bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel human and mouse genes encoding a shank‐interacting protein and its upregulation in gastric fundus of W/WV mouse
Authors: DAIGO YATARO , TAKAYAMA ICHIRO , WARD SEAN M , SANDERS KENTON M , FUJINO MASAYUKI A
Published: May 2003

Background and Aims: A division of labor exists between different classes of interstitial cells of Cajal (ICC) in the gastrointestinal tract. In the stomach and small intestine, ICC at the level of the myenteric plexus (IC‐MY) act as slow wave pacemaker cells, whereas intramuscular ICC (IC‐IM) in the stomach act as intermediaries in enteric motor neurotransmission. The muscle layers of the gastric fundus do not have IC‐MY, therefore electric slow waves are not generated. Intramuscular ICC are absent in the gastric fundus of W/WV mutant mice, and excitatory and inhibitory motor nerve responses are reduced in these tissues. The absence of IC‐IM in W/WV mutants in the fundus provides a unique opportunity to study the molecular changes that are associated with the loss of these cells.

Methods: The tissue gene expression of wild‐type and W/WV mice from gastric fundus was assayed using a murine microarray chip analysis displaying a total of 8734 elements.

Results: Twenty‐one queries were differentially expressed in wild‐type and W/WV mice. One candidate gene, encoding a novel protein homologous to rat Shank‐interacting protein (Sharpin) was significantly upregulated in fed and starved W/WV mice. The full‐length clone of the murine gene and its human counterpart were isolated and designated as Shank‐interacting protein‐like 1 (SIPL1). Human SIPL1 complementary DNA encodes a protein of 345 amino acids. This gene was localized to chromosome 8. SIPL1 was abundantly expressed in human stomach and small intestine, and scarcely expressed in cecum and rectum.

Conclusions: Gene analysis showed that SIPL1 differentially express in the gastric fundus of normal and W/WV mice. The upregulation of SIPL1 in the fundus of W/WV mice, and expression in the upper gastrointestinal tract suggest that the SIPL1 gene could be associated with ICC function in mice and humans.

© 2003 Blackwell Publishing Asia Pty Ltd
Loss of heterozygosity on chromosome 17p predicts neoplastic progression in Barrett's esophagus
Authors: DOLAN KEVIN , MORRIS ANTHONY I , GOSNEY JOHN R , FIELD JOHN K , SUTTON ROBERT
Published: May 2003

Background and Aim: Endoscopic surveillance for adenocarcinoma in patients with Barrett's esophagus is costly, with one cancer detected every 48–441 patient years of follow up. Genetic abnormalities, including loss of heterozygosity at sites of tumor suppressor genes, have been detected in malignant and premalignant Barrett's esophagus. The aim of this prospective study was to determine if loss of heterozygosity analysis could identify patients with Barrett's esophagus at greatest risk of adenocarcinoma, for whom endoscopic surveillance is most appropriate.

Methods: Loss of heterozygosity analysis was performed on endoscopic biopsies from 48 patients as part of a Barrett's surveillance program using 14 microsatellite markers shown previously to detect loss of heterozygosity in more than 30% of esophageal adenocarcinomas. Patients were followed up endoscopically for a median of 5 years.

Results: Loss of heterozygosity was detected in nine patients. Three patients with loss of heterozygosity on chromosome 5q or 9p did not progress beyond metaplasia. Loss of heterozygosity at 17p11.1–p13 was detected in six patients, all of whom demonstrated dysplasia and/or carcinoma during follow up (four low‐grade dysplasia, one high‐grade dysplasia and one adenocarcinoma).

Conclusion: Loss of heterozygosity at 17p11.1–p13 on chromosome 17p identifies patients with Barrett's esophagus at risk of neoplastic progression and can supplement histology in determining the frequency of endoscopy during surveillance.
Delta 13C‐urea breath test value is a useful indicator for Helicobacter pylori eradication in patients with functional dyspepsia
Authors: CHANG YOUNG‐WOON , MIN SUN‐KEE , KIM KYUNG‐JIN , HAN YO‐SEOB , LEE JOO‐HEE , DONG SEOK‐HO , KIM HYO‐JONG , KIM BYUNG‐HO , LEE JOUNG‐IL , CHANG RIN
Published: May 2003

Background: Eradication of Helicobacter pylori is not routinely recommended for the symptomatic relief and the prevention of gastric cancer in patients with functional dyspepsia. The present study investigated a useful indicator of H. pylori eradication in such patients by determining the optimal cutoff value of a 13C‐urea breath test (UBT).

Methods: One hundred dyspeptic patients participated in the study. Dyspepsia was scored, and a 13C‐UBT administered. A level of delta 13C‐UBT of>4‰ was diagnosed as H. pylori‐positive. After the stomach was endoscopically sprayed with phenol red, biopsy specimens were taken from the antrum, body and cardia of the stomach for the assessment of H. pylori density, and activity (neutrophil infiltration) and degree (lymphocyte infiltration) of gastritis.

Results: Correlation between delta 13C‐UBT and dyspepsia score was not found. Delta 13C‐UBT significantly correlated with H. pylori density score in the total stomach (r = 0.53, P < 0.0001), neutrophil (r = 0.34, P = 0.0005) and lymphocyte score (r = 0.69, P < 0.0001). Twenty‐six of the 100 subjects had a neutrophil score of ≥4, lymphocyte score of ≥4, and H. pylori score of ≥4. Their 95% confidence interval of mean was 58.2‰, which reflects moderate to marked acute and chronic gastritis, and dense H. pylori colonization.

Conclusions: The 13C‐UBT is a reliable semiquantitative test to assess H. pylori density and the activity and degree of gastritis. It is proposed that H. pylori eradication therapy might be beneficial for patients with functional dyspepsia with a delta 13C‐UBT of >58.2‰.
Decreased ratio of CD4/CD8 lymphocytes might be predictive for successful interferon alpha and lamivudine combined therapy in childhood chronic hepatitis B infection: A preliminary study
Authors: GENEL FERAH , UNAL FATIH , OZGENC FUNDA , AKSU GUZIDE , AYDOGDU SEMA , KUTUKCULER NECIL , YAGCI RASIT V
Published: May 2003

Background: In the development of chronic hepatitis with hepatitis B virus infection and in response to therapy, the immune status of the infected host plays a critical role. In this study, immunological variables were assessed in patients before interferon alpha and lamivudine therapy to determine if any pretreatment immunological parameter could be an indicator of response to therapy in childhood chronic hepatitis B infection.

Methods: Forty‐four patients with chronic hepatitis B virus infection, aged 9.0 ± 3.9 years, were enrolled in the study. The pretreatment clinical features, biochemical test results, histological activity indexes and immunological parameters were evaluated. All patients received interferon alpha for 6 months and lamivudine for 52 weeks. Four patients who could not be followed up were excluded from the study. The other 40 patients have been followed for a mean period of 27.5 ± 9.7 months after therapy discontinuation.

Results: Seventeen patients showed loss of hepatitis B early antigen (HBeAg) with appearance of anti‐HBe (42.5%) and six of those who responded also showed loss of hepatitis B surface antigen (HBsAg) with the presence of anti‐HBs (15%). Except elevated aspartate aminotransferase levels, there was no significantly correlation between response and sex, age, pretreatment duration of disease and histological activity indexes. Pretreatment immunoglobulins (Ig), IgG subclasses, complement C3, C4 and secretory IgA levels were also not found to be significantly related to response. The evaluation of lymphocyte subsets showed that therapy responders had significantly reduced pretreatment ratios of CD4/CD8+ lymphocytes due to prominent increased percentages of CD8+ cells. The other cellular immunity parameters and some cell surface adhesion molecules were similar in both groups.

Conclusion: This study emphasizes the importance of increased pretreatment CD8+ lymphocyte percentages leading to a significant decrease in CD4/CD8 ratio in chronic hepatitis B virus infection of childhood as an immunological factor predicting response to treatment.
Scirrhous changes in dysplastic nodules do not indicate high‐grade status
Authors: AN HEE J , ILLEI PETER , DIFLO THOMAS , JOHN DEVON , MORGAN GLYN , TEPERMAN LEWIS , THEISE NEIL
Published: May 2003

Background and Aims: Dysplastic nodules (DN) may be divided into high‐grade and low‐grade, and the former has been known as a precancerous or borderline lesion. Recently many morphological characteristics concerning these types of DN have been reported. In the present study we attempted to evaluate the scirrhous change in DN as an indicative feature of high‐grade DN, based on the morphological and cell‐kinetic analyses using immunohistochemical stains for Ki‐67.

Methods: We reviewed 35 livers with DN and selected 15 DN with scirrhous change. We stained DN‐bearing sections of each case with hematoxylin and eosin, trichrome, reticulin and Perls’ stain. We tried to subclassify and characterize the scirrhous change according to the fibrosis pattern. We also stained with Ki‐67 immunohistochemically to assess the proliferative activity of DN with scirrhous change.

Results: We found two types of scirrhous change, that is, pericellular and stellate. The pericellular type was related to the Mallory body‐forming cholestatic degeneration, whereas the stellate type was associated with extensive portal fibrosis probably induced by ischemic damage. Among DN with scirrhous change, high‐grade DN comprised five nodules (33%) and there were 10 (67%) low‐grade nodules. There was no significant relationship between the presence or the types of scirrhous change and the grade of DN. The significant differences of Ki‐67 labeling indices between types of scirrhous change were not shown in this study. We also could not find the differences between Ki‐67 labeling indices of scirrhous DN (high and low grades) and those of surrounding regenerative nodules.

Conclusions: This evidence indicated that the scirrhous change in DN was not a specific feature of high‐grade DN. We also found that scirrhous DN have two morphological varieties that may represent biologically different processes, that is, pericellular scirrhous type and stellate scirrhous type.
Evaluation of Helicobacter pylori stool antigen test before and after eradication therapy
Authors: TANAKA AKIFUMI , WATANABE KAZUHIRO , TOKUNAGA KENGO , HOSHIYA SATOSHI , IMASE KIYOTO , SUGANO HAJIME , SHINGAKI MASAO , KAI AKEMI , ITOH TAKESHI , ISHIDA HITOSHI , TAKAHASHI SHIN’ICHI
Published: May 2003

Background and Aim: The Helicobacter pylori stool antigen (HpSA) test is useful for initial diagnosis of H. pylori infection, but there is disagreement regarding its diagnostic accuracy after eradication therapy. The aim of the present study was to evaluate the diagnostic accuracy of the HpSA test before and after eradication therapy.

Methods: One hundred and thirty‐six patients underwent upper gastrointestinal endoscopy with biopsies for the diagnosis of H. pylori infection using culture, histology and the rapid urease test. Fifty‐four H. pylori‐positive patients were treated with 1‐week triple therapy. Six to 10 weeks after the end of therapy, the patients underwent re‐endoscopy and received the same biopsy‐based methods. In addition, the 13C‐urea breath test was performed. The HpSA test was performed before and 6–10 weeks after the end of therapy. In 23 patients, the HpSA test was also performed at the end of therapy.

Results: Before therapy, the sensitivity and specificity of the HpSA test was 98.3% (95% confidence interval (CI): 95.9–100%) and 95.0% (95% CI: 75.1–99.9%), respectively. At the end of therapy, the HpSA tests were all negative both for eradication and non‐eradication patients. The sensitivity and specificity of the HpSA test after eradication therapy were 90% (95% CI: 55.5–99.7%) and 97.7% (95% CI: 93.3–100%), respectively.

Conclusions: The HpSA test is a useful method for the diagnosis of H. pylori infection before and after eradication therapy.
A case of Legionella pneumophila pneumonia complicated by miliary tuberculosis
Authors: UCHIDA Kou , AOIKE Nozomi , YOSHIDA Kanako , KOYA Ai , TAKAI Yujiro , TATEDA Kazuhiro , YAMAGUCHI Keizo
Published: May 2003

A 47‐year‐old woman was admitted to hospital with severe Legionella pneumonia. The respiratory symptoms improved dramatically and the X‐rays revealed a decrease in the diffuse chest infiltrates after treatment with erythromycin and rifampicin. However, chest CT scans showed that the reticulonodular opacities persisted for several weeks after the onset of pneumonia. Two months after admission, the chest X‐rays showed the progression of small nodules in both lungs and there was increasing respiratory distress. A diagnosis of miliary tuberculosis was confirmed. The present case should alert physicians to this potentially confusing combination of respiratory pathogens.
Pulmonary thromboembolism with massive vaginal bleeding due to thrombolytic therapy
Authors: EKIM Numan , KOKTURK Nurdan , YEGIN Demet , KOKTURK Oguz , HABESOGLU M. Ali
Published: May 2003

Thrombolytic therapy may reduce the morbidity of pulmonary thromboembolism (PTE) and the risk of recurrent disease. The most important complication of thrombolytic therapy is bleeding. We report a patient with PTE complicated by massive vaginal bleeding due to thrombolytic therapy.
Prescribing and administration of nebulized bronchodilators: A prospective audit in a university hospital
Authors: KHOO See Meng , LIM T. K.
Published: May 2003

Objective:  Inaccurate and incomplete prescribing of nebulized bronchodilators can result in uncertainty and suboptimal treatment. A prospective study was carried out to assess the completeness of prescription and the quality of bronchodilator drug administration via nebulizers.

Methodology:  A total of 121 consecutive inpatient nebulized bronchodilator prescriptions and treatments administered to 93 adult medical inpatients in a university hospital were studied prospectively. Five different aspects of the prescriptions were examined to assess their accuracy and completeness. The administration of each nebulizer treatment was studied using audit of medication charts and interview with ward nurses.

Results:  No prescription was correct and complete in all five aspects assessed. The most common mistake was failure to state the type and flow rate of driving gas (100%). This was followed by failure to prescribe recommended doses of bronchodilators (46%) and failure to give unambiguous instruction on frequency of treatment (39%). It was found that in only 21.5% of instances was the administration of nebulized bronchodilator drugs optimal.

Conclusion:  This prospective audit has demonstrated major deficiencies in the prescribing and administration of nebulized bronchodilators and it has highlighted the need for a local protocol and continuing staff education. The alternative method of administering bronchodilator via metered dose inhaler with large volume spacer should be evaluated in the treatment of acute airflow obstruction in hospitalized patients.
The significance of tumour markers as an indication for mediastinoscopy in non‐small cell lung cancer
Authors: ANDO Soichiro , KIMURA Hideki , IWAI Naomichi , KAKIZAWA Kimitaka , SHIMA Masayuki , ANDO Michiko
Published: May 2003

Objective:  The purpose of this study was to verify the significance of tumour markers as indicators for mediastinoscopy in non‐small cell lung cancer.

Methodology:  In the past 4 years, 205 patients with non‐small cell lung carcinoma (NSCLC) underwent surgical resection at Chiba Cancer Center, Chiba, Japan. The correlation between the serum levels of eight tumour markers (CEA, AFP, CA19‐9, SCC, NSE, CA125, CYFRA, ProGRP) and the presence of N2 disease was analysed. Univariate and multivariate analyses were performed to determine the relationship between both marker levels and clinical findings and N2 disease.

Results:  In multivariate analysis, positive CEA was significantly associated with the diagnosis of N2 disease. We also demonstrated that when CA125, CYFRA and ProGRP were positive, they were individually significantly associated with N2 disease. However, CEA was superior to the other markers and equivalent to a combination of various tumour markers.

Conclusion:  It was concluded that evaluation of CEA in addition to CT is of use in the diagnosis of N2 disease in NSCLC patients and should be used as an indication for mediastinoscopy.
Bronchoalveolar lavage fluid cells in mixed connective tissue disease
Authors: ENOMOTO Katsumi , TAKADA Toshinori , SUZUKI Eiichi , ISHIDA Takashi , MORIYAMA Hiroshi , OOI Hidemi , HASEGAWA Takashi , TSUKADA Hiroki , NAKANO Masaaki , GEJYO Fumitake
Published: May 2003

Objective:  Patients with mixed connective tissue disease (MCTD) exhibit clinical features of systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and polymyositis and dermatomyositis (PM–DM). The objective of this study was to clarify differences in BAL findings and immunophenotypes of BAL fluid (BALF) cells of patients with interstitial lung disease associated with these diseases.

Methodology:  We were unable to recruit a sufficient number of SLE patients with lung disease. We compared immunophenotypes of lymphocytes and alveolar macrophages (AM) in BALF of 20 MCTD patients with those of 21 SSc and 27 PM–DM patients and tested the relationships between immunophenotypes and pulmonary function in MCTD.

Results:  MCTD patients had a significantly higher CD4/CD8 ratio with more CD4 positive lymphocytes than PM–DM patients (P = 0.025). In AM phenotypes, MCTD patients had a significantly lower percentage of CD71 positive AM compared with SSc patients (P = 0.023). DLCO was negatively related to absolute numbers of CD8 positive lymphocytes (R = −0.517, P= 0.033).

Conclusions:  CD4 positive lymphocytes in BALF were increased in MCTD compared to PM–DM patients, while CD71 positive AM were decreased in MCTD compared to SSc patients. CD8 positive lymphocytes correlated negatively with DLCO measurements in MCTD patients.
Sputum eosinophilia and bronchial responsiveness in patients with chronic non‐productive cough responsive to anti‐asthma therapy
Authors: FUJIMOTO Keisaku , YAMAGUCHI Shinji , URUSHIBATA Kazuhisa , KOIZUMI Tomonobu , KUBO Keishi
Published: May 2003

Objective:  We aimed to examine airway inflammation and bronchial responsiveness in patients with chronic non‐productive cough responsive to anti‐asthma therapy.

Methodology:  Bronchial responsiveness to methacholine as well as the number of inflammatory cells and concentration of eosinophil cationic protein (ECP) in induced sputum were measured in 42 patients with chronic non‐productive cough of unknown origin. Their response to bronchodilator, antiallergic and inhaled or oral glucocorticoid therapy was subsequently assessed.

Results:  Complete remission of coughing was attained with anti‐asthma therapies in 34 patients (responder group), while eight patients did not respond (non‐responder group). Twenty patients in the responder group and three in the non‐responder group showed bronchial hyperresponsiveness (BHR). The number of eosinophils and ECP levels in the sputum from responders with BHR were significantly increased when compared with those from non‐responders and healthy subjects. These sputum measures were also significantly increased in responders without BHR when compared with healthy subjects. However, there were no significant differences in these inflammatory markers between the responders with and without BHR. The neutrophil numbers in the sputum from non‐responders and responders both with and without BHR were also significantly higher than in control subjects, but there were no significant differences.

Conclusions:  These findings suggest that patients with chronic non‐productive cough responsive to anti‐asthma therapy characteristically have eosinophilic airway inflammation, which may play an important role in the development of chronic cough. Furthermore, the evaluation of not only bronchial responsiveness but also airway inflammation by examination of induced sputum may be useful for diagnosis and deciding on therapeutic strategies.
Microangiopathic haemolytic anaemia and thrombocytopenia following lung volume reduction surgery in a single lung transplant recipient on maintenance tacrolimus (FK506) therapy
Authors: REID David W. , STREET Alison , MANSFIELD Darren , CHIN Weng , COLE‐SINCLAIR Marie , WILLIAMS Trevor J. , SNELL Gregory I.
Published: May 2003

Microangiopathic haemolytic anaemia (MAHA) describes intravascular haemolysis due to mechanical destruction of red cells as a result of pathological changes in small blood vessels. It is well recognized as a complication of cyclosporin A therapy in solid organ transplantation but has been uncommonly reported in association with tacrolimus therapy and never before in the setting of lung transplantation. Discussed is a 54‐year‐old female recipient of a left single lung transplant who developed anaemia, thrombocytopenia and red blood cell fragmentation consistent with MAHA following lung volume reduction surgery (VRS) of the native right lung in the setting of high serum tacrolimus levels. Treatment with fresh frozen plasma and plasmapharesis plus supportive therapy with blood and platelet transfusions resulted in successful resolution of the haemolytic process. Cyclosporin A was substituted for tacrolimus and 18 months later there has been no evidence of recurrence. Tacrolimus therapy is a rare cause of MAHA in solid organ transplants but the diagnosis should be considered if there is an unexplained fall in haemoglobin and/or platelet count in the context of high serum tacrolimus levels.
Chromosome 9p deletion in squamous metaplasia in cystic lesion of the lung
Authors: SAWADA Megumi , INASE Naohiko , IMAI Miwa , OHTANI Yoshio , MIYAKE Shuji , AKAMATSU Hideki , YOSHIZAWA Yasuyuki
Published: May 2003

A 70‐year‐old man presented with squamous cell carcinoma of the lung. Examination of the resected specimen showed a tumour and a thickly walled cyst not immediately adjacent to the main tumour. The surface of the cyst was lined by squamous metaplastic epithelium. Microsatellite analysis of microdissected specimens was performed with seven markers from four chromosomal regions. In the squamous cell carcinoma, a non‐informative homozygosity at two markers on 3p, loss of heterozygosity (LOH) at D5S346 on 5q, and LOH at D9S146, D9S150, and D9S1748 on 9p were detected. In the metaplastic epithelium of the cyst, LOH was detected at D9S1748 on 9p21. This appears to be the first report providing possible evidence of genetic changes by demonstrating allelic loss on 9p21 in the metaplastic epithelium of a cyst. This allelic loss might be related to an early step in carcinogenesis in lung cysts.
Respiratory health effects of exposure to environmental tobacco smoke
Authors: CHAN‐YEUNG Moira , DIMICH‐WARD Helen
Published: May 2003

Abstract:  Tobacco smoke is a major component of indoor air pollution. Exposure to environmental tobacco smoke (ETS) is prevalent worldwide despite growing awareness of its adverse health effects on non‐smokers. ETS contains the same toxic substances as identified in mainstream tobacco smoke. Cotinine (a metabolite of nicotine) can be measured in urine and serum of non‐smokers exposed to ETS and reflects the degree of exposure. In children, exposure to ETS leads to reduced lung function, increased risk of lower respiratory tract illnesses, acute exacerbation of asthma resulting in hospitalization, increased prevalence of non‐allergic bronchial hyperresponsiveness, increased risk for sudden infant death syndrome (SIDS) and possibly increased risk for asthma. Exposure to ETS is responsible for excess cost to the family's financial resources and demands on health services. In adults, exposure to ETS is associated with increased risk of lung cancer, particularly in those with high exposure and acute and chronic respiratory symptoms that improve after the cessation of exposure. Healthcare providers should advocate for non‐smokers’ rights in the community and support legislation to limit tobacco exposure.
Effect of osmolality on mucociliary transportability and rheology of cystic fibrosis and bronchiectasis sputum
Authors:   Yasuhiro SHIBUYA, WILLS Peter J. , COLE Peter J.
Published: May 2003

Objective:  Water is the main constituent of mucus, and its concentration is likely to be important in all aspects of mucus function, including ciliary clearance. The objective of this study was to investigate the effect of water content and osmolality of the mucus on mucociliary transportability.

Methodology:  Rheology and ciliary transportability of 10 sputum samples that had been subjected to various manipulations were measured using a mucus‐depleted bovine trachea model.

Results:  It was shown that addition of sodium chloride 0.2 Osmoles/kg (0.585% weight for weight) increased the transportability by 41% (P < 0.01). Evaporation of the sputum to 50% of its original weight caused a 118% increase in transportability (P < 0.0006), but iso‐osmolal removal of 50% of the liquid with filter cards led to a non‐significant, 25% increase in transportability. Parallel plate viscoelasticity was approximately doubled in both the evaporated and liquid‐depleted samples, but was not changed by the addition of 0.2 Osmoles/kg of sodium chloride. The correlation between the osmolality of sputum and ciliary transportability (r = 0.54, P= 0.005) was better than the correlations between the viscosity (r = 0.21, P= 0.27) or elasticity (r = 0.23, P= 0.23) and ciliary transportability.

Conclusions:  These results suggest that the osmolality of sputum exerts a greater influence on mucociliary clearance than its viscoelastic properties.
The effects of air pollution on acute respiratory conditions
Authors:   Mohammad Reza MASJEDI, JAMAATI Hamid Reza , DOKOUHAKI Pouneh , AHMADZADEH Zarrin , TAHERI Sima Alinezhad , BIGDELI Masoud , IZADI Shirin , ROSTAMIAN Abdorrahman , AAGIN Khosro , GHAVAM Seyed Masoud
Published: May 2003

Objective:  Air pollution and its potential health effects are very important worldwide. It is particularly problematic in densely populated cities of developing countries that suffer from a lack of both short‐ and long‐term programmes for air pollution control. We decided to study the short‐term effects of air pollution on lung health by assessing the relationship between the levels of six air pollutants and emergency visits for asthma and COPD exacerbations in Tehran, Iran.

Methodology:  We monitored the daily attendances for acute respiratory conditions (asthma attacks and COPD exacerbations) to the emergency departments of five major hospitals together with the daily concentrations of six major pollutants during a 5‐month period in Tehran. The association between these acute respiratory conditions and the levels of air pollutants was determined by multiple stepwise regression.

Results:  A correlation was observed between the number of hospital admissions for asthma and the weekly mean concentration of nitrogen dioxide (P < 0.05). The 3‐day and 10‐day mean concentrations of sulphur dioxide were also found to be directly associated with the number of asthma admissions during this period (P < 0.05). No direct correlation was observed for other variables.

Conclusion:  This study further emphasizes the deleterious effects of air pollution on respiratory health in major populated cities such as Tehran and suggests that increased attention needs to be given to urgent control of air pollution problems.
Influence of stressful life events on the onset of sarcoidosis
Authors: YAMADA Yoshihito , TATSUMI Koichiro , YAMAGUCHI Tetsuo , TANABE Nobuhiro , TAKIGUCHI Yuichi , KURIYAMA Takayuki , MIKAMI Riichiro
Published: May 2003

Objective:  The onset of sarcoidosis may be triggered by any hereditary and/or environmental factor. Among these factors, psychosocial stress may play a critical role in the onset of sarcoidosis. The aim of the present study was to evaluate the influence of stressful life events on the onset of sarcoidosis.

Methodology:  The social and/or life events experienced prior to diagnosis in 55 patients with sarcoidosis, were evaluated quantitatively using the Social Readjustment Rating Scale (SRRS), the most authoritative method to quantify the magnitude of the events requiring changes in lifestyle. In addition, personality with respect to stress‐reactivity was simultaneously evaluated using the Minnesota Multiphasic Personality Inventory (MMPI) alexithymia scale. Both the degree of stress, evaluated by SRRS, and stress‐reactivity, evaluated by MMPI scale, of sarcoidosis patients were compared with those of 92 healthy controls.

Results:  The magnitude of stressful life events was significantly higher in patients with sarcoidosis compared with healthy controls. In addition, capacity for coping with stress was found to be inferior in sarcoidosis patients compared with that in the control groups.

Conclusion:  These results indicated that psychosocial stress assessed on the basis of alexithymic characteristics of the self perception of stress may be partly implicated in the development of sarcoidosis.
Differences in clinical features between influenza A H1N1, A H3N2, and B in adult patients
Authors: KAJI Masahide , WATANABE Aya , AIZAWA Hisamichi
Published: May 2003

Objective:  The differences in clinical features between influenza A H1N1, A H3N2, and B in the past three influenza seasons were examined.

Methodology:  Patients with respiratory symptoms who consulted Kurume University Medical Center, Department of Internal Medicine, Kurume, Fukuoka, Japan, from January to March in 1999, 2000, and 2001 were included. Based on virological and serological findings, the influenza patients were divided into the above three groups for comparison of symptoms and laboratory data.

Results: Patients (n = 196) included 54 with influenza A H1N1, 98 with A H3N2, and 44 with B. Mean ages in the groups were 33 ± 8.4 years, 41 ± 15.2 years, and 29 ± 9.8 years (influenza B patients tended to be younger). Fever was much greater in the A H3N2 group (38.6 ± 0.46°C) than in the A H1N1 or B groups. This was also true for laboratory indices of viral infection. Gastrointestinal symptoms such as nausea, epigastralgia, and diarrhoea were prominent in influenza B. Myalgia was common in all groups.

Conclusions:  Influenza A H3N2 infection was more severe than A H1N1 or B in terms of fever, leukopenia, and C‐reactive protein. Myalgia and other symptoms such as fever, headache, general malaise and sore throat were equally frequent in influenza A H3N2, A H1N1, and B infections. Gastrointestinal symptoms were more common in influenza B.
COPD prevalence in 12 Asia–Pacific countries and regions: Projections based on the COPD prevalence estimation model
Authors: Regional COPD Working Group
Published: May 2003

Objective:  COPD is a leading cause of mortality and morbidity worldwide. Despite the high rates of cigarette smoking, and the wide use of biomass fuels, there is very little objective data on the prevalence of COPD in Asia.

Methodology:  We used a COPD prevalence model to estimate the prevalence of COPD in 12 Asian countries. This model is a validated, computerized tool that uses epidemiological relationships and risk factor prevalence to project the prevalence of COPD within a given population aged 30 years and older.

Results:  The total number of moderate to severe COPD cases in the 12 countries of this region, as projected by the model, is 56.6 million with an overall prevalence rate of 6.3%. The COPD prevalence rates for the individual countries range from 3.5% (Hong Kong and Singapore) to 6.7% (Vietnam).

Conclusions:  The COPD prevalence rates projected by the model reflect the high prevalence of the risk factors for the disease in Asia. The combined prevalence of 6.3% for these countries is considerably higher than the overall rate of 3.8% as extrapolated from WHO data for this region. These estimates highlight the need for further epidemiological studies to support appropriate allocation of resources for the prevention and management of COPD.
Rhinovirus is not detectable in peripheral lung tissue after asthma death
Authors: WATSON Mark W. , BEASLEY Richard , HOLGATE Stephen T. , BARDIN Philip G.
Published: May 2003

Objective:  Viral infections are associated with both mild and severe exacerbations of asthma and may therefore be associated with asthma death. As such we hypothesized that it might be possible to detect rhinovirus (RV), the virus most frequently implicated in acute asthma, in lung tissue from patients who died from asthma.

Methodology:  We studied archival, wax‐embedded lung tissue obtained postmortem from: (i) patients who died from asthma (n = 12), (ii) asthma patients with non‐asthma‐related death (n = 3), and (iii) non‐asthmatic individuals who died from unrelated causes (n = 3). A validated reverse transcription‐polymerase chain reaction (RT‐PCR) assay was used to detect RV. To confirm RNA preservation, RT‐PCR was used to detect expression of the constitutive gene adenine‐phosphoribosyl‐transferase (APRT). Sensitivity of the assay was assessed using wax‐embedded RV‐infected cells.

Results:  Sensitivity of RT‐PCR for RV in wax‐embedded sections was similar to previous studies (approximately 100 viral copies). Specimens used for study were predominantly of alveolar and small airway origin (< 2 mm). All tissues examined were negative for the presence of RV mRNA and positive for APRT mRNA.

Conclusions:  RV infection of the lower airway may be an uncommon cause of fatal asthma. Alternatively, RV may not extend to peripheral airways and more proximal tissue sampling or PCR assays for other viruses may be required to determine an association between viral respiratory tract infection and fatal asthma.
Secretory leukocyte proteinase inhibitor, alpha‐1‐antitrypsin deficiency and emphysema: Preliminary study, speculation and an hypothesis
Authors: AYAD Monna S. , KNIGHT Kenneth R. , BURDON Jonathan G. W. , BRENTON Sue
Published: May 2003

Objectives:  This study investigated (i) whether adequate concentrations of secretory leukocyte proteinase inhibitor (SLPI) in the lungs of alpha‐1‐antitrypsin (A1AT) deficient patients can explain the variability in the development of emphysema in these individuals, and (ii) whether cigarette smoking jeopardises the protective screen provided by functional SLPI.

Methodology:  Four subjects [two normal proteinase inhibitor M (PiM), two abnormal PiZ] were selected from patients presenting for diagnostic bronchoscopy and lung function testing (spirometry, DLco). Each subject underwent BAL and had blood taken for A1AT and SLPI estimation.

Results:  As expected serum and BAL A1AT concentrations were within the normal range in the normal PiM subjects. In normal subjects, SLPI concentrations in serum and BAL were within the normal range. A1AT‐deficient subjects had reduced serum and BAL levels of A1AT reflecting their genetic disorder but showed increased concentrations of SLPI in BAL and serum. Percentage neutrophil elastase (NE) inhibitory capacity of BAL fluid was low in both A1AT‐deficient subjects and a cigarette‐smoking normal subject. In contrast, the NE inhibitory capacity for the normal subject who had never smoked was normal.

Conclusions:  These findings suggest that in A1AT deficiency there may be a compensatory increase in SLPI. This may protect the lung against the development of emphysema in A1AT‐deficient individuals. Cigarette smokers may have a lower SLPI concentration than non‐smokers. This provides an explanation for at least some of the observed variation in the development of emphysema in A1AT deficient subjects.
Women and tobacco
Authors: MACKAY Judith , AMOS Amanda
Published: May 2003

Abstract:  Smoking prevalence is lower among women than men in most countries, yet there are about 200 million women in the world who smoke, and in addition, there are millions more who chew tobacco. Approximately 22% of women in developed countries and 9% of women in developing countries smoke, but because most women live in developing countries, there are numerically more women smokers in developing countries. Unless effective, comprehensive and sustained initiatives are implemented to reduce smoking uptake among young women and increase cessation rates among women, the prevalence of female smoking in developed and developing countries is likely to rise to 20% by 2025. This would mean that by 2025 there could be 532 million women smokers. Even if prevalence levels do not rise, the number of women who smoke will increase because the population of women in the world is predicted to rise from the current 3.1 billion to 4.2 billion by 2025. Thus, while the epidemic of tobacco use among men is in slow decline, the epidemic among women will not reach its peak until well into the 21st century. This will have enormous consequences not only for women's health and economic wellbeing but also for that of their families. The health effects of smoking for women are more serious than for men. In addition to the general health problems common to both genders, women face additional hazards in pregnancy, female‐specific cancers such as cancer of the cervix, and exposure to passive smoking. In Asia, although there are currently lower levels of tobacco use among women, smoking among girls is already on the rise in some areas. The spending power of girls and women is increasing so that cigarettes are becoming more affordable. The social and cultural constraints that previously prevented many women from smoking are weakening; and women‐specific health education and quitting programmes are rare. Furthermore, evidence suggests that women find it harder to quit smoking. The tobacco companies are targeting women by marketing light, mild, and menthol cigarettes, and introducing advertising directed at women. The greatest challenge and opportunity in primary preventive health in Asia and in other developing areas is to avert the predicted rise in smoking among women.
A step‐wise application of methylprednisolone versus dexamethasone in the treatment of acute exacerbations of COPD
Authors: LI Huiping , HE Guojun , CHU Haiqing , ZHAO Lan , YU Hui
Published: May 2003

Objective:  The aim of the study was to explore the clinical value of a step‐wise application of methylprednisolone (MP) compared to dexamethasone (DXM) in acute exacerbations of COPD.

Methodology:  One hundred and forty‐two patients with an acute exacerbation of COPD were divided randomly into two groups: 71 patients were treated with MP and the other 71 patients were treated with DXM. Otherwise each group was given the same basic treatments: antibiotics, bronchodilators, oxygen therapy as well as standard hospital care. The patients in the MP group were given a tapering dose of MP for 7–14 days, and the patients in the DXM group were given a corresponding tapering dose of DXM for 7–14 days. Then both groups were given a gradually reducing dose of oral prednisone for 2–3 weeks. Two weeks before the prednisone was tapered off, inhaled corticosteroid was introduced. The patients’ symptom scores, physical signs, per cent predicted FEV1%, and arterial blood gases were monitored before treatment and after the seventh day of treatment.

Results:  There was an obvious improvement in symptoms after 1–3 days in all 71 patients in the MP group, with their wheezing being distinctly reduced or disappearing entirely. The maximum benefit that occurred in the MP group (90.14%) was considerably higher than that of the DXM group (25.35%), P < 0.05. The predicted FEV1% in the MP group increased from 46.7 ± 10.6 to 67.5 ± 12.4, compared with an increase in the DXM group from 50.1 ± 7.6 to 58.9 ± 10.8. The difference between the two groups was significant (P < 0.05).

Conclusions:  An adequate and tapering dose of MP used in acute exacerbations of COPD can relieve the inflammatory reaction in airways and reduce airway spasm more promptly than DXM.
Choice Reaction Time and Adequacy of Dialysis: A New Application of an Old Method
Authors: Ahmad Suhail
Published: May 2003

Background:  Choice Reaction Time (CRT) is the time it takes for a subject to accurately respond to a flashing panel of lights. The CRT has been used to assess the quality of dialysis in hemodialysis patients and to assess the neurological impairments in patients with Parkinson's disease.

Methods:  Three groups of end‐stage renal disease (ESRD) patients on three different renal replacement therapies were tested using CRT: intermittent peritoneal dialysis (IPD, n = 11), thrice weekly hemodialysis (HD, n = 22), and well‐functioning kidney transplant (Tx, n = 6). A group of volunteers with normal renal function (NL, n = 12) was also tested.

Results:  The CRT was significantly longer in IPD patients (618 ± 89 ms) than observed in the other three groups (p < 0.0001). CRT in HD patients was 461 ± 50 ms, which was significantly longer than in Tx patients (396 ± 25 ms, p = 0.05). However, the CRT in the Tx patients was no different from the NL (382 ± 22, p = 0.32). There was a strong negative correlation between CRT and weekly creatinine clearance in the IPD group (r =− .96) and between the dialysis index and CRT in HD (r =− 0.79).

Conclusions:  CRT may be a useful tool in assessing the adequacy of dialysis.
Severe Cortical and Trabecular Osteopenia in Secondary Hyperparathyroidism
Authors: Brancaccio Diego , Di Leo Claudio , Bestetti Alberto , Carpani Paola , Tagliabue Luca , Cozzolino Mario , Galassi Andrea , Luigi Tarolo Gian , Gallieni Maurizio
Published: May 2003

Background:  Peripheral quantitative computed tomography (pQCT) provides real volumetric bone density values, not only of the total, but also of trabecular and cortical bone, separately. In addition, it provides data on bone geometry that can be related to the risk of fracture.

Methods:  Total, cortical, and trabecular volumetric bone mineral densities (BMD), as well as the main geometric parameters (cross‐sectional area, cortical area, trabecular area, and cortical thickness) were assessed by pQCT at the distal radius in 24 hemodialysis patients affected by severe secondary hyperparathyroidism (PTH, mean ± SD: 1444 ± 695 pg/mL). The strength‐strain index (SSI), a biomechanical parameter describing bone fragility, was also determined.

Results:  Compared with a control group of 64 healthy age‐matched subjects, volumetric BMD (mg/cm3) was significantly reduced in all patients (total BMD: 243 ± 87 vs. 405 ± 138, cortical BMD: 605 ± 218 vs. 856 ± 204, trabecular BMD: 95 ± 51 vs. 182 ± 75). Cortical area and cortical thickness showed significant modifications, while cross‐sectional area did not. SSI was significantly reduced (547 ± 125 vs. 927 ± 306 mm3). PTH levels showed a significant inverse correlation with cortical BMD (r = −0.56), cortical thickness (r = −0.46), cortical area (r = −0.61), and SSI (r = −0.54). Quantitative analysis of bone demonstrated cortical porosity.

Conclusions:  In dialysis patients with severe secondary hyperparathyroidism, pQCT showed a significant cortical osteopenia, associated with geometric and mechanical bone impairment. Interestingly, we also found a comparable deficit of trabecular bone, which may be related to the very high PTH levels. Generalized cortical thinning, intracortical porosity and cortical‐endosteal resorption (“trabecularization” of the cortical bone) are major determinants of reduced bone strength, which may be quantitated by pQCT.
Anticoagulation Options for Pediatric Hemodialysis
Authors: Davenport Andrew
Published: May 2003

Blood coagulation in the extracorporeal hemodialysis circuit is one of the manifestations of bio‐incompatibility that is related to the activation of monocytes, platelets, and the coagulation cascades. Compared to adults, in pediatric patients, the surface area of the extracorporeal circuit is increased relative to blood volume. This is due to the patient's smaller blood volume and the combination of the higher relative surface area of the dialyzer, smaller lumen lines, and small‐bore vascular catheters, potentially increasing contact activation of coagulation proteins, platelets, and inflammatory cells. Although unfractionated heparin remains the most commonly used anticoagulant, low molecular weight heparin offers the advantages of a single bolus, less fibrin and platelet deposition in the dialyzer, and perhaps more importantly, less osteoporosis, hyperkalemia, and abnormal lipoprotein profile. Although regional anticoagulants are available, these are often prohibitively expensive or require increased complexity of the dialysis procedure (e.g., citrate), but have the advantage of reducing the risk of bleeding when compared to heparin. Thrombin inhibitors are now available, and with the advent of argatroban, which is metabolized in the liver, have become the anticoagulants of choice for the few patients who develop heparin‐induced thrombocytopenia type II.
Phosphorus‐Enriched Hemodialysates: Formulations and Clinical Use
Authors: Ing Todd S. , Chebrolu Srivasa B. , Cheng Yuk Lun , Yu Alex W. Y. , Choi Peter , Kjellstrand Carl M.
Published: May 2003

Although hyperphosphatemia is a cardinal feature of renal failure, the occasional patient suffering from end‐stage renal disease (ESRD) may present with hypophosphatemia. For example, hypophosphatemia can develop in ESRD patients if they suffer from malnutrition or if they are aggressively dialyzed. Hypophosphatemia is commonly prevented or treated with the oral or the intravenous administration of soluble phosphate salts; however, determination of the required oral or intravenous dose is difficult. Under appropriate circumstances, phosphorus‐enriched dialysates can also be employed for the purpose of phosphorus administration. Various preparations of soluble phosphate salts can be used to enrich hemodialysates.
Efficacy of Tissue Plasminogen Activator for Thrombolysis in Central Venous Dialysis Catheters
Authors: O'Mara Neeta B. , Ali Samina , Bivens Kathleen , Sherman Richard A. , Kapoian Toros
Published: May 2003

Background:  Low blood flow is a frequent complication of central‐vein (CV) dialysis catheters. Since thrombotic occlusion accounts for many cases of reduced blood flow, it is common practice to administer empiric thrombolytic therapy in an attempt to restore catheter patency and improve function.

Methods:  We prepared tissue plasminogen activator (tPA) from 50 mg lyophilized powder, which was diluted (1 mg/mL) in sterile water for injection. A volume of 1 mL was frozen in 3 cc polystyrene syringes at −20 °C and thawed at room temperature when needed. tPA was then administered into the arterial and venous ports of the central venous catheter in a volume equal to the manufacturer's stated luminal volume and was allowed to dwell for 30 minutes.

Results:  tPA was administered 62 times in 25 patients with 30 catheters (11 Tesio, 17 PermCath, 2 Shiley) for treatment of low blood flow (pump speed < 250 mL/min). Complete restoration of patency was achieved in 23 episodes (mean blood flow pre‐tPA 130 mL/min; post‐tPA 320 mL/min); partial restoration of patency was achieved in 20 episodes (mean blood flow pre‐tPA 69 mL/min; post‐tPA 233 mL/min). tPA was just as likely to be effective in patients with complete catheter occlusion (i.e., no blood flow) as it was when some initial blood flow was present. Nineteen episodes failed to respond to tPA. These episodes occurred in 13 catheters, 12 of which ultimately underwent radiologic evaluation; an extraluminal cause for low blood flow was found in all 12 catheters (6 malpositioned, 6 fibrin sheaths).

Conclusions:  tPA at a dose of 1 mg/mL is effective for restoring patency in CV dialysis catheters. Failure to respond to tPA strongly suggests an extraluminal cause of catheter malfunction.