bluuebunny/crossref_metadata_2025 huggingface dataset:
Outbreak of leptospirosis in New Caledonia: diagnosis issues and burden of disease
Authors: Goarant C. , Laumond‐Barny S. , Perez J. , Vernel‐Pauillac F. , Chanteau S. , Guigon A.
Published: June 2009

A leptospirosis epidemic affected New Caledonia during the first semester of 2008. A total of 135 cases were diagnosed with a relatively low fatality rate of 3.7%. Heavy rainfalls, related to La Niña, favoured this epidemic. The PCR, routinely used, confirmed 54% of the cases, and the microagglutination test 56%. Epidemiological and economical data on this epidemic are presented and discussed.
Nutritional status of Malawian adults on antiretroviral therapy 1 year after supplementary feeding in the first 3 months of therapy
Authors: Ndekha MacDonald , Van Oosterhout Joep J. G. , Saloojee Haroon , Pettifor John , Manary Mark
Published: June 2009

Objective  To test the hypothesis that individuals on antiretroviral therapy (ART) for 3 months with a greater body mass index (BMI) as a result of supplementary feeding with ready‐to‐use fortified spread would maintain a higher BMI 9 months after the feeding ended.

Methods  Two cohorts of wasted adults with AIDS, after 12 months of ART and 3 months of supplementary feeding with either ready‐to‐use fortified spread, an energy dense lipid paste; or corn/soy blended flour, were assessed for clinical and anthropometric status, quality of life, and ART adherence after 3 and 9 months.

Results  336 ART patients participated: 162 who had received ready‐to‐use fortified spread and 174 who had received corn/soy blended flour. 9 months after stopping food supplements, both groups had a similar BMI, fat‐free body mass, hospitalization rate and mortality. Binary logistic regression modelling showed that lower BMI, lower CD4 count, and older age at baseline were associated with a higher risk of death (odds ratio for BMI = 0.63, 95% CI 0.47–0.79). Adherence to the ART regimen and quality of life were similar in both cohorts.

Conclusion  While supplementary feeding with ready‐to‐use fortified spread can ameliorate the BMI, an established risk factor for mortality, this effect is sustained only during the time of the intervention. Supplementary feeding of wasted patients for longer than 3 months should be investigated.
Severe malaria and concomitant bacteraemia in children admitted to a rural Mozambican hospital
Authors: Bassat Quique , Guinovart Caterina , Sigaúque Betuel , Mandomando Inácio , Aide Pedro , Sacarlal Jahit , Nhampossa Tacilta , Bardají Azucena , Morais Luís , Machevo Sonia , Letang Emilio , Macete Eusébio , Aponte John J. , Roca Anna , Menéndez Clara , Alonso Pedro L.
Published: June 2009

Objectives  To describe the prevalence, aetiology and prognostic implications of coexisting invasive bacterial disease in children admitted with severe malaria in a rural Mozambican Hospital.

Methods  Retrospective study of data systematically collected from June 2003 to May 2007 in a rural Mozambican hospital, from all children younger than 5 years admitted with severe malaria.

Results  Seven thousand and forty‐three children were admitted with a diagnosis of malaria. 25.2% fulfilled the criteria for severe malaria. 5.4% of the children with severe malaria and valid blood culture results had a concomitant bacteraemia. Case fatality rates of severe malaria cases rose steeply when bacteraemia was also present (from 4.0% to 22.0%, P < 0.0001), and bacteraemia was an independent risk factor for death among severe malaria patients (adjusted OR 6.2, 95% CI 2.8–13.7, P = 0.0001). Streptococcus pneumoniae, Gram‐negative bacteria, Staphilococcus aureus and non‐typhoid Salmonella (NTS) were the most frequently isolated microorganisms among severe malaria cases. Their frequency and associated case fatality rates (CFR) varied according to age and to syndromic presentation. Streptococcus pneumoniae had a relatively low CFR, but was consistently associated with severe malaria syndromes, or anaemia severity groups. No clear‐cut relationship between malarial anaemia and NTS bacteraemia was found.

Conclusions  The coexistence of malaria and invasive bacterial infections is a frequent and life‐threatening condition in many endemic African settings. In Mozambique, S. pneumoniae is the leading pathogen in this interaction, possibly as a consequence of the high HIV prevalence in the area. Measures directed at reducing the burden of both those infections are urgently needed to reduce child mortality in Africa.
Pentamidine as secondary prophylaxis for visceral leishmaniasis in the immunocompromised host: report of four cases
Authors: Patel T. A. , Lockwood D. N.
Published: June 2009

We report a retrospective and descriptive study of four immunocompromised patients (three with HIV‐1 and one with idiopathic CD4+‐lymphopenia) with relapsing visceral leishmaniasis seen at the Hospital for Tropical Diseases, London, in whom pentamidine was used as secondary prophylaxis to prevent relapse. Patients experienced between one and four relapses before commencing prophylaxis with subsequent relapse‐free periods ranging from 5 to 98 months. Based on these observational data, we recommend large trials to investigate the efficacy of pentamidine over other agents in preventing relapse of VL in the immunocompromised patient.
A model for community mental health services in South Africa
Authors: Lund Crick , Flisher Alan J.
Published: June 2009

Objectives  To provide a model to estimate human resource needs for community‐based mental health services in South Africa.

Methods  A situation analysis was conducted of current community‐based mental health service provision in South Africa, which comprise outpatient and emergency services, residential care and day care. Service utilisation rates and staffing needs were estimated for two levels of service coverage, using data from the situation analysis, local epidemiological studies and consultation with key stakeholders.

Results  For a population of 100 000 people, 7.3–23.8 full‐time equivalent staff would be required to provide services in outpatient services, 14.9–41.6 in day care and 11.5–23.0 in residential care at minimum and full coverage levels respectively. The model can facilitate rational planning by requiring transparency and accountability in the assumptions used. This method can be adapted to a range of countries, by entering relevant country data.

Conclusions  The model fills a gap, particularly in low‐ and middle‐income countries, where community‐based mental health services are sparse, and decisions regarding allocations to them are hampered by a lack of good quality data. The results of the model are limited by the quality of data and the assumptions upon which the modelling are based.
Reduced IFN‐γ‐ and enhanced IL‐4‐producing CD4+ cord blood T cells are associated with a higher risk for atopic dermatitis during the first 2 yr of life
Authors: Herberth Gunda , Heinrich Joachim , Röder Stefan , Figl Adina , Weiss Michael , Diez Ulrike , Borte Michael , Herbarth Olf , Lehmann Irina ,   for the LISA study group
Published: June 2009

Herberth G, Heinrich J, Röder S, Figl A, Weiss M, Diez U, Borte M, Herbarth O and Lehmann I, for the LISA study group. Reduced IFN‐γ‐ and enhanced IL‐4‐producing CD4+ cord blood T cells are associated with a higher risk for atopic dermatitis during the first 2 yr of life. Pediatr Allergy Immunol 2010: 21: 5–13. © 2009 John Wiley & Sons A/S

The aim of this study was to analyse whether altered cytokine production by cord blood (CB) T cells is of relevance regarding the development of allergic diseases during the first 2 yr of life independent from known or suspected risk factors for allergy. Within an ongoing birth cohort study (Life style – Immune System – Allergy; LISA) the cytokine production of PMA/ionomycin‐stimulated CB cells was measured by intracellular cytokine staining. Data of 98 children from Leipzig and Munich with complete information on cytokine production at birth and allergic outcomes during the first 2 yr were analysed. Statistical analysis was performed using a regression model adjusted for gender, month of birth, parental history of atopy, parental education, exposure to environmental tobacco smoke, maternal smoking during pregnancy, renovation activities during pregnancy, pet ownership and study centre. During the first 2 yr of life, 17.3% of the children developed a physician‐diagnosed atopic dermatitis. Children with reduced frequencies of interferon‐γ (IFN‐γ)‐producing CD4+ T cells in the CB (1st quartile) had a higher risk to develop atopic dermatitis (adjusted OR 5.16, 95% CI: 1.04–25.6). Furthermore, a high percentage of interleukin (IL)‐4‐producing T cells in CB in children from the Leipzig cohort were associated with an increased risk for atopic dermatitis (adjusted OR 8.92, 95% CI: 1.40–56.93 for the 90th percentile). CD8+ cytokine‐producing CB T cells had no relation to increased risk for atopic dermatitis. Low amounts of IFN‐γ and high amounts of IL‐4‐producing T cells at birth may enhance the risk of subsequent development of atopic dermatitis.
Maternal meat and fat consumption during pregnancy and suspected atopic eczema in Japanese infants aged 3–4 months: The Osaka Maternal and Child Health Study
Authors: Saito Kyoko , Yokoyama Tetsuji , Miyake Yoshihiro , Sasaki Satoshi , Tanaka Keiko , Ohya Yukihiro , Hirota Yoshio
Published: June 2009

Saito K, Yokoyama T, Miyake Y, Sasaki S, Tanaka K, Ohya Y, Hirota Y. Maternal meat and fat consumption during pregnancy and suspected atopic eczema in Japanese infants aged 3–4 months: The Osaka Maternal and Child Health Study. Pediatr Allergy Immunol 2010: 21: 38–46. © 2009 John Wiley & Sons A/S

Interest has increased in the possibility that maternal dietary intake during pregnancy might influence the development of allergic disorders in children. The present prospective study examined the association of maternal intake of selected foods high in fatty acids and specific types of fatty acids during pregnancy with the risk of suspected atopic eczema among Japanese infants aged 3–4 months. Subjects were 771 mother–child pairs. Information on maternal dietary intake during pregnancy was assessed with a validated self‐administered diet history questionnaire. The term ‘suspected atopic eczema’ was used to define an outcome based on results of our questionnaire completed by mothers 3–4 months postpartum. The risk of suspected atopic eczema was 8.4% (n = 65). Higher maternal intake of meat during pregnancy was significantly associated with an increased risk of suspected atopic eczema in the offspring: the multivariate odds ratio (OR) for the highest vs. lowest quartile was 2.59 [95% confidence interval (CI): 1.15–6.17, p for trend = 0.01]. The positive association was strengthened when the definition of the outcome was confined to a definite physician’s diagnosis of atopic eczema (n = 35): the multivariate OR between extreme quartiles was 3.53 (95% CI: 1.19–12.23, p for trend = 0.02). No material exposure–response relationships were observed between maternal intake of eggs, dairy products, fish, total fat, saturated fatty acids, monounsaturated fatty acids, n‐3 polyunsaturated fatty acids, α‐linolenic acid, eicosapentaenoic acid, docosahexaenoic acid, n‐6 polyunsaturated fatty acids, linoleic acid, arachidonic acid and cholesterol and the ratio of n‐3 to n‐6 polyunsaturated fatty acid consumption and the risk of suspected atopic eczema. Higher maternal meat intake may increase the risk of infantile atopic eczema, whereas we found no evidence that maternal intake of fish and n‐3 polyunsaturated fatty acids are preventive against infantile atopic eczema.
Spatial association of photosynthesis and chemical defense in Arabidopsis thaliana following herbivory by Trichoplusia ni
Authors: Tang Jennie , Zielinski Ray , Aldea Mihai , DeLucia Evan
Published: June 2009

Because they share common precursors and require significant amounts of energy, photosynthesis and defense against herbivores and pathogens may be inversely related. This relationship was examined in Arabidopsis thaliana exposed to herbivory by Trichoplusia ni neonates. The spatial pattern of photosynthesis was compared statistically with that of induction of the defense‐related cinnamate‐4‐hydroxylase (C4H) gene across individual leaves exposed to herbivory in transgenic plants harboring a C4H:GUS gene fusion. In portions of the leaf where C4H:GUS expression was upregulated, photosynthesis was depressed, while non‐photochemical quenching was increased, suggesting a trade‐off between these two processes. However, photosynthetic damage spread further into surrounding areas than the induction of C4H:GUS expression. Photosynthetic depression was observed up to 1 mm from the edges of holes, whereas C4H:GUS induction typically was limited to about 0.5 mm or less from edges. Other mechanisms may be responsible for the spread of photosynthetic damage beyond where C4H‐related defense was induced. Alternatively, C4H induction may reflect a subset of defensive responses more limited in their spatial distribution than the downregulation of photosynthesis. The suppression of photosynthesis in remaining leaf tissue represents a ‘hidden cost' of herbivore damage.
Evolutionary history shapes the association between developmental instability and population‐level genetic variation in three‐spined sticklebacks
Authors: VAN DONGEN S. , LENS L. , PAPE E. , VOLCKAERT F. A. M. , RAEYMAEKERS J. A. M.
Published: June 2009

Developmental instability (DI) is the sensitivity of a developing trait to random noise and can be measured by degrees of directionally random asymmetry [fluctuating asymmetry (FA)]. FA has been shown to increase with loss of genetic variation and inbreeding as measures of genetic stress, but associations vary among studies. Directional selection and evolutionary change of traits have been hypothesized to increase the average levels of FA of these traits and to increase the association strength between FA and population‐level genetic variation. We test these two hypotheses in three‐spined stickleback (Gasterosteus aculeatusL.) populations that recently colonized the freshwater habitat. Some traits, like lateral bone plates, length of the pelvic spine, frontal gill rakers and eye size, evolved in response to selection regimes during colonization. Other traits, like distal gill rakers and number of pelvic fin rays, did not show such phenotypic shifts. Contrary toa prioripredictions, average FA did not systematically increase in traits that were under presumed directional selection, and the increases observed in a few traits were likely to be attributable to other factors. However, traits under directional selection did show a weak but significantly stronger negative association between FA and selectively neutral genetic variation at the population level compared with the traits that did not show an evolutionary change during colonization. These results support our second prediction, providing evidence that selection history can shape associations between DI and population‐level genetic variation at neutral markers, which potentially reflect genetic stress. We argue that this might explain at least some of the observed heterogeneities in the patterns of asymmetry.
Life cycle abbreviation in trematode parasites and the developmental time hypothesis: is the clock ticking?
Authors: LAGRUE C. , POULIN R.
Published: June 2009

The typical multi‐host life cycle of many parasites, although conferring several advantages, presents the parasites with a highly hazardous transmission route. As a consequence, parasites have evolved various adaptations increasing their chances of transmission between the different hosts of the life cycle. Some trematode species like the opecoelidCoitocaecum parvumhave adopted a more drastic alternative strategy whereby the definitive host is facultatively dropped from the cycle, resulting in a shorter, hence easier to complete, life cycle. Like other species capable of abbreviating their life cycle,C. parvumdoes so through progenetic development within its intermediate host. Laboratory‐rearedC. parvumcan modulate their developmental strategy inside the second intermediate host according to current transmission opportunities, though this ability is not apparent in naturalC. parvumpopulations. Here we show that this difference is likely due to the timeC. parvumindividuals spend in their intermediate hosts in the natural environment. Although transmission opportunities, i.e. chemical cues of the presence of definitive hosts, promoted the adoption of a truncated life cycle in the early stages of infection, individuals that remained in their amphipod host for a relatively long time had a similar probability of adopting progenesis and the abbreviated cycle, regardless of the presence or absence of chemical cues from the predator definitive host. These results support the developmental time hypothesis which states that parasites capable of facultative life cycle abbreviation should eventually adopt progenesis regardless of transmission opportunities, and provide further evidence of the adaptive plasticity of parasite transmission strategies.
Genetic variation ofMimetes hirtusandMimetes fimbriifolius(Proteaceae) – a comparative analysis of two closely related fynbos species
Authors: Reisch C. , Kaiser A. J. , Horn A. , Poschlod P.
Published: June 2009

We investigated the influence of differing life history traits on the genetic structure of the related speciesMimetes fimbriifoliusandMimetes hirtus(Proteaceae), which occur in the South African fynbos. Both species are bird‐pollinated and ant‐dispersed, but differ in rarity, longevity, ecological strategy and the fragmentation of their distribution area. We used AFLPs to study genetic variation within and between 21 populations of these two species across their distribution range. AFLP analysis revealed significantly higher genetic variation within populations ofM. fimbriifoliusthan withinM. hirtus. WhileM. fimbriifoliusclearly lacked any significant genetic differentiation between populations, a distinct geographic pattern was observed forM. hirtus. Differentiation was, however, stronger at the regional (ΦPT = 0.57) than at the local scale (ΦPT = 0.08). Our results clearly indicate that even closely related species that share the same mode of pollination and seed dispersal can differ in their genetic structure, depending on the magnitude of fragmentation, longevity of individuals and ecological strategy.
Neonatal sucking behavior: Comparison of perioral movement during breast‐feeding and bottle feeding
Authors: Aizawa Madoka , Mizuno Katsumi , Tamura Masanori
Published: June 2009

Background:  The aim of the present study was to compare orofacial motion and mouth angle during breast‐feeding and bottle feeding in normal infants.

Methods:  Thirteen normal infants were enrolled in the study, and feeding sessions were recorded using a digital video camera at 4 or 5 days following birth. The analysis was successfully performed for 12 infants during both breast‐feeding and bottle feeding. Markers were placed at the lateral angle of the eye, the tip of the jaw, and the throat region. Jaw and throat region movements were calculated using the direct linear transformation method. The angle of the mouth was also measured.

Results:  Throat region movement was significantly larger than jaw movement in both breast‐feeding (eye–throat region changes: 1.51 ± 0.37 mm, eye–jaw changes: 0.91 ± 0.31 mm, P < 0.001) and bottle feeding (eye–throat region changes: 2.91 ± 0.46 mm, eye–jaw changes: 1.77 ± 0.33 mm, P < 0.001). Jaw and throat region movements were significantly smaller during breast‐feeding than those during bottle feeding (P < 0.001). The angle of the mouth during breast‐feeding is larger than that during bottle feeding (P < 0.001). There was a negative correlation between the angle of the mouth and jaw movement.

Conclusions:  Jaw and throat region movements during bottle feeding differ from those during breast‐feeding. This partly results from the difference in the angle of the mouth during feeding.
An evaluation of Web‐based education as an alternative to group lectures for diabetes self‐management
Authors: Song Misoon , Choe Myoung‐Ae , Kim Keum Soon , Yi Myung Sun , Lee Insook , Kim Jeongeun , Lee Mira , Cho Young Min , Shim Young Suk
Published: June 2009

This study evaluated the efficacy of Web‐based diabetes self‐management education for newly diagnosed patients with type II diabetes as an alternative to group lectures. Using a non‐equivalent control group, pretest‐post‐test design, the participants in the Web group (n = 15) took part in a Web‐based diabetes self‐management program, while those in the lecture group (n = 16) attended 3 h of group lectures provided by health‐care professionals specializing in diabetes care. The outcome variables were measured at the baseline (T0), and 6 weeks (T1) and 3 months (T2) after the interventions. The glycosylated hemoglobin (HbA1c) percentage and diabetes care knowledge in the Web group improved significantly from T0 to T1, while the diabetes care behavior improved significantly from T0 to T1 and from T1 to T2. The diabetes care knowledge and diabetes care behavior in the lecture group improved significantly from T0 to T1, but the HbA1c percentage did not change significantly between any times. These results show the potential of the Web‐based program as an alternative to group lectures for diabetes self‐management education.
NO EVIDENCE FOR PATIENT‐TO‐PATIENT TRANSMISSION OF HEPATITIS C VIRUS DURING UPPER GASTROINTESTINAL ENDOSCOPY: MOLECULAR STUDIES ON THREE ACUTE HEPATITIS C PATIENTS
Authors: Toda Takayuki , Mitsui Takehiro , Tsukamoto Yukie , Ebara Takeshi , Masuko Kazuo , Takahashi Masaharu , Okamoto Hiroaki
Published: June 2009

Background:  The risk of patient‐to‐patient transmission of hepatitis C virus (HCV) during endoscopy remains controversial. Using molecular approaches, we examined the possibility of patient‐to‐patient transmission of HCV in three patients who developed acute hepatitis C 1–6 months after examination by upper gastrointestinal endoscopy (UGIE) in a hospital endoscopy unit in Japan.

Methods:  For the source of HCV infection, we used frozen sera obtained from potential candidates who underwent UGIE earlier than three index patients on the same days in the same unit. HCV genotype was determined by multiplex polymerase chain reaction (PCR) with genotype‐specific primers. The 1087‐nucleotide (nt) sequence of the NS5B region of the HCV genome was compared between index patients and their HCV‐viremic candidates.

Results:  The three index patients were exclusively infected with HCV of genotype 1b. Among a total of 60 candidate patients who underwent UGIE earlier than the index patients, 14 were positive for anti‐HCV, of whom 12 had detectable HCV‐RNA (1b, n = 9; 2a, n = 1; 2b, n = 2) on sera collected during each UGIE. Shared identity within the 1087‐nt NS5B sequence was less than 95.0% between index patients and HCV/1b‐infected candidates (n = 3, 1 and 5, respectively). None of the remaining 46 candidates who were negative for anti‐HCV at UGIE examination tested positive for HCV‐RNA, nor seroconverted to anti‐HCV on their sera, which most likely excludes the possibility of HCV viremia despite the anti‐HCV‐negative serology at UGIE examination.

Conclusion:  The present study suggests that patient‐to‐patient transmission of HCV during UGIE is infrequent.
RELATION BETWEEN OBESITY AND ADENOMATOUS POLYPS OF THE LARGE BOWEL
Authors: Sato Yumi , Nozaki Ryoichi , Yamada Kazutaka , Takano Masahiro , Haruma Ken
Published: June 2009

Background:  We compared the prevalence of colorectal adenoma (polyps) in men and women and examined the role of body mass index (BMI) on polyp risk according to patient age and gender.

Methods:  The risk of developing colorectal polyps was studied in 15 380 subjects (7155 men and 8225 women) who underwent colonoscopy for the first time from April 1998 to March 2006 at our ‘Human Dry Dock’, which is the check‐up service provided in Japan. Eligible subjects were 20–86 years old (mean age ± SD, 47.3 ± 8.5) and were free of invasive cancer, hyperplastic polyps and familial polyposis. Polyps were found in 1590 subjects (1062 men and 528 women). The odds ratio (OR) of detection of polyps in relation to obesity was determined in all cases by multivariate logistic regression analysis after making an adjustment for gender and age.

Results:  The OR of polyp detection in obese subjects (BMI ≥ 25) versus non‐obese subjects (BMI < 25, OR = 1) was 1.34 (P < 0.001) in men and 1.13 (P = 0.26) in women. As the BMI increased in increments of one, the OR in men increased significantly to 1.01 (P < 0.001), whereas the OR in women was unchanged at 1.00 (P = 0.23), which was without significance.

Conclusions:  We conclude that obesity in men is a risk factor for the development of polyps. These results must be confirmed by additional epidemiological studies.
ENDOSCOPIC SPHINCTEROTOMY ALONE IN THE MANAGEMENT OF LOW‐GRADE BILIARY LEAKS DUE TO CHOLECYSTECTOMY
Authors: Aksoz Kadir , Unsal Belkis , Yoruk Gazi , Buyrac Zafer , Haciyanli Mehmet , Akpinar Zehra , Alper Emrah
Published: June 2009

Aim:  Endoscopic retrograde cholangiopancreatography (ERCP) is important in the diagnosis and management of postoperative bile leaks. Endoscopic sphincterotomy (ES) alone, ES with stent or nasobiliary drain (NBD) placement and stent or NBD without ES are the methods of choice. In the present study, we aimed to show the efficacy of ES alone in the management of low‐grade (LGL) cystic duct stump (CDS) leaks due to cholecystectomy.

Methods:  Between September 2005 and January 2008, ES was carried out on 31 patients with LGL from the CDS due to cholecystectomy who were referred to the endoscopy unit of Izmir Ataturk Training and Research Hospital. Biliary leakage was detected by biliary discharge from a tube drain inserted during the operation. In cases of retaining common bile duct stones, balloon extraction was carried out. If bile discharge continued, a stent was introduced for cessation of the leak as a second procedure.

Results:  The success rate of ES alone was 87.1% (27 of 31 patients). In four patients (12.9%), ES alone was inadequate, therefore a stent was placed. The biliary leak ceased gradually and stopped in all patients at a mean of 11 (7–21) days. Balloon extraction of retained stones was carried out in six patients (19.6%). In two (6.5%) patients, mild hemorrhage and in two patients self‐limited pancreatitis was seen (6.5%) as complications.

Conclusion:  Endoscopic retrograde cholangiopancreatography is essential in the management of postoperative biliary leaks. Endoscopic sphincterotomy alone can be the initial procedure in the treatment of LGL from the CDS due to cholecystectomy.
A PROPOSAL FOR DIFFERENTIATION BETWEEN EARLY‐ AND ADVANCED‐STAGE AUTOIMMUNE PANCREATITIS BY ENDOSCOPIC ULTRASONOGRAPHY
Authors: Kubota Kensuke , Kato Shingo , Akiyama Tomoyuki , Fujita Koji , Yoneda Masato , Takahashi Hirokazu , Ogawa Masami , Inamori Masahiko , Abe Yasunobu , Kirikoshi Hiroyuki , Kobayashi Noritoshi , Saito Satoru , Hisatomi Kantaro , Matsuhashi Nobuyuki , Nakajima Atsushi
Published: June 2009

Aim:  We evaluated the characteristic endoscopic ultrasonography (EUS) findings of early autoimmune pancreatitis (AIP).

Methods:  Nineteen patients with AIP were identified from our database. We reviewed the following features of EUS as being potentially characteristic of early AIP: hyperechoic foci, hyperechoic strands, lobularity, hyperechoic pancreatic duct margins and reduced echogenicity. According to the Cambridge classification for chronic pancreatitis, we classified AIP into early AIP (Grades 0–2) and advanced AIP (Grades 3–5) and examined the histopathological findings in each stage of AIP.

Results:  There were nine cases of early AIP and 10 cases of advanced AIP. Five of the nine early cases of AIP showed spontaneous remission without corticosteroid therapy (P < 0.05). The EUS findings were as follows (early vs advanced): hyperechoic foci, 100% (9/9) vs 100% (10/10); hyperechoic strands, 66.7% (6/9) vs 70% (7/10); lobularity, 77.8% (7/9) vs 20% (2/10); hyperechoic pancreatic duct margin, 88.9% (8/9) vs 30% (3/10); reduced echogenicity, 88.9% (8/9) vs 90% (9/10). Lobularity and hyperechoic pancreatic duct margin were detected at a significantly higher frequency in early AIP than in the advanced AIP patients (P < 0.05). Regarding the histopathological findings, acinar cells were better preserved in the cases of early AIP, whereas acinar cells were reduced in number and replaced by massive fibrosis in the patients with advanced AIP.

Conclusions:  Lobularity and hyperechoic pancreatic duct margin are characteristic EUS features of early AIP, which has a more favorable prognosis, and shows a higher frequency of spontaneous remission and preservation of acinar cells, than advanced AIP.
ERCP AFTER ROUX‐EN‐Y RECONSTRUCTION CAN BE CARRIED OUT USING AN OBLIQUE‐VIEWING ENDOSCOPE WITH AN OVERTUBE
Authors: Kikuyama Masataka , Sasada Yuzo , Matsuhashi Toru , Ota Yuji , Nakahodo Jun
Published: June 2009

Background:  We report that an oblique‐viewing endoscope facilitates endoscopic retrograde cholangiopancreatography (ERCP) in Billroth II reconstruction. With this endoscope, we carried out ERCP in Roux‐en‐Y reconstruction.

Methods:  Fifteen patients with Roux‐en‐Y reconstruction were enrolled. Eleven of these patients had undergone gastrectomy, while Whipple's operation or choledochectomy had each been carried out in two patients. Among the 11 post‐gastrectomy patients, eight had bile duct stones, and there was one case each of pancreatic abscess with chronic pancreatitis, bile duct obstruction due to gallbladder, or pancreatic cancer. The remaining four patients suffered from stenotic anastomosis of choledochojejunostomy. All procedures were carried out with an oblique‐viewing endoscope.

Results:  The papilla of Vater or anastomosis was reached in 10 patients. In these 10 patients, all planned procedures were completed. Endoscopic papillary balloon dilatation (EPBD) was carried out in three patients with bile duct stones. The remaining three patients with bile duct stones underwent sphincterotomy with tube stent placement, EPBD after sphincterotomy with biliary tube stent placement, and biliary tube stent placement, respectively. Pancreatic stent placement via the minor papilla was carried out in one patient with pancreatic abscess, and a biliary tube stent was introduced in the patient with gallbladder cancer. Two patients underwent cutting of a stenotic anastomosis with a needle knife, followed by balloon dilatation. None of the patients experienced any complications.

Conclusion:  The results appear to support the feasibility of using an oblique‐viewing endoscope for ERCP in Roux‐en‐Y reconstruction. Further studies including a large population of patients should be planned to confirm these results.
REFRACTORY DIVERTICULAR COLITIS WITH PROGRESSIVE ULCERATIVE COLITIS‐LIKE CHANGES EXTENDING TO THE RECTUM
Authors: Yamane Tateki , Uchiyama Kan , Ishii Takayuki , Ishii Hironori , Omura Mitsuhiro , Fujise Kiyotaka , Tajiri Hisao
Published: June 2009

A 68‐year‐old man visited our department because of diarrhea and bloody stools. Colonoscopy revealed diverticula scattered in the sigmoid colon with localized mucosal edema and reddening. The mucosa became somewhat rough 9 months later, and had an erosive, ulcerative colitis (UC)‐like appearance after a further 6 months, with these changes extending to the rectum. These findings led to a diagnosis of diverticular colitis (DC) with UC‐like changes. The condition was refractory to treatment including drug therapy and was thus surgically treated. No cases of DC have been reported in Japan, and a refractory case of DC with progressive UC‐like changes extending to the rectum is rare even in Europe and the USA.
GASTRIC SCHWANNOMA WITH ADJACENT EXTERNAL PROGRESSION HARBORED ABERRANT NF2 GENE
Authors: Ogasawara Naotaka , Sasaki Makoto , Ishiguro Hideyuki , Itoh Yukimi , Nojiri Syunsuke , Kubota Eiji , Wada Tsuneya , Kataoka Hiromi , Kuwabara Yoshiyuki , Joh Takashi
Published: June 2009

Gastric schwannomas are rare benign mesenchymal tumors. We describe a schwannoma of gastric origin with adjacent external progression. Sections showed a spindle cell tumor arranged in interlaced bundles and fascicles that was S‐100 and CD34 positive but c‐KIT protein negative. Histology and immunohistochemistry revealed the typical appearance of a gastric schwannoma. Genetic evaluation revealed that the tumor harbored a point mutation in exon 6 of the tumor suppressor neurofibromatosis 2 (NF2) gene, which resulted in an amino acid substitution of NF2 protein, and no mutation in exon 4b of the NF1 gene. In conclusion, we identified a rare mutation of the NF2 gene in gastric schwannoma. A diagnosis can only be definitive when based on histological and immunohistochemical findings. Digestive tract schwannomas are rare mesenchymal tumors that are differentiated from gastrointestinal stromal tumors by the absence of KIT protein. Follow up suggested that complete resection is an effective long‐term treatment strategy.
LONG INTESTINAL TUBE INSERTION WITH THE ROPEWAY METHOD FACILITATED BY A GUIDEWIRE PLACED BY TRANSNASAL ULTRATHIN ENDOSCOPY FOR BOWEL OBSTRUCTION
Authors: Kanno Yoshihide , Hirasawa Dai , Fujita Naotaka , Noda Yutaka , Kobayashi Go , Ishida Kazuhiko , Ito Kei , Obana Takashi , Suzuki Takashi , Sugawara Toshiki , Horaguchi Jun , Takasawa Osamu , Nakahara Kazunari , Ohira Tetsuya , Onochi Kengo , Harada Yoshihiro , Iwai Wataru , Kuroha Masatake
Published: June 2009

Aim:  For patients with bowel obstruction, intestinal decompression by a long tube is recommended. We assessed the usefulness of a new technique for insertion of a long tube with a guidewire placed by transnasal ultrathin endoscopy.

Methods:  Nineteen patients who had been diagnosed as suffering from bowel obstruction underwent long‐tube insertion with the ropeway technique using a guidewire placed by transnasal endoscopy. Thirty‐three patients who had undergone conventional insertion of a long tube were included as controls. The success rate of intubation of the small bowel and the time required for the procedure were compared between the subjects and controls.

Results:  The success rate of intubation was 94.7% (18/19) in subjects and 84.8% (28/33) in controls (P = 0.53). The time required for insertion in the subjects and controls was 24.1 ± 8.1 min and 48.7 ± 25.3 min, respectively, with a statistically significant difference (P < 0.001). No complications relevant to the procedure were encountered in either of the groups.

Conclusion:  Long‐tube insertion facilitated by transnasal endoscopy reduces the time required for insertion in comparison with the conventional technique without endoscopy. Endoscopy‐assisted long‐tube insertion with the ropeway method is a safe and useful procedure for decompression in patients with bowel obstruction.
ENCOSCOPIC MANAGEMENT OF STENOTIC ANASTOMOSIS USING A RENDEZVOUS TECHNIQUE AFTER PANCREATOGASTROSTOMY
Authors: Ota Yuji , Kikuyama Masataka , Sasada Yuzo , Matsuhashi Toru , Nakahodo Jun , Yamao Kenji , Shirafuji Tomoyuki
Published: June 2009

A 46‐year‐old female patient was referred to our hospital for endoscopic treatment of stenotic pancreatogastrostomy. She had undergone pylorus‐preserving pancreatoduodenectomy due to duodenal carcinoma of the papilla of Vater 5 years before referral. Two years after the operation, she had to be hospitalized several times during a 1‐year period because of acute recurrent pancreatitis caused by stenosis of the anastomosis of the pancreatoduodenostomy. An endoscopic ultrasound (EUS)‐guided rendezvous technique was selected to puncture the main pancreatic duct via a transgastric approach. We identified the dilated main pancreatic duct with a convex array echoendoscope from the lower gastric body near the anastomosis and successfully punctured the dilated main pancreatic duct. The guidewire passed through the stenosis to the gastric cavity and we could place a stent through the stenotic anastomosis. After the procedure, the patient has not experienced acute recurrent pancreatitis for 9 months. Pancreatogastrostomy has been the preferred method used to carry out post‐pancreatoduodenectomy reconstruction. However, stenosis of the anastomosis has been reported as one of the late complications of pancreatogastrostomy. The main symptom of this complication is recurrent epigastralgia due to obstructive pancreatitis. As a result, patients are compelled to stay in the hospital for an extended duration with no oral intake allowed. Surgical resection of the stenosis is often the treatment of choice but can be troublesome due to post‐operative adhesions. Here, we report a case of pancreatogastrostomy complicated by stenosis, which was treated using the EUS‐guided rendezvous technique.
FORMATION OF GASTROCOLIC FISTULA DURING TREATMENT FOR PEPTIC ULCER
Authors: Iwasaki Yoshimi , Kubota Keiichi , Shimoda Mitsugi , Ishikawa Kunifumi , Satoh Naoki
Published: June 2009

We report a case of gastrocolic fistula (GCF) caused by a gastric ulcer and rare endoscopic findings indicating the early stages of GCF formation. The patient was a 58‐year‐old man who was hospitalized with upper abdominal pain. He was diagnosed as having a gastric ulcer, and was prescribed a proton pump inhibitor (PPI), but did not comply with the medication. One year later, he was again referred with recurrent abdominal pain. Endoscopic examination showed what appeared to be a portion of exposed colonic wall located in the center of an active gastric ulcer, and repeated endoscopy after PPI treatment for 8 days demonstrated a typical GCF. A preoperative diagnosis of GCF was made, and the patient underwent wide gastrectomy with partial resection of the transverse colon.
Exenatide efficacy and safety: a systematic review
Authors: Norris S. L. , Lee N. , Thakurta S. , Chan B. K. S.
Published: June 2009

Objective  To examine the efficacy, effectiveness and side effects of exenatide when compared with oral glucose‐lowering agents or insulin therapy.

Research design and methods  Relevant citations were identified from searches of multiple bibliographic databases supplemented with searches of the US Food and Drug Administration website and other sources. A qualitative synthesis was performed, with a random effects meta‐analysis when appropriate.

Results  We identified 17 studies. In placebo‐controlled trials of subjects with poorly controlled diabetes (with both groups receiving various oral glucose‐lowering agents), exenatide 10 μg twice daily improved glycated haemoglobin (HbA1c) by approximately 1.0% over 30 weeks [pooled estimate −0.97%, 95% confidence interval (CI), −1.16 to −0.79%, P < 0.0001] and exenatide treatment over 16–30 weeks was associated with weight loss of 1.0–2.5 kg. Exenatide appeared to confer a similar benefit to various insulin regimes for glycaemic control at follow‐up between 16 and 52 weeks (pooled estimate HbA1c−0.04%, 95% CI, −0.14 to 0.06%, P = 0.41), but was advantageous over insulin with respect to weight loss (3–6 kg loss at up to 52 weeks of follow‐up). Nausea was the most common adverse event in placebo‐ and active‐controlled trials. Rates of hypoglycaemia were similar in exenatide and insulin groups, but were higher with exenatide 10 μg twice daily compared with placebo and hypoglycaemia was most frequent when a sulphonylurea was administered.

Conclusions  In subjects with poorly controlled diabetes, exenatide was associated with a reduction in HbA1c that was similar to introducing another oral agent or insulin. Weight loss may be an advantage with exenatide. Long‐term studies in diverse and unselected populations are needed to clarify the benefit vs. harm profile of this drug.
Effects of a short‐term improvement in glycaemic control on skin microvascular dysfunction in Type 1 and Type 2 diabetic patients
Authors: Meyer M. F. , Rose C. J. , Schatz H. , Klein H. H.
Published: June 2009

Aims  To investigate whether Type 1 and Type 2 diabetic patients differ in the effects of short‐term improvement in glycaemic control on skin microvascular dysfunction.

Methods  Fourteen Type 1 and 14 Type 2 diabetic patients admitted to hospital to improve glycaemic control were investigated. Two age‐ and sex‐matched groups of non‐diabetic subjects served as controls. Capillary blood cell velocity (CBV) was assessed at the dorsal middle phalangeal area of the ring finger at rest and after 3‐min arterial occlusion using laser Doppler anemometry.

Results  Comparing the measurements before and after improvement in glycaemic control, there were no significant changes in peak CBV, time to peak CBV and vasomotion amplitudes in Type 1 and Type 2 diabetic patients. On admission to hospital, time to peak CBV was prolonged in Type 1 (20.9 ± 2.9 vs. 12.3 ± 1.6 s, P = 0.003) and Type 2 diabetic patients (20.6 ± 2.6 vs. 11.9 ± 1.3 s, P = 0.021) compared with control subjects. After improvement in glycaemic control, there was no significant difference in time to peak CBV between Type 1 diabetic patients and their control subjects (17.8 ± 4.2 vs. 12.3 ± 1.6 s, P = 0.535). In Type 2 diabetic patients, the time to peak CBV increased non‐significantly.

Conclusions  Short‐term improvement in glycaemic control did not appear to reverse microcirculatory dysfunction in Type 1 and Type 2 diabetes. However, there was an improvement of the delayed reactive hyperaemia in Type 1 diabetic patients.
Interrogating Notions of the Powerless Oustee
Authors: Beazley Kim
Published: June 2009

This article investigates the year leading up to the relocation of Botezari village from Tadoba‐Andhari Tiger Reserve, India, and suggests that it does not accord with the conventional scholarly theory of the powerless oustee. The village's pre‐relocation phase was characterized by a genuine local openness to displacement; a socially‐aware displacement authority; lively NGO and press presence; and a relatively assertive and astute village community. This facilitated constructive dialogue, culminating in meaningful concessions and a perceptible power structure shift, which, I argue, indicates that the received wisdom of inevitable oustee powerlessness may in some instances require qualification, at least in the Indian context. There, the last decade has witnessed some broad changes in regimes of governance and civil society, and a growth of cultures of opposition and struggle from ‘below’. Where such wider structural changes come together with other more locally‐specific favourable factors, cases such as the one described here may materialize, in which the acute powerlessness of the displaced should not be assumed.
Defining Political Community and Rights to Natural Resources in Botswana
Authors: Poteete Amy R.
Published: June 2009

Community‐Based Natural Resource Management (CBNRM), once presented as the best way to protect common pool natural resources, now attracts a growing chorus of critiques that either question its underlying assumptions or emphasize problems related to institutional design. These critiques overlook connections between the definition of rights to natural resources and membership in political communities. The potential for competing definitions of political identity and rights across natural resources arises when property rights regimes differ across natural resources and these different systems of rights appeal to alternative definitions of community. In Botswana, the entangling of natural resource policy with identity politics contributed to a partial recentralization of CBNRM in 2007.
The Politics of Disciplining Water Rights
Authors: Boelens Rutgerd
Published: June 2009

This article examines how the legal systems of Andean countries have dealt with the region's huge plurality of local water rights, and how official policies to ‘recognize’ local rights and identities harbour increasingly subtle politics of codification, confinement and disciplining. The autonomy and diversity of local water rights are a major hindrance for water companies, elites and formal rule‐enforcers, since State and market institutions require a predictable, uniform playing field. Complex local rights orders are seen as irrational, ill‐defined and disordered. Officialdom cannot simply ignore or oppress the ‘unruliness and disobedience’ of local rights systems: rather it ‘incorporates’ local normative orders that have the capacity to adequately respond to context‐based needs. This article examines a number of evolving, overlapping legal domination strategies, such as the ‘marrying’ of local and official legal systems in ways that do not challenge the legal and power hierarchy; and reviews the ways in which official regulation and legal strategies deny or take into consideration local water rights repertoires, and the politics of recognition that these entail. Post‐colonial recognition policies are not simply responses to demands by subjugated groups for greater autonomy. Rather, they facilitate the water bureaucracy's political control and help neoliberal sectors to incorporate local water users’ rights and organizations into the market system — even though many communities refuse to accept these policies of recognition and politics of containment.
Ageing, Poverty and the Role of a Social Pension in Vietnam
Authors: Long Giang Thanh , Pfau Wade Donald
Published: June 2009

Using the Vietnam Household Living Standard Survey in 2004, this article seeks to quantify the potential role and impacts of a social pension scheme for reducing elderly poverty in Vietnam. The authors simulate changes in the poverty rate, poverty gap and poverty severity of the elderly in the counterfactual situation that such a scheme had been introduced to Vietnam in the past. They consider a number of categorical targeting groups of elderly people along with various transfer parameters to assess the impacts of the scheme on social welfare. They conclude that, depending on the characteristics of the social pension, there would be beneficial poverty reductions, but also large leakages to the non‐poor people. For a variety of measures, the results suggest that targeting the elderly in rural areas might be the most effective use of limited resources. Simulations for different budgetary constraints show that, even with limited budgeting, a social pension scheme would significantly reduce poverty incidence for the elderly. Furthermore, for a given programme cost, combining lower benefits with lower eligibility requirements is more effective at reducing poverty than providing larger benefits to a more limited group of recipients.
Young children follow pointing over words in interpreting acts of reference
Authors: Grassmann Susanne , Tomasello Michael
Published: June 2009

Adults refer young children’s attention to things in two basic ways: through the use of pointing (and other deictic gestures) and words (and other linguistic conventions). In the current studies, we referred young children (2‐ and 4‐year‐olds) to things in conflicting ways, that is, by pointing to one object while indicating linguistically (in some way) a different object. In Study 1, a novel word was put into competition with a pointing gesture in a mutual exclusivity paradigm; that is, with a known and a novel object in front of the child, the adult pointed to the known object (e.g. a cup) while simultaneously requesting ‘the modi’. In contrast to the findings ofJaswal and Hansen (2006), children followed almost exclusively the pointing gesture. In Study 2, when a known word was put into competition with a pointing gesture – the adult pointed to the novel object but requested ‘the car’– children still followed the pointing gesture. In Study 3, the referent of the pointing gesture was doubly contradicted by the lexical information – the adult pointed to a known object (e.g. a cup) but requested ‘the car’– in which case children considered pointing and lexical information equally strong. Together, these findings suggest that in disambiguating acts of reference, young children at both 2 and 4 years of age rely most heavily on pragmatic information (e.g. in a pointing gesture), and only secondarily on lexical conventions and principles.