bluuebunny/crossref_metadata_2025 huggingface dataset:
A new histological classification for intra‐operative histological examination of the ductal resection margin in cholangiocarcinoma
Authors: Konishi Masaru , Ochiai Atsushi , Ojima Hidenori , Hasebe Takahiro , Mano Masayuki , Ohta Tamaki , Ito Ichiro , Sasaki Keiko , Yasukawa Satoru , Shimada Kazuaki , Iwasaki Motoki , Yanagisawa Akio
Published: December 2008

The purpose of this study was to establish a standard histological classification for intra‐operative histological examination of ductal resection margins in cholangiocarcinoma to distinguish between epithelial and intramural lesions and to clarify correlations between the new classification and clinical outcomes. Intra‐operative diagnosis of ductal margins was performed for 357 stumps from 216 patients undergoing surgical resection of cholangiocarcinoma at the National Cancer Center, Japan. Three expert pathologists reviewed the materials and established a histological classification defined by grade of atypia. The new classification comprised four categories: ‘insufficient’, insufficient for diagnosis due to distortion of specimen; ‘negative for malignancy’, no atypia suggestive of neoplasia; ‘undetermined lesion’, specimen showing either cellular or structural atypia; and ‘positive for malignancy’, specimen showing both cellular and structural atypia. Each category was defined to distinguish between epithelial and intramural lesions. Validity and reproducibility of the proposed classification were found to be moderate to substantial. Multivariate analyses using the clinicopathological factors identified to be associated with overall survival by univariate analyses indicated that patients diagnosed with ‘positive for malignancy’ in intramural lesions of the proximal margin displayed significant poor prognosis. Meanwhile, in patients diagnosed with ‘positive for malignancy’ or ‘undetermined lesion’ in epithelial lesions of the proximal margin, no difference in overall survival was apparent compared to patients diagnosed with ‘negative for malignancy’. We propose new histological classification for intra‐operative histological examination of ductal resection margins in cholangiocarcinoma that shows a correlation with patients’ prognosis and should facilitate the determination of ductal resection margin status for cholangiocarcinoma. (Cancer Sci 2009; 100: 255–260)
Strategy and mechanism for the prevention of hepatocellular carcinoma: Phosphorylated retinoid X receptor α is a critical target for hepatocellular carcinoma chemoprevention
Authors: Shimizu Masahito , Takai Koji , Moriwaki Hisataka
Published: December 2008

Hepatocellular carcinoma (HCC) is a major health care problem worldwide. The prognosis of patients with HCC is poor because even in the early stages when surgical treatment might be expected to be curative, the incidence of recurrence in patients with underlying cirrhosis is very high due to multicentric carcinogenesis. Therefore, strategies to prevent recurrence and second primary HCC are required to improve the prognosis. One of the most practical approaches to prevent the multicentric development of HCC is ‘clonal deletion’ therapy, which is defined as the removal of latent (i.e. invisible) (pre)malignant clones from the liver in a hypercarcinogenic state. Retinoids, a group of structural and functional analogs of vitamin A, exert their biological function primarily through two distinct nuclear receptors, retinoic acid receptors and retinoid X receptors (RXR), and abnormalities in the expression and function of these receptors are highly associated with the development of various cancers, including HCC. In particular, a malfunction of RXRα due to phosphorylation by the Ras–mitogen‐activated protein kinase signaling pathway is profoundly associated with the development of HCC and thus may be a critical target for HCC chemoprevention. Acyclic retinoid, which has been clinically shown to reduce the incidence of a post‐therapeutic recurrence of HCC, can inhibit Ras activity and phosphorylation of the extracellular signal‐regulated kinase and RXRα proteins. In conclusion, the inhibition of RXRα phosphorylation and the restoration of its physiological function as a master regulator for nuclear receptors may be a potentially effective strategy for HCC chemoprevention and clonal deletion. Acyclic retinoid, which targets phosphorylated RXRα, may thus play a critical role in preventing the development of multicentric HCC. (Cancer Sci 2009; 100: 369–374)
A comparison of sub‐Tenon’s with peribulbar anaesthesia in patients undergoing sequential bilateral cataract surgery
Authors: Budd M. , Brown J. P. R. , Thomas J. , Hardwick M. , McDonald P. , Barber K.
Published: December 2008

The aim of this study was to compare efficacy and particularly patient preference of sub‐Tenon’s anaesthesia with peribulbar anaesthesia in patients undergoing sequential, bilateral, cataract surgery. Fifty patients were randomised to either sub‐Tenon’s or peribulbar anaesthesia for their first operation and the alternative technique for their subsequent operation. Intra‐ocular pressure was measured, globe and lid akinesia were scored, patients completed a visual rating score of injection and operative pain and their preference for anaesthesia was assessed. Intra‐ocular pressure rose significantly following peribulbar injection (p = 0.02) but was comparable at 5 min. There was no significant difference in lid or globe movement. Injection and operative pain scores were low and comparable. Both methods provided similar anaesthesia and akinesia. The majority (86%) chose the method they received first irrespective of whether it was sub‐Tenon’s or peribulbar, but 10% of patients preferred sub‐Tenon’s, disliking the facial numbness from peribulbar anaesthesia.
Reliability of the anaerobic threshold in cardiopulmonary exercise testing of patients with abdominal aortic aneurysms*
Authors: Kothmann E. , Danjoux G. , Owen S. J. , Parry A. , Turley A. J. , Batterham A. M.
Published: December 2008

Anaerobic threshold (AT), determined by cardiopulmonary exercise testing (CPET), is a well‐documented measure of pre‐operative fitness, although its reliability in patient populations is uncertain. Our aim was to assess the reliability of AT measurement in patients with abdominal aortic aneurysms. Eighteen patients were recruited. CPET was performed four times over a 6‐week period. We examined shifts in the mean AT to evaluate systematic bias with random measurement error assessed using typical within‐patient error and intraclass correlation coefficient (ICC, 3,1) statistics. There was no significant or clinically substantial change in mean AT across the tests (p = 0.68). The typical within‐patient error expressed as a percentage coefficient of variation was 10% (95% CI, 8–13%), with an ICC of 0.74 (95% CI, 0.55–0.89). We consider the reliability of the AT to be acceptable, supporting its clinical validity and utility as an objective marker of pre‐operative fitness in this population.
The Diamedica Draw‐Over Vaporizer: a comparison of a new vaporizer with the Oxford Miniature Vaporizer
Authors: English W. A. , Tully R. , Muller G. D. , Eltringham R. J. J.
Published: December 2008

The Diamedica Draw‐Over Vaporizer (DDV) has been developed as an alternative to the Oxford Miniature Vaporizer (OMV). Both can function as draw‐over or plenum vaporizers. The performances of these two vaporizers were compared under conditions simulating intermittent positive pressure ventilation (IPPV) and continuous flow (CF). Series 1 experiments were conducted with the vaporizers in water baths at 20, 25 and 30 °C. Vaporizers were tested at dial settings of 1–4% over a range of minute volumes (1.75–6 l.min−1) and flow rates (3–8 l.min−1). Series 2 experiments compared output of the vaporizers over time at ambient temperatures of 20, 25 and 30 °C. A minute volume of 6 l.min−1 (IPPV) and a gas flow of 8 l.min−1 (CF) were used with a vaporizer setting of 2%. Vapour concentrations were recorded at 5‐min intervals. In series 1 IPPV experiments, the DDV vaporizer was more accurate, producing significantly fewer vapour concentrations 0.5% more than or less than setting (p = 0.013). The OMV tended to produce more favourable results under continuous flow (p = 0.42). In series 2 experiments, the accuracy of both vaporizers was similar but consistency of output over time was better for the DDV and consistency of output according to differences in ambient temperature was better for the DDV. The OMV produced more vapour concentrations that were markedly higher than dial setting, particularly at high ambient temperatures. The DDV is a suitable alternative to the OMV with some distinct advantages. These include a larger reservoir, tendency towards greater accuracy during IPPV and improved consistency of output.
An evaluation of a groupwork intervention for teenage mothers and their families
Authors: McDonald Lynn , Conrad Tammy , Fairtlough Anna , Fletcher Joan , Green Liz , Moore Liz , Lepps Betty
Published: December 2008

This paper describes the implementation of a specific, community‐based, multi‐family group (MFG) intervention strategy (Families and Schools Together [FAST] babies) aimed at improving the outcomes for infants of teenage mothers in 11 Canadian communities. The aims of this social work group intervention were (1) to engage the teenage mothers into a socially inclusive experience that might challenge the social disapproval they often experience, (2) to enhance the mother–infant bond, while increasing feelings of parental efficacy, and (3) to enhance the social context of the teenage mother by reducing stress, social isolation and intergenerational family conflict. Groups were co‐led by teams of service users (a young mother, a grandmother of the baby of a teenage mother and a father of the baby of a teenage mother) collaborating with multi‐agency professionals (health visitors and social workers). Teams that reflected the ethnic diversity of the participating family members were trained to facilitate eight weekly group meetings. They showed respect for the young women's ‘voice’, and supported her ‘choice’ to prioritize motherhood as her defining identity. The meetings comprised a range of activities, including crafts and singing, discussion of ‘conflict scenarios’ in cross‐familial, cross‐generational groups, infant massage delivered to babies by the young mothers, grandmother support groups, and a shared community meal. Where necessary, teams made referrals for specialist help. One hundred twenty‐eight young mothers came once to 17 groups, and 90% graduated having attended a minimum of six sessions. Evaluation data from mothers and grandmothers showed positive change when comparing pre and post, based on standardized questionnaires. One‐tailed, pairedt‐tests showed statistically significant increases in parental self‐efficacy for the teenage mothers, improved parent–child bonds, reductions in stress and family conflict, and increases in social support. Given that rates of teenage pregnancy in the UK are among the highest in Europe, this paper concludes with a discussion of the feasibility and possible merits of introducing FAST babies to England.
Allergy and autoimmune disease: a registry‐based study
Authors: Lindelöf B. , Granath F. , Tengvall‐Linder M. , Lindelöf H. , Ekbom A.
Published: December 2008

Background
Allergy and autoimmunity are two potential outcomes of a dysregulated immune system, but the relationship between them is unclear. It has been hypothesized that they could be inversely associated because of different T helper cell reactivity patterns. However, both positive and negative associations have been reported. Therefore, our aim was to perform a large epidemiological study with a defined allergic disease cohort.

Methods
During the years 1990–2002, 68 770 subjects were tested for total serum IgE (Total‐IgE) and 72 228 were tested with Phadiatop for diagnosing allergic disease at Karolinska University Hospital, Stockholm, Sweden. This cohort was then linked with the Swedish Inpatient Registry 1968–2004 for a follow‐up with regard to recorded discharges for 28 autoimmune diseases. We then used Cox regression and logistic regression to estimate the risk of autoimmune diseases in general in the allergy‐tested subjects.

Results
Subjects with positive Phadiatop test were at a statistically decreased risk of subsequent autoimmune disease in comparison with subjects with negative test; hazard ratio (HR): 0.80 [95% (Confidence interval) CI: 0.68–0.94). Prior autoimmune disease was associated with a decreased risk of positive Phadiatop test [odds ratio: 0.83 (95% CI: 0.72–0.96)] in comparison with negative test. Subjects with highly elevated Total‐IgE were at a statistically increased risk of a subsequent autoimmune disease in comparison with subjects with normal levels [HR: 1.36 (95% CI: 1.09–1.70)], but no association was found between prior autoimmune disease and different Total‐IgE levels.

Conclusion
The study supports the hypothesis that allergy, defined as positive Phadiatop test, could be inversely related to autoimmune disease but this association is weak.
Levothyroxine (LT4) suppression treatment for benign thyroid nodules alters coagulation
Authors: Demir Tevfik , Akinci Baris , Comlekci Abdurrahman , Karaoglu Oguzhan , Ozcan Mehmet Ali , Yener Serkan , Yuksel Faize , Secil Mustafa , Yesil Sena
Published: December 2008

Objective  Endogenous hyperthyroidism is associated with altered coagulation. The aim of the present study is to investigate the effect of levothyroxine (LT4) suppression treatment for benign thyroid nodules on coagulation system.

Design  Prospective case‐control study.

Patients  Thirty consecutive euthyroid pre‐menopausal women with nodular goitre disease and 28 healthy controls were included in the study.

Measurements  Plasma fibrinogen, d‐dimer, von Willebrand factor (vWF), tissue factor (TF), tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI‐1) and tissue factor pathway inhibitor (TFPI) levels were measured at baseline and after LT4 suppression therapy.

Results  Plasma levels of fibrinogen, d‐dimer, vWF, TF and PAI‐1 increased significantly after treatment with LT4 for 1 year. Serum FT4 was a significant predictor of increased fibrinogen, vWF and PAI‐1 levels, when the data was controlled for age and BMI.

Conclusions  Our results suggest that LT4 suppression therapy for benign thyroid nodules is associated with enhanced coagulation.
Role of aldosterone and angiotensin II in insulin resistance: an update
Authors: Lastra‐Lastra Guido , Sowers James R. , Restrepo‐Erazo Katherine , Manrique‐Acevedo Camila , Lastra‐González Guido
Published: December 2008

The role of the Renin–Angiotensin–Aldosterone system (RAAS) on the development of insulin resistance and cardiovascular disease is an area of growing interest. Most of the deleterious actions of the RAAS on insulin sensitivity appear to be mediated through activation of the Angiotensin II (Ang II) Receptor type 1 (AT1R) and increased production of mineralocorticoids. The underlying mechanisms leading to impaired insulin sensitivity remain to be fully elucidated, but involve increased production of reactive oxygen species and oxidative stress. Both experimental and clinical studies also implicate aldosterone in the development of insulin resistance, hypertension, endothelial dysfunction, cardiovascular tissue fibrosis, remodelling, inflammation and oxidative stress. There is abundant evidence linking aldosterone, through non‐genomic actions, to defective intracellular insulin signalling, impaired glucose homeostasis and systemic insulin resistance not only in skeletal muscle and liver but also in cardiovascular tissue. Blockade of the different components of the RAAS, in particular Ang II and AT1R, results in attenuation of insulin resistance, glucose homeostasis, as well as decreased cardiovascular disease morbidity and mortality. These beneficial effects go beyond to those expected with isolated control of hypertension. This review focuses on the role of Ang II and aldosterone in the pathogenesis of insulin resistance, as well as in clinical relevance of RAAS blockade in the prevention and treatment of the metabolic syndrome and cardiovascular disease.
Pushing the vibrator ground‐force envelope towards low frequencies
Authors: Wei Zhouhong
Published: December 2008

Several mechanical and hydraulic limitations hinder the ground‐force energy output of a seismic vibrator at low frequencies. The hydraulic pump flow, pump response time, reaction mass stroke, servo valve stroke, engine horsepower, accumulator size, harmonic distortion and vehicle chassis isolation each play a role in limiting the ground‐force energy output of vibrators. In addition, the peak‐decoupling force – which is defined as the smaller value of either the maximum peak force or the hold‐down weight – also plays a role in limiting ground‐force energy production. A model useful for simulating seismic vibrator dynamics is developed to evaluate the impact of these parameters on the vibrator fundamental force envelope at low frequencies. Model data show that among these factors the reaction mass stroke and the peak‐decoupling force are key parameters for setting the target fundamental force that can be achieved at low frequencies. Formulas are derived to estimate fundamental force, peak force and the reaction mass displacement. These formulas can serve as guidelines for sweep designers who plan to design low frequency sweeps with considerable dwell time in the lower frequency ranges. Test data show that formulas can be used to profile the vibrator envelope at low frequencies.
Comparison of scaling methods for waveform inversion
Authors: Jang Ugeun , Min Dong‐Joo , Shin Changsoo
Published: December 2008

Waveform inversion can lead to faint images for later times due to geometrical spreading. The proper scaling of the steepest‐descent direction can enhance faint images in waveform inversion results. We compare the effects of different scaling techniques in waveform inversion algorithms using the steepest‐descent method. For the scaling method we use the diagonal of the pseudo‐Hessian matrix, which can be applied in two different ways. One is to scale the steepest‐descent direction at each frequency independently. The other is to scale the steepest‐descent direction summed over the entire frequency band. The first method equalizes the steepest‐descent directions at different frequencies and minimizes the effects of the band‐limited source spectrum in waveform inversion. In the second method, since the steepest‐descent direction summed over the entire frequency band is divided by the diagonal of the pseudo‐Hessian matrix summed over the entire frequency band, the band‐limited property of the source wavelet spectrum still remains in the scaled steepest‐descent directions. The two scaling methods were applied to both standard and logarithmic waveform inversion. For standard waveform inversion, the method that scales the steepest‐descent direction at every frequency step gives better results than the second method. On the other hand, logarithmic waveform inversion is not sensitive to the scaling method, because taking the logarithm of wavefields automatically means that results for the steepest‐descent direction at each frequency are commensurate with each other. If once the steepest‐descent directions are equalized by taking the logarithm of wavefields in logarithmic waveform inversion, the additional equalizing effects by the scaling method are not as great as in conventional waveform inversion.
Experimental oesophagitis in the rat is associated with decreased voluntary movement
Authors: Miwa H. , Oshima T. , Sakurai J. , Tomita T. , Matsumoto T. , Iizuka S. , Koseki J.
Published: December 2008

Abstract  Growing interest has arisen regarding the mechanism of dyspeptic symptom generation. However, no evaluation system of these symptoms in animals has been developed. In this study, we examined whether voluntary movement of rats could be a measure to assess visceral symptoms of reflux oesophagitis. A chronic acid reflux oesophagitis model was made using rats, and the size of erosions was measured. Omeprazole was administered to the oesophagitis rats for 10 days. The amount of voluntary movement was measured by an infrared sensor. Intracellular spaces in oesophageal epithelium were also measured using a emission electron microscope. NP‐40 soluble and insoluble fractions of claudins were examined by Western blot. Voluntary movement was significantly lower in the oesophagitis model rats than in the sham‐operated rats (P < 0.01). Although omeprazole reduced the size of erosions, it did not significantly affect the total amount of voluntary movement (r = −0.033, P = 0.916). Intracellular spaces were significantly dilated in the oesophagitis model rats and claudin‐3 showed a significantly lower relative quantity in the NP‐40 insoluble fraction. Omeprazole significantly increased voluntary movement of oesophagitis model rats and the relative quantity of claudin‐3 in the insoluble fraction (P < 0.05). Dilated intercellular spaces and the lower level of claudin‐3 may relate to the voluntary movement of oesophagitis model rats. Decreases in voluntary movement of oesophagitis model rats may reflect visceral symptoms and be able to serve as an index of chronic abdominal symptoms.
Inhibition of endothelial cell adhesion molecule expression improves colonic hyperalgaesia
Authors: Winchester W. J. , Johnson A. , Hicks G. A. , Gebhart G. F. , Greenwood‐van Meerveld B. , Mclean P. G.
Published: December 2008

Abstract  Leucocyte–endothelial cell interactions are prerequisite to leucocyte infiltration and intestinal inflammation. GI270384X is a novel inhibitor of ICAM‐1 and E‐selectin expression and inhibits leucocyte adhesion and improves experimental colitis. We hypothesized that GI270384X maybe effective in treatment of visceral hyperalgaesia. Visceromotor behavioural responses to colorectal distension (CRD) were obtained in naïve rats or rats treated with zymosan (3 h) or 2,4,6‐trinitrobenzene sulphonic acid (TNBS) (4 and 30 days) or rats exposed to acute restraint stress. Studies were also performed in a high‐anxiety genetic model of colonic hyperalgaesia using Wistar–Kyoto (WKY) rats. Rats were treated orally with GI270384X or vehicle either prior to or after the administration of sensitizing stimulus. The visceromotor response to CRD was significantly enhanced in all models. GI270384X attenuated the enhanced responses to distension induced by inflammatory stimuli (TNBS and zymosan) and in the high‐anxiety WKY rats; however, the drug did not inhibit the hypersensitivity induced by acute restraint stress. GI270384X was most potent in the models of acute inflammatory hyperalgaesia with a minimum efficacious dose (MED) of 0.3 and 1 mg kg−1 observed in the TNBS and zymosan models respectively. The compound was less potent in the chronic and postinflammatory models with an MED of 10 and 30 mg kg−1 observed in the WKY and 30‐day TNBS models respectively. These findings show for the first time that inhibition of leucocyte–endothelial cell interactions can have a beneficial effect on visceral hyperalgaesia associated with inflammatory and chronic anxiety states, but is less effective against stress‐associated visceral hyperalgaesia.
BioCycle study: design of the longitudinal study of the oxidative stress and hormone variation during the menstrual cycle
Authors: Wactawski‐Wende Jean , Schisterman Enrique F. , Hovey Kathleen M. , Howards Penelope P. , Browne Richard W. , Hediger Mary , Liu Aiyi , Trevisan Maurizio
Published: December 2008

Studies in both human and animal species have suggested that oxidative stress may be associated with health outcomes, including the risk of infertility in both males and females. Sex hormones have been shown to have antioxidant properties. The difficulty in studying the role of oxidative stress in females is partly due to fluctuation in these endogenous sex hormones across the menstrual cycle.

The aim of this study was to determine the association of oxidative stress levels with endogenous reproductive hormone levels and antioxidants, including vitamin levels, across the menstrual cycle in a prospective cohort of premenopausal women. The goal was to enrol 250 healthy, regularly menstruating premenopausal women for two menstrual cycles. Participants visited the clinic up to 8 times per cycle, at which time blood and urine were collected. The visits occurred at key hormonally defined phases of the menstrual cycle, with the help of an algorithm based on cycle length and data from a fertility monitor. In addition, participants were administered standardised questionnaires, had various physical measures taken, and had other pertinent data collected. A total of 259 women were enrolled in this study, with 250 completing two cycles, despite a demanding study protocol which participants were required to follow. This report describes the study design, baseline characteristics and visit completion rate for the BioCycle study.
Neural tube defects: an analysis of neighbourhood‐ and individual‐level socio‐economic characteristics
Authors: Grewal Jagteshwar , Carmichael Suzan L. , Song Jun , Shaw Gary M.
Published: December 2008

Several studies have reported that neural tube defects (NTD) occur more frequently among children born to women of lower socio‐economic status (SES). This study investigated the relationship between individual‐ and neighbourhood‐level SES and the risk of an NTD‐affected pregnancy. Data were drawn from a population‐based case‐control study of fetuses and infants among a cohort of California births between July 1999 and June 2003. Information on individual SES was obtained via telephone interviews with mothers of 337 (76% of eligible) cases and 626 (79% of eligible) non‐malformed liveborn controls. Respondents' addresses were linked to the 2000 US Census to characterise six measures of neighbourhood SES (education, poverty, unemployment, occupation, crowding and rental occupancy).

The analyses indicated that relative to women with a high school education, those with less than a high school education had a 1.7‐fold increased risk of delivering infants with NTDs [95% CI 1.2, 2.6]. Twofold elevated risks for NTDs were observed for women with less than a high school education who lived in neighbourhoods where a majority of residents had not graduated from high school [95% CI 1.3, 3.1]. No consistent risk gradients were observed between NTD‐affected pregnancies and indicators of lower neighbourhood SES. Results for phenotype subgroups were similar to those for all cases. Low maternal education was associated with an elevated risk of NTD in offspring. This risk varied by the education profile of the neighbourhood: women who did not graduate from high school and lived in less educated neighbourhoods exhibited a higher risk.
Allergic rhinitis in children: Incidence and treatment in Dutch general practice in 1987 and 2001
Authors: De Bot Cindy M. A. , Moed Heleen , Schellevis François G. , De Groot Hans , Van Wijk Roy Gerth , Van Der Wouden Johannes C.
Published: December 2008

Allergic rhinitis is a common chronic disorder in children, mostly diagnosed in primary health care. This study investigated the national incidence and treatment of allergic rhinitis among children aged 0–17 yr in Dutch general practice in 1987 and 2001 to establish whether changes have occurred. A comparison was made with data from the first (1987) and second (2001) Dutch national surveys of general practice on children aged 0–17 yr. Incidence rates were compared by age, sex, level of urbanization and season. The management of the general practitioner was assessed regarding drug prescriptions and referrals to medical specialists, and compared with the clinical guideline issued in 1996. The incidence rate of allergic rhinitis increased from 6.6 (1987) to 9.2 (2001) per 1000 person‐years. We found a male predominance with a switch in adolescence to a female predominance at both time points. The increase in incidence was the highest in rural (<30,000 inhabitants) and suburban areas (30,000–50,000 inhabitants). Compared to 1987, there was a significant increase in incidence in the central part of the Netherlands in 2001. In both years, the incidence was higher in spring compared with the other seasons. In 2001, children of natives and western immigrants visited the general practitioner more often with complaints of allergic rhinitis compared to 1987. In 1987, prescribed medication consisted mainly of nasal corticosteroids (36%) and in 2001 of oral antihistamines (45%). Although a clinical guideline was not issued until 1996, overall, the treatment of allergic rhinitis by general practitioners was in both years in accordance with the current clinical guideline, but with a stronger adherence in 2001. The results show an increased incidence in the past decades of allergic rhinitis in children in Dutch general practice. The shift to a smaller spectrum of prescriptions in 2001 may be a result of the 1996 clinical guideline.
Significance of pre‐storage leucoreduction for autologous blood
Authors: Tasaki T. , Ohto H. , Sasaki S. , Kanno T. , Igari T. , Hoshi Y.
Published: December 2008

Background and Objectives  To reveal the associations between cytokines in blood and transfusion‐related adverse events, we studied whether pre‐storage leucoreduction of autologous blood could reduce the degree of inflammatory responses, infection rates, or the duration of hospitalizations.

Materials and Methods  Patients scheduled to donate autologous blood for elective orthopaedic surgery were assigned to receive either leucoreduced (LR) or non‐leucoreduced (N‐LR) autologous blood based on their date of birth. Levels of cytokines in the autologous blood, values for C‐reactive protein, complete blood count and body temperature of the patients, as well as adverse clinical events, were evaluated periodically.

Results  Four hundred patients entered this study (LR group: 196, N‐LR group: 204). The production of cytokines, excluding interleukin 1β (IL‐1β), was suppressed for the LR group. However, for unknown reasons, IL‐1β actually increased during storage for the LR group. There were no differences between the two groups in the length of hospital stay, postoperative C‐reactive protein changes, leucocyte count, or body temperature, and no clinical problems associated with blood transfusion were observed in either group.

Conclusion  Pre‐storage leucoreduction for autologous blood may be effective to suppress cytokine accumulation. However, clinical benefits such as prevention of febrile non‐haemolytic reactions could not be demonstrated.
Expression of apoptotic tumour necrosis factor receptor‐associated factor, caspase recruitment domain and cell death‐inducing DFF‐45 effector genes in therapy‐treated renal cell carcinoma
Authors: RAJANDRAM RETNAGOWRI , PAT BETTY K , LI JUN , JOHNSON DAVID W , GOBE GLENDA C
Published: December 2008

Aim:  Dysfunction in apoptosis plays a role in development of renal cell carcinoma (RCC). This investigation aimed to identify expression of apoptosis‐related genes not previously characterized in human RCC.

Methods:  The RCC ACHN cell line was treated with radiation plus interferon‐alpha to induce significant apoptosis. Apoptosis RNA microarrays were used to compare control and treated RCC for apoptosis‐regulatory genes with significantly altered expression (≥twofold). Translational correlates were analysed using western blot. Immunohistochemistry of human RCC and non‐cancerous kidney in tissue microarrays was also completed.

Results:  Several gene families, not well characterized in RCC, were significantly upregulated in RNA microarray. These were the tumour necrosis factor receptor‐associated factors (TRAF1, 3 and 4), caspase recruitment domain (NOL3 and PYCARD), and cell death‐inducing DFF‐45 effector domain (ICAD/CAD) genes. The protein expression patterns did not always increase similarly, perhaps indicating some post‐transcriptional controls needing further investigation. TRAF1 had significantly increased expression for RNA and protein (P < 0.01). NOL3 had significantly decreased whole‐cell protein expression (P < 0.05), but had strongly localized nuclear positivity in RCC in the immunohistochemistry.

Conclusion:  These newly identified RCC apoptosis genes have shown potential for improving outcome in other cancers and may prove to have the same potential in RCC with further study.
Serial monitoring of nutritional status in Chinese peritoneal dialysis patients by Subjective Global Assessment and comprehensive Malnutrition Inflammation Score
Authors: CHENG TIMOTHY HUA‐TSE , LAM DEBBY HIU‐HA , TING STEVEN KONG‐LING , WONG CLAUDIA LAI‐YIN , KWAN BONNIE CHING‐HA , CHOW KAI‐MING , LAW MAN‐CHING , LI PHILIP KAM‐TAO , SZETO CHEUK‐CHUN
Published: December 2008

Aim:  The Malnutrition Inflammation Score (MIS) has been proposed for the assessment of nutritional status in peritoneal dialysis (PD) patients. The MIS and the Subjective Global Assessment (SGA) for serial monitoring of nutritional status in PD patients were compared.

Methods:  The change in the MIS and SGA overall score of 59 PD patients (28 male) over 12 months was studied. Clinical factors relating to the discrepancy between the two instruments were explored.

Results:  The average patient age was 55.8 ± 9.7 years. Thirty of the 59 patients (50.8%) had exact agreement in the changed MIS and SGA scores. Cohen's κ score was 0.274, indicating a modest degree of agreement. For the detection of deterioration in nutritional status and using the MIS as the reference measure, the SGA had a sensitivity of 61.9% and specificity of 86.8%; serum ferritin level was substantially higher in the ones whose SGA did not detect a deterioration in nutrition (1464.1 ± 873.3 vs 800.5 ± 561.6 pmol/L, P = 0.046). For the detection of improvement in nutritional status, the SGA had a sensitivity of 45.8% and specificity of 82.9%; patients whose SGA did not detect an improvement in nutrition were dialyzed longer (53.8 ± 35.3 vs 27.6 ± 18.9 months, P = 0.038), had higher total iron binding capacity (TIBC) (45.6 ± 5.5 vs 38.2 ± 8.1 µmol/L, P = 0.015), had higher total Kt/V (2.02 ± 0.36 vs 1.75 ± 0.23, P = 0.048) and higher normalized protein nitrogen appearance (1.16 ± 0.25 vs 0.95 ± 0.23 g/kg per day, P = 0.048).

Conclusion:  The longitudinal changes in the MIS and SGA score have modest agreement with each other. However, PD patients with a longer duration of dialysis, higher serum ferritin, TIBC, total Kt/V or normalized protein nitrogen appearance tend to have discrepancies between the longitudinal changes in the MIS and SGA overall score.
Increased risks of chronic kidney disease associated with prescribed Chinese herbal products suspected to contain aristolochic acid
Authors: LAI MING‐NAN , LAI JUNG‐NIEN , CHEN PAU‐CHUNG , TSENG WEI‐LUM , CHEN YA‐YIN , HWANG JING‐SHIANG , WANG JUNG‐DER
Published: December 2008

Aim:  Nephropathy associated with aristolochic acid (AA) has been documented by human and animal studies. Ancient Chinese herbology claimed to reduce toxicity in their mixtures. It was the objective of this study to determine the risk of chronic kidney disease (CKD) associated with AA‐related Chinese herbal products (CHP) or mixtures of herbs in a national cohort.

Methods:  A retrospective follow‐up study was conducted, using a systematic random sample (200 000 people) in the National Health Insurance reimbursement database during 1997–2002. The incidence rates of CKD and end‐stage renal disease (ESRD) were calculated for the whole sample and those that had used CHP suspected to contain AA. Cox regression models were constructed to control potential confounders, including age, sex, hypertension, diabetes mellitus, and use of non‐steroidal anti‐inflammatory drugs and acetaminophen.

Results:  A total of 199 843 persons were included in the final analysis, 102 464 (51.3%) men and 97 379 (48.7%) women, with an average incidence rate of 1964/106 person‐years for CKD and 279/106 person‐years for ESRD. After controlling other risk factors, the hazard ratios for development of CKD seemed to increase for patients that had consumed more than 30 g Mu‐Tong, and more than 60 g Fangchi.

Conclusion:  Prescription of more than 30 g Mu‐Tong or more than 60 g Fangchi CHP was associated with an increased risk of developing CKD. In addition to prohibiting the use of Guan‐Mu‐Tong and Guang‐Fangchi, patients who have used these CHP should continue to be followed up.
Purinergic receptor‐mediated effects of adenosine 5′‐triphosphate in urological malignant diseases
Authors: Shabbir Majid , Burnstock Geoffrey
Published: December 2008

Adenosine 5′‐triphosphate (ATP) mediates a variety of biological functions and has been shown to play a physiological role in almost every system in the body. In the genito‐urinary system, extracellular ATP has been shown to play a functional role in several different capacities, ranging from nociception in the ureter and bladder, to erectile dysfunction via its action on different ‘purinergic receptors’. Discovery of the trophic effects of ATP has led to a surge in interest in this signalling system in various malignancies. To date five P2 receptor subtypes have been implicated in the growth inhibition of cancer cells, namely P2X5, P2X7, P2Y1, P2Y2and P2Y11. Limited data are available on urological malignancies. ATP induces its anti‐neoplastic effect primarily via purinergic receptor‐mediated apoptosis via calcium‐independent pathways, and this has been confirmedin vitroandin vivo. Studies have highlighted functional roles for the P2X5and/or P2Y11receptors in both hormone refractory prostate cancer and high‐grade bladder cancer, although the contributory effect of pro‐apoptotic P2X7receptors remains unclear. Clinical trials have shown intravenous ATP successfully attenuates a range of systemic symptoms associated with advanced malignancies. This raises the possibility that selective targeting of specific aberrant pathways may allow for treatment of advanced primary malignancies and their systemic effects.
Implications of insulin‐like growth factor‐I for prostate cancer therapies
Authors: Kojima Satoko , Inahara Masahiko , Suzuki Hiroyoshi , Ichikawa Tomohiko , Furuya Yuzo
Published: December 2008

In the last decade, abundant evidence has suggested that the insulin‐like growth factor (IGF) family comprises a multi‐component network of molecules involved in the regulation of both physiological and pathological growth processes in the prostate. The IGF axis plays an important role in the tumorigenesis and neoplastic growth of prostate cancer. Epidemiological observations indicate that circulating IGF‐I levels are positively associated with increased risk of prostate cancer. Activation of IGF‐I receptor (IGF‐IR) by IGF‐I has mitogenic and anti‐apoptotic effects on normal and malignant prostate cells. Therapeutic alternatives in men with progressive prostate cancer after androgen ablation are very limited and more effective therapies are needed for such patients. Inactivation of the IGF‐I axis represents a potential target to treat androgen‐independent prostate cancer. This review addresses epidemiological studies of IGF‐I and therapeutic strategies including reduction of IGF‐I levels, inhibition of IGF‐IR and the signaling mechanisms involved.
THE URINARY ASPECTS OF PARAPLEGIA
Authors: DICK T. B. S.
Published: December 2008

The writer has reviewed in retrospect some of the problems arising from the urological aspect in 187 paraplegics admitted to Winwick Spinal Centre between February 1940 and June 1946.

He found that posture appeared to play a major part in the control of infection, also that a closed bladder of the reflex cord or cauda equina type was the most satisfactory end result. Examination of seventeen further cases at least three and a half years after injury appears to confirm these findings. The problem of early bladder drainage is reviewed; the prevention of calculi, the abolition of residual urine, and urinary antiseptics are discussed and certain conclusions drawn.

My thanks are due to Dr Fergus Ferguson and Sir Geoffrey Jefferson who were responsible for stimulating my interest in this work and made it possible for me to re‐examine the cases at Lyme Green, and who have always been ready with valuable advice.
A FURTHER CASE OF HYPERNEPHROMA METASTASISING TO THE THYROID
Authors: BENNETT W. E. J.
Published: December 2008

1. Twenty cases of hypernephroma metastasising to the thyroid have been collected and one has been added.

2. An account of this case which had misleading features is given.

3. In all cases of growths exhibiting unusual features a carcinoma of the kidney should be excluded.

My thanks are due to Sir Cecil Wakeley for permission to publish the clinical details of this case and for his encouragement, to Professor H. A. Magnus for the use of the pathological reports and helpful advice, to Dr J. Blewett for permission to reproduce the radiological findings, and to Mr Smith for the photographs.
FENWICK'S ULCER
Authors: HICKEY B. BRENDAN
Published: December 2008

A case of Fenwick's ulcer of the bladder is described.

The symptomatology, aetiology, and treatment of this condition are discussed.

I am indebted to Dr M. E. Sharp, B.Sc, L.R.C.P., M.R.C.S., for the description of the morbid histology.
THE BLOOD SUPPLY OF THE HUMAN URETER IN RELATION TO URETEROCOLIC ANASTOMOSIS1
Authors: DANIEL OWEN , SHACKMAN RALPH
Published: December 2008

Any method of ureterocolic anastomosis in which the ureter is always divided at the same point, or mobilised for more than 2–5 cm., irrespective of its blood supply, is liable to failure, due to ischsemic necrosis of the ureter, in 10 to 15 per cent, of subjects.

As the result of a study of the blood supply of the ureters of fifty cadavers it is suggested that ureters may be safely divided 2 cm. below the point of entry of a pulsating, long, ureteric artery, or in the absence of such, 2 cm. below the bifurcation of the common iliac artery.
THE MICTURATING CYSTO‐URETHROGRAM IN RELATION TO FUNCTION AFTER PROSTATECTOMY 1
Authors: Frain‐Bell Lockhart , Grieve John
Published: December 2008

A simple technique of micturating cysto‐urethrography is described. Forty‐two patients have been examined post‐operatively in this way (twenty‐eight retropubic and fourteen transvesical). These cysto‐urethrograms have in general afforded radiographic confirmation of good clinical results, and have shown probable causes such as diverticula, ureteric, and seminal reflux for poor clinical results in the others.

Seven patients were unable to micturate after the introduction of radio‐opaque medium, and on screening all of them showed a characteristic upward convexity of the anterior bladder wall.
PERIURETERITIS PLASTICA: A REPORT OF A CASE, WITH INDICATIONS OF THE PROBABLE PATHOLOGY
Authors: Houston William
Published: December 2008

A case is described of a condition not previously reported in British urological literature, resembling the“periureteritis plastica”of Vest and Barclare (1953).

 It is suggested that the lesion is due to infection partially controlled by antibiotics, leading to pathological changes resembling those associated with the infective granulomata.
PARTIAL NEPHRECTOMY FOR TUBERCULOSIS OF A SOLITARY KIDNEY
Authors: Leask L. R.
Published: December 2008

A case of partial nephrectomy for tuberculosis of a solitary kidney is reported. Thirty months afterwards the patient remains well and free from a detectable recurrence.
THE TREATMENT and PROGNOSIS OF CARCINOMA OF PENIS
Authors: Savage C. R.
Published: December 2008

A series of eighteen cases of carcinoma of the penis is presented in which treatment has been carried out by radiotherapy or surgery.

 The incidence of metastatic inguinal gland involvement was low, and only one patient is so far known to have died of his disease.

 The problem of the prevention of stricture formation following partial amputation is discussed.

 Conservative management was found satisfactory in most cases and reduced both post‐operative morbidity and disability to a minimum.
NEPHROSTOMY
Authors: Tresidder G. C.
Published: December 2008

Two cases are described illustrating the improved results obtainable by the use of through‐and‐through nephrostomy compared with the ordinary type of operation. This method assures adequate drainage of the kidney and complete control of the tube and also facilitates its regular changing.
DIVERTICULUM OF THE FEMALE URETHRA: CASE REPORT and REVIEW OF THE LITERATURE
Authors: Lane Victor
Published: December 2008

Diverticula of the female urethra have frequently been reported from the United States in the last twenty years, but reference to them in the British literature has been scanty. They can be diagnosed only by being aware of their existence (and possibly greater frequency), and by adequate examination of the urethra.

The morbid anatomy, Etiology, symptoms, and diagnosis are described.

In the past the majority of cases were treated by excision, but attention is drawn to a new method devised by Ellik.

A case of female urethral diverticulum containing a calculus is reported. It was treated satisfactorily by Ellik's method.
NON‐PARASITIC CHYLURIA
Authors: Grieve John , Thomson James
Published: December 2008

Intermittent non‐filarial chyluria occurring on rising is described in a healthy man of 43. Renal function was normal, but human tubercle bacilli were cultured from the urine.

Pyelovenous and pyelolymphatic backflow was shown on the affected left side, in which there was evidence of ureteric obstruction.

A prolonged course of streptomycin and I.N.A.H. has been followed by almost complete remission for one year.
DEMONSTRATION OF RENAL LYMPHATICS IN VIVO BY INTRAVENOUS INJECTION OF DYE: THE EFFECT OF LYMPHATIC LIGATURE ON THE BLOOD‐PRESSURE
Authors: Barer Gwenda R. , Ward‐McQuaid J. N.
Published: December 2008

Renal lymphatics become filled with certain dyes when these are given intravenously, facilitating operations upon them. In forty rabbits all visible renal lymphatics were ligated but no significant rise in blood‐pressure or histological change ensued. Lymph flow was probably re‐established rapidly and could usually be demonstrated after three weeks.
TREATMENT OF BLADDER CANCER BY MEGAVOLTAGE THERAPY1
Authors: SWINNEY JOHN
Published: December 2008

An account has been given of the use of megavoltage X‐ray therapy in the treatment of bladder cancer. Technically and clinically its use has many advantages over conventional X‐ray treatment, and therapeutically the results may be better.
THE NEPHROPLASTY PROCEDURE IN THE TREATMENT OF HYDRONEPHROSIS1
Authors: STEWART H. HAMILTON
Published: December 2008

The technique of the nephroplasty operation has been described. The operation was originally devised for the relief of hydronephrosis due to a lower polar artery. It has now been shown that nephroplasty also improves the hydrodynamics of a hydronephrotic kidney and eliminates or reduces residual urine in the kidney once the cause of the obstruction has been removed.
RARE RENAL TUMOURS: WITH SPECIAL REFERENCE TO THOSE OCCURRING IN CHILDREN1
Authors: MOGG RICHARD A.
Published: December 2008

Three rare renal tumours are reported: a renal embryoma, a carcinoma of the renal tubules, and a large liposarcoma of the kidney. The renal embryoma occurred in a premature infant on whom nephrectomy was successfully performed (this being the youngest nephrectomy in the world literature). The incidence and classification of the tumours have been discussed, together with a review of the literature.
URETHROPLASTY: AN ASSESSMENT AFTER SEVEN YEARS‘ EXPERIENCE1
Authors: SWINNEY JOHN
Published: December 2008

An attempt has been made to remove stricture of the urethra and to correct and prevent the complications of the condition by radical excision and reconstruction of the urethra, using a strip of buried skin. The results of the investigation are encouraging, and with achievement of greater technical ability many of the minor difficulties encountered should be overcome. The only real disadvantage of the operation to the patient is the long period of hospitalisation which may be necessary, two to three months being an average time, but most patients who have suffered severely for years are only too ready to seize on any suggestion which might offer them a hope of healthy life.