of the UV photosensitizer tryptophan. Certain ROS scavengers [mannitol, a hydroxyl radical (•OH) scavenger; 1,4‐diazabicyclo[2.2.2] octane; and iodide] strongly inhibited UV‐induced CH4production from dry pectin. Furthermore, pectin solutions emitted CH4in darkness upon the addition of•OH, but not superoxide or H2O2. Model carbohydrates reacted similarly if they possessed —CH3groups [e.g. methyl esters or (more weakly) acetyl esters but not rhamnose]. We conclude that UV evokes CH4production from pectic methyl groups by interacting with UV photosensitizers to generate•OH. We suggest that diverse processes generating•OH could contribute to CH4emissions independently of UV irradiation, and that environmental stresses and constitutive physiological processes generating ROS require careful evaluation in studies of CH4formation from foliage.
HEPATITIS C AND ADDICTION: Chronic viral hepatitis is a significant contributor to the immunosenescent phenotype of parenteral drug addiction
Authors: Reece Albert S.
Published: September 2008

Intravenous drug addiction is known to be associated with an inordinate morbidity and mortality. As our previous report had identified an immune phenotype consistent with accelerated ageing, we wished to investigate how much of this change may have been related to chronic viral hepatitis. A total of 12 409 clinical pathology results from the period 1995–2007 were reviewed. To control for the differences in age, only patients less than 48 years of age were considered. A total of 636 substance use disorder (SUD) and 6103 non‐SUD (N‐SUD) patients were studied. They had comparable ages (mean ± SD 31.32 ± 6.90 versus 31.57 ± 9.23, P‐value not significant), but the SUD group had more males (74.37% versus 53.20%, P < 0.001). For most of the changes examined splitting the two SUD groups into hepatitis C positive (HCV+) and hepatitis C negative (HCV−) demonstrated that the majority of the described changes were most marked in the HCV+ group. The globulins were higher in the HCV+ group and the albumin was lower and fell more markedly with age than in N‐SUD or HCV− (all P < 0.001). The globulin/albumin ratio was significantly higher in HCV+ than HCV− or N‐SUD (both P < 0.0001) and rose more with age. These changes were paralleled by the ESR, elevations in the CRP and lymphocyte count. Transaminases were elevated in SUD and HCV+ groups compared with N‐SUD (all P < 0.02). At multivariate analysis ESR, lymphocyte count, dual hepatitis B and C seropositivity, AST and HCVAb were significant predictors of the serum globulin level and accounted for 21% of the variance. These data extend our earlier report and show that much of the immunosenescent phenotype of SUD, encompassing the known immunosuppression and the observed immunostimulation, is statistically related to chronic viral hepatitis. Important theoretical and practical management (vaccination) implications ensue.
REVIEW: Norepinephrine and stimulant addiction
Authors: Sofuoglu Mehmet , Sewell R. Andrew
Published: September 2008

No pharmacotherapies are approved for stimulant use disorders, which are an important public health problem. Stimulants increase synaptic levels of the monoamines dopamine (DA), serotonin and norepinephrine (NE). Stimulant reward is attributable mostly to increased DA in the reward circuitry, although DA stimulation alone cannot explain the rewarding effects of stimulants. The noradrenergic system, which uses NE as the main chemical messenger, serves multiple brain functions including arousal, attention, mood, learning, memory and stress response. In pre‐clinical models of addiction, NE is critically involved in mediating stimulant effects including sensitization, drug discrimination and reinstatement of drug seeking. In clinical studies, adrenergic blockers have shown promise as treatments for cocaine abuse and dependence, especially in patients experiencing severe withdrawal symptoms. Disulfiram, which blocks NE synthesis, increased the number of cocaine‐negative urines in five randomized clinical trials. Lofexidine, an α2‐adrenergic agonist, reduces the craving induced by stress and drug cues in drug users. In addition, the NE transporter (NET) inhibitor atomoxetine attenuates some of d‐amphetamine's subjective and physiological effects in humans. These findings warrant further studies evaluating noradrenergic medications as treatments for stimulant addiction.
Association of TNF‐α with severe respiratory syncytial virus infection and bronchial asthma
Authors: Puthothu Beena , Bierbaum Sibylle , Kopp Matthias V. , Forster Johannes , Heinze Jessica , Weckmann Markus , Krueger Marcus , Heinzmann Andrea
Published: September 2008

Tumor necrosis factor (TNF‐)α is a proinflammatory cytokine that is important in the innate host defence and thus in the defence of infectious agents. However, in excess it provokes the development of chronic inflammatory diseases. The aim of this study was to test association of TNF with severe RSV bronchiolitis as example of an infectious disease and asthma as representative for a chronic inflammatory condition. The following study populations were genotyped for 4 polymorphisms within TNF‐β (rs909253) and TNF‐α (rs1799964, rs1799724, rs1800629): 322 asthmatic children, 151 children with severe respiratory syncytial virus (RSV) bronchiolitis and 270 controls. Furthermore, serum TNF‐α levels were measured by a FlowCytomix Assay. Asthma showed association with two TNF‐α polymorphisms as well as with TNF haplotpyes (p = 0.0050). In contrast, RSV bronchiolitis was associated with TNF haplotypes (p < 0.00001) but not with any single polymorphism. In addition, TNF‐α serum levels correlated with rs1799724 (p = 0.034). A genetically mediated up‐regulation of TNF‐α expression might provoke a pronounced inflammation of the airways and thus a more severe course of RSV infection as well as the onset of asthma. It remains to be elucidated whether severe RSV bronchiolitis starts TNF‐α upregulation and is one first step in the direction to asthma later in life, or whether both dieases are independent from each other and supported by TNF‐α upregulation.
Simultaneous mold infections in an orthotopic heart transplant recipient
Authors: Clauss H. , Samuel R.
Published: September 2008

Abstract: Simultaneous mold infections in heart transplant recipients have not been previously reported. Here we describe early onset post‐transplant pulmonary aspergillosis and cutaneous zygomycosis in a 46‐year‐old heart transplant recipient who was also treated with basiliximab. Along with surgical debridement, medical treatment of his cutaneous abdominal wall zygomycosis at the former left ventricular assist device driveline site with liposomal amphotericin B and voriconazole also led to cure of his pulmonary aspergillosis.
Vibrio cholerae non‐O1 infection in cirrhotics: case report and literature review
Authors: Patel N.M. , Wong M. , Little E. , Ramos A.X. , Kolli G. , Fox K.M. , Melvin J. , Moore A. , Manch R.
Published: September 2008

Abstract: Vibrio species are ubiquitous in the marine environment and can cause severe infections in cirrhotic patients. Patients with liver disease should be warned about the potential dangers of consuming raw or undercooked seafood, and avoiding exposure of wounds to seawater. We report a case of severe sepsis from Vibrio cholerae non‐O1 in a patient with cirrhosis awaiting orthotopic liver transplant. This case is aimed to advise clinicians about the importance of V. cholerae subtypes, and non‐cholera Vibrio species infections in cirrhotic patients, highlighting the need to educate these patients to stay away from undercooked seafood.
Prospective monitoring of BK virus replication in renal transplant recipients
Authors: Koukoulaki M. , Grispou E. , Pistolas D. , Balaska K. , Apostolou T. , Anagnostopoulou M. , Tseleni‐Kotsovili A. , Hadjiconstantinou V. , Paniara O. , Saroglou G. , Legakis N. , Drakopoulos S.
Published: September 2008

Background. BK virus‐associated nephropathy (BKVAN) can be diagnosed only with renal graft biopsy. Definitive diagnosis of BKVAN requires demonstration of BK virus (BKV) replication in renal allograft tissues. Non‐invasive analysis of urine and blood is considered essential in screening renal transplant recipients.

Patients and methods. This study evaluated prospectively the replication of BKV in plasma and urine with qualitative and quantitative real‐time polymerase chain reaction in 32 de novo (group A) and 34 chronic (group B) renal transplant recipients and the long‐term impact on graft function.

Results. In group A, 456 samples (228 plasma, 228 urine) were examined and BKV was detected in 31 (31/228, 14%) samples of plasma and 57 (57/228, 25%) samples of urine in 20 (20/32, 62.5%) and 23 (23/32, 72%) recipients, respectively. Incidence of viremia and viruria increased during the first 6 months presenting a peak the third postoperative month (viremia: 28% and viruria: 31%). Immune suppressive treatment with tacrolimus showed significant relation with viremia. Renal graft function in de novo renal transplant recipients remained stable throughout the follow‐up period without influence of BKV replication. In group B, incidence of viremia and viruria were 3% (1/34) and 9% (3/34) correspondingly, indicating that after the first post‐transplant year the risk of BKV re‐activation is diminished.

Conclusion. The highest incidence of BK viremia and viruria is observed the third post‐transplantation month, confirming previously published studies in Europe and the United States, and long‐term follow up shows that BKV replication decreases significantly after the third post‐transplant month and even transient viremia or viruria does not have an impact on renal function.
Deficiency of cytomegalovirus (CMV)‐specific CD8+ T cells in patients presenting with late‐onset CMV disease several years after transplantation
Authors: Cummins N.W. , Deziel P.J. , Abraham R.S. , Razonable R.R.
Published: September 2008

Abstract: Cytomegalovirus (CMV) is a major cause of morbidity and mortality among transplant recipients. The routine use of anti‐CMV prophylaxis has modified the epidemiology of post‐transplant CMV infection by delaying the onset of clinical disease. While the majority of delayed‐onset CMV disease still occurs during the first year after transplant, reports of late‐onset CMV disease presenting many years after transplantation are increasing. Here, we describe 2 CMV‐seropositive transplant recipients who presented with late‐onset CMV disease at 8 and 11 years after transplantation. To determine whether CMV disease occurring at a very late period after transplantation is related to immune competence, we assessed global and CMV‐specific cellular immunity by evaluating the activation capability of CD8+ T cells to a mitogenic stimulus and by quantitative and functional analysis (as assessed by intracellular cytokine production and degranulation) of CMV‐specific CD8+ T cells. In both patients, we demonstrated the absence or marked deficiency of CMV‐specific T‐cell immunity despite CMV seropositivity, and in one patient, a partial defect in the immune response to phorbol myristate acetate and ionomycin suggesting impaired global immune competence. Hence, our data suggest that late‐onset CMV disease occurring many years after transplantation remains related to defects in the immune competence of patients. Measurement of CMV‐specific cellular immune competence may therefore provide an additional tool to screen for patients at high risk of developing late‐onset CMV disease. The clinical utility of this assay, however, will need to be evaluated in larger prospective studies.
New immunosuppressive strategies and the risk of infection
Authors: Mueller N.J.
Published: September 2008

Abstract: Newer immunosuppressive strategies have resulted in a marked reduction in graft rejection after transplantation, with the price being an increase of infectious complications, such as BK‐related nephropathy. The targeting of new immunosuppressive pathways, such as interleukin‐2–mammalian target of rapamycin inhibition, may have unexpected consequences for the immune response. Cell‐depleting agents have long‐lasting effects on cellular recovery and function, with the activation of latent viral infections and late viral and fungal infections. The multitude of different induction and maintenance protocols renders the detection of small increases of often rare infections very difficult. At the same time, preemptive and prophylactic strategies have gained widespread acceptance and may further offset small changes in infection rates. Other factors related to an increase or shift of infections may be of equal importance, such as increased use of marginal donors, older age at transplantation, or more patients receiving a second transplant. Not all the changes observed result in an increased immunosuppression. Steroid‐ and calcineurin inhibitor‐sparing protocols may have a beneficial impact on infectious complications. Antimycotic or antiviral activity has been described for specific immunosuppressive agents, although the in vivo effect of these activities is uncertain. The possible role of specific drugs in the occurrence of infections is discussed, with emphasis on the antibodies and fusion proteins. The unequivocal attribution of a given infection to a specific drug is often impossible, as the risk of infection is dependent on the entirety of immunosuppression and the epidemiological pressure (‘net immunosuppression’). It is important to remain vigilant for unexpected infections, not only in the context of clinical studies with selected patients, but also in the routine follow‐up of our transplant patients.
Divergence in parental care, habitat selection and larval life history between two species of Peruvian poison frogs: an experimental analysis
Authors: BROWN J. L. , MORALES V. , SUMMERS K.
Published: September 2008

Changes in the nature of the ecological resources exploited by a species can lead to the evolution of novel suites of behaviours. We identified a case in which the transition from large pool use to the use of very small breeding pools in neotropical poison frogs (family Dendrobatidae) is associated with the evolution of a suite of behaviours, including biparental care (from uniparental care) and social monogamy (from promiscuity). We manipulated breeding pool size in order to demonstrate experimentally that breeding habitat selection strategy has evolved in concert with changes in parental care and mating system. We also manipulated intra‐ and interspecific larval interactions to demonstrate that larval adaptation to the use of very small pools for breeding affected the evolution of larval competition and cannibalism. Our results illustrate the intimate connection between breeding pool ecology, parental care and mating strategies in Peruvian poison frogs.
Evaluation of Drought‐Related Traits and Screening Methods at Different Developmental Stages in Spring Barley
Authors: Szira F. , Bálint A. F. , Börner A. , Galiba G.
Published: September 2008

Despite intensive research and breeding efforts, the physiological and quantitative genetic bases of drought tolerance are still poorly understood. The comparison of results obtained from different sources is also complex, because different testing methods may lead to controversial conclusions. This report discusses various drought stress experiments (hydroponics and in soil) in which the plant tolerance was studied at different developmental stages. Tests were performed in the germination, seedling and adult plant stages on the parental lines of five well‐known barley‐mapping populations. The results suggest that drought tolerance is a stage‐specific trait and changes during the life cycle. The effect of drought stress depended not only on the duration and intensity of water deficiency, but also on the developmental phase in which it began. To induce the same type of stress and to obtain comparable tolerance information from the replications, it is recommended that drought stress should be induced at the same growth stage. Correlations between the traits, commonly associated with improved drought resistance (high relative water content under stress, proline accumulation, osmoregulation) with stress tolerance indexes, are also presented, while the advantages and disadvantages of the most frequently used screening methods are discussed.
Recovery and Cryopreservation of Epididymal Sperm of Plains Bison (Bison bison bison) as a Model for Salvaging the Genetics of Wood Bison (Bison bison athabascae)
Authors: Aurini LC , Whiteside DP , Elkin BT , Thundathil JC
Published: September 2008

Contents

The objective of this study was to optimize recovery and cryopreservation of epididymal sperm from plains bison, as a model for wood bison. In Phase 1, cauda epididymides were recovered from bison (n = 14) immediately after slaughter, minced and incubated in Sp‐TALPH buffer for 3 h at 36°C. The resulting sperm suspensions were cryopreserved in Triladyl®, using a protocol for bovine semen. In Phase 2, epididymal sperm were cryopreserved in either Triladyl® or Andromed®. The mean (±SD) estimated number of sperm recovered was 468 ± 207 × 106. There was an increase (p < 0.05) in the proportion of sperm with normal morphology between initial recovery and after extension (52.4 ± 4.6 vs 69.7 ± 2.4%), with a concurrent decrease (p < 0.05) in the proportion of sperm with distal droplets. Median values for progressively motile sperm in post‐thaw samples (60%) were lower (p < 0.05) than that after extension or after chilling (70% for both). The mean percentages of viable sperm and of sperm with an intact acrosome were lower (p < 0.05) for frozen‐thawed samples (38.7 ± 2.8 and 85.2 ± 1.1) compared with extended (66.2 ± 2.2 and 92.4 ± 0.9) or chilled (63.7 ± 2.5 and 90.0 ± 1.0) samples. Rates of cleavage, morulae and blastocyst production were not significantly different for chilled (70.9, 38.7 and 8.0%) vs post‐thaw sperm (73.0, 46.0 and 6.3%). There was no significant difference between extenders for most sperm characteristics. In conclusion, we developed a functional protocol for the recovery and cryopreservation of epididymal sperm from plains bison, which may have implications for the genetic preservation of wood bison.
Shorter break‐in period is a viable option with tighter PD catheter securing during the insertion
Authors: SHARMA AJAY P , MANDHANI ANIL , DANIEL SHAJI P , FILLER GUIDO
Published: September 2008

Background:  Recent single‐arm studies reported good catheter outcome despite shorter break‐in periods after peritoneal dialysis (PD) catheter insertions. These results were attributed to tight catheter securing during the insertions.

Objective:  To compare catheter‐related outcomes after different break‐in periods in the tightly secured PD catheters.

Patients and Methods:  The study cohort comprised 48 patients, who underwent catheter insertions with the modified insertion technique. Based on the duration of break‐in period, the patients were grouped into a shorter break‐in period arm, with break‐in period of 7 days or less and a standard break‐in period arm, with break‐in period of about 2 weeks. Mean patient follow up was 9.68 ± 4.35 months, with a similar follow‐up duration between the two break‐in period arms (P = 0.94).

Results:  In the study cohort, the incidence of pericatheter leaks, pericatheter haemorrhage, catheter malfunction and peritonitis was 2/48 (4%), 1/48 (2%), 1/48 (2%) and 3/48 (6%), respectively. There was no other‐site leak, bowel perforation, hernia formation or wound dehiscence. Of these complications, two pericatheter leaks, one catheter malfunction and three peritonitis episodes followed standard break‐in periods, whereas, one pericatheter haemorrhage occurred in the shorter break‐in period arm.

Conclusion:  After a tight catheter securing during the insertions, overall pericatheter leak incidence remained low in the whole study cohort, and it did not worsen despite a shorter break‐in period. Future studies with larger patient numbers are needed to validate the role of shorter break‐in period in PD practice.
Race and end‐stage renal disease in the United States Medicare population: The disparity persists
Authors: TOMSON CHARLES RV , FOLEY ROBERT N , LI QI , GILBERTSON DAVID T , XUE JAY L , COLLINS ALLAN J
Published: September 2008

Aim:  A marked preponderance of end‐stage renal disease among African Americans was described more than two decades ago. The objective of this study was to determine whether racial disparities in end‐stage renal disease in the United States have changed over time.

Methods:  The authors compared renal replacement therapy rates in five biennial cohorts (1993–1994, 1995–1996, 1997–1998, 1999–2000, 2001–2002; n = 6 315 283), using annual random samples of 5% of the US Medicare population and the United States Renal Data System registry.

Results:  The proportion of African American subjects rose from 8.8% in the first cohort to 9.4% in the last. Renal replacement therapy rates (per 1000 patient‐years) among white Americans in successive cohorts were 0.84, 0.96, 1.08, 1.16 and 1.20, compared with 2.98, 3.24, 3.65, 3.80 and 3.57 among African Americans (P < 0.0001 for race comparison within each biennial cohort). Corresponding hazards ratios, adjusted for demographic characteristics and comorbid conditions, were 2.01 (95% confidence interval 1.82–2.33), 1.96 (1.78–2.17), 2.00 (1.81–2.20), 2.01 (1.83–2.21) and 1.86 (1.69–2.04), suggesting the absence of meaningful reduction in racial disparities in renal replacement therapy rates over time.

Conclusion:  Disparities in renal replacement therapy rates between white and African American Medicare beneficiaries have persisted over time.
An in vitro investigation of herbs traditionally used for kidney and urinary system disorders: Potential therapeutic and toxic effects
Authors: WOJCIKOWSKI KEN , WOHLMUTH HANS , JOHNSON DAVID W , ROLFE MARGARET , GOBE GLENDA
Published: September 2008

Aim:  Renal fibrosis is central to progression of most chronic renal pathologies. Antioxidants that protect the tubular epithelium and anti‐fibrotics that induce apoptosis of pro‐fibrotic myofibroblasts without adversely affecting tubular epithelium may slow progression of renal fibrosis, while toxic substances may exacerbate renal scarring. We investigated 47 herbs for their in vitro toxic or antioxidant effects on normal renal mammalian fibroblasts (NRK49F) and tubular epithelial cells (NRK52E) to determine their potential value as therapeutic agents in renal fibrosis involving oxidative stress.

Methods:  Herbs were chosen because of their traditional use in kidney or urinary system disorders, or because of recent published interest in their therapeutic or toxic potential in kidney disease. Extracts of herbs were made using a sequential multi‐solvent extraction process. Each extract was analysed separately. Extraction solvents were ethyl acetate, methanol and 50% aqueous methanol. Cells were treated with extracts with/without oxidative stress (1.0 mM hydrogen peroxide). Cellular changes (apoptosis, necrosis, mitosis, transdifferentiation) were identified and quantified using defined criteria.

Results:  All extracts of Dioscorea villosa showed significant toxicity to both cell lines. At low concentrations (5–50 µg/mL) they induced epithelial to mesenchymal transdifferentiation, as demonstrated by increased immunohistochemistry staining for α‐smooth muscle actin and transforming growth factor‐β1 in treated versus control cells. Angelica sinensis, Centella asiatica, Glycyrrhiza glabra, Scutellaria lateriflora, and Olea europaea demonstrated strong antioxidant effects in epithelial cells and/or apoptotic effects on fibroblasts.

Conclusion:  This investigation has revealed renotoxicity of D. villosa and anti‐fibrotic, oxidant potential of several herbal extracts, all of which require further study.
Heart and iron deficiency anaemia in rats with renal insufficiency: The role of hepcidin
Authors: TOBLLI JORGE EDUARDO , CAO GABRIEL , RIVAS CARLOS , KULAKSIZ HASAN
Published: September 2008

Aim:  Anaemia is prevalent in chronic kidney disease (CKD) and induces significant changes in heart and kidney. In this study, we evaluated the relationship between iron metabolism, hepcidin and inflammation focusing on left ventricular (LV) function, in a remnant kidney rat model.

Methods:  Rats with 5/6 subtotal nephrectomy (STNx) and sham operation. Haemoglobin (Hb), serum iron (SI), fractional shortening (FS%) by echocardiograms were evaluated. Six months after STNx, the heart and kidney were processed by immunohistochemistry with antibodies against hypoxia‐inducible factors (HIF)‐1α, erythropoietin (EPO), pro‐hepcidin, caspase‐3, tumour necrosis factor (TNF)‐α and interleukin (IL)‐6.

Results:  Hb (g/dL) STNx: 10.8 ± 0.8, sham: 14.7 ± 0.6 (P < 0.01); SI (µg/dL) STNx: 154.5 ± 24.5, sham: 287.5 ± 32.1 (P < 0.01); heart weight (g) STNx: 2.21 ± 0.15, sham: 1.12 ± 0.12 (P < 0.01); FS% STNx: 28.4 ± 2.5, sham: 45.1 ± 4.1 (P < 0.01). There was a correlation between Hb and FS% (r = 0.95; P < 0.01) and between SI and FS% (r = 0.86; P < 0.01) in the STNx group. Tissue ferritin was reduced in heart and in kidney in the STNx group (P < 0.01). HIF‐1α was expressed in cardiomyocytes (positive cells/area) STNx: 32 ± 5, sham: 4 ± 1; and tubular cells in STNx group: 70 ± 16, sham: 10 ± 3, P < 0.01. Hepcidin (% staining/area) in heart STNx: 6.6 ± 0.8, sham: 0.8 ± 0.1; in kidney STNx: 9.7 ± 2.6, sham: 3.7 ± 0.9, P < 0.01. EPO (% staining/area) in heart STNx: 2.6 ± 0.4, sham: 0.8 ± 0.2; in kidney STNx: 10.2 ± 1.4, sham: 1.2 ± 0.6; P < 0.01. In STNx group positive caspase‐3, TNF‐α and IL‐6 were detected in heart and renal cells.

Conclusion:  Low LV performance is associated with iron deficiency anaemia in rats with CKD. Furthermore, overproduction of HIF‐1α and the activation of caspase‐3 seem to be associated with iron deficiency and with inflammatory markers. Hepcidin seems to plays a key role in this mechanism.
Colonial Governmentality and the Public Sphere in India
Authors: Kalpagam U
Published: September 2008

Colonial governmentality in India reconstituted the public sphere. New political rationalities that constituted modern governmental power and the liberal technologies of government effected a new conception of economy and society. Governmentality’s governance of colonial conduct in an improving direction socialized native public opinion to question the legitimacy of the colonial covenant. As native opinion against colonial rule sharpened, colonial liberalism had often to make a volte‐face of its liberal principle and was forced to suppress public opinion. Gandhi alone sought to overturn colonial governmentality and in doing so, provided a conception of public opinion that could transcend the limits of liberal reason.
Small cell carcinoma of the uterine cervix metastasizing to the bone marrow: A case report
Authors: Ota Tsuyoshi , Kitano Takamitsu , Miyai Kentaro , Ogishima Daiki , Yoshida Manabu , Miyake Kazunori , Kinoshita Katsuyuki
Published: September 2008

We report a case of small cell carcinoma (SmCC) of the uterine cervix that metastasized to the bone marrow. A 60‐year‐old woman with stage IIB SmCC of the cervix was treated with three courses of neoadjuvant chemotherapy followed by radical hysterectomy. Because of the presence of a large residual tumor, the patient underwent postoperative adjuvant chemotherapy. Two months after the last course of chemotherapy, severe pancytopenia developed, and erythroblastic cells were found in the peripheral blood. The hematological disorder was shown to be secondary to bone marrow metastasis, and no other metastases were found. The patient died of the disease 8 months after the initial diagnosis. This case suggests that SmCC of the cervix can metastasize to bone marrow, that such metastasis can occur in isolation and lead to severe pancytopenia, influencing the clinical course of the disease.
Iatrogenic ileal perforation: An accidental clamping of a hernia into the umbilical cord and a review of the published work
Authors: Asabe Koushi , Oka Yoichiro , Kai Hiroki , Shirakusa Takayuki
Published: September 2008

This report describes the case of an ileal perforation secondary to clamping of the exomphalos minor in 3‐day‐old girl. Eighteen accidental clamping or cutting cases were found in the published work. It is thought that this defect resulted from either the clamping, ligation or cutting of the bowel in a small unrecognized omphalocele. These complications are extremely rare, but should be held in mind when performing an umbilical ligation.
Cholangiocarcinoma in pregnancy: A case report
Authors: Marasinghe Jeevan P. , Karunananda S. Asoka , Angulo Paul
Published: September 2008

A 32‐year‐old pregnant woman underwent laparotomy for suspected intra‐abdominal mass lesion obstructing the biliary tree. Imaging studies revealed a mass in the fourth segment of the liver. Microscopic examination of the biopsy revealed a cholangiocarcinoma. The clinical course of the malignancy was worsened by her gravid state.
Case of Budd–Chiari syndrome 3 months after vaginal delivery
Authors: Hiroe Sasaki , Itoh Hiroaki , Matsumoto Hisanori , Takahasi Syhugen , Sato Yukiyasu , Yamada Shigetoshi , Okagaki Atsuhiko , Kuzushita Noriyoshi , Ban Chiaki
Published: September 2008

Budd–Chiari syndrome is a rather unusual clinical situation caused by occlusion of the hepatic vein of inferior vena cava, the classical triad of which are abdominal pain, ascites and hepatomegaly. A 29‐year‐old gravida 3 para 1 woman delivered an immature male baby weighing 2172 g with an Apgar score of 9 points at 35 weeks and 3 days of gestation. She was transferred to the National Hospital Organization Osaka National Hospital 112 days after delivery due to the sudden development of massive ascites. Magnetic resonance angiography and enhanced computed tomography detected the occlusion by thrombosis of both the middle and left hepatic veins, so she was diagnosed with Budd–Chiari syndrome. Her protein C antigen and activity were 37% and 50%, respectively, corresponding to type 1 protein C deficiency. Conservative treatment by continuous oral treatment of spironolactone (25 mg/day), furosemide (20 mg/day) and prophylactic warfarin (2 mg/day) much improved the ascites.
Exaggerated placental site reaction following an elective abortion
Authors: Hasegawa Toru , Matsui Kazuhiro , Yamakawa Yoshihiro , Ota Satoshi , Tateno Masaya , Saito Shigeru
Published: September 2008

We encountered a case of exaggerated placental site (EPS) reaction following an elective abortion. EPS is a miscellaneous trophoblastic lesion. There have been few reports describing its clinical course, and the ultrasonogram and magnetic resonance imaging characteristics have not been reported previously. We present the ultrasonogram and magnetic resonance imaging findings of EPS together with histopathological observations.
Management of two pregnancies in a woman with mixed connective tissue disease, pulmonary fibrosis, frequent pneumothorax and oxygen inhalation therapy along with a published work review
Authors: Hoshino Tatsuji , Kita Masato , Takahashi Takayuki , Nishimura Takashi , Yamakawa Masaru
Published: September 2008

Two pregnancies in a woman on oxygen inhalation therapy before pregnancy, due to pulmonary fibrosis and frequent pneumothorax that are secondary to mixed connective tissue disease, were managed safely. As usual for this condition, the patient was rather older and her ordinary daily life was restricted. This is a truly very rare case of a successful pregnancy in these circumstances. In a published work review using key words such as “pregnancy”, “mixed connective tissue disease” and “oxygen inhalation therapy”, no similar case could be found. For the management of such high‐risk patients, close cooperation of the obstetrician, clinical immunologist, clinical pneumologist and neonatologist in the same hospital is indispensable.
Group A Streptococcus causing a life‐threatening postpartum necrotizing myometritis: A case report
Authors: Lurie Samuel , Vaknine Hananya , Izakson Alexander , Levy Tally , Sadan Oscar , Golan Abraham
Published: September 2008

During childbirth, group A Streptococcus (GAS) can cause a diverse spectrum of disorders ranging from asymptomatic infection to puerperal sepsis and toxic shock syndrome. We report on a healthy parturient who survived a life‐threatening necrotizing myometritis due to GAS following an unremarkable spontaneous delivery. Approximately 29 h after an unremarkable spontaneous vaginal delivery, a generally healthy 28‐year‐old multiparous woman developed a life‐threatening necrotizing myometritis due to GAS. The patient subsequently underwent a total abdominal hysterectomy. Following the surgery, she made a prompt and complete recovery. The course of this extremely rare complication might be so fulminant that the diagnosis is sometimes made after the patient cannot be saved. Clinicians should still consider GAS in life‐threatening infections occurring during the perinatal period.
Fetoscopic laser photocoagulation of placental communicating vessels for twin‐reversed arterial perfusion sequence
Authors: Nakata Masahiko , Sumie Masahiro , Murata Susumu , Miwa Ichiro , Matsubara Masakazu , Sugino Norihiro
Published: September 2008

Twin‐reversed arterial perfusion (TRAP) sequence is a rare and compromised complication in monochorionic pregnancies. The retrograde blood flow through placental communicating vessels is mainly involved to develop the syndrome. Increased cardiac output in the pump twin can lead to severe clinical manifestations. Various surgical techniques to occlude vascular communications between the pump twin and acardiac twin have been reported. A woman with TRAP sequence, at 22 weeks of gestation, complicated with progressive polyhydramnios underwent fetoscopic laser photocoagualtion of vascular communications on the placental surface. Fetoscopic observation demonstrated one artery‐to‐artery anastomosis and one venous‐to‐venous anastomosis from the pump twin to the acardiac twin, and these communications were successfully photocoagulated. The patient delivered a 2308‐g female infant at 34 weeks and 1 day of gestation, following premature rupture of membrane. The infant is now 1 year old without any neurological problem. Fetoscopic laser photocoagulation of placental communicating vessels can be the procedure of choice for TRAP sequence.
Prenatal three‐dimensional ultrasonography in a case of agnathia‐otocephaly
Authors: Tantbirojn Patou , Taweevisit Mana , Sritippayawan Suchila , Tanawattanacharoen Somchai , Uerpairojkit Boonchai
Published: September 2008

A case of prenatally diagnosed agnathia‐otocephaly is reported. Agnathia is an extremely rare anomaly characterized by an absence or hypoplasia of the mandible and abnormal horizontal position of the ears. The targeted 2‐D ultrasonography at 24 weeks of gestation revealed abnormal lower facial profile. Surface rendering 3‐D ultrasonography was used to evaluate the facial feature, showing excellent image when compared to the fetal face at autopsy. The reported case is discussed with a short review of the literature.
Prenatal diagnosis of schizencephaly with septo‐optic dysplasia by ultrasound and magnetic resonance imaging
Authors: Hung Jeng‐Hsiu , Shen Shu‐Huei , Guo Wan‐You , Chen Chih‐Yao , Chao Kuan‐Chong , Yang Ming‐Jie , Hung Chia‐Yi Selena
Published: September 2008

A 28‐year‐old woman, gravida 1, para 0, was referred to our fetal diagnosis unit at 28+2 gestational weeks because no fetal movements were detected. On 2‐D ultrasonography, the cephalic axial view showed multiple hypoechoic spaces in the fetal brain, both cerebral cortex and occipital lobe showed bilateral defects, and the septum pellucidum was absent. Multiple irregularly shaped cystic lesions connected with subarachnoid spaces were observed by three‐dimensional ultrasonography in surface rendering mode. Septo‐optic dysplasia with dysgenesis of corpus callosum was confirmed by prenatal magnetic resonance imaging (MRI). The fetus was complicated with cleft schizencephaly involving bilateral frontal, parietal and occipital lobes, which can often lead to learning disability, epilepsy and cerebral palsy after birth. The flaccid mobility of all four extremities of the fetus, demonstrated prenatally by real‐time ultrasound and functional MRI, forecast the risk of postnatal spastic quadriplegia.
Acute right lower quadrant abdominal pain as the presenting symptom of ovarian vein thrombosis in pregnancy
Authors: Suleyman Turedi , Gultekin Hos , Abdulkadir Gunduz , Tevfik Patan , Abdulkerim Unsal Mesut , Ali Ahmetoglu , Ismail Koramaz
Published: September 2008

Ovari an vein thrombosis (OVT) is an uncommon, life‐threatening complication of pregnancy. OVT clinical presentation is similar to that of acute appendicitis, and the latter is therefore the suspected diagnosis in most cases. We describe a case of a 36‐year‐old woman experiencing deep vein thrombosis and pulmonary embolism during the course of pregnancy and presenting to the emergency department with sudden pain in the right lower quadrant and severe abdominal pain. This case illustrates the difficulty in diagnosing OVT, which should be considered in any pregnant woman with unexplained lower abdominal pain suggestive of acute appendicitis.
Transformation of vulvar pseudolymphoma (lymphoma‐like lesion) into a marginal zone B‐cell lymphoma of labium majus
Authors: Martorell Miguel , Gaona Morales John Jairo , Garcia Jose Angel , Manuel Gutierrez Herrera Jair , Grau Francisco Gozalbo , Calabuig Consuelo , Vallés Ana Pérez
Published: September 2008

Lymphomas arising in the female genital tract are extremely uncommon. Diffuse large B‐cell lymphoma and follicular lymphoma are the most common types. We describe the case of an 80‐year‐old woman with a recurrent lesion in the vulva initially diagnosed as a lymphoma‐like lesion and evolving 7 years later into a marginal zone B‐cell lymphoma (lymphoplasmacytic lymphoma). Diagnosis was based on the monotypic pattern of the plasmacellular component and the clonal rearrangement of immunoglobulin heavy chain genes. No previous cases of vulvar marginal zone B‐cell lymphoma arising in the context of a persistent lymphoma‐like lesion have been reported. We highlight the importance of differentiating benign from malignant lymphoid infiltrates in the vulva.