bluuebunny/crossref_metadata_2025 huggingface dataset:
Denaturing gradient gel electrophoresis and its use in the detection of major histocompatibility complex polymorphism
Authors: Knapp L.A.
Published: February 2005

Abstract:  The major histocompatibility complex (MHC) has been studied extensively in humans and in mice and many methods are available for MHC typing of these well‐characterized species. Studies of MHC variation in other species are ever increasing and researchers can choose one of a number of approaches for MHC typing of their species of interest. DNA sequencing is regarded as the ‘gold standard’ and it is frequently used for MHC typing. However, DNA sequencing is impractical when many individuals must be typed. Denaturing gradient gel electrophoresis (DGGE) offers a flexible and sensitive method for identifying and characterizing MHC alleles in any vertebrate species. This article reviews the theory and the practice of DGGE and examines the use of DGGE for MHC identification in various species. DGGE is compared to other similar techniques for MHC typing, such as single‐stranded conformational polymorphism and reference strand‐mediated conformational analysis. The advantages, problems, pitfalls and limitations of DGGE are considered and future perspectives on the use of DGGE for MHC typing are discussed.
Validation of sperm sexing in the cattle (Bos taurus) by dual colour fluorescence in situ hybridization
Authors: Habermann F.A. , Winter A. , Olsaker I. , Reichert P. , Fries R.
Published: February 2005

Separation of X‐ and Y‐bearing sperm cells, together with artificial insemination using sex‐specific semen, makes it possible to pre‐determine the sex of calves. This has the potential to considerably improve cattle breeding, genetic resource management and particularly the efficiency of dairy and meat production. However, the broad use of sexed semen will depend on availability, price, fertilizability and in particular the actual sorting purity of sperm doses. To validate the accuracy of sperm sexing in Bos taurus, we have developed a simple, fast and reliable dual colour fluorescence in situ hybridization (FISH) test, where Y‐bearing spermatozoa are identified by a DNA fragment hybridizing to a large pericentromeric repetitive DNA block on the bovine Y chromosome (locus DYZ1, Yp13–q12). To avoid an underestimation of Y signals, we used a second DNA probe identifying a large subcentromeric block of complex repetitive DNA on the bovine autosome 6 (locus D6Z1, 6q12–15) as a positive control. Bovine sperm were fixed with methanol:acetic acid and denatured by simply immersing in 3 m NaOH, yielding consistent hybridization results and good preservation of sperm morphology. The FISH protocol was evaluated on unsorted sperm as well as on sperm samples sexed using the Beltsville technology, which separates X‐ and Y‐bearing spermatozoa by staining with Hoechst 33342 and flow sorting according to their DNA content (Johnson et al. 1987).
Phylogenetic analysis and species allocation of individual equids using microsatellite data
Authors: Krüger K. , Gaillard C. , Stranzinger G. , Rieder S.
Published: February 2005

The taxonomic status of all equid species is not completely unravelled. This is of practical relevance for conservation initiatives of endangered, fragmented equid populations, such as the Asiatic wild asses (in particular Equus hemionus onager and E. hemionus kulan). In this study, a marker panel consisting of 31 microsatellite loci was used to assess species demarcation and phylogeny, as well as allocation of individuals (n = 120) to specific populations of origin (n = 11). Phylogenetic analysis revealed coalescence times comparable with those previously published from fossil records and mtDNA data. Using Bayesian approaches, it was possible to distinguish between the studied equids, although individual assignment levels varied. The observed results support the maintenance of separate captive conservation herds for E. hemionus onager and E. hemionus kulan. The first molecular genetic results for E. hemionus luteus remained contradictory, as they unexpectedly indicated a closer genetic relationship between E. hemionus luteus and E. kiang holderi compared with the other hemiones.
A canine X chromosome painting probe applied to four canid species: close relationship of a heterochromatic‐like sequence between the dog and the blue fox
Authors: Pieńkowska‐Schelling A. , Zawada M. , Schelling C.
Published: February 2005

Microdissection of chromosomes is an invaluable tool to physically isolate single chromosomes, chromosome‐arms or chromosome‐bands and, subsequently generate painting probes with which numerical or structural aberrations of chromosomes can be studied. In addition, such painting probes can be used to compare karyotypic relationships among mammalian species. For the present study a canine whole X chromosome painting probe was prepared by means of conventional microdissection and degenerate‐oligonucleotide‐primed PCR. The application of this paint to the chromosomes of the domestic dog, red fox, blue fox and Chinese raccoon dog revealed hybridization to the entire X chromosome and the pseudo‐autosomal region of the Y chromosome in all four species analysed. In the blue fox the same paint revealed additional strong hybridization signals on the heterochromatic arms after low‐stringent posthybridization washes. The present study indicates the existence of an ancient canid heterochromatic‐like DNA sequence, which survived in the proximal part of the X chromosome of all species studied and, in addition, was involved in the formation of heterochromatic arms in the blue fox.
Hypothalamo‐pituitary‐adrenocortical axis in stress‐susceptible and stress‐resistant pigs: endocrine responses to corticotrophin‐releasing factor and vasopressin*
Authors: Hari J.J. , Pliska V.
Published: February 2005

Swiss Landrace pigs selected into genetically well‐characterized low and high tissue fat lines (f and F respectively) react differently to exogenous and endogenous stressors. Response of the hypothalamo‐pituitary‐adrenocortical (HPA) axis to i.v. administered ovine corticotrophin‐releasing factor (oCRF) and lysine vasopressin (LVP) in young females, intact and pretreated with dexamethasone or metyrapone, leads to the conclusion that different stress susceptibility of the two lines correlates with the sensitivity of pituitary corticotrophs to oCRF stimulation. Total amount of ACTH released after stimulation with submaximal oCRF doses was roughly equal in both lines, and cortisol level is even lower in the f‐line, most likely due to the considerably enhanced metabolic clearance rate of cortisol (lower half‐life of plasma cortisol compared with F‐line). LVP‐stimulated ACTH release is comparable with that of oCRF is stronger in the f‐line. Combined effect of oCRF and LVP is rather additive than synergistic but the half‐life ratio cortisol/ACTH after this stimulation is about four times higher than for stimulation by LVP and oCRF separately. In cases of externally stimulated HPA axis, cortisol plasma concentration tightly cross‐correlates with that of ACTH.
Virtual colonoscopy: Issues in implementation
Authors: Mendelson R , Ramsay D , Edwards J , Forbes G
Published: February 2005

The following issues and requirements related to the implementation of a CT colonography (CTC) service are important: (i) policies are needed regarding the indications for CTC. Concomitant with this is the need for education of potential referrers and patients. Expectations of the procedure, particularly by general practitioners, may be unrealistic and indications for referral may otherwise be inappropriate. At present there is not general acceptance of CTC for screening asymptomatic persons; (ii) a flexible approach to CT protocols is useful, dependant on the indication for and clinical context of referral, the age and body habitus of the patient; (iii) attention to the issues related to the special skills required by the reporting radiologist. While there is a temptation to regard CTC interpretation as an extension of skills used in interpreting other cross‐sectional images, there is a need to realise that there are skills required specific to CTC and there should be adequate provision for training; (iv) matters related to reporting, such as reporting format, and lesions that will be reported/not reported; and (v) informed consent from the patient. Information should be provided with regard to the limitations of CTC, the implications of a positive finding and radiation dosage.
Distinctive new form of spondyloepimetaphyseal dysplasia with severe metaphyseal changes similar to Jansen metaphyseal chondrodysplasia
Authors: Al Kaissi A , Ghachem MB , Nessib N , Chehida FB , Hammou A , Kozlowski K
Published: February 2005

We report a boy with a unique, ‘new’ form of spondyloepimetaphyseal dysplasia. The conspicuous features of the spinal changes were the delay in ossification of the cervical spine and posterior elements of the thoraco‐lumbar spine. The vertebral bodies were of abnormal shape but of normal size and well ossified. The hallmark of epiphyseal changes was markedly delayed ossification (bone age). The severely disturbed metaphyseal ossification was similar to Jansen metaphyseal dysplasia. This pattern of changes has not yet been described in spondyloepimetaphyseal dysplasia.
Degree of adaptability of the somatosensory cortex to change: Prospects for integration of bone‐mounted dental prostheses
Authors: Calford Mike B
Published: February 2005

1. The topographic representation of the body surface in the somatosensory cortex provides an important model system for thein vivostudy of neuronal plasticity, induced changes in somatotopy providing a direct measure of plasticity not available in most parts of the central nervous system.

2. Over the past two decades, animal experimentation in a number of laboratories has shown a remarkable degree of adaptability of the cortical representation following peripheral lesions and has had a widespread influence by challenging the once‐accepted dogma that the brain is a structurally fixed organ.

3. Although some aspects of original stimulation will be missing, it is likely that receptors stimulated through bone conduction and compression by bone‐mounted dental prostheses preserve some of the geometric and temporal relationships of original stimulation. By analogy with data obtained from the forearm representations, it would be expected that many features of the original cortical representations will be recreated.

4. There are also examples in the literature of perceptual learning without gross changes to the cortical representation (some being within a class of adaptability known as gain control) and it is likely that perceptual integration of many dental prostheses occurs within the limits of these neural adaptation mechanisms.
BLOCK OF Na+ AND K+ CURRENTS IN RAT VENTRICULAR MYOCYTES BY QUINACAINOL AND QUINIDINE
Authors: Pugsley Michael K , Walker Michael JA , Saint David A
Published: February 2005

1. The electrophysiological actions of quinacainol were investigated on sodium (INa), transient outward (ito) and sustained‐outward plateau (iKsus) potassium currents in rat isolated cardiac myocytes using the whole‐cell patch‐clamp technique and compared with quinidine.

2. Quinacainol blocked sodium currents in a concentration‐dependent manner and with a potency similar to that of quinidine (mean (±SEM) EC50 50 ± 12 vs 95 ± 25 µmol/L for quinidine and quinacainol, respectively). However, quinacainol had a considerably prolonged onset and recovery from block compared with quinidine.

3. Neither quinacainol nor quinidine significantly changed the steady state voltage dependence of activation of sodium currents. Quinidine produced a hyperpolarizing shift in the voltage dependence for sodium current inactivation, but no such shift was observed with quinacainol at doses that produced a substantial current block.

4. Although quinacainol did not effectively block voltage‐dependent potassium currents, even at concentrations as high as 1.5 mmol/L, quinidine, at a half‐maximal sodium channel‐blocking concentration, reduced peak ito current amplitude, increased the rate of inactivation of ito and blocked iKsus.

5. These results indicate that quinacainol, a quinidine analogue, blocks sodium currents in cardiac myocytes with little effect on ito or iKsus potassium currents, which suggests that quinacainol may be exerting class 1c anti‐arrhythmic actions.
EFFECT OF ULTRASONIC STIMULATION ON mRNA ABUNDANCE OF UNCOUPLING PROTEIN (UCP) 2 AND UCP 3 IN GASTROCNEMIUS MUSCLE OF RATS
Authors: Kogure Akinori , Yoshida Toshihide , Takakura Yasuto , Umekawa Tsunekazu , Hioki Chizuko , Yoshioka Keiji , Yoshimoto Kanji , Yoshikawa Toshikazu
Published: February 2005

1. The hypothesis that ultrasonic stimulation upregulates uncoupling protein (UCP) 2 and UCP3 in gastrocnemius muscle by a different mechanism of exercise was investigated in Wister rats.

2. The ultrasnonic‐stimulated group was given ultrasonic stimulation to the leg (1 MHz frequency, 1 W/cm2 intensity, 10 min continuously).

3. The exercise group was given exercise training by swimming for 10 min in plastic barrels filled with warm water.

4. After 3 h, rats were killed and the gastrocnemius muscle was removed rapidly, weighed and frozen in liquid nitrogen for real‐time quantitative reverse transcription–polymerase chain reaction analysis.

5. In gastrocnenius muscles of ultrasonic‐stimulated rats, UCP3 mRNA abundance was significantly increased 3.6‐fold and UCP2 mRNA abundance was significantly increased 2.2‐fold compared with control rats.

6. In gastrocnenius muscles of exercised rats, UCP3 mRNA abundance was significantly increased 3.5‐fold compared with control rats, but no change in UCP2 mRNA abundance was observed.

7. Plasma free fatty acid (FFA) levels were also significantly increased in the ultrasonic stimulation group, as well as the exercise group, compared with the control group.

8. These findings show that ultrasonic stimulation lipolyses subcutaneous fat into FFA and glycerol and upregulates UCP2 and UCP3 mRNA by a mechanism different to that of exercise.
Prolongation of the QT interval in primary aldosteronism
Authors: Matsumura Kiyoshi , Fujii Koji , Kansui Yasuo , Arima Hisatomi , Iida Mitsuo
Published: February 2005

1. Only limited information is available concerning the changes in the electrocardiogram in primary aldosteronism. The aim of the present study was to determine factors influencing the QTc interval in patients with primary aldosteronism.

2. Nineteen patients with primary aldosteronism caused by a Conn's adenoma and 69 patients with essential hypertension, in whom all possible causes of secondary hypertension had been excluded, were included in the present study. Before and 10–20 days after adrenalectomy, blood and electrocardiographic examinations were conducted.

3. Systolic and diastolic blood pressures in primary aldosteronism were found to be comparable to those in essential hypertension. However, the QTc interval was significantly prolonged and serum potassium concentrations were significantly decreased in patients with primary aldosteronism compared with patients with essential hypertension (492.7 ± 20.3 vs 428.5 ± 3.1 msec for QTc interval, respectively (P < 0.01); 3.07 ± 0.12 vs 4.07 ± 0.05 mEq/L for serum potassium concentrations, respectively (P < 0.01)). The QTc interval was significantly correlated with serum potassium concentrations in primary aldosteronism (P = 0.0011; r = −0.6902), but not in patients with essential hypertension.

4. Blood pressure significantly decreased after adrenalectomy. Furthermore, serum potassium concentrations increased significantly and did not correlate with the QTc interval after adrenalectomy (P = 0.54; r = −0.1500).

5. Our results indicate that the QTc interval is prolonged in patients with primary aldosteronism, probably owing to hypokalaemia.
Differences in long‐term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed
Authors: MEMBRENO FERNANDO , BAEZ ARTURO L , PANDULA REKA , WALSER ERIC , LAU DARYL T‐Y
Published: February 2005

Objective: To compare the survival after transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites and variceal bleed, and to identify the factors predictive of survival.

Methods: Single tertiary center, retrospective‐prospective study. Chart review was performed on all patients who underwent TIPS between 1993 and 2000 and prospective follow‐up to determine survival. Pre‐ and post‐TIPS clinical parameters were compared and Kaplan–Meier analysis was applied to compare the survival of both groups. Cox regression was used to identify predictors of survival after TIPS.

Results: A total of 163 patients were included, 62 with refractory ascites and 101 with variceal bleed. Both groups had similar age (48.2 vs 48.9 year; P = 0.65) and consisted of predominantly Caucasians (51%) and Mexican‐Americans (39%). More than 75% had chronic hepatitis C, alcoholic liver disease or both. Overall, the median survival was significantly better for variceal bleed (2 years) compared with refractory ascites (6 months) (P < 0.001). This survival advantage persisted in patients with Mayo risk score greater than 1.17. Transjugular intrahepatic portosystemic shunt improved severe ascites in 45% of patients (P = 0.03). Mayo risk score was highly predictive of survival after TIPS with a hazard ratio of 2.3, followed by Child–Pugh score, creatinine, albumin and ethnicity, with better survival among Mexican‐Americans. Shunt dysfunction (31%) and hepatic encephalopathy (27%) were the most common complications of TIPS.

Conclusions: Patients who received TIPS for variceal bleed had significantly longer survival compared with those for refractory ascites. Mexican‐Americans had an improved long‐term survival compared with Caucasians. The reason for this ethnic difference in survival is unclear and warrants further prospective evaluation.
Bird’s‐eye view on gastric cancer research of the past 25 years
Authors: FAN DAIMING , ZHANG XUEYONG , CHEN XITAO , MOU ZHENXIAN , HU JIALU , ZHOU SHAOJUAN , DING JIE , WU KAICHUN
Published: February 2005

Abstract  This paper provides a bird’s‐eye view of our 25‐year research work on gastric cancer, including both exploration of pathogenesis and preclinical or clinical applications of diagnosis and treatment. Although there have been achievements and reasons for applause, there are, nonetheless, more failings and teachings. Some problems that we experienced 25 years ago are still problems we have to face today. We are absolutely not singing the same old tune. Looking back makes us wiser and our way smoother. Although it is a long and arduous way to further study gastric cancer, we are willing to devote ourselves to it.
Papillary adenocarcinoma of the renal pelvis and ureter producing carcinoembryonic antigen, carbohydrate antigen 19‐9 and carbohydrate antigen 125
Authors: ONISHI TAKEHISA , FRANCO OMAR E , SHIBAHARA TAKUJI , ARIMA KIMINOBU , SUGIMURA YOSHIKI
Published: February 2005

Abstract  We report a case of advanced renal pelvis and ureter adenocarcinoma producing carcinoembryonic antigen (CEA), carbohydrate antigen 19‐9 (CA19‐9) and carbohydrate antigen 125 (CA125). A 72‐year‐old woman was diagnosed with right renal pelvic and ureter tumor with para‐aortic lymph node swelling. Biopsy of the ureteral mass revealed papillary adenocarcinoma. Serum levels of CEA, CA19‐9 and CA125 were extremely elevated. The patient was successfully treated with paclitaxel/carboplatin chemotherapy followed by surgery.
THE POTENTIAL OF INTEGRATED POPULATION MODELLING†
Authors: Besbeas P. , Freeman S.N. , Morgan B.J.T.
Published: February 2005

Recent work has shown how the Kalman filter can be used to provide a simple framework for the integrated analysis of wild animal census and mark‐recapture‐recovery data. The approach has been applied to data on a range of bird species, on Soay sheep and on grey seals. This paper reviews the basic ideas, and then indicates the potential of the method through a series of new applications to data on the northern lapwing, a species of conservation interest that has been in decline in Britain for the past 20 years. The paper analyses a national index, as well as data from individual sites; it looks for a change‐point in productivity, corresponding to the start of the decline in numbers, considers how to select appropriate covariates, and compares productivity between different habitats. The new procedures can be applied singly or in combination.
WAS IT THERE? DEALING WITH IMPERFECT DETECTION FOR SPECIES PRESENCE/ABSENCE DATA†
Authors: Mackenzie Darryl I.
Published: February 2005

Species presence/absence surveys are commonly used in monitoring programs, metapopulation studies and habitat modelling, yet they can never be used to confirm that a species is absent from a location. Was the species there but not detected, or was the species genuinely absent? Not accounting for imperfect detection of the species leads to misleading conclusions about the status of the population under study. Here some recent modelling developments are reviewed that explicitly allow for the detection process, enabling unbiased estimation of occupancy, colonization and local extinction probabilities. The methods are illustrated with a simple analysis of presence/absence data collected on larvae and metamorphs of tiger salamander (Ambystoma tigrinum) in 2000 and 2001 from Minnesota farm ponds, which highlights that misleading conclusions can result from naive analyses that do not explicitly account for imperfect detection.
PRICING AUSTRALIAN S&P200 OPTIONS: A BAYESIAN APPROACH BASED ON GENERALIZED DISTRIBUTIONAL FORMS
Authors: Flynn David B. , Grose Simone D. , Martin Gael M. , Martin Vance L.
Published: February 2005

This paper develops a new class of option price models and applies it to options on the Australian S&P200 Index. The class of models generalizes the traditional Black‐Scholes framework by accommodating time‐varying conditional volatility, skewness and excess kurtosis in the underlying returns process. An important property of these more general pricing models is that the computational requirements are essentially the same as those associated with the Black‐Scholes model, with both methods being based on one‐dimensional integrals. Bayesian inferential methods are used to evaluate a range of models nested in the general framework, using observed market option prices. The evaluation is based on posterior parameter distributions, as well as posterior model probabilities. Various fit and predictive measures, plus implied volatility graphs, are also used to rank the alternative models. The empirical results provide evidence that time‐varying volatility, leptokurtosis and a small degree of negative skewness are priced in Australian stock market options.
Regional variation of intracortical porosity in the midshaft of the human femur: age and sex differences
Authors: Thomas C. David L. , Feik Sophie A. , Clement John G.
Published: February 2005

This study investigated age and sex differences in patterns of porosity distribution in the midshaft of the human femur. Cross‐sections were obtained from 168 individuals from a modern Australian population. The sample comprised 73 females and 95 males, aged between 20 and 97 years. Microradiographs were made of 100‐µm sections and pore and bone areas were determined using image processing software. Initially the sample was divided by age: young (20–44 years), middle (45–64 years) and old (65+ years), but it was found that analysis on the basis of the ratio of medullary area to total subperiosteal area gave clearer results. The cortex was divided into three rings radially and into octants circumferentially and the porosity of each segment was calculated. Results showed that a pattern with raised porosity in the posterior and anterolateral regions, and with greater porosity in the inner parts of the cortex, becomes more pronounced with age. In males this pattern develops steadily; in females there are much greater differences between the middle and older groups than earlier in life. The patterns observed are consistent with progressive bone loss occurring along a neutral axis of the cortex where bending stress is lowest and the mechanical advantage of the bone is least.
Relationships among microstructural properties of bone at the human midshaft femur
Authors: Goldman H. M. , Thomas C. D. L. , Clement J. G. , Bromage T. G.
Published: February 2005

Mineralization density and collagen fibre orientation are two aspects of a bone's microstructural organization that influence its mechanical properties. Previous studies by our group have demonstrated a distinctly non‐random, though highly variable, spatial distribution of these two variables in the human femoral cortex. In this study of 37 specimens, these variables are examined relative to one another in order to determine whether regions of bone demonstrating higher or lower mineralization density also demonstrate a prevalence of either transversely or longitudinally oriented collagen fibres. An analysis of rank‐transformed collagen fibre orientation (as determined by circularly polarized light) and mineralization density (as determined by backscattered electron microscopy) data sets demonstrated that areas of low mineralization density (predominantly in the anterior‐lateral cortex) tended to correspond to regions of higher proportions of longitudinally oriented collagen fibres. Conversely, areas of higher mineralization density (postero‐medially) tended to correspond to regions of higher proportions of transversely oriented collagen fibres. High variability in the sample led to generally low correlations between the two data sets, however. A second analysis focused only on the orientation of collagen fibres within poorly mineralized bone (representing bone that was newly formed). This analysis demonstrated a lower proportion of transverse collagen fibres in newly formed bone with age, along with some significant regional differences in the prevalence of collagen fibres of either orientation. Again high variability characterized the sample. These results are discussed relative to the hypothesized forces experienced at the midshaft femur.
2004 Carolyn Sherif Award Address: Heart Disease and Gender Inequity
Authors: Travis Cheryl Brown
Published: February 2005

Individual patient records from the National Hospital Discharge Survey for 1988 and 1998 comprising approximately 10 million cases were the basis for a binary logistic regression model to predict coronary artery bypass graft. Patterns in 1988 and in 1998 indicated a dramatic and pernicious gender discrepancy in medical decisions involving bypass surgery. Overall, men were twice as likely to have bypass as were women with comparable medical profiles. This result was particularly evident for women in their 40s and 50s, when angina was a primary diagnosis, and in the presence of any comorbid condition (e.g., diabetes or hypertension). Failure to pursue proactive case management of women with heart disease costs women's lives.
Inspiration‐induced vasoconstrictive responses in dominant versus non‐dominant hands
Authors: Mayrovitz Harvey N. , Groseclose Edye E.
Published: February 2005

Single rapid and deep inspirations (inspiratory gasps, IG) result in arteriolar vasoconstriction with concomitant transient decreases in skin blood flow that are most prominent in fingers and toes. Vascular responses (inspiratory gasp responses, IGR) are determined as the maximum percentage reduction in blood flow and have been used to assess sympathetic neurovascular function in several conditions. Previous studies have described various features of the response but there has been no reported systematic investigation of the degree of similarity between IGR obtained on dominant and non‐dominant hands. This aspect is important in procedures that may use IGR to evaluate suspected unilateral sympathetic dysfunction of a limb‐pair or to test the effectiveness of physiological interventions imposed on a single limb of a pair. Thus, the goal of our study was to compare IGR magnitudes that were simultaneously determined in paired‐fingers of dominant and non‐dominant hands. In 30 healthy seated subjects, skin blood perfusion via laser‐Doppler (SBF) was measured on the dorsum of the middle finger of both hands while subjects performed three sequential IG at 3‐min intervals. Analysis of variance for repeated measures revealed no significant difference in IGR between dominant (79·3 ± 11·2%) and non‐dominant hands (81·9 ± 11·6%,P = 0·965) with an overall IGR of 80·6 ± 11·4%. These results indicate that hand‐dominance is not a factor that is likely to significantly effect IGR differentials determined in paired‐limbs.
Misoprostol for second and third trimester termination of pregnancy: A review of practice at the Women's and Children's Hospital, Adelaide, Australia
Authors: DODD Jodie , O'BRIEN Lauri , COFFEY Judy
Published: February 2005

Aims:  To assess clinical outcomes for women undergoing induction of labour either for fetal anomaly or following intrauterine fetal death using intravaginal misoprostol.

Methods:  Between January 1999 and December 2002, clinical outcomes for women who were admitted to the delivery suite of the Women's and Children's Hospital, South Australia, were prospectively collected and entered onto a database by the attending midwife. The effect of cumulative dose of misoprostol, indication for induction of labour, parity and gestational age were assessed.

Results:  One hundred and ninety nine women were admitted during the study period. Women who required in excess of 800 µg of misoprostol were more likely to have side‐effects (57/78 women dose > 800 µg misoprostol versus 71/121 women dose ≤ 800 µg, RR 0.80 95% CI 0.66–0.98), in particular diarrhoea (12/78 women dose > 800 µg misoprostol versus 5/121 women dose ≤ 800 µg, RR 0.27 95% CI 0.10–0.73) and elevated temperature (46/78 women dose > 800 µg misoprostol versus 36/121 women dose ≤ 800 µg, RR 0.50 95% CI 0.36–0.70). Women with an intrauterine fetal death (IUFD) were less likely to require in excess of 800 µg of misoprostol to effect the termination (10/56 women IUFD versus 70/143 women fetal anomaly, RR 0.36 95% CI 0.20–0.66), had a shorter induction to birth interval (mean 13.2 h ± 7.5 h, women IUFD versus 21.2 ± 17.5 h, women fetal anomaly, WMD −8.02 95% CI −11.49 to −4.55) and were more likely to give birth within 24 h of the induction process commencing (48/56 women IUFD versus 106/143 women fetal anomaly, RR 1.16 95% CI 1.00–1.34).

Conclusions:  Side‐effects increase with increasing dose of misoprostol. Induction following intrauterine fetal death is associated with a need for lower doses of misoprostol and a shorter induction to birth interval.
15 Circulating Levels of Interleukin‐6 in Hemodialysis Patients
Authors: Rus I , Avberšek‐Lužnik I
Published: February 2005

Introduction  Interleukin‐6 (IL‐6) has been described as both pro–inflammatory and anti–inflammatory molecule, a hematopoietic factor, an inducer of plasma cell development and modulator of bone resorption. Various studies reported that this cytokine induces osteoclast–mediated bone resorption in vitro and in vivo. Few studies have been reported circulating IL‐6 levels in hemodialysis (HD) patients so far. In the present study we measured IL‐6 serum levels in a group of HD patients. We hypothesized direct relationship between parathyroid hormone (PTH) and IL‐6 serum levels.

Methods  Criteria for patient entry into the study were patients with end stage renal failure without signs of inflammation (CRP < 5 mg/L). We enrolled 35 HD patients (mean age: 60.2 years, HD duration: 6 to 384 months). Patients were divided into two subgroups with PTH below (N = 21) and above (N = 14) 450 pg/mL. The mean value of two consecutive PTH measurements within 1 month was obtained for each patient. In all patients IL‐6 and intact PTH were measured by immunometric assays (Immulite, DPC, USA).

Results  We obtained higher serum IL‐6 in HD patients (5.43 ± 3.52 pg/mL) than in healthy people (reference range: 2.0–3.3 pg/mL, presented by manufacturer). Pearson's correlation between IL‐6 and PTH was not significant (r = −0.039, P = 0.824). IL‐6 levels differed significantly between low and high PTH subgroups (5.28 ± 4.17 pg/mL vs 5.65 ± 2.35 pg/mL; P = 0.033). The correlation between IL‐6 and PTH was not significant in both subgroups.

Conclusions  Mean IL‐6 serum levels were 1.6‐fold higher in HD patients than the upper level of reference range. They were also significantly higher in HD patients with PTH above 450 pg/mL. The direct relationship between PTH and IL‐6 was not confirmed. Our results provide only a brief insight into circulating levels of IL‐6 in uremic patients which might reflect resorptive phase of bone remodeling process. This, however, has not yet been confirmed.
17 Osteoprotegerin and Bone Turnover Markers in Serum of Dialysis Patients
Authors: Rus I , Avberšek‐Lužnik I , Marc J
Published: February 2005

Introduction  Recent studies have shown high circulating levels of osteoprotegerin (OPG), one of the local regulators of bone remodelling in renal osteodystrophy. For non‐invasive bone turnover assessment several serum markers are used, therefore we investigated the relationship between OPG and some of established serum markers.

Methods  The 33 dialysis patients (age: 56.6 ± 12.2 years) and 20 control individuals (age: 56.0 ± 20.6 years) were included in this study. Dialysis patients were divided according PTH serum levels (below/above 300 pg/mL) into low (N = 23) and high (N = 10) PTH subgroups. Bone alkaline phosphatase (BALP), osteocalcin (OC), tartarate‐resistant acid phosphatase 5b (TRAP 5b) and OPG were measured in all serum samples by specific immunoassays, using commercially available reagent kits.

Results  Serum OPG levels in the whole group of dialysis patients (679.0 ± 213.0 pg/mL) were approximately two times higher than in controls (337.1 ± 103.0 pg/mL). The difference in OPG levels between low (708.8 ± 219.3 pg/mL) and high (613.3 ± 191.9 pg/mL) PTH subgroup was not significant (P = 0.223). In contrast, serum levels of OC and TRAP 5b differed significantly (P < 0.045) and BALP near the limit of significance (P = 0.065). We observed nonsignificant correlation between OPG and measured bone markers in both PTH subgroups (r < 0.18). The relation between OPG and PTH was also inverse and nonsignificant (r < −0.365).

Conclusions  These results indicate that OPG alone does not match the requirements of a useful biochemical marker for differentiation between dialysis patients with low and high bone turnover. However, established serum bone markers could serve clinicians in diagnosing specific types of renal osteodystrophy.
21 Review of Treatment with Vitamin D: Ten Month Observation
Authors: Malovrh M , Premru V
Published: February 2005

Introduction  Hyperparathyroidism continues to be a major problem in patients with chronic kidney disease (CKD). Hypocalcemia and hyperphosphatemia are crucial for the development of secondary hyperparathyroidism (SHP). Preventing hyperphosphatemia ameliorates the progression of SHP. Vitamin D analogs (Alpha D3) per oral after hemodialysis (HD) could be used in the therapy of SHP. The purpose of this review in one dialysis center was to analyze the quality of such treatment.

Patients and methods  Patients (pts) on HD in one dialysis center were included in this analysis. Calcium (Ca) and phosphate (P) were followed during a 10 month period every 3 weeks and intact parathyroid hormone (iPTH) every three months. Vitamin D was given after HD per oral under nurse control.

Results  Sixty‐four pts, 34 female and 30 male, mean age 59.9 ± 11.5 (range 32–82) years, HD treatment length mean 8.8 ± 7.2 (range 0.7–30.7) years were observed. Mean Ca was 2.46 ± 0.04 mmol/L, (range from 1.06 to 2.72), mean P 1.52 ± 0.08 mmol/L (range from 0.62 to 3.53), mean iPTH 211.9 ± 36.7 ng/L (range from 1 to 699). Mean calcium concentration in dialysis fluid was 1.51 ± 0.02 mmol/L and mean dose of vitamin D was 0.35 ± 0.11 mg.

Mean values of parameters during the 10 months observation are shown in Table A21.

December  2003
February  2004
April  2004
June  2004

Ca (mmol/L)
  2.46
  2.44
  2.35
  2.38

P (mmol/L/
  1.52
  1.56
  1.71
  1.53

iPTH (ng/L)
204.8
173.1
272.3
196.5

Ca in fluid (mmol/L)
  1.52
  1.53
  1.49
  1.49

Dose of vitamin D (mg)
  0.47
  0.28
  0.21
  0.43

Conclusions  Regular evaluation of Ca, P, iPTH and strict correction of calcium concentration in dialysis fluid, per oral vitamin D are very helpful in prevention of SHP. Critical elevation of iPTH was in pts with low compliance in hypophosphatemic diet and therapy. If concentration of phosphate is normal, elevated iPTH could be diminished very effective by titration of vitamin D.
28 The Influence of Aerobic Training During Hemodialysis Procedure on Blood Pressure, Heart Rate and Aerobic Capacity of Chronic Hemodialysis Patients
Authors: Fazlić S , Ponikvar R , Buturović‐Ponikvar J
Published: February 2005

Background  Several studies have shown beneficial effect of aerobic exercise performed during hemodialysis procedure. The aim of our prospective clinical study was to evaluate the effect of 2 months aerobic exercise during hemodialysis procedure on blood pressure, heart rate and aerobic capacity of chronic hemodialysis patients.

Methods  Eleven adult chronic hemodialysis patients participated the prospective clinical study. Nine of them completed a 2 month aerobic exercise program. Exercise training was carried out during hemodialysis procedure, three times a week, in lying position, on the “bed” cycle ergometer Thera‐Joy (Medica, Germany). The exercise was prescribed based on aerobic capacity and Borg's scale of subjective effort perceiving and corresponded to moderate physical exercise (50–70% of the maximum target heart rate). Heart rate and blood pressure were monitored continuously during the procedure. Aerobic capacity was tested before and after the 2 month exercise program.

Results  Mean values of systolic, diastolic blood pressure and heart rate before exercise were 146 ± 9 mmHg, 87 ± 5 mmHg, and 77 ± 7 beats/min, respectively. After the exercise systolic and diastolic blood pressure were significantly lower and heart rate significantly higher than before (142 ± 9 mmHg, 84 ± 6 mmHg, 82 ± 8, P < 0.05). If comparing systolic and diastolic blood pressure before and after the exercise in the first and eighth week of the exercise program, no significant differences were found. However, heart rate was significantly lower before as well as after the exercise in the eighth week compared to the first week of exercise. Mean VO2 increased from 29.2 ± 8.3 to 30.5 ± 9.3 mL/kg/min, mean double product increased from 29.7 × 103 ± 6.4 to 32.0 × 103 ± 6.2, both differences not being statistically significant.

Conclusion  Controlled aerobic exercise during hemodialysis procedure was safe and well tolerated. No significant difference in blood pressure, significantly lower heart rate and slight (although statistically not significant) improvement in aerobic capacity were observed.
29 Temporary Hemodialysis Catheters as a Long Term Vascular Access in Chronic Hemodialysis Patients
Authors: Ponikvar R , Likar C , Premru V , Benedik M , Varl J , Knap B , Urbančič A , Marn‐Pernat A , Buturović‐Ponikvar J
Published: February 2005

Background  In chronic hemodialysis patients with exhausted arteries and veins in whom AV fistula or AV graft can not be performed any more, hemodialysis catheters become the last resort, either tunneled, so called “permanent”, or non‐tunneled, so called “temporary” catheters which can be usefully used for a longer period of time than a permanent vascular access.

The aim of our clinical study was to asses temporary, precurved, jugular catheters as permanent vascular access in chronic hemodialysis patients.

Methods  Thirty chronic hemodialysis patients, 15 men, 16 women, mean age 65.3 ± 13.5 years (range 30–90), with average dialysis treatment time of 6.3 ± 8.1 years (range 1 month−30 years), have had single lumen, “temporary” precurved nontunneled jugular catheters (Medcomp, USA) as permanent vascular access. Catheters were placed into right internal jugular vein, by Seldinger's technique, in local anesthesia (2% lidocain), locking solution was 4% trisodium citrate. Catheters were placed by experienced nephrologists, with ultrasound assistance, dressing was performed by dialysis nurses. Mupirocin was applied at the exit site after each hemodialysis. In the case of malfunction, thrombosis or infection, the catheter was replaced with the new one, using a guidewire. Prophylactic ceftazidime in a single dose was used after the catheter`s exchange. Unfractionated or fractionated heparin was anticoagulant.

Results  Hemodialysis catheters were used for vascular access on average for 9.1 ± 6.5 months, range 1–22.7 months, total 271.7 months or 8151 days. Average catheter running time was 3.1 ± 1.9 months, range 0.5–10 months. Total number of side effects was 57, 7.0/1000 catheter days; 26 thrombosis, 3.2/ 1000 catheter days; 9 ruptures of the catheter, 1.1/1000 catheter days; 15 malfunction, 1.8/1000 catheter days; 2 exit site infections, 0.2/1000 catheter days; 2 bacteremias, 0.2/1000 catheter days; 1 avulsion of the catheter, 0.1/1000 catheter days; and 2 catheters were removed because AV fistula was successfully used.

In 21 patients single needle hemodialysis was performed, mean blood flow 251 ± 16 mL/minute, range 250–300, mean KT/V 0.96 ± 0.16, range 0.72–1.27and in 9 patients double needle hemodialysis was performed (catheter and peripheral vein) with mean blood flow 252 ± 14 mL/minute, range 200–300, mean KT/V 1.63 ± 0.25, range 1.21–1.96.

Conclusions  ‘Temporary’ jugular single lumen non‐tunneled hemodialysis catheters provide good long term vascular access with acceptable functioning time and low infection rate. KT/V for single needle hemodialysis was rather low, however it significantly improved when double needle hemodialysis was performed. The main reasons for catheter removal was thrombosis, malfunction, and mechanical damage of the catheter.
2 Renal Anemia Treatment In Peritoneal Dialysis Patients: A Multicenter Slovenian Study
Authors: Pajek J , Grego K , Guček A , Bevc S , Ekart R , Vujkovac B , Golob Kosmina P , Kandus A , Bren A F
Published: February 2005

Objectives  The aim of our study was to: (i) assess the number of patients who need epoetin treatment and the adequacy of iron treatment, (ii) assess the influence of presence of diabetes mellitus, polycystic kidney disease and the influence of therapy with aluminum phosphate binders and angiotensin system antagonists on the epoetin requirements, (iii) assess the role of other factors possibly influencing epoetin resistance – secondary hyperparathyroidism, inflammation, dialysis dose and residual renal function.

Design and Methods  Fifty‐one stable peritoneal dialysis (PD) patients (mean age ± SD was 52 ± 13 years, 20 women) without recent bleeding, surgery, bone marrow disease, malignancy, or hypothyroidism were recruited in four Slovenian centers. The dose of epoetin was adjusted to maintain a target hemoglobin of above 110 g/L. At the time of inclusion (median 36 months of PD, range 3–124 months) the PET test results and relevant clinical and laboratory parameters were recorded. Index of epoetin resistance (IRE) was expressed as weekly epoetin dose/body weight/hemoglobin concentration.

Results  Twenty four percent of patients did not need epoetin treatment, the rest were treated with Epoetin‐beta at a dose of 70 ± 56 U/kg/week s.c.; hemoglobin concentration was 124 ± 15 g/L; 14% had hemoglobin below 110 g/L. Iron adequacy parameters (ferritin > 100 µg/L and TSAT > 20%) were fulfilled by 63% of patients, and their IRE was lower (0.43 ± 0.5 U/kg/week/g/L vs. 0.6 ± 0.72 U/kg/week/g/L), but not significantly (P = 0.502). Patients with polycystic kidneys had lower IRE (0.13 ± 0.3 vs. 0.52 ± 0.55 U/kg/week/g/L, P = 0.011) and majority of them (71%) did not need epoetin treatment (P = 0.006). No difference was found for diabetic patients. Treatment with angiotensin system antagonists, but not with aluminum phosphate binders, is associated with increased IRE (0.56 ± 0.59 vs. 0.3 ± 0.4 U/kg/week/g/L, P = 0.038). A statistically significant correlation was found for IRE and CRP (r = 0.48, P = 0.001) and iPTH (r = 0.46, P = 0.001). No correlation between IRE and residual renal function was found (r = −0.2, P = 0.173). Stepwise linear regression analysis for multiple variables (residual renal glomerular filtration rate, total weekly creatinine clearance, CRP, iPTH, iron adequacy, angiotensin system antagonist treatment, presence of polycystic kidneys) showed CRP and treatment with angiotensin system antagonists to be the most significant variables influencing IRE.

Conclusion  Our results show that systemic inflammation and angiotensin system antagonist treatment are the most important parameters affecting epoetin requirements in stable peritoneal dialysis patients.
32 Chronic LDL Apheresis in Children and Young Adults
Authors: Ponikvar R , Žugić R , Fejzuli Č , Dedič H , Gaber L , Buturović‐Ponikvar J
Published: February 2005

Background  Familial homozygous hypercholesterolemia is an inherited disease which without therapy, leads to a lethal outcome before the age of 20 due to accelerated atherosclerosis. Therapy is either “gene therapy”, liver transplantation, or chronic low density lipoprotein (LDL) apheresis. The aim of the study is to asses the efficacy of LDL apheresis in two patients with familial homozygous hypercholesterolemia, who have been treated with chronic LDL apheresis in our Dialysis center for more than 10 years.

Methods  A girl, born in 1977 entered a chronic LDL apheresis program in 1990, aged 13 years. Apheresis sessions have been carried out every two to three weeks. Vascular access was via cubital peripheral vein, and the anticoagulant used was heparin. LDL apheresis monitor was Kaneka, Japan, with dextran sulphate column. Three volumes of plasma (each 8000 mL) were processed per session, which lasted for about 4 hours.

A boy, born in 1988 entered an LDL apheresis programe in 1994, aged 6 years. Vascular access was at first via double lumen hemodialysis catheter, but at age 8, AV fistula was created because of serious access problems. LDL apheresis was performed as membrane plasma exchange up to the age of 10. Since then a monitor Kaneka with dextran sulphate column was used. LDL apheresis was performed every 2 weeks, 3 volumes of plasma being processed, each 6000 mL.

Serum concentration of total cholesterol, LDL, high density lipoprotein (HDL), and triglycerides were monitored at the start and end of the LDL apheresis.

Results  The girl has been treated for 14 years. In total 302 LDL procedures have been performed. In the year 2004 average concentrations of total cholesterol at start (12.7 mmol/L) and at the end (2.1 mmol/L), as well as time average concentration (TAC; 7.0 mmol/L) were stable and comparable with concentrations in the past. The same was true for the average concentration of LDL cholesterol at the start (10.7 mmol/L), at the end (1.2 mmol/L), and for TAC (5.6 mmol/L).

The boy has been treated for 10 years, a total of 135 LDL apheresis procedures being carried out. Average concentration (at start, after LDL apheresis, and TAC) of total cholesterol and LDL cholesterol were 11.0 mmol/L, 2.3 mmol/L, 6.6 mmol/L and 9.4 mmol/L, 1.3 mmol/L, 5.1 mmol/L, respectively.

Conclusion  Chronic LDL apheresis performed every 2–3 weeks provides stable metabolism of cholesterol and acceptable concentration of lipids. Up to now there has been no sign of accelerated atherosclerosis in the patients.