bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term outcome from a medium secure service for people with intellectual disability
Authors: Alexander R. T. , Crouch K. , Halstead S. , Piachaud J.
Published: February 2006

Background  The purpose of this paper is to describe long‐term outcomes for patients discharged over a 12‐year period from a medium secure service for people with intellectual disabilities (ID).

Methods  A cohort study using case‐notes analysis and a structured interview of current key informants.

Results  Eleven per cent of the sample was reconvicted. Fifty‐eight per cent of the sample showed offending‐like behaviour that did not lead to police contact. Twenty‐eight per cent of the sample was currently detained in hospital under the Mental Health Act. The presence of a personality disorder, a history of theft or burglary, and young age increased the risk of reconviction. Contact with the police was less likely in those with schizophrenia. Re‐admission to hospital was associated with the presence of offending‐like behaviours, rather than any specific diagnosis.

Conclusion  In terms of reconviction, these results are good compared with those from general forensic services; however, behavioural problems continue for many years and are managed without recourse to the criminal justice system. There is a borderline group whose needs are poorly defined and serviced.

Declaration of interests  Horizon National Health Service Trust, the managing authority of the service, gave the grant for this study; the corresponding author was working in the service.
An audit of red cell and blood product use after the institution of thromboelastometry in a cardiac intensive care unit
Authors: Anderson L. , Quasim I. , Soutar R. , Steven M. , Macfie A. , Korte W.
Published: February 2006

summary.  Cardiac surgery is estimated to use 20% of the UK blood supply. However, there has been much interest recently in decreasing red cell and blood product use not only to ease strain on blood stocks or avoid potential transmission of infection but also to decrease post‐operative transfusion‐related complications. Coagulopathies are not uncommon in cardiac surgical patients, but the time lapse for reporting conventional laboratory results has been highlighted as an obstacle to the appropriate use of blood products. Accordingly, much interest has arisen in rapid near‐patient testing of coagulation and, in January 2002, a thromboelastometer (ROTEM®, Pentapharm, Germany) was purchased for our unit.

This audit sought to assess its impact by retrospective analysis of 990 sequential patients' demographic data and transfusion details covering 6 months prior to its introduction and 6 months after.

In the 6 months prior to its introduction, red cells were used in 60% of patients and fresh frozen plasma (FFP) and platelets used in 17 and 16% of patients, respectively. In the following 6 months, red cell use had fallen to 53% and FFP and platelets to 12 and 11%, respectively (P < 0·05).

Introduction of thromboelastometry has significantly decreased our use of red cells and blood products.
The emergency room transfusion score (ETS): prediction of blood transfusion requirement in initial resuscitation after severe trauma
Authors: Ruchholtz S. , Pehle B. , Lewan U. , Lefering R. , Müller N. , Oberbeck R. , Waydhas C.
Published: February 2006

summary.  The presented study was initiated to develop a scoring system for the prediction of red blood cell transfusion requirement in the early care of trauma patients.

All trauma patients admitted to our institution who needed trauma team activation were evaluated during a 4‐year period. A set of nine parameters with possible predictive value for the need of blood transfusion was recorded. All relevant data can be acquired during the first 10 min in the emergency room (ER). The data underwent multivariate logistic regression analysis for correlation and the calculation of predictive power. To transform the model into a practical score, we rounded all coefficients. The predictive power of the score was evaluated based on a linear regression equation.

Of the 1103 patients (Injury Severity Score [ISS] 21 ± 16) included in the study, 116 (10·5%; ISS 39 ± 18) received blood in the ER. Early transfusion need was significantly correlated with systolic blood pressure (SBP) <90 mmHg (coefficient 2·5), SBP 90–120 mmHg (1·5), free fluid in abdominal ultrasound (2·0), clinically unstable pelvic ring fracture (1·5), age 20–60 years (0·5), age >60 years (1·5), admission from scene (1·0), traffic accident (1·0) and fall from >3 m (1·0). The probability for transfusion exponentially increased with the sum of points in the ER transfusion score, i.e. from 0·7% at one point to 5% at three points and 97% at 9·5 points maximum. To establish a practical cutoff point (risk <5%) a low‐risk group was defined at <points (64% of the whole study group).

The presented ER transfusion score is based on rapidly assessable parameters. The score identifies patients in need for immediate red blood cell substitution. Cost effectiveness appears to be a further advantage of the score. For patients not in need of urgent transfusion (low‐risk group), the costs for transportation, cross‐matching and loss by maltreatment of blood products may be avoided.
Colonic pseudolipomatosis, microscopically classified into two groups
Authors: NAKASONO MASAHIKO , HIROKAWA MITSUYOSHI , MUGURUMA NAOKI , OKAMURA SEISUKE , ITO SUSUMU , IGA AKIKO , WADA SATOSHI , OKAZAKI MICHIYO , HORIE TAKAHIRO , FUKUDA TAMOTSU , SANO TOSHIAKI
Published: February 2006

Background:  Colonic pseudolipomatosis is rare and the pathogenesis is controversial. The purpose of the present paper was to clarify endoscopic and histological characteristics of colonic pseudolipomatosis and to discuss the etiology.

Methods:  A total of 15 lesions from 14 patients was reviewed. They were able to be histologically classified into two groups on the basis of variety in size of the vacuoles: Group A, the ratio of largest vacuole to smallest vacuole in size is less than three, Group B, the ratio is more than four.

Results:  Four of 15 lesions were group A, and were endoscopically polypoid or flat lesions covered with normal‐looking mucosa. They were microscopically characterized by (i) predominant location in the upper portion of the lamina propria; (ii) no submucosal involvement; (iii) less variation in vacuolar size; and (iv) no association with lymph follicles. The vacuoles of group A contained proteinaceous materials in two of four lesions. Group B (11 lesions) had small elevated mucosa with normal‐looking surface or non‐elevated reddish mucosa. Microscopically, the lesions were mainly located in the lower portion of the lamina propria, occasionally also in the submucosa, had variable‐sized vacuoles, and were related to lymph follicles.

Conclusion:  It is suggested that the vacuoles in group A contain fluid, and may indicate an abnormal stagnation of interstitial fluid. Microscopic appearance of group B is essentially similar to that of pneumatosis coli. It is thought that group B probably results from penetration of gas from the crypts into the mucosa during colonoscopy. It is unclear why group B had a preference for ileocecal valve and an association with lymph follicles.
Prevalence and risk factors of non‐alcoholic fatty liver disease among Korean adults
Authors: PARK SEUNG H , JEON WOO K , KIM SANG H , KIM HONG J , PARK DONG I , CHO YONG K , SUNG IN K , SOHN CHONG I , KEUM DONG K , KIM BYUNG I
Published: February 2006

Background and Aim:  Differences in the prevalence of non‐alcoholic fatty liver disease (NAFLD) between Eastern and Western populations are primarily attributable to differences in definitions and biased population selection. Thus, the aim of the present study was to accurately determine the actual prevalence of NAFLD by sonography and to characterize the risk factors for NAFLD.

Methods:  The present cross‐sectional study was performed with data obtained from 6648 subjects, all of whom were older than 20 years of age (3530 men and 3118 women). The term ‘non‐drinker’ was applied to men who consumed less than 30 g alcohol/day and to women who consumed less than 20 g alcohol/day. Non‐alcoholic fatty liver disease was defined as a sonographically detected fatty liver in the absence of viral hepatitis in a non‐drinker.

Results:  Of the 1613 subjects who were diagnosed with sonographic fatty liver, 1240 were non‐drinkers and had no viral hepatitis. Overall, the unadjusted and age‐adjusted prevalences of NAFLD were 18.7% (23% in men, 13.7% in women) and 16.1% (21.6% in men, 11.2% in women), respectively. Multivariate analysis revealed that several risk factors were profoundly associated with the prevalence of NAFLD, including obesity, insulin resistance, hyperlipidemia and hyperglycemia in both genders, as well as age, menopausal status and estrogen medication in women only.

Conclusions:  These results demonstrate that the prevalence of NAFLD in Korean adults, according to sonographic surveys, is comparable to that seen in more developed countries. From the perspective of increasing obesity, the high prevalence rates noted in the study may herald an increased burden of chronic liver disease in the Korean population.
Short‐term effects of magnetic sacral dermatome stimulation for idiopathic slow transit constipation: Sham‐controlled, cross‐over pilot study
Authors: LEE KWANG JAE , KIM JIN HONG , CHO SUNG WON
Published: February 2006

Background and Aim:  An increase in recto‐sigmoid colon activity through electrical stimulation of the sacral dermatomes has previously been reported. It has not been evaluated whether or not sacral dermatome stimulation has beneficial effects on constipation symptoms and anorectal function in constipated patients. Our aim was to evaluate short‐term effects of magnetic stimulation of the sacral dermatomes on constipation symptoms and anorectal function in patients with idiopathic slow transit constipation.

Method:  Fourteen patients with idiopathic slow transit constipation were enrolled. Constipation symptoms, stool form and anorectal function were assessed before treatment, and at 3 and 6 weeks of treatment. Six‐week treatment consisted of either a 3‐week period of sham treatment or a 3‐week period of magnetic stimulation of the S2‐S3 dermatomes, which was performed in a randomized cross‐over design.

Results:  During the stimulation period, the frequency score of spontaneous bowel movements decreased in eight of the 14 patients (2.9 [2–3]vs 1.4 [0–2]), whose threshold volumes for urge to defecate and maximum tolerable volumes were significantly greater than those of the non‐responders, and significantly decreased at the end of treatment. The degree of straining on defecation also significantly decreased in the responders. Responders had shorter right colonic transit time and longer left colonic transit time compared to the non‐responders. Sham treatment did not affect constipation symptoms, stool form and rectal sensation.

Conclusion:  Sacral dermatome stimulation may offer potential for therapeutic benefit for a subset of patients with idiopathic slow transit constipation, particularly constipated patients with rectal hyposensation or hindgut dysfunction.
Predictors of fibrosis in Asian patients with non‐alcoholic steatohepatitis
Authors: TSANG STEVEN WOON CHOY , NG WING FUNG , WU BRIAN PING YING , CHOW DAVID ALAN , LI ERIC TING HO , WONG TAK CHEUNG
Published: February 2006

Background and Aim: Non‐alcoholic steatohepatitis (NASH) is increasingly recognized as an important cause of chronic liver disease. However, data on Asians with NASH is lacking in the literature. The aim of the present study was to describe the clinical, biochemical and histological characteristics of NASH in Asians and to determine the predictors for septal fibrosis.

Method: Sixty consecutive patients aged over 18 years with elevated serum alanine transferase, sonographic evidence of steatosis, and consent for liver biopsy were included. Patients with chronic hepatitis B or C, alcoholic, autoimmune, genetic, or drug‐induced liver disease were excluded. Clinical, biochemical and histological variables were tested for association with septal liver fibrosis (F2/3).

Results: Median age of the cohort was 45.5 years (range 21–75 years) and 63% were male. Ninety percent of patients were obese (body mass index [BMI]≥ 25), 70% had hypertriglyceridemia, 68% had hypercholesterolemia, 58% had metabolic syndrome, 53% had hypertension, 47% had diabetes mellitus (DM), and 18% had obstructive sleep apnea. Sixty‐eight percent had gamma‐glutamyl transferase (GGT) ≥ 2 × upper limit of normal (ULN), 55% had alanine aminotransferase (ALT) ≥ 2 × ULN, and 23% had aspartate aminotransferase (AST) ≥ 2 × ULN. Of the 40 non‐diabetic patients undergoing oral glucose tolerance testing, 45% had normal tests, 30% had impaired glucose tolerance, 23% DM, and 2% impaired fasting glucose. Eighteen patients (30%) had septal fibrosis (F2/3), but none had cirrhosis. Necroinflammatory grade ≥ 2 (odds ratio [OR] 13), AST ≥ 2 × ULN (OR 5.3) and DM (OR 5) were significantly and independently correlated with septal fibrosis.

Conclusion: Septal fibrosis is common in Asians with NASH. Necroinflammatory grade ≥ 2, AST ≥ 2 × ULN and DM are independent predictors for septal fibrosis.
Role of transferrin receptor 2 in hepatic accumulation of iron in patients with chronic hepatitis C
Authors: MIFUJI RUMI , KOBAYASHI YOSHINAO , MA NING , QIANG QIN LI , URAWA NAOHITO , HORIIKE SHINICHIRO , IWASA MOTOH , KAITO MASAHIKO , MALAVASI FABIO , ADACHI YUKIHIKO
Published: February 2006

Background and Aim:  Iron deposition in the liver is a common finding in patients with chronic hepatitis C (CH‐C). The mechanism of this hepatic accumulation of iron is not completely understood. This study assessed if the protein expression of transferrin receptor 2 (TfR2) is upregulated in the liver of patients with CH‐C and if TfR2 protein mediates iron accumulation during hepatitis C virus (HCV) infection.

Method:  Liver specimens from patients with CH‐C that underwent interferon (IFN) therapy (n = 23) and from patients with CH‐B (n = 18) were evaluated. Hepatic expression of TfR2 protein was analyzed by immunohistochemistry. Total hepatic iron score (THIS) was evaluated by Prussian blue staining.

Results:  TfR2 protein was expressed in the cell membrane and cytosol of hepatocytes. Cytosol TfR2 protein was found to co‐localize with Tf. THIS (P = 0.0198) and hepatic TfR2 (P = 0.0047) expression were significantly higher in CH‐C than in CH‐B. The change in THIS values (rho = 0.580, P = 0.0079) and the grade of histological activity (rho = 0.444, P = 0.0373) were significantly correlated with changes in TfR2 expression after IFN therapy.

Conclusions:  The protein expression of TfR2 is significantly associated with iron deposition in the liver in patients with CH‐C. HCV infection may affect the hepatic expression of TfR2, leading to iron accumulation in the liver.
Fas‐associated phosphatase‐1 promotes Fas‐mediated apoptosis in human colon cancer cells: Novel function of FAP‐1
Authors: MIYAZAKI TAKAKO , ATARASHI YOSHINARI , YASUMURA SATOSHI , MINATOYA ISAO , OGAWA KOHEI , IWAMOTO MASAYA , MINEMURA MASAMI , SHIMIZU YUKIHIRO , SATO TAKA‐AKI , WATANABE AKIHARU , SUGIYAMA TOSHIRO
Published: February 2006

Background and Aim:  Fas‐associated phosphatase‐1 (FAP‐1) has been thought as an inhibitor in Fas‐mediated apoptosis. Here, we investigated the role of FAP‐1 in Fas‐mediated apoptosis of human colon cancer cells.

Method:  The viability of four colon cancer cell lines treated with agonistic anti‐Fas antibody was determined using WST‐1 assay and cell death detection ELISA. pRc/CMV‐FAP‐1 was transfected to a FAP‐1‐negative, Fas‐resistant colon cancer cell line SW480 by lipofection and the clones expressing FAP‐1 protein were selected by limiting dilution. In the clones, expression of 550 genes was analyzed by cDNA microarrays. Protein expression of FAP‐1 and molecules related to apoptosis was examined by western blot.

Results:  We obtained two FAP‐1 overexpressed clones which were much more susceptible to Fas‐mediated apoptosis than control cells. In the clones, caspase 8 and caspase 3 were fully activated by agonistic anti‐Fas antibody treatment. Bcl‐2 family proteins were not related to the high susceptibility of these clones, because caspase 9 was not activated. Transfection of FAP‐1 did not suppress the survival actions of insulin‐like growth factor (IGF‐1) which enhanced survival signal through Akt phosphorylation. Upregulation in 21 genes and downregulation in 29 genes was revealed by cDNA arrays. We confirmed protein expression of p21 and phosphorylated p21 were much more enhanced in the clones than in control cells.

Conclusions:  Overexpression of FAP‐1 enhanced susceptibility to Fas‐mediated apoptosis in SW480 and upregulation of p21 may contribute to this phenomenon. Our results indicate a novel function of FAP‐1 in Fas‐mediated apoptosis of human colon cancer cells.
Slow‐wave photic stimulation relieves patient discomfort during esophagogastroduodenoscopy
Authors: NOMURA TSUTOMU , HIGUCHI KAZUHIDE , YU HIDENORI , SASAKI SHIN‐ICHI , KIMURA SHUJI , ITOH HIROYUKI , TANIGUCHI MICHIYO , ARAKAWA TETSUO , KAWAI KOKI
Published: February 2006

Background and Aim:  Although pretreatment with a sedative drug is effective in relieving pain during esophagogastroduodenoscopy (EGD), such drugs can cause significant side‐effects. The aim of this study was to examine the effect of slow‐wave photic stimulation on discomfort and/or pain felt during EGD.

Methods:  Forty consecutive patients (25 men and 15 women) who underwent diagnostic EGD in our hospital were included in the study. Twenty patients received photic stimulation for 25 min, and underwent electroencephalographic recording, in addition to the usual premedications. Twenty control patients received the same treatment but without photic stimulation. All patients evaluated the discomfort/pain felt during endoscopy against a five‐grade scale in comparison with what they had experienced in their previous examination.

Results:  Patients with an improved discomfort/pain score were 18/20 and 3/20 in the treated and control groups, respectively. Overall comparison of pain scores between both groups was significant (P < 0.0001). The proportion of slow‐wave activity recorded in patients’ electroencephalograms significantly increased in the treated group compared to control values (36.6 ± 6.8% vs 29.1 ± 3.4%, P < 0.001). There was a close correlation between the degree of discomfort/pain felt during endoscopy and the proportion of slow‐wave activity (P < 0.001).

Conclusion:  Slow‐wave photic stimulation shows promise as a treatment for relieving the discomfort and/or pain felt by patients undergoing EGD.
Endoscopic characteristics and Helicobacter pylori infection in NSAID‐associated gastric ulcer
Authors: KAMADA TOMOARI , HATA JIRO , KUSUNOKI HIROAKI , SUGIU KUNIAKI , TANIMOTO TATSURO , MIHARA MITSUHIRO , HAMADA HIROSHIGE , KIDO SOICHIRO , DONGMEI QIAN , HARUMA KEN
Published: February 2006

Background and Aim:  Helicobacter pylori infection and non‐steroidal anti‐inflammatory drugs (NSAIDs) are deeply involved in the etiology of gastric ulcers. The aim of our study was to clarify the endoscopic characteristics and H. pylori infection status of NSAID‐associated gastric ulcers.

Methods:  The study group comprised 50 patients (23 men, 27 women; mean age 66.5 years) with NSAID‐associated gastric ulcers and 100 sex‐ and age‐matched patients with gastric ulcer associated with other factors (control group). Ulcer morphology, size and number of lesions, onset site and incidence of hemorrhagic ulcers were investigated endoscopically in both groups. H. pylori infection was diagnosed by serology, histology and 13C‐urea breath test.

Results:  Multiple lesions (68% vs 20%, P < 0.001), occurrence in the antrum (56% vs 6%, P < 0.001), and hemorrhagic ulcer (34% vs 4%, P < 0.001) were significantly more prevalent in patients with NSAID‐associated gastric ulcers than in patients with non‐NSAID‐associated gastric ulcer. The H. pylori infection rate was significantly lower in NSAID‐associated gastric ulcer patients than in non‐NSAID‐associated gastric ulcer patients (48% vs 96%, P < 0.001). In the NSAID‐associated gastric ulcer group, the prevalence of H. pylori infection was significantly lower in patients with ulcers in the antrum than in those with ulcers in the angulus or corpus (25% vs 77.3%, P < 0.001).

Conclusions:  In contrast to non‐NSAID‐associated gastric ulcers, NSAID‐associated gastric ulcers frequently occur in the antrum with bleeding. The rate of H. pylori infection in NSAID‐associated gastric ulcers is significantly lower than that in non‐NSAID‐associated gastric ulcers.
Efficacy of interferon α‐2b and lamivudine combination treatment in comparison to interferon α‐2b alone in chronic delta hepatitis: A randomized trial
Authors: Canbakan Billur , Senturk Hakan , Tabak Fehmi , Akdogan Meral , Tahan Veysel , Mert Ali , Sut Necdet , Ozaras Resat , Midilli Kenan , Ozbay Gulsen
Published: February 2006

Background and Aim:  Delta hepatitis is characterized by rapidly progressive liver disease with adverse prognosis in most patients. Patients benefit from high doses and prolonged courses of interferon (IFN) therapy; however, lamivudine as a single agent has been disappointing. Data relating to the efficacy of IFN and lamivudine in combination is limited. The aim of this study was to test the efficacy of IFN‐α 2b and lamivudine combination treatment in comparison to IFN‐α 2b alone in patients with chronic delta hepatitis.

Methods:  Twenty‐six patients with chronic delta hepatitis were randomized into two groups. Twelve patients received IFN‐α 2b alone (eight men, four women; mean ± SD age: 43.83 ± 8.57 years), and 14 patients received IFN‐α 2b plus lamivudine combination (seven men, seven women; mean ± SD age: 42.5 ± 11.02 years). The dose of IFN‐α 2b was 10 MU t.i.w. and of lamivudine was 100 mg/day. The groups were comparable in reference to serum alanine aminotransferase (ALT), aspartate aminotransferase, bilirubin, albumin levels, histological activity and stage. Four patients (33.3%) in the IFN group and two (14.3%) in the combination group had cirrhosis (P = 0.2). The duration of treatment was 48 weeks with an untreated follow‐up period of at least 96 weeks (mean ± SD, 3.1 ± 1.9 years). A liver biopsy was performed at the end of treatment.

Results:  Eight patients from the IFN group and 11 from the combination group completed treatment. Serum ALT values became normal in 8/14 patients (57.1%) treated with IFN plus lamivudine and in 5/12 patients (41.7%) treated with IFN alone (P = 0.43). Serum hepatitis delta virus RNA was no longer detectable in nine of 14 (64.3%) patients treated with IFN plus lamivudine as compared to five of 12 (41.6%) patients treated with IFN alone (P = 0.024). In both groups female patients had significantly better virological response rate (P = 0.007). There was a significant improvement in histological activity in the combination group (mean decrease 5.27 ± 1.08 score, P = 0.001), but not in the IFN group (mean decrease 1.44 ± 1.59 score, P = 0.39). No significant improvement was observed in regards to fibrosis. Four of the 14 patients (28.6%) treated with combination therapy as compared to two of 12 patients treated with IFN (16.7%) were sustained virological responders (P = 0.47). The 5‐year survival rate was 65% in the IFN group and 85% in the combination group (P > 0.05).

Conclusion:  Interferon and lamivudine in combination is an encouraging treatment method and may be superior to IFN alone in chronic delta hepatitis.
Surface structure of antral gastric mucosa represents the status of histologic gastritis: Fundamental evidence for the evaluation of antral gastritis by magnifying endoscopy
Authors: Kim Sunjin , Ito Masanori , Haruma Ken , Egi Yasuo , Ueda Hiroyuki , Tanaka Shinji , Chayama Kazuaki
Published: February 2006

Background:  Recent studies have demonstrated the diagnostic potential of magnifying endoscopy in cases of histologic gastritis. The aim of the present study was to clarify whether the mucosal surface structure reflects the degree of histologic gastritis below the surface.

Methods:  Gastric biopsy specimens were obtained from 1018 Japanese patients and were stained with hematoxylin and eosin. In 863 sections examined, gastritis was graded by means of the updated Sydney system, and the surface structure was classified as one of four types: flat, irregular, papillary, or non‐structured. In addition, 103 patients underwent gastric examination by magnifying gastroscopy.

Results:  The surface structure of most biopsy sections with normal mucosa and no Helicobacter pylori infection was classified as the flat type. Grades of histological gastritis were statistically lower in flat‐type sections than in other types. Histologic gastritis was found in 91% of sections with a non‐flat surface structure. Helicobacter pylori infection was confirmed in 96% of these cases. Most biopsy sections in patients with abnormal magnifying endoscopy features were of the non‐flat type and showed histologic gastritis.

Conclusions:  The surface structure of the gastric mucosa reflects the status of histologic gastritis. Magnifying gastroscopy could be a useful non‐invasive method of diagnosing histologic gastritis.
Non‐steroidal anti‐inflammatory drugs have bacteriostatic and bactericidal activity against Helicobacter pylori
Authors: Shirin Haim , Moss Steven F , Kancherla Sandy , Kancherla Kevin , Holt Peter R , Weinstein I Bernard , Sordillo Emilia M
Published: February 2006

Background:  Helicobacter pylori infection and non‐steroidal anti‐inflammatory drugs (NSAIDs) are each associated with gastrointestinal mucosal damage, but the extent and direction of their interactions remain controversial. Therefore, the purpose of the present paper was to examine whether specific NSAIDs inhibit the growth of Helicobacter pylori in vitro.

Methods:  Sodium salicylate, ibuprofen, indomethacin, the selective cyclooxygenase‐2 inhibitor NS‐398 and two derivatives of sulindac sulfoxide were tested against two laboratory strains of H. pylori, the mouse‐adapted Sydney strain, and against seven fresh clinical isolates of Helicobacter pylori. Possible effects on Campylobacter jejuni, Staphyloccoccus aureus, Escherichia coli, Salmonella typhimurium, and Shigella boydii were also examined.

Results:  Certain NSAIDs possess antibacterial activity against Helicobacter pylori at therapeutically achievable doses; an effect that appears to be independent of cyclooxygenase enzymes inhibition. For Helicobacter pylori, >90% growth inhibition and bactericidal activity were observed consistently for sulindac sulfide at ≤70 µg/mL and sulindac sulfone at ≤175 µg/mL. The minimal inhibitory concentration against Helicobacter pylori was 125 µg/mL for ibuprofen, 100 µg/mL for indomethacin and 300 µg/mL for NS‐398 but much higher concentration of sodium salicylate (4000 µg/mL) and sulindac sulfoxide (≥1250 µg/mL) were required to inhibit the growth of Helicobacter pylori.

Conclusions:  The decreased prevalence of Helicobacter pylori in specimens from some NSAID users and the chemopreventive effects of NSAIDs in gastric cancer may be related to inhibition of Helicobacter pylori growth.
Hepatitis B post‐partum e antigen clearance in hepatitis B carrier mothers: Correlation with viral characteristics
Authors: Lin Ho‐Hsiung , Wu Wen‐Yih , Kao Jia‐Horng , Chen Ding‐Shin
Published: February 2006

Background:  The purpose of the present paper was to correlate hepatitis B virus (HBV) genotype, e antigen titer, HBV‐DNA level and precore/basal core promoter mutations with post‐partum e antigen clearance in hepatitis B e antigen (HBeAg)‐positive carrier mothers.

Methods:  A total of 40 consecutive HBeAg‐positive carrier mothers were studied from January 2002 to January 2003. The blood samples were taken at delivery, 3–4 months and at 1 year after delivery, and the follow‐up period was until 1 year after delivery. All sera were assayed for HBeAg, HBV‐DNA level, HBV genotype and precore/basal core promoter mutations. The correlation between HBV characteristics and post‐partum e antigen clearance was analyzed by Mann–Whitney, Pearson χ2 and multiple logistic regression tests.

Results:  The mean age of the 40 HBeAg‐positive carrier mothers was 29.9 ± 5.3 years with a mean parity of 1.4 ± 0.7. Five of them (group I) had post‐partum e antigen clearance, which persisted thereafter, whereas the remaining 35 carrier mothers (group II) had persistent positivity of HBeAg during the follow‐up period. The prepartum comparisons of HBV characteristics between groups I and II were comparable in terms of demographics and distributions of HBV genotype and precore/basal core promoter mutations. In contrast, group I carrier mothers had lower HBeAg titer and HBV‐DNA level than group II carrier mothers (1:80 vs 1:4000, P = 0.02, and 3.75 × 105 vs 3 × 108 copies/mL, P = 0.028, respectively).

Conclusions:  Post‐partum e antigen clearance in HBeAg‐positive carrier mothers is closely associated with prepartum low HBeAg titer or HBV‐DNA level.
Origin of neovascular structure in an early stage of hepatocellular carcinoma: Study of alpha‐smooth muscle actin immunohistochemistry in serial thin sections of surgically resected cancer
Authors: IKEDA KENJI , KOBAYASHI MASAHIRO , SAITOH SATOSHI , SOMEYA TAKASHI , HOSAKA TETSUYA , SEZAKI HITOMI , SUZUKI YOSHIYUKI , SUZUKI FUMITAKA , AKUTA NORIO , ARASE YASUJI , KUMADA HIROMITSU
Published: February 2006

Background:  To elucidate the origin of the neovascular structure found in well‐differentiated hepatocellular carcinoma (HCC), an immunohistochemical study was performed on sequential thin section specimens.

Method:  Eleven surgically resected specimens of well‐differentiated HCC were analyzed for neovascular structure using monoclonal alpha‐smooth muscle actin (α‐SMA) antibody. Each paraffin specimen was serially sliced to a thickness of 3 µm for immunohistochemistry. When a ring‐shaped structure was found unrelated to portal triads on α‐SMA staining, it was regarded as abnormal neovascularity (non‐triadal vessel or unaccompanied vessel).

Results:  All of the 11 liver cancers had thin‐walled, round‐ or oval‐shaped non‐triadal vessels in their well‐differentiated parts. Immunohistochemistry of serial thin sections of HCC showed that these non‐triadal vessels were connected to portal veins in portal triads in well‐differentiated cancer in a total of nine patients (81.8%). This type of neovascular structure found in a well‐differentiated cancer seemed to be a surviving portal vein among diminishing and disappearing arteries and bile ducts. All 11 tumors showed isovascular staining on ordinary digital subtraction angiography, and four of the tumors showed negative enhancement on intra‐arterial carbon dioxide‐enhanced ultrasonography or computerized tomographic (CT) hepatic arteriography, suggesting a relative arterial blood scarcity in the tumor nodules.

Conclusion:  At an early stage of HCC, non‐triadal vessels originate from ordinary portal veins in intratumoral portal triads. This fact sufficiently explains the reason why a well‐differentiated liver cancer can sometimes show arterial blood paucity on CT arteriography or enhanced ultrasonography.
Anesthetic management of staged separation of craniopagus conjoined twins1
Authors: GIRSHIN MICHAEL , BRODERICK CARLENE , PATEL DARSHANA , CHACKO SABEENA , REDDY SHAMANTHA , STAFFENBERG DAVID , GOODRICH JAMES , WASNICK JOHN
Published: February 2006

We present a case of successful separation of craniopagus conjoined twins. The procedure was staged to permit each child to develop adequate independent cerebral venous drainage and to prevent deleterious, perioperative cerebral edema. Surgical hemorrhage, blood product delivery, and hemodilution were minimized.
1  A novel approach to decision support for men diagnosed with prostate cancer: the proscan study
Authors: STEGINGA S.K. , CLUTTON S. , GARDINER R.A. , NICOL D.L. , HEATHCOTE P. , JAMES T. , WOOD G. , YAXLEY J.
Published: February 2006

Introduction:  Men diagnosed with prostate cancer experience a range of psychosocial and physical difficulties, and in particular high levels of decision‐related distress. There is a need for a robust, theory based and targeted intervention to address men's needs at diagnosis and during the acute phase of rehabilitation.

Methods:  In previous research we found that cancer threat appraisal predicts decision‐related and psychological distress and further that threat appraisal also predicts the trajectory of adjustment over time. Specifically, as men's cancer threat appraisal becomes more negative, their adjustment trajectory worsens. This finding offers great hope for the malleability of outcomes and their potential for response to intervention. Accordingly, we integrated psycho‐education and decision support in a novel intervention for men newly diagnosed with prostate cancer.

Results:  In a pilot study men newly diagnosed with localised prostate cancer reported clinically lower decision‐related distress (P = 0.001) after the intervention suggesting a moderate effect size. Further to this, to date 250 men have been recruited (86% participation) to a randomised control trial of the intervention. Patterns of care and baseline data for these men will also be presented.

Conclusion:  Psychosocial interventions for men with prostate cancer need to be finely tuned to the treatment experience and flexible to articulate effectively with men's varied individual decision making processes and clinician practices. The need for this approach will only increase as diagnostic methods further develop and treatment options continue to be the subject of debate.
10  What factors predict biochemical recurrence after radical retropubic prostatectomy?
Authors: O'MALLEY P.J. , HAWIZY A. , HURLE R.A. , REES J. , HUGHES O. , KYNASTON H.
Published: February 2006

Objectives:  Several factors can predict biochemical recurrence (BCR) after radical retropubic prostatectomy (RRP). Our objective was to review these factors in our practice and whether preoperative MRI stage is an additional factor.

Patients and Methods:  Data was collected prospectively from over 800 patients who attended an early prostate cancer clinic between Feb 1997–Sept 2005. 279 patients underwent RRP (14 excluded). BCR was defined as any PSA level >0.2 ng/ml at any time post operatively. Probability estimates for BCR were calculated using the Kaplan–Meier method. Log Rank and Cox proportional hazard regression ratios were used to compare the results.

Results:  Median follow up was 23 months (range 3–115 months) and 10% (25/265) of patients developed BCR. Margin positivity (P = 0.001) Gleason score (P = 0.008) and preoperative MRI stage (P = 0.04) were significant predictors for BCR on univariate analysis. However, clinical stage, PSA and final pathology stage were not significant predictors of BCR. On multivariate analysis only margin positivity and Gleason score remained significant.

Conclusion:  Patients with Gleason ≥7, positive surgical margins at surgery and visible tumour on MRI are at a higher risk of BCR. Adjuvant treatments should be considered in such patients.
16  Kallikrein 15 (KLK15) in prostate cancer: in silico analysis and single nucleotide polymorphism verification
Authors: KEDDA M.A. , SKEIE L.M. , SMITH R.L.G. , HIGGINS M. , SPURDLE A.B. , YAXLEY J. , STEGINGA S. , CLEMENTS J.A.
Published: February 2006

Introduction:  Prostate cancer is the most common cancer in Caucasian men and there is strong evidence that kallikreins are part of an enzymatic cascade pathway activated in this disease. Altered KLK15 expression has been associated with cancer progression and grade and we postulate that single nucleotide polymorphisms (SNPs) in the KLK15 gene, will alter gene expression and will be associated with prostate cancer susceptibility and prognosis.

Materials and Methods:  We have used in silico prediction of function of wildtype and variant promoter sequences through assessment of hormone receptor elements and transcription factor binding sites; as well as prediction of likely splice variants through genomic, splicing and EST databases and web sites, and multiple sequence alignment packages. We have also used PCR and sequence analysis to further characterise the promoter region of the gene.

Results:  In silico analysis of the KLK15 gene has identified the following: two putative promoter regions, two putative androgen response elements (AREs) and four putative estrogen response elements (EREs); two clusters of cis elements; and 109 SNPs. Forty‐seven SNPs alter transcription factor sites (22 gain sites), 20 gain/increase probability of an ERE and three alter nuclear hormone receptor binding sites. Three new EST clones have been identified by analysis of gene expression in CGAP databases and suggest a new KLK15 splice variant, with a different start site.

Conclusion:  We have identified a number of new SNPs in the KLK15 gene, which may be functionally important and, in collaboration with the Queensland Cancer Fund (ProsCan Study), we will further investigate the association of these SNPs with prostate cancer risk and prognosis.
18  Prostrate cancer: molecular diagnosis from prostatic fluid
Authors: BURGER M.J. , LANDERS K.A. , ROPER K. , SAMARATUNGA M.L.T.H. , YAXLEY J. , STENING S. , LAVIN M.F. , GARDINER R.A.
Published: February 2006

Introduction:  Deficiencies in the use of PSA in the diagnosis of prostate cancer have led to research into examining the cellular contents of the prostate more directly. To this end, Bostwick Laboratories now provide a test which assays for PCA3/DD3 RNA (http://www.bostwicklaboratories.com/) from prostatic cells in urine immediately following DRE to provide a sensitivity and specificity as high as 84% and 80%, respectively, for a PSA of 4–10 ng/ml.

Methods:  In this study, we are examining four validated RNA markers, Hepsin, PSMA, AMACR as well as PCA3/DD3, in cells from prostatic fluid obtained following DRE and from ejaculate and urines immediately following ejaculation, from men undergoing ≥12 TRUS biopsies for suspected prostate cancer. The ejaculate specimens have been processed using techniques developed on our laboratory which enrich for prostatic cells.

Results:  Twenty‐two men have provided specimens of urines following DRE, ejaculate and urine immediately following ejaculation and the findings are being related to those from TRUS biopsies.

Conclusion:  Unlike the use of one (albeit a highly discriminating) marker, multiple widely overexpressed markers in prostate cancer promises to detect all patients with malignancy. Furthermore, the relationship of the two methods for obtaining specimens is being evaluated to determine whether one is better than the other as well as the possibility that they are complementary in providing 100% sensitivity and specificity in the detection of this disease.

Acknowledgements:  We are indebted to the Australasian Urological Foundation, the Northern Section of Urological Society of Australasia, Queensland Cancer Fund, US Department of Defense and the NHMRC for their support with this project.
19  Cytosolic phospholipase A2 increases proliferation, inhibits apoptosis and facilitates angiogenesis in prostate cancer: a potential new therapeutic target
Authors: PATEL M.I. , KRUEK C. , YAO M. , TUCKERMANN R. , DONG Q.
Published: February 2006

The end‐products from the arachadonic acid (AA) pathway have been shown to be tumourigenic in prostate cancer (CaP). Cytosolic phospholipase A2 (cPLA2) is the enzyme that liberates AA from plasma membranes and feeds it to the cycloxygenase and lipoxygenase pathways. In this study we aim to determine the importance of cPLA2 in prostate cancer by examining human prostate cancer specimens and in vitro cell line models. Immunohistochemistry of human prostate specimens revealed that activated cPLA2 levels were significantly higher in prostate cancer compared to benign glands.. Next to determine if inhibition of cPLA2 would lead to decreases in prostate cancer growth, we treated three CaPcell lines (PC3, DU145 and LNCaP) with pyrrolidine 2 (P2), a specific cPLA2 inhibitor and showed it significantly inhibited the growth of all three cell lines at concentrations between 1–10μM by MTS assay. P2 treatment induced a cell cycle block at G0/G1 and a corresponding reduction in BrdU incoprporation by flow cytometry and 3H‐Thymidine incorporation. In addition cPLA2 knock by siRNA also showed a similar inhibition in proliferation, confirming the importance of cPLA2 in CaP proliferation. P2 also induced apoptosis in CaP cell lines by Caspase 3/7 assay. Treatment of Endothelial cell (HUVECs) cells with P2 had a very significant inhibitory effect on capillary tube formation in matrigel. We conclude that cytosolic phospholipase A2 is overactive in human prostate cancer. It leads to CaP proliferation as well as apoptosis. cPLA2 also is required in endothelial angiogenesis. Inhitibion of cPLA2 by P2 will reduce cancer growth, induce apoptosis and inhibit angiogeneisis in an in vitro model. Together, these findings suggest that cPLA2 could be a potential target in CaP treatment and warrants further validation in animal and human trials.
2  Are urological cancer patients receiving care in accordance with good practice?
Authors: BROOKS A. , SMITH D. , BERRY M. , KNEEBONE A. , TYNAN K.
Published: February 2006

Introduction:  The NSW Urology Oncology Program is an initiative of the Cancer Institute NSW bringing together individuals and organisations with an interest in Urological Oncology. The multidisciplinary collaboration will implement the NSW Cancer Plan as it pertains to Urological Oncology. The aim is to utilise the members expertise to determine ‘good practice’ in Urological Oncology and develop practical guidelines and protocols to support service providers. In addition the program will pursue a planned approach to research, education and training.

Method:  Expressions of Interest were sought from clinicians, industry representatives, consumers and researchers with an interest in Urological Oncology. Through a series of working parties the members will address the priority issues arising from ‘Patterns of Care’ studies particularly the NSW Cancer Council study for Prostate Cancer. Specific projects are:

• Tumour site specific Minimum Data Set

• Guidelines and protocol development

• Clinical Trials

• Research

• Education (multidisciplinary education)

Outcomes:  A planned and coordinated program underpinned by research, education and training, will progressively reduce mortality from Urological cancer and improve the quality of patient care.

Conclusion:  The NSW Urology Oncology Program will provide leadership to deliver a State‐wide planned approach to Urological Oncology in accord with ‘good practice’.
22  A gene promoter hypermethylation panel to detect transitional cell carcinoma of the bladder
Authors: YATES D.R. , REHMAN I. , MEUTH M. , CROSS S.S. , HAMDY F.C. , CATTO J.W.F.
Published: February 2006

Introduction:  Promoter methylation has been established as a mechanism for silencing of tumour suppressor genes (TSGs) in TCC. Detection of aberrant methylation has been proposed as a novel diagnostic test, but the desired sensitivity and specificity has not been proven. The gene specific nature of methylation necessitates investigators to identify a panel of TSG's, that when analysed for aberrant methylation in tumour DNA, demonstrate a high sensitivity, specificity and diagnostic accuracy for clinical use. Here, we analyse a panel of 16 genes in the DNA of 96 TCCs and 30 samples of normal urothelium.

Methods:  DNA was obtained from 96 TCCs and 30 normal bladders. The DNA was bisulphite modified and quantitative methylation specific PCR (QMSP) was performed for 16 gene promoters.

Results:  Methylation was detected for all 16 genes in the 96 TCCs. This ranged from 3% to 75%. The genes with the highest frequency of methylation were RASSF1a (54%), E‐cadherin (41%), BCL2 (45%), TNFRS25 (75%), EDNRB (66%), IGFBP3 (43%) and WIF1 (56%). High levels of methylation were detected in the normal controls for RASSF1a (50%) and E‐cadherin (20%), with 11 other genes having low levels of methylation. Using a panel of 5 heavily methylated genes, a sensitivity of 57%, specificity of 89% and a diagnostic accuracy of 80% resulted.

Conclusion:  The frequency of methylation varied widely for different genes, confirming the gene specific nature of aberrant methylation in TCC. Using our panel of gene loci, the sensitivity and specificity of methylation DNA analysis was not adequate. However, our study does demonstrate the feasibility of TCC DNA methylation analysis and with the identification of further cancer specific gene loci, it may prove a useful early detection strategy.
25  Interobserver agreement in the evaluation of urine cytology for the detection of urothelial malignancy
Authors: BUCHAN N.C. , CAMPBELL P.A. , SHIELD P. , COSIER J. , COMINOS D. , KERR K. , MACTAGGART P. , NICOL D.L.
Published: February 2006

Introduction:  Urine cytology is a test used to diagnose and monitor for urothelial malignancy. It is a biological test for which there is no gold standard. The diagnosis offered is based on the subjective interpretation by the cytopathologist viewing the slide. As in all biological systems for which there is no gold standard, the interpretation is subject to clinical disagreement and interobserver variation. The aim of this study is to evaluate the agreement between cytopathologists in the interpretation of urine cytology.

Materials and Methods:  Two hundred urine cytology slides were collected over a six month period, from a busy metropolitan pathology firm. The series was made up of four categories, normal, atypical, suspicious for malignancy, and malignant. Each category contained fifty representative slides. The slides were reviewed by two independent reviewers as quality control and masked prior to been given randomly to four raters for assessment. The raters consisted of two screening scientists and two cytopathologists. Each rater received each slide in a random fashion and was asked to independently categorise the slide into one of the above categories. The level of agreement was analysed using Cohen weighted Kappa statistics.

Results:  The interobserver agreement in the assessment of urine cytology by cytopathologits in the detection of urothelial malignancy is moderate using Cohen's kappa weighted statistics.

Conclusions:  The interobserver agreement in the assessment of urine cytology by cytopathologists is moderate and as such should be born in mind when investigating patients for urothelial malignancy.
28  Bladder dome air bubbles in TURBT: is there any benefit from removing the air bubble at TURBT?
Authors: DELANEY D.P. , OPESKIN K. , WILLIAMS E. , TEMELCOS C. , ASOPA R. , CLARKE A. , NIALL O. , BRENNAN J. , GOAD J.
Published: February 2006

Introduction:  The recurrent nature of superficial bladder cancer is currently explained by two theories – field change and implantation, with good evidence supporting each theory. Many recurrent tumours occur at the dome of the bladder. It is postulated at transurethral resection of superficial bladder cancer (TURBT) tumour fragments are held within the air bubble that forms at the dome and lead to recurrent tumours. In a pilot study we have shown there are viable tumour cells at the air‐bubble fluid interface. In this study we examine the effects of removing the air‐bubble on reducing tumour fragments in voided urine following TURBT and its effect on tumour recurrence. We have used urine cytology as a surrogate marker of the likelihood of tumour recurrence. Positive urine cytology at day 3 following TURBT has been associated with increased incidence of recurrent tumours.

Method:  All patients having a TURBT for primary or recurrent superficial bladder cancer (Ta, T1 and CIS) were entered prospectively. Two groups were examined – group one had a standard TURBT and group two had removal of the air bubble and macroscopic tumour fragments at the end of standard TURBT. All patients then had a voided urine specimen on day 1 postTURBT. The voided urine had quantitative analysis performed. Patients were then followed for tumour recurrence with cystoscopy surveillance.

Results:  Formal results to be tabulated.

Conclusion:  Removal of the air bubble at the time of TURBT does reduce the incidence of tumour cells in voided urine at day 1 postTURBT.