bluuebunny/crossref_metadata_2025 huggingface dataset:
Copeptin, a fragment of the vasopressin precursor, as a novel predictor of outcome in heart failure
Authors: Stoiser B. , Mörtl D. , Hülsmann M. , Berger R. , Struck J. , Morgenthaler N. G. , Bergmann A. , Pacher R.
Published: October 2006

Background Natriuretic peptides, particularly brain natriuretic peptide (BNP), are elevated in heart failure and therefore considered to be excellent predictors of outcome. Vasopressin is also known to be related to the severity of heart disease. Copeptin – an inactive fragment of the vasopressin precursor – has not been previously investigated in the context of heart failure.

Materials and methods We prospectively studied 268 patients with advanced heart failure after they had been discharged from the hospital. We investigated the ability of BNP and copeptin to predict death, re‐hospitalization due to heart failure, and a combination of the two endpoints.

Results Over a mean follow‐up period of 15·8 months (up to 24 months), 83 patients died, 122 patients experienced worsening of heart failure, and 145 patients achieved the combined endpoint. Univariate predictors of death were copeptin, BNP, age and impaired kidney function. In multivariate analysis, copeptin (χ2 = 16,P < 0·0001) and age (χ2 = 4,P < 0·05) were independent predictors. Univariate predictors of re‐hospitalization due to heart failure were copeptin, BNP, age and impaired kidney function. Furthermore, in multivariate analysis BNP (χ2 = 18,P < 0·0001), age (χ2 = 11·8,P < 0·001) and copeptin (χ2 = 4·2,P < 0·05) were found to be independent predictors.

Conclusion Our study is the first to show that copeptin is an excellent predictor of outcome in advanced heart failure patients. Its value is superior to that of BNP in predicting death and a combined endpoint, although BNP is still suitable for predicting chronic heart failure (CHF) re‐hospitalization. Our data imply that vasopressin antagonism might be a new target to improve outcome in this population.
Randomized comparison of two rescue therapies for Helicobacter pylori infection
Authors: Wu D. C. , Hsu P. I. , Chen A. , Lai K. H. , Tsay F. W. , Wu C. J. , Lo G. H. , Wu J. Y. , Wu I. C. , Wang W. M. , Tseng H. H.
Published: October 2006

Background  Bismuth salts are not available worldwide. It remains unknown whether clarithromycin can replace bismuth salts as an adjuvant agent in the rescue regimens for Helicobacter pylori infection. We therefore designed the prospective study to compare the efficacies of two rescue therapies for H. pylori infection after standard triple therapies.

Patients and methods  Ninety‐three patients who failed H. pylori eradication using proton pump inhibitor plus clarithromycin and amoxicillin were randomly assigned to undergo rescue therapy with esomeprazole, clarithromycin, tetracycline and metronidazole (ECTM group, n = 46) or esomeprazole, bismuth subcitrate, tetracycline and metronidazole (EBTM group, n = 47). Follow‐up endoscopy was performed at 8 weeks after the end of treatment to assess the treatment response.

Results  Intention‐to‐treat analysis demonstrated both groups had similar eradication rates (ECTM 74% vs. EBTM 77%; P = 0·76) and drug compliance (ECTM 94% vs. EBTM 96%; P = 0·68). However, the frequency of adverse events in the ECTM group was higher than that in EBTM group (ECTM 57% vs. EBTM 36%, P = 0·05). In the EBTM group, eradication rate of metronidazole‐resistant strains was lower than that of metronidazole‐susceptible strains (67%[8/12] vs. 100%[9/9], P = 0·05). However, eradication rates were similar between metronidazole‐susceptible and metronidazole‐resistant strains in ECTM group (69%[9/13] vs. 70%[7/10], P = 1·00).

Conclusions  The new ECTM second‐line therapy can achieve similar eradication rate as standard EBTM therapy. It may be very useful in countries where bismuth salts are not available.
Hypercholesterolaemia alters the responses of the plasma lipid profile and inflammatory markers to supplementation of the diet with n‐3 polyunsaturated fatty acids from fish oil
Authors: Bravo E. , Napolitano M. , Lopez‐Soldado I. , Valeri M. , Botham K. M. , Stefanutti C.
Published: October 2006

Background  The influence of supplementing the diet with long‐chain n‐3 polyunsaturated fatty acids (PUFA) from fish oil on plasma lipids and lipid peroxides and the production of pro‐inflammatory mediators in normolipidaemic and hypercholesterolaemic rats were studied.

Materials and methods  Rats were divided into four groups and fed one of the following diets: a control diet (containing 4% corn oil); an n‐3 PUFA diet [containing 4% eicospentaenoic (EPA) + docosahexaenoic (DHA)]; a hypercholesterolaemic diet (HCH); or a HCH + n‐3 PUFA diet over a 4‐week period. Plasma lipids, lipid peroxides, cytokines [tumour necrosis factor (TNF)α, interleukin (IL)‐6, interferon (IFN)γ] and mRNA for hepatic nuclear factor‐4α (HNF4α) were determined.

Results  Plasma triglyceride (TG), but not cholesterol, levels were decreased by the n‐3 PUFA as compared with the control diet (P < 0·001), but the addition of n‐3 PUFA to the HCH diet decreased both the TG (P < 0·01) and cholesterol (P < 0·05) concentrations. Plasma lipid peroxides and expression HNF4α mRNA were increased by n‐3 PUFA in the normolipidaemic (P < 0·05), but not in the hyperlipidaemic rats. Compared with the control diet group, plasma concentrations of TNFα and IL‐6 were increased in the n‐3 PUFA (P < 0·05) and HCH diet (P < 0·05, P < 0·01, respectively) groups, but not in animals given the HCH + n‐3 PUFA diet, whereas IFNγ levels were increased in hypercholesterolaemia (P < 0·05), but were unaffected by n‐3 PUFA.

Conclusion  These results demonstrate that the major effect of fish oil n‐3 PUFA is to lower the TG levels in both normo‐ and hyperlipidaemia. Furthermore, in the hypercholesterolaemic state, fish oil n‐3 PUFA induces additional beneficial changes in the immune and peroxidation responses.
Assessing progression to impaired glucose tolerance and type 2 diabetes mellitus
Authors: Guerrero‐Romero F. , Rodríguez‐Morán M.
Published: October 2006

Background  A prospective evaluation of the relationship between insulin secretion and insulin sensitivity, derived from the fasting state, is needed in clinical practice in order to identify the worsening of glucose metabolism. In this study the authors examine whether the product of insulin sensitivity and insulin secretion, assessed from the fasting state, predicts progression from normal glucose tolerance (NGT) to impaired fasting glucose (IFG) and from impaired glucose tolerance (IGT) to type 2 diabetes mellitus (T2DM).

Materials and methods  A cohort of 300 subjects with NGT and 75 subjects with IGT were followed up over a 5‐year period. Insulin sensitivity was calculated using the Belfiore index (B) and insulin secretion by the homeostasis model analysis β‐cell (HOMA‐β cell) index: the product of B‐β is expressed as: (40 × Ins0 pmol L−1)/Glu0 mmol L−1{[(Glu0 mmol L−1× Ins0 pmol L−1) + 1] − 3·5[(Glu0 mmol L−1 × Ins0 pmol L−1) − 1]}, where Glu0 is fasting glucose and Ins0 is fasting insulin.

Results  From baseline at the end of the follow‐up period, the product B‐β decreased 10·7% and 52·2% in progressors to IGT and T2DM, respectively. The product B‐β predicts the progression from NGT to IGT [relative risk (RR) 2·7, CI95% 1·2–9·1] and from IGT to T2DM (RR 5·3, CI95% 1·3–8·55). The cut‐off point for the product B‐β that better predicts progression from NGT to IGT is 0·25 (sensitivity 88%, specificity 92%) and from IGT to T2DM 0·15 (sensitivity 92%, specificity 95%).

Conclusions  Adaptation of insulin secretion to compensate for decreased insulin sensitivity during transition to IGT and T2DM can be successfully assessed with simple measures derived from the fasting state. The product B‐β predicts the development to IGT and T2DM.
An empirical examination of the determinants of honey consumption in Romania
Authors: Arvanitoyannis Ioannis , Krystallis Athanasios
Published: October 2006

While not much attention has been paid in the international literature to the consumption of premium food products with enhanced quality properties in Central‐Eastern European Countries (CEECs), the present survey aims to investigate consumer behaviour in Romania as regards ‘honey’ as an example of such a product. The research concludes that, despite the changes in eating habits induced by changes in the retail environment, honey remains a popular product, the purchase of which in bulk from producers and in open markets is still the dominant trend. The survey further identifies four main dimensions of honey‐purchasing motivation: medical benefits of its consumption, dietary quality, ethical character of honey and suitability with food consumption lifestyle. Using these dimensions validated by factor analysis, three clusters of honey consumers in Romania emerged through cluster analysis: the common consumers, the younger consumers indifferent towards honey and the enthusiastic consumers, who are also more willing to pay premium prices for the organic type of honey. If the first segment may be the keenest on competitive prices, quality differentiation strategies can target the enthusiastic honey consumers. The distinctive features of Romanian consumers also include a low attention paid to labels, related in a low awareness of the energy content of honey. Quality cues are defined by search attributes of the bulk product (colour, taste, aroma, thickness), rather than credence attributes (warranties, brand name, country‐of‐origin). Marketers targeting this market should be aware of this scepticism towards label information, which necessitates more communication effort to built consumer trust.
Stability of isoflavone phytoestrogens in fermented soymilk with Bifidobacterium animalis Bb12 during storage at different temperatures
Authors: Otieno Daniel O. , Ashton John F. , Shah Nagendra P.
Published: October 2006

Soy isoflavones in fermented soymilk with Bifidobacterium animalis Bb12 were stored at various temperatures (−80, 4, 24.8 and 37 °C) for 8 weeks and the concentration of isoflavones determined weekly using reverse‐phase high‐performance liquid chromatography (RP‐HPLC). The first‐order kinetic model was used to assess the degradation of each isomer at each storage temperature. Soymilk predominantly possesses high concentrations of isoflavone glucosides and very low concentration of bioactive aglycone component. During storage at various temperatures, concentrations of individual isoflavone isomers appeared to be significantly stable (P < 0.01). Interestingly, aglycones showed much smaller degradation constants compared with glucosides at all the storage temperatures studied. Genistein and daidzein were much more stable than glycitein and had almost similar degradation patterns, despite differences in their concentrations in the fermented soymilk. It was, however, observed that 4 °C was the most suitable storage temperature for the product in order to guarantee minimal degradation of bioactive isoflavone aglycones.
Pre‐exposure to infectious hypodermal and haematopoietic necrosis virus or to inactivated white spot syndrome virus (WSSV) confers protection against WSSV in Penaeus vannamei (Boone) post‐larvae
Authors: Melena J , Bayot B , Betancourt I , Amano Y , Panchana F , Alday V , Calderón J , Stern S , Roch Ph , Bonami J‐R
Published: October 2006

Larvae and post‐larvae of Penaeus vannamei (Boone) were submitted to primary challenge with infectious hypodermal and haematopoietic necrosis virus (IHHNV) or formalin‐inactivated white spot syndrome virus (WSSV). Survival rate and viral load were evaluated after secondary per os challenge with WSSV at post‐larval stage 45 (PL45). Only shrimp treated with inactivated WSSV at PL35 or with IHHNV infection at nauplius 5, zoea 1 and PL22 were alive (4.7% and 4%, respectively) at 10 days post‐infection (p.i.). Moreover, at 9 days p.i. there was 100% mortality in all remaining treatments, while there was 94% mortality in shrimp treated with inactivated WSSV at PL35 and 95% mortality in shrimp previously treated with IHHNV at N5, Z1 and PL22. Based on viral genome copy quantification by real‐time PCR, surviving shrimp previously challenged with IHHNV at PL22 contained the lowest load of WSSV (0–1 × 103 copies μg−1 of DNA). In addition, surviving shrimp previously exposed to inactivated WSSV at PL35 also contained few WSSV (0–2 × 103 copies μg−1 of DNA). Consequently, pre‐exposure to either IHHNV or inactivated WSSV resulted in slower WSSV replication and delayed mortality. This evidence suggests a protective role of IHHNV as an interfering virus, while protection obtained by inactivated WSSV might result from non‐specific antiviral immune response.
Epitheliocystis in fish
Authors: Nowak B F , LaPatra S E
Published: October 2006

Epitheliocystis is a condition affecting the gills and skin of fish, which has been reported from more than 50 freshwater and marine species. It is caused by intracellular Gram‐negative bacteria. Mortalities have been associated with epitheliocystis infections in cultured fish. This review provides an update of our current understanding of this condition, including characterization of the pathogen using immunohistochemical and molecular studies. In most fish species the epitheliocystis agent was negative to an antibody specific for chlamydial genus‐specific lipopolysaccharide antigen. Recently, four epitheliocystis agents from four different fish species have been characterized using molecular analysis. While they all belong to the order Chlamydiales, in a lineage separate from the Chlamydiaceae, they are distinct organisms and similarity analysis showed that they had highest similarity values with other chlamydia‐like bacteria isolated from various sources, including humans or pig. This confirms the high diversity and host specificity of the pathogen. Further molecular analysis should result in an increased understanding of this condition. To date the pathogen has not been cultured, making experimental studies difficult. High stocking densities, presence of nutrients, season, temperature and fish age have been identified as potential risk factors for the manifestation of this condition.
Isolation of viral haemorrhagic septicaemia virus from muskellunge, Esox masquinongy (Mitchill), in Lake St Clair, Michigan, USA reveals a new sublineage of the North American genotype
Authors: Elsayed E , Faisal M , Thomas M , Whelan G , Batts W , Winton J
Published: October 2006

Viral haemorrhagic septicaemia virus (VHSV) was isolated from muskellunge, Esox masquinongy (Mitchill), caught from the NW portion of Lake St Clair, Michigan, USA in 2003. Affected fish exhibited congestion of internal organs; the inner wall of the swim bladder was thickened and contained numerous budding, fluid‐filled vesicles. A virus was isolated using fish cell lines inoculated with a homogenate of kidney and spleen tissues from affected fish. Focal areas of cell rounding and granulation appeared as early as 24 h post‐inoculation and expanded rapidly to destroy the entire cell sheet by 96 h. Electron microscopy revealed virions that were 170–180 nm in length by 60–70 nm in width having a bullet‐shaped morphology typical of rhabdoviruses. The virus was confirmed as VHSV by reverse transcriptase‐polymerase chain reaction. Sequence analysis of the entire nucleoprotein and glycoprotein genes revealed the virus was a member of the North American genotype of VHSV; however, the isolate was sufficiently distinct to be considered a separate sublineage, suggesting its origin may have been from marine species inhabiting the eastern coastal areas of the USA or Canada.
Surfactant Protein D of the Innate Immune Defence is Inversely Associated with Human Obesity and SP‐D Deficiency Infers Increased Body Weight in Mice
Authors: Sorensen G. L. , Hjelmborg J. v. B. , Leth‐Larsen R. , Schmidt V. , Fenger M. , Poulain F. , Hawgood S. , Sørensen T. I. A. , Kyvik K. O. , Holmskov U.
Published: October 2006

Surfactant protein D (SP‐D) is a key regulator of pathogen‐induced inflammation. SP‐D is further involved in lipid homeostasis in mouse lung and circulation and recent data have demonstrated that the body mass index (BMI; in kg/m2) is influenced by genes in common with SP‐D. The objective of the present study was to describe the association between serum SP‐D and weight, waist circumference or BMI, and furthermore to observe body weight development in SP‐D‐deficient (Spd−/−) mice. As a part of the Danish population‐based twin study (GEMINAKAR) on the metabolic syndrome, we analysed 1476 Danish twins for serum SP‐D and investigated associations with weight, waist circumference and BMI by multiple regression analysis. Serum SP‐D was significantly and inversely associated with weight (P = 0.001) and waist circumference in men (P < 0.001) and to BMI in both genders (P = 0.039 women, P < 0.001 men). The age‐dependent increase in serum SP‐D was most prominent in lean persons (BMI < 20). Spd−/− mice and wild‐type mice were subjected to a feeding study and body weights were recorded in a time course over 24 weeks. Spd−/− mouse weight gain was significantly increased, with 90 mg/week (P < 0.0001) in males on normal chow. Fat percentage was significantly increased by 17% in the Spd−/− male mice (P = 0.003). We conclude, that there is an association between low levels or absent SP‐D and obesity.
Eosinophilic esophagitis in adults – no clinical relevance of wheat and rye sensitizations
Authors: Simon D. , Straumann A. , Wenk A. , Spichtin H. , Simon H.‐U. , Braathen L. R.
Published: October 2006

Background:  Eosinophilic esophagitis (EE) is often associated with concomitant atopic diseases. In children with EE in whom food allergens have been identified as causative factors, elemental and elimination diets result in an improvement or resolution of symptoms. Most adult EE patients are sensitized to aeroallergens, which cross‐react with plant‐derived food allergens, most commonly to grass pollen and cereals.

Aims of the study:  To investigate the clinical relevance of the sensitization to wheat and rye, and the efficacy of an allergen‐specific elimination diet in adult EE patients.

Methods:  Six patients (five men, one women) with permanently active EE sensitized to grass pollen and the cereals wheat and rye underwent a double‐blind placebo‐controlled food challenge and were kept on an elimination diet avoiding wheat and rye for 6 weeks.

Results:  The challenge tests with wheat and rye did not provoke any EE symptoms in all patients. The elimination diet failed in reducing disease activity. Although one patient noticed an improvement of symptoms, endoscopic and histopathologic findings remained unchanged.

Conclusions:  In adult EE patients, sensitization to wheat and rye does not seem causative for EE. Elimination diet is not a reliable and efficient therapeutic measure in EE patients sensitized to wheat and rye. Low specific immunoglobulin‐E levels to wheat and rye may be a consequence of the underlying grass pollen allergy.
Predictive and pre‐natal testing for Huntington Disease in Australia: results and challenges encountered during a 10‐year period (1994–2003)
Authors: Tassicker RJ , Marshall PK , Liebeck TA , Keville MA , Singaram BM , Richards FH
Published: October 2006

This study summarizes 10‐years’ experience of predictive and pre‐natal testing and pre‐implantation genetic diagnosis (PGD) for Huntington disease (HD) in Australia. Results are presented from 2036 direct mutation predictive tests conducted between January 1994 and December 2003. Thirty‐eight per cent of results (776/2036) were positive, 56% (1140/2036) were negative, and 6% (120/2036)) were in the mutable normal (27–35 CAG repeats) or in the reduced penetrance (36–39 CAG repeats) ranges. Ninety‐four per cent (1908/2036) and 6% (128/2036) of those tested had prior genetic risks of 50% and 25%, respectively. Twenty‐seven per cent (34/128) of those at 25% risk had their genetic status changed to positive, thus revealing the positive status of their at‐risk parent. During this period, 63 pre‐natal tests were also conducted, and 13 children were born following PGD for HD. Social workers specializing in predictive testing counselling over this 10‐year period across Australia identified and summarized particularly challenging counselling issues. These included the interpretation of mutable normal and reduced penetrance range test results, potential conflicts of interest between family members regarding testing decisions, unanticipated consequences of both predictive and pre‐natal testing decisions, the importance of following protocols for predictive testing to facilitate long‐term adjustment to results, and the potential for genetic discrimination. The identified issues highlight the importance of the protocols for predictive testing and indicate that extension of the international guidelines published in 1994 may be timely.
Mechanisms of Cache Retrieval in the Group Nesting Southern Flying Squirrel (Glaucomys volans)
Authors: Winterrowd Michael F. , Weigl Peter D.
Published: October 2006

We examined the proximate mechanisms of cache retrieval in the group‐living, southern flying squirrel,Glaucomys volans, through a series of behavioral experiments conducted in a large indoor arena. The effectiveness of several retrieval mechanisms was determined including spatial memory, olfaction, random searching and a heuristic under different environmental conditions. Our goal was to elucidate the hoarding strategy of individuals in a nest group and to address whether food storing individuals possess a retrieval advantage over pilfering nestmates. A storer's retrieval advantage is necessary for scatter hoarding to be an evolutionarily stable strategy (ESS) within aggregations of unrelated individuals. Our previous work has shown that,G. volanslives in such groups, and consequently it was important to address the storer's retrieval advantage under a range of environmental conditions. Initially in our baseline experiment, we developed methods to eliminate olfactory‐based retrieval and to control for random searching. Subsequently, we experimentally determined the effectiveness of cache retrieval via spatial memory, a heuristic and olfaction. We examined the mechanisms of cache retrieval in three additional experiments using two independent subject populations and found that under dry, odorless conditions spatial memory was the most effective retrieval mechanism in support of a storer's retrieval advantage. In a fifth experiment we examined cache retrieval under wet environmental conditions and showed that olfactory‐based retrieval was effective and the storer's advantage was reduced. We interpret these laboratory results based on considerations of natural environmental conditions and game theory. We propose a conditional ESS strategy where animals store and retrieve their own caches as the primary food hoarding tactic and opportunistically pilfer caches as a secondary tactic.
Fatigue crack propagation in the wing to fuselage connection of the new trainer aircraft M346
Authors: LANCIOTTI A. , NIGRO F. , POLESE C.
Published: October 2006

The series version of the M346 military trainer aircraft is currently under construction at Aermacchi (Venegono Superiore, Italy). The design target life of the aircraft, which will be certified for Damage Tolerance, is 12 000 flight hours (FH), with the possible extension to 16 000 FH after specific inspections. Fatigue tests were performed on critical elements at the Department of Aerospace Engineering at University of Pisa in order to verify crack propagation calculations.

The wing to fuselage connection is one of the most interesting elements from the fatigue point of view. Spars and frames, both integrally machined, are connected by two lug‐fork joints; the base material is aluminium alloy 7050‐T7451 for both the elements. High interference bushings, ForceMate®, produced by FTI (Fatigue Technology Inc., Seattle, WA) were used in the lug/fork connections.

Experimental activity was carried out on two different specimens. The first, a Compact Tension specimen, was tested under constant amplitude loading to verify the fatigue crack growth rate data contained in NASGRO 4, the software used for Damage Tolerance evaluations. Experimental results were fully comparable with the NASGRO 4 material database. Additional variable amplitude loading tests were carried out in order to calibrate crack growth prediction models used in the analyses.

The second specimen was a lug‐fork joint designed as the actual joints present on the aircraft. Both constant and variable amplitude loading fatigue tests were carried out in this case too. Results obtained clearly indicated the beneficial effect of ForceMate bushings, compared to shrink fit bushings.
Transanal endoscopic microsurgery: risk factors for local recurrence of benign rectal adenomas
Authors: Whitehouse P. A. , Tilney H. S. , Armitage J. N. , Simson J. N. L.
Published: October 2006

Objective  Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for excision of selected benign and malignant rectal neoplasms. It is considered a safe and effective treatment but recurrence rates of 1–13% are reported for benign lesions. The aim of this study was to assess risk factors for local recurrence of benign rectal lesions and to evaluate mortality and morbidity following TEM.

Method  Data were prospectively collected from all patients undergoing TEM for benign adenomas from January 1998 to March 2005. The procedure was performed by a single surgeon and patients were regularly followed up.

Results  One hundred and forty‐six procedures were included, with a median patient age of 74 years (range 22–92 years). The mean lesion area was 16 cm2 (range 0.3–150 cm2) and the median distance from the dentate line was 9 cm (range 0–17 cm). Immediate complications included bleeding (six) and acute urinary retention (six). There has been one (0.68%) procedure‐related death. After a median follow up of 39 months (range 4–89 months) there have been seven recurrences (4.8%), recurring at a mean time of 23.3 months (range 5–48 months). Only microscopic involvement of the circumferential resection margin was found to be significantly associated with recurrence (P = 0.0059). Recurrence was not associated with age, size of lesion, previous treatment, severity of dysplasia or use of the harmonic scalpel.

Conclusion  TEM is a safe and effective treatment for benign rectal adenomas. Circumferential resection margin involvement is associated with recurrence, which tends to occur late. Therefore extended follow up is recommended.
Do supervised colorectal trainees differ from consultants in terms of quality of TME surgery?
Authors: Maslekar S. , Sharma A. , MacDonald A. , Gunn J. , Monson J. R. T. , Hartley J. E.
Published: October 2006

Objective The quality of surgical excision is held to be a major determinant of outcome following surgery for rectal cancer. Macroscopic examination of the excised mesorectum allows for reproducible assessment of the quality of surgery. We aimed to determine whether quality of excision undertaken by colorectal trainees under supervision was comparable with that performed by consultants, as measured using mesorectal grades.

Method A total of 130 consecutive patients undergoing potentially curative resection for primary adenocarcinoma of the rectum in our centre from 2001 to 2003 were included in the study. The pathologists graded the excised mesorectum according to staged classification proposed by Quirke. The outcome (quality of mesorectal excision and secondary outcomes including local recurrence and overall recurrence) of operations performed by consultants was compared with that of trainees. Statistical significance was tested using Pearsonχ2test.

Results Eighty‐nine operations were performed by consultants and 41 by senior colorectal trainees with consultant supervision. Forty‐four patients (49%) had good mesorectum when operated by consultants in comparison with 17 (41.5%) by the trainees. There was no statistically significant difference (P = 0.717) between the two groups in terms of quality of mesorectum excised after potentially curative resection. Furthermore, there were seven local recurrences in patients operated by consultants (7.8%) when compared with four in the trainee group (9.5%) and once again there was no statistical significance between the two groups (P = 0.719).

Conclusion We conclude that the quality of rectal cancer excision, as defined by mesorectal grades, achieved by supervised colorectal trainees is comparable with that achieved by consultants.
Local recurrence after curative resection for rectal cancer – role of the multi‐disciplinary team
Authors: Khera G. , Walsh I C. J. , Anderson J. A. , El‐Sayed T. Y. , Haylock B. J. , Myint A. S. , Smith D. B. , Makin C. A.
Published: October 2006

Objective:  We believe optimal management of rectal cancer should be tailored to the individual patient. This is achieved by close liaison within a well‐established multidisciplinary team (MDT). Patients also benefit from the unusual alliance between our district general hospital and regional oncology center with expertise in radiotherapy for rectal cancer. To test our beliefs, we reviewed the incidence of local recurrence following curative resection for rectal cancer.

Method:  A total of 201 consecutive patients with rectal cancer treated from 1 April 1999 to 31 March 2002 were reviewed by one author (GK). 100 per cent case note retrieval was achieved of which 122 curative resections were identified (122/201 = 60.7%). Mean follow‐up 4½ years.

Conclusion:  The incidence of local recurrence was 2.5% (3/122). All occurred in patients having Hartmann's operation. There were no local recurrences following anterior resection or abdomino‐perineal resection.

Discussion:  Data support our belief that, combining modern surgical techniques with radiotherapy ± chemotherapy, high quality outcomes are achievable when care is tailored to individuals by a functional MDT.

Number (%)
Average distance from anal verge (cm)
Number (%) receiving preoperative radiotherapy

Anterior resection
76/122 (62.3)
11.2
13/76 (17.3)

Hartmanns
9/122 (7.4)
8
4/9 (44.4)

Abdomino‐perineal resection
27/122 (22.1)
4.7
11/27 (40.7)
Analysis of national database for TEM resected rectal cancer
Authors: Bach S. , Mortensen N. ,   the TEM Users Group
Published: October 2006

Objective:  Transanal endoscopic microsurgery (TEM) is a minimally invasive alternative to rectal resection for cancer. Patients benefit from rapid recovery, excellent function and stoma avoidance.

Method:  The national TEM database has prospectively collated data from 21 centres since 1993. Details of preoperative evaluation, neoadjuvant therapy, technical aspects of surgery, postoperative complications, pathological staging, salvage, recurrence and survival have been recorded for 454 patients with rectal cancer, median follow‐up 35 months.

Results:  Intention was curative in 69%, for compromise in 22% and palliative in 5%. The morbidity and mortality of TEM was 17.2% and 1.5%. Neoadjuvant radiotherapy was administered in 8% of cases. Pathological staging: pT0 (1.8%), pT1 (52.9%), pT2 (32.8%), pT3 (9.9%) and pTx (3.1%). Margin positivity (< 1 mm) occurred in 20%; this was markedly stage dependent. 18 per cent received adjuvant radiotherapy while 13% progressed to major surgery. 5‐year disease free survival was 77% pT1, 74% pT2 and 35% pT3 with local recurrence rates of 20%, 25% and 59% respectively. Age (P = 0.01), tumour area (P = 0.02) and pT stage (P = 0.07) predicted for relapse (Cox regression model).

Conclusion:  TEM offers a safe alternative to major surgery curing three quarters of patients with pT1 disease. Although classical surgery must remain the standard of care we envisage future studies of TEM combined with adjuvant therapy.
Waist circumference cut‐off points for identification of abdominal obesity among the tunisian adult population
Authors: Bouguerra R. , Alberti H. , Smida H. , Salem L. B. , Rayana C. B. , El Atti J. , Achour A. , Gaigi S. , Slama C. B. , Zouari B. , Alberti K. G. M. M.
Published: October 2006

Aims:  Waist circumference (WC) is a convenient measure of abdominal adipose tissue. It itself is a cardiovascular disease (CVD) and diabetes‐risk factor and is strongly linked to other CVD risk factors. There are, however, ethnic differences in the relationship of WC to the other risk factors.The aim of this study was to determine the optimal cut‐off points of WC and body mass index (BMI) at which cardiovascular risk factors can be identified with maximum sensitivity and specificity in a representative sample of the Tunisian adult population and to investigate any correlation between WC and BMI.

Methods:  We used a sample of the Tunisian National Nutrition Survey, a cross‐sectional population‐based survey, conducted in 1996 on a large nationally representative sample, which included 3435 adults (1244 men and 2191 women) of 20 years or older. WC, BMI, blood pressure and fasting blood measurements (plasma glucose, total cholesterol, triglycerides) were recorded. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut‐off values of WC and BMI to identify with maximum sensitivity and specificity the detection of high blood pressure, hyperglycaemia, high blood cholesterol and hypertriglyceridaemia.

Results:  ROC curve analysis suggested WC cut‐off points of 85 cm in men and 85 cm in women for the optimum detection of high blood pressure, diabetes and dyslipidaemia. The optimum BMI cut‐off points for predicting cardiovascular risk factors were 24 kg/m2 in men and 27 kg/m2 in women. The cut‐off points recommended for the Caucasian population differ from those appropriate for the Tunisian population. The data show a continuous increase in odds ratios of each cardiovascular risk factor, with increasing level of WC and BMI. WC exceeding 85 cm in men and 79 cm in women correctly identified subjects with a BMI of ≥25 kg/m2, sensitivity of >90% and specificity of >83%.

Conclusions:  Based on the ROC analysis, we suggest a WC of 85 cm for both men and women as appropriate cut‐off points to identify central obesity for the purposes of CVD and diabetes‐risk detection among Tunisians. WCs of 85 cm in men and 79 cm in women were the most sensitive and specific to identify most subjects with a BMI ≥25 kg/m2.
Pygeum africanum extract inhibits proliferation of human cultured prostatic fibroblasts and myofibroblasts
Authors: Boulbès Delphine , Soustelle Laurent , Costa Pierre , Haddoum Mohammed , Bali Jean‐Pierre , Hollande Frédéric , Magous Richard
Published: October 2006

OBJECTIVE

To investigate the effect of Pygeum africanum (PA) extract on the proliferation of cultured human prostatic myofibroblasts and fibroblasts; this extract is used for treating urinary disorders associated with benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

Primary cultures of prostatic stromal cells were obtained from histologically confirmed human BPH by enzymatic digestion. Cell proliferation was measured by 5‐bromo2′‐deoxy‐uridine (BrdU) incorporation assays, and cytotoxicity by luminescent quantification of adenylate kinase activity.

RESULTS

Cultured cells were labelled by an anti‐vimentin antibody, and most of them by an α−smooth‐muscle‐actin antibody, revealing the presence of fibroblasts and myofibroblasts. BrdU incorporation tests showed that proliferation of cultured human stromal cells, stimulated by fetal calf serum, by basic fibroblast growth factor and by epidermal growth factor, was dose‐dependently inhibited by PA extract (5–100 µg/mL). Except at 100 µg/mL, no acute cytotoxicity of the extract was detected after 24 h of culture. Similarly, the extract dose‐dependently inhibited the proliferation of Madin–Darby canine kidney epithelial cells, but to a lesser extent; whatever the dose of extract, no acute toxicity was evident on this cell line.

CONCLUSION

PA extract inhibits the proliferation of cultured human prostatic myofibroblasts and fibroblasts. We propose that cultured human prostatic cells offer a reliable model for preclinical screening of therapeutic agents, and to study the mechanisms underlying the inhibition of proliferation.
Effects of ovariectomy and oestrogen replacement on the function and expression of Rho‐kinase in rat bladder smooth muscle
Authors: Hong Sung K. , Yang Ji H. , Kim Tae B. , Kim Soo W. , Paick Jae‐Seung
Published: October 2006

OBJECTIVE

To investigate the effects of ovariectomy and oestrogen replacement on the function and expression of Rho‐kinase in rat bladder smooth muscle, as the actual effects of oestrogen deprivation on bladder smooth muscle are unclear.

MATERIALS AND METHODS

Female Sprague–Dawley rats were placed into one of three groups: sham‐operated, bilateral ovariectomy‐only, and bilateral ovariectomy plus oestrogen replacement groups. In the last group, oestrogen was replaced by weekly injection of β‐estradiol 17‐cypionate (250 µg/kg subcutaneously for 6 weeks) beginning at 1 week after ovariectomy, whereas the other groups received vehicle‐only injections for 6 weeks. After treatment, the bladder was removed for muscle strip studies to evaluate the effects of Y‐27632, a specific inhibitor of Rho‐kinase, on baseline tension and carbachol‐induced tonic contractions. Also, the protein expression of RhoA and Rho‐kinase isoenzymes was assessed by Western blot analysis.

RESULTS

Of the three groups, incubation with 10 µm Y‐27632 resulted in the largest decrease in baseline tension of strips from the bilateral ovariectomy‐only group, but this was not statistically significant (P > 0.05). For carbachol‐induced tonic contractions, strips from the bilateral ovariectomy‐only group were attenuated the most among the three groups after adding Y‐27632 (P < 0.05). However, there were no significant differences in the levels of RhoA and the two Rho‐kinase isoenzymes in bladder tissues from the three groups.

CONCLUSION

Our data show that oestrogen might inhibit the function of Rho‐kinase in bladder smooth muscle, while having no significant effect on its expression. This finding might help to explain the greater incidence of urinary tract symptoms suggestive of overactive bladder after the menopause in women.
The role of anticholinergics in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta‐analysis
Authors: Blake‐James Benedict T. , Rashidian Arash , Ikeda Youko , Emberton Mark
Published: October 2006

Authors from the UK present a systematic review of publications on the safety and efficacy of anticholinergics in men with LUTS; they found them to be safe, but suggested that further studies are required to establish precisely their efficacy.

Authors from the USA studied the correlation between risk factors for vascular disease and the AUA symptom score; there was a possible association between vascular disease and the development and severity of LUTS in men.

OBJECTIVE

To assess the safety and efficacy of anticholinergics in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) by a systematic review of published reports and a meta‐analysis of the reported outcomes.

METHODS

We searched Medline, Embase and Cochrane databases (1966–2006), and hand‐searched relevant reference lists and conference proceedings, for studies on the use of anticholinergics in men with BPH or bladder outlet obstruction. Eligible studies were assessed for quality and foreign language studies were translated. We collected data on all reported outcomes, conducted meta‐ analyses on the maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR) and volume at first contraction, and calculated the acute urinary retention (AUR) rate. We used sensitivity analysis to confirm the findings.

RESULTS

We identified five randomized controlled trials (RCTs) and 15 observational studies. Four RCTs incorporating 633 patients were included in the meta‐analyses. Anticholinergics did not significantly alter Qmax (0.1 mL/s, 95% confidence interval, CI, 0.6–0.7). The PVR was increased by 11.6 mL (95% CI 4.5–18.6) although there was no significant difference between AUR rates. The total International Prostate Symptom Scores (IPSS) were not significantly different, but there were improvements for IPSS storage subscores in one RCT. The AUR rate was 0.3% at the 12‐week follow‐up in 365 men in the RCTs and observational studies.

CONCLUSION

Anticholinergic use in men with LUTS suggestive of BPH appears to be safe. Further studies are required to establish efficacy with a suitable precision.
Reorganising the Infantry: Drivers of Change and What This Tells Us about the State of the Defence Debate Today
Authors: Dorman Andrew M.
Published: October 2006

This article uses the case study of the reorganisation of the infantry announced in December 2004 to argue that the government undertook reforms that were in the army's interest rather than its own and that the existing schools of thinking within defence fail to explain this behaviour. The article goes on to make three conclusions. Firstly, our traditional assumptions about structure-agency within defence are incorrect and that agency has a far greater role to play. Secondly, that the battle of the Scottish Regiments raises questions about the balance between local, regional and ethnic identity. Thirdly, that the army reorganisation highlights the weakness of the current defence debate in the United Kingdom with much of the existing literature left over from the Cold War period.
Europeanising Antitrust: British Competition Policy Reform and Member State Convergence
Authors: Baldi Gregory
Published: October 2006

This article argues that the patterns of competition policy convergence in EU member states challenge formulations of the process of Europeanisation and specifically the notion that the likelihood of policy harmonisation is a function of the pre-existing compatibility or ‘fit’ between national and supranational policies. In the case of antitrust, the member states in which existing arrangements were least compatible with the European policy were generally the first to adopt the European competition enforcement regime, while Britain, in spite of having an established—albeit dysfunctional—competition regime since the 1940s, was the last of the medium- and large-sized members to move towards harmonising its antitrust rules. The article finds that the pre-existence of an antitrust system actually made harmonisation more difficult for Britain by allowing British industrial interests to develop preferences for the domestic system, which stymied attempts to Europeanise British policy.
Mapping Processes of Policy Change in Contemporary European Political Economies: The Irish Case
Authors: Smith Nicola J.
Published: October 2006

This article engages with debates about the trajectory of contemporary European political economies, emphasising in particular the need to map processes of policy change over time (by placing contemporary developments in historical perspective) and space (by considering a variety of policy areas). The article then explores these issues with respect to the Irish case. Placing more recent developments within historical perspective, it argues that the trajectory of the Irish state is not best characterised in terms of a shift from one state form (the ‘activist state’) to another (‘the competition state’). Rather, the path of Irish economic and social policy has been both highly complex and (at times) contradictory, so that change is best characterised in terms of the ebb and flow of tendencies and counter-tendencies rather than in terms of a shift between state forms.
DISENTANGLING THE EFFECTS OF POLITICAL FRAGMENTATION ON VOTER TURNOUT: THE FLEMISH MUNICIPAL ELECTIONS
Authors: GEYS BENNY , HEYNDELS BRUNO
Published: October 2006

Political fragmentation has been shown to be an important determinant of electoral turnout. We introduce an empirical approach that allows disentangling the impact of two dimensions of such fragmentation: the number of parties and the size inequalities between those parties. This is important as it allows us to assess the size, significance, and direction of the individual effects of each element – an aspect disregarded in previous research. Our empirical analysis of the 2000 Flemish municipal elections shows that a higher number of parties competing in the election lowers turnout. The size inequalities between the parties exert a positive – though insignificant – influence on voter participation.
Influences of reactive oxygen species and nitric oxide on hepatic fibrogenesis
Authors: Novitskiy Gennadiy , Potter James J. , Wang Lan , Mezey Esteban
Published: October 2006

Abstract
Background/Aims: This study determined the roles of NAD(P)H oxidase, which generates reactive oxygen species (ROS), and of inducible nitric oxide synthase (iNOS), which generates nitric oxide (NO) on the development of hepatic fibrosis in mice.

Methods: Hepatic fibrosis was produced by carbon tetrachloride administered for 12 weeks in wild‐type (WT) mice and in mice with knockout of either the gp91phox subunit of the NAD(P)H complex (gp91phox−/−) or of iNOS (iNOS−/−).

Results: Liver fibrosis and hydroxyproline after carbon tetrachloride was lower in gp91phox−/− and in iNOS−/− mice than in WT mice. The increase in α2(I) collagen mRNA was absent in the gp91phox−/− but not in the iNOS−/− mice. Transformation growth factor β (TGF‐β) mRNA was increased more in the gp91phox−/− than in the WT mice, while in the iNOS−/− mice there was no increase in TGF‐β mRNA. 3‐Nitrotyrosine was similarly increased by carbon tetrachloride in gp91phox−/− and WT mice, while there was no increase in the iNOS−/− mice.

Conclusions:
Deficiencies in NAD(P)H oxidase and in iNOS separately reduce, but do not eliminate carbon tetrachloride‐induced liver fibrosis. Likely causes for this inhibitory effects are decreases in the production of ROS in NAD(P)H deficiency and of peroxinitrite radicals in iNOS deficiency.
Endogenous Adaptation: The Effects of Technology Position and Planning Mode on IT‐Enabled Change*
Authors: Mitchell Victoria L. , Zmud Robert W.
Published: October 2006

The redesign of information technology (IT)‐enabled work processes often necessitates fundamental design changes to the intended work process, the IT platform hosting the work process, or both. Research suggests that such design changes often can be traced to earlier decisions involving endogenous adaptation or internal organizational change. Two such decisions are a firm's technology position and planning mode. This study examines the relationship between technology position and planning mode in predicting the magnitude of design change in process redesign projects. The conceptual frame applied in examining these relationships involves a synthesis of Miles and Snow's adaptive cycle with elements central to concurrent engineering. Our results indicate that the magnitude of design change is related to differences in technology position and planning mode. To effectively implement organizational change, firms must leverage their IT platform by carefully timing IT investments in accordance with their adopted technology position. Directing the trajectory of a firm's IT platform and deploying it so as to complement the firm's technology position reduces design uncertainty, promoting reengineering success.
Initial Public Offerings: CFO Perceptions
Authors: Brau James C. , Ryan Patricia A. , DeGraw Irv
Published: October 2006

We examine four issues pertaining to initial public offerings (IPOs) using a survey of 438 chief financial officers (CFOs). First, why do firms go public? Second, is CFO sentiment stationary across bear and bull markets? Third, what concerns CFOs about going public? Fourth, do CFO perceptions correlate with returns? Results support funding for growth and liquidity as the primary reasons for IPOs. CFO sentiment is generally stationary in pre‐ and post‐bubble years. Managers are concerned with the direct costs of going public, such as underwriting fees, as well as indirect costs. We find a negative relation between a focus on immediate growth and long‐term abnormal returns.