bluuebunny/crossref_metadata_2025 huggingface dataset:
The frequency of constipation in children with nocturnal enuresis: a comparison with parental reporting
Authors: McGrath Kathleen H , Caldwell Patrina HY , Jones Michael P
Published: September 2007

Aims:  To identify the prevalence of constipation in children with nocturnal enuresis presenting to a tertiary paediatric outpatient service and to assess parental and clinician recognition of constipation.

Methods:  A prospective cross‐sectional study of children with nocturnal enuresis at presentation to a continence service. Data relating to the child’s bowel habits, pattern of enuresis and other history items were obtained from parental questionnaires and paediatrician assessments. Presence and severity of constipation was assessed independently by parents and clinicians. Kappa was used to compare agreement between parental reporting and clinician assessment of constipation.

Results:  Of the 277 participants aged 4.8–17.5 years (median 8.6 years), 36.1% (n = 95) were identified as constipated by the clinician‐based scoring method (‘Constipation Score’) compared with 14.1% from parental reporting (Kappa = 0.155, P = 0.003). Despite the poor overall recognition of constipation by parents, parental and clinician assessment of frequency of bowel motions (Kappa = 0.804) and soiling (Kappa = 0.384) were similar. Major factors influencing parental reporting of constipation were frequency of bowel motions and soiling with less emphasis on straining and stool consistency.

Conclusions:  Prevalence of constipation was high among children with nocturnal enuresis as assessed by clinicians despite poor identification by parents. This may limit optimal diagnosis and management.
Maternal psychosocial aspects in hypernatremic dehydration with high sodium concentrations in breast milk: A case–control study
Authors: Ozbek Aylin , Kumral Abdullah , Guvenir Taner , Tas Fatma Varol , Gencer Ozlem , Duman Nuray , Ozkan Hasan
Published: September 2007

Objective:  To investigate whether mothers, with no known biological reason to account for elevated breast milk sodium (BMS) and associated hypernatremic dehydration (HND) in their exclusively breastfed infants, have more adverse psychosocial characteristics compared with controls.

Methods:  Design is prospective case–control. Mothers of 21 term infants diagnosed as HND with associated high BMS and mothers of 43 healthy, exclusively breastfed term infants, with expected milk sodium levels, were compared on rates of socio‐demographic and relationship variables, pregnancy wantedness and planning, maternal attitudes towards breastfeeding, postnatal maternal depression and anxiety. A semi‐structured interview, State and Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale were used.

Results:  Reported maternal history of previous psychiatric morbidity (57.1% vs. 18.6%; P = 0.003), poor relationship with her own mother (36.8% vs. 9.6%; P = 0.026), not finding herself suitable to be a mother (28.6% vs. 4.6%; P = 0.012), unplanned pregnancy (52.4% vs. 20.9%; P = 0.020) and higher state anxiety scores (mean (SD) = 42.2 (11.1) vs. 35.5 (10.5); P = 0.038) in the post‐partum period were significantly common in mothers with elevated BMS levels compared with the controls. Univariate analyses revealed that unplanned pregnancy and maternal perception of not being suitable to be mother constitute significant risks with odds ratios 4.2 and 8.2, respectively.

Conclusion:  The present study displays that mothers, with no known biological reason to account for elevated BMS, have more adverse psychosocial characteristics compared with controls; emphasising the importance of psychosocial and emotional factors during lactation and offering implications for the establishment of successful lactation through providing additional psychosocial support to vulnerable mothers.
Bronchiolitis obliterans in children: Clinical presentation, therapy and long‐term follow‐up
Authors: Chiu Chih‐Yung , Wong Kin‐Sun , Huang Yhu‐Chering , Lin Tzou‐Yien
Published: September 2007

Aim:  To delineate the predisposing factors, clinical, radiological features and outcomes of bronchiolitis obliterans (BO) in children for minimising morbidity and mortality.

Methods:  Ten children who had BO from July 1995 to July 2005 were retrospectively reviewed at a tertiary paediatric facility in northern Taiwan.

Results:  Bronchiolitis obliterans complicated by infections, Stevens–Johnson syndrome was found in eight and two patients, respectively. In children with post‐infectious BO, adenoviruses were the most common etiologic agents (7/8). Among them, six patients needed intensive management and five patients needed mechanical ventilation. All patients presented persistent dyspneic respirations and wheezing since the initial lung infection. Initial focal atelectasis (n = 3) on chest radiographs progressed to atelectasis/lobar collapse (n = 8) when the diagnosis of BO was made. After adequate supportive management, atelectatic bronchiectasis was the most common complication (n = 5).

Conclusion:  Severe adenovirus bronchiolitis and/or pneumonia appear to have higher risk of development of BO in children. In order to minimise associated complications of BO, meticulous respiratory care for preventing pulmonary collapse may be considered in such instances.
Lipoprotein(a) levels in girls with premature adrenarche
Authors: Andiran Nesibe , Yordam Nursen
Published: September 2007

Aim:  Elevated lipoprotein(a) (Lp(a)) level is a risk factor for cardiovasculary disease (CVD). Women with polycystic ovary syndrome (PCOS) have higher Lp(a) and risk for CVD than controls. The girls with premature adrenarche (PA) were shown to share similar hormonal/metabolic properties with PCOS. We compared Lp(a) levels in PA, with healthy and PCOS girls.

Methods:  In total, 25 PA, 20 controls and 10 girls with PCOS were evaluated. Lp(a), lipid profiles and insulin, glucose, free testosterone, dehydroepiandrosterone sulfate (DHEAS) and androstenedione levels were measured. A family history about CVD was obtained.

Results:  The mean age of girls with PA, at time of the study, was 10.04 ± 1.53, control 9.83 ± 1.58 and PCOS was 16.58 ± 1.46 years. The median (range) of Lp(a) levels were 22.5 (3.50–99.90), 9.6 (3.33–32.40) and 21.2 (5.89–85.65) mg/dL in PA, control and PCOS groups, respectively (P > 0.05). The median Lp(a)’s were 14.5 (3.50–87.00) and 24.30 (6.20–99.90) mg/dL, in prepubertal (Tanner 1) and pubertal PA girls (Tanner 2–5), respectively (P > 0.05). The median Lp(a) of prepubertal peers was 8.7 (3.33–21.17), while that of pubertal ones was 15.4 (4.72–32.40) mg/dL (P > 0.05). There was no difference between Lp(a) levels of pre‐pubertal PA girls and their peers; however, significant difference was found in Lp(a) levels in pubertal stages of PA and healthy peers (P < 0.05). The positive family history of CVD was 60% in PA; 55% and 80% in the control and PCOS groups, respectively, with no statistical difference. Lp(a) level was correlated with DHEAS (r = 0.386, P = 0.008) and free testosterone (r = 0.337, P = 0.022) levels positively. There was no significant correlation between Lp(a) and body mass index, fasting insulin and fasting glucose/insulin ratio.

Conclusions:  Lipoprotein(a) levels in pubertal girls with PA differ significantly from healthy peers. However, to clarify whether the girls with PA have an additional risk for CVD with respect to Lp(a), further follow‐up studies with larger number of patients are necessary.
Effect of single loading dose of intravenous caffeine infusion on superior mesenteric artery blood flow velocities in preterm infants
Authors: Soraisham Amuchou S , Elliott Davis , Amin Harish
Published: September 2007

Aim:  To evaluate the effects of a single loading dose of caffeine base (10 mg/kg) on superior mesenteric artery (SMA) blood flow velocities (BFV).

Methods:  Eighteen preterm infants of gestational age ≤32 weeks gestation were investigated prospectively. SMA BFV before infusion, 1 h, 2 h and 6 h after a single loading dose of caffeine were measured using Doppler ultrasonography.

Results:  The peak systolic velocity in SMA decreased by 18% from baseline at 1 h after caffeine infusion and improved towards the baseline by 6 h after the infusion. The reduction in velocity after caffeine infusion was not statistically significant. No significant changes were observed in heart rate, blood pressure and incidence of necrotising enterocolitis.

Conclusion:  A single 10 mg/kg intravenous loading dose of caffeine does not cause a significant reduction in SMA BFV and therefore does not place the preterm intestine at increased risk of ischemic injury.
Increased prevalence of constipation in pre‐school children is attributable to under‐consumption of plant foods: A community‐based study
Authors: Lee Warren TK , Ip Kin S , Chan June SH , Lui Noel WM , Young Betty WY
Published: September 2007

Aim:  To evaluate consumption of foods rich in dietary fibre and its relation to the prevalence of constipation in pre‐school children.

Methods:  In total, 368 children aged 3–5 years were randomly selected from kindergartens in Hong Kong. Constipation was confirmed by Rome‐criteria. Children with normal bowel habits served as non‐constipated controls. Consumption of vegetables, fruits, whole‐grain cereals and fluid were determined using a 3‐day food record.

Results:  A total of 28.8% children were reported to have constipation. Median dietary fibre intake of constipated children was significantly lower than non‐constipated children (3.4 g/d (inter‐quartile range (IQR): 2.3–4.6 g/d) vs. 3.8 g/d (IQR: 2.7–4.9 g/d); P = 0.044) corresponding to 40% reference dietary fibre intake. Constipated children also had significantly lower intakes of vitamin C (P = 0.041), folate (P = 0.043) and magnesium (P = 0.002). Fruit intake and total plant foods intake were significantly lower in the constipated than non‐constipated children: (61 g/d (IQR: 23.8–115 g/d) vs. 78 g/d (IQR: 41.7–144.6 g/d); P = 0.047) and (142.5 g/d (IQR: 73.7–214.7 g/d) vs. 161.1 g/d (IQR: 98.3–233.3 g/d); P = 0.034), respectively. Total fluid intake did not differ between groups but milk intake among the constipated children was marginally higher than the non‐constipated children (P = 0.055)

Conclusion:  Insufficient dietary fibre intake is common in Hong Kong pre‐school children. Constipated children had significantly lower intakes of dietary fibre and micronutrients including vitamin C, folate and magnesium than non‐constipated counterparts which was attributable to under‐consumption of plant foods. However, milk intake was marginally higher in the constipated children. More public education is necessary for parents to help develop healthy dietary habit and bowel habit in early life in order to prevent childhood constipation.
High volume‐low intensity exercise camp and glycemic control in diabetic children
Authors: Ruzic Lana , Sporis Goran , Matkovic Branka R
Published: September 2007

Aim:  To evaluate the effects of the designed regime encompassing high volume‐low intensity physical activity programme on glycemic control in diabetic children, 20 subjects (age 12.81 ± 2.14) spent 2 weeks in a controlled environment of a summer camp.

Methods:  An exercise physiologist and a kinesiology specialist programme and conducted the three exercise sessions a day. Total daily caloric intake was controlled and the blood glucose was monitored four times a day with special concern for hypoglycaemia episodes. Short and long‐term effects (HbA1c) of the summer camp were evaluated 10 days and 2 months following programme completion. The insulin dosage was not lowered at the beginning of the camp for everyone, but it was individually modified according to the blood glucose monitoring.

Results:  Initial HbA1c was 8.28 ± 1.3% and decreased to 7.92 ± 1.42% measured 10 days after the camp (P = 0.023) while the number of children with the satisfactory HbA1c level lower than 7.5% doubled. HbA1c increased again 2 months following the camp. The average blood glucose concentrations decreased in the last days of the camp when compared with the first day in three out of four daily measurements (P < 0.05). There were only two clinically manifested hypoglycaemia episodes recorded.

Conclusion:  With a low rate of hypoglycaemia crisis and better glycemic control the proposed programme was found to be satisfactory but the downside was that the duration of the effects was too short. With no participation in organised exercise programmes and with absence of controlled nutrition, the beneficial effects of the camp disappeared within 2 months after the camp.
Fulminant mitral regurgitation due to ruptured chordae tendinae in acute rheumatic fever
Authors: Anderson Yvonne , Wilson Nigel , Nicholson Ross , Finucane Kirsten
Published: September 2007

Aims:  Description of the presentation and management of cases of fulminant mitral regurgitation in acute rheumatic fever (ARF).

Methods:  Retrospective case series of 4 children, aged 6–10 years, presenting in acute pulmonary oedema because of rupture of elongation of the chordae tendinae of the mitral valve leading to flail leaflets and severe mitral regurgitation.

Results:  Urgent cardiac surgery with mitral valve repair was performed. Resolution of heart failure was achieved in each case. The difficulties in diagnosis and management of this uncommon and often unrecognised presentation of ARF are discussed.

Conclusions:  Cardiac surgery can be life saving for fulminant mitral regurgitation due to rupture of chordae tendinae of the mitral valve in ARF
High perinatal seroprevalence of cytomegalovirus in northern Taiwan
Authors: Chen Mei‐Huei , Chen Pau‐Chung , Jeng Suh‐Fang , Hsieh Chia‐Jung , Su Feng‐Chiao , Liao Hua‐Fang , Su Yi‐Ning , Lin Shio‐Jean , Hsieh Wu‐Shiun
Published: September 2007

Aim:  The living style, health‐care system and socio‐economic environments have changed substantially in Taiwan over past 20 years. This study was aimed to estimate the current perinatal cytomegalovirus (CMV) seroprevalence in northern Taiwan.

Methods:  In a Taiwan Birth Panel Study, 483 pairs of mothers and neonates were prospectively recruited from one tertiary medical center, one local hospital, and two obstetric clinics located in northern Taiwan from April 2004 through January 2005. Sera of their paired maternal and cord blood were tested by an enzyme‐linked immunosorbent assay method for CMV IgG and IgM antibodies. Additional data were collected for health measures and epidemiological characteristics through trained interviewers utilising structured questionnaires.

Results:  Among 483 mothers studied, 93% were Taiwanese, 6.4% were immigrants from the south‐eastern Asia and Mainland China, and 0.6% was aborigines. The seropositive rate of CMV IgG and IgM among the mothers was 91.1% and 3.5%, respectively. The immigrant mothers and the mothers younger than 20 years of age had a higher IgM seroprevalence (P < 0.05). Furthermore, 90.8% of the offspring had CMV IgG seropositivity and yet none of the neonates were CMV IgM positive.

Conclusion:  The seroprevalence of CMV among childbearing women is high in northern Taiwan. The immigrant mothers and the teenage mothers appear to have higher seropositivity of CMV IgM.
Curing dyslexia and attention‐deficit hyperactivity disorder by training motor co‐ordination: Miracle or myth?
Authors: Bishop Dorothy VM
Published: September 2007

Abstract:  Dore Achievement Centres are springing up world‐wide with a mission to cure cerebellar developmental delay, thought to be the cause of dyslexia, attention‐deficit hyperactivity disorder, dyspraxia and Asperger’s syndrome. Remarkable success is claimed for an exercise‐based treatment that is designed to accelerate cerebellar development. Unfortunately, the published studies are seriously flawed. On measures where control data are available, there is no credible evidence of significant gains in literacy associated with this intervention. There are no published studies on efficacy with the clinical groups for whom the programme is advocated. It is important that family practitioners and paediatricians are aware that the claims made for this expensive treatment are misleading.
Complete robotic‐assistance during laparoscopic living donor nephrectomies: An evaluation of 38 procedures at a single site
Authors: Hubert Jacques , Renoult Edith , Mourey Eric , Frimat Luc , Cormier Luc , Kessler Michèle
Published: September 2007

Objective:  To evaluate our initial experience with entirely robot‐assisted laparoscopic live donor (RALD) nephrectomies.

Methods:  From January 2002 to April 2006, we carried out 38 RALD nephrectomies at our institution, using four ports (three for the robotic arms and one for the assistant). The collateral veins were ligated, and the renal arteries and veins clipped, after completion of ureteral and renal dissection. The kidney was removed via a suprapubic Pfannenstiel incision. A complementary running suture was carried out on the arterial stump to secure the hemostasis.

Results:  Mean donor age was 43 years. All nephrectomies were carried out entirely laparoscopically, without complications and with minimal blood loss. Mean surgery time was 181 min. Average warm ischemia and cold ischemia times were 5.84 min and 180 min, respectively. Average donor hospital stay was 5.5 days. None of the transplant recipients had delayed graft function.

Conclusions:  Robot‐assisted laparoscopic live donor nephrectomy can be safely carried out. Robotics enhances the laparoscopist's skills, enables the surgeon to dissect meticulously and to prevent problematic bleeding more easily. Donor morbidity and hospitalization are reduced by the laparoscopic approach and the use of robotics allows the surgeon to work under better ergonomic conditions.
Body mass index influences prostate‐specific antigen in men younger than 60 years of age
Authors: Kim Yong‐June , Han Byung Kuy , Hong Sung Kyu , Byun Seok‐Soo , Kim Wun‐Jae , Lee Sang Eun
Published: September 2007

Objectives:  Prostate‐specific antigen (PSA) levels can be affected by many factors. Body mass index (BMI) is suspected to influence PSA levels, but the associations are controversial. The aim of this study was to examine whether PSA levels were affected by BMI and age in Koreans.

Methods:  We evaluated the association between BMI and PSA in a group of 8640 Korean men (aged 40–79 years) without prostate cancer who received a general health checkup. Eligible men were classified into age groups spanning 10 years. BMI was categorized as normal (BMI <22.9), overweight (BMI 23.0–24.9), obese (BMI 25.0–29.9), and very obese (BMI ≥30) according to the re‐defined World Health Organization (WHO) criterion for the Asia Pacific Region. PSA levels were stratified by age and BMI category.

Results:  Prostate‐specific antigen levels decreased with increasing BMI (P trend <0.001). However, the inverse correlations between PSA and BMI were significant only among men 40–59 years old (P trend <0.05, respectively). BMI showed no significant associations with PSA in 60–79 years old (P trend >0.05, respectively).

Conclusions:  Our study demonstrates that increased BMI is associated with decreased PSA levels only in men younger than 60 years of age. When determining whether to carry out prostate biopsy as part of early prostate cancer detection, obesity should be considered as a factor associated with reduced PSA in healthy young men (<60 years old) with marginal PSA levels.
Diagnostic performance of three‐dimensional ultrasound extended imaging at scrotal mass lesions
Authors: Elwagdy Salah , Razmy Samy , Ghoneim Sayed , Elhakim Samy
Published: September 2007

Objectives:  High resolution two‐dimensional ultrasound (2D US) difficulty in evaluation of some scrotal mass lesions is not frequent. The aim of the present study was to prospectively evaluate the diagnostic performance of three‐dimensional ultrasound extended imaging (3D XI) in characterization of those lesions.

Methods:  The study protocol had the approval of the University's review board all participants' informed consents were obtained. The study included 28 selected patients (12 testicular and 16 para‐testicular mass lesions) examined by 2D US and 3D XI applications including computed multi‐slice view (MSV) and multi‐resolution enhanced images (XI MR). Results were correlated with histopathological findings.

Results:  Two‐dimensional ultrasound did not adequately characterize 28 patients out of 329 (8.5%). 3D XI interrogation was an easy procedure and distinctive of the pathological findings in 27 patients out of 28 (96.4%). The performance of XI MR with respect to characterization provided additional diagnostic information over MSV.

Conclusions:  The performance of 3D XI with respect to testicular mass characterization proved better than static 2D US. Subsequently, the results of this study suggest that the routine use of 2D US in diagnosis of scrotal mass lesions should preferably be upgraded to 3D XI methods.
Bladder sparing approach for initial T1G3 bladder cancer: Do multifocality, size of tumor or concomitant carcinoma in situ matter? A long‐term analysis of 132 patients
Authors: Denzinger Stefan , Otto Wolfgang , Fritsche Hans‐Martin , Roessler Wolfgang , Wieland Wolf F. , Hartmann Arndt , Burger Maximilian
Published: September 2007

Objectives:  In T1 bladder cancer (BC) multifocality, size of tumor (≥3 cm) and concomitant carcinoma in situ (CIS) are used to stratify patients' risk. We compared the long‐term results in patients with initial T1G3 bc treated with transurethral resection of the bladder (TURB), bacille Calmette‐Guérin (BCG) instillations and repeat resection with special regard to these clinical risk factors. The aim was to determine if they influence the outcome in the bladder sparing approach for initial T1G3 bc.

Methods:  One hundred and thirty‐two consecutive patients with initial T1G3 and no prior history of BC were identified. All patients completed six weekly adjuvant BCG instillations followed by control TURB. Follow‐up consisted of cystoscopy with bladder wash cytology every 3 months for 2 years and every 6 months thereafter.

Results:  Forty‐two percent of patients had residual disease, 65% developed recurrence of any stage and 41% had progression to muscle‐invasive disease. Cancer‐specific survival was 89% and 78% at 5 and 10 years, respectively. Only CIS was significantly correlated with all end points on multivariate analysis. While the presence of one or two risk factors was not related to recurrence, progression or cancer‐related death, the presence of all three risk factors predicted the latter.

Conclusions:  While no guideline has been established for the decision between cystectomy and bladder sparing, concomitant CIS and the presence of all three risk factors together seem to predict an adverse oncological outcome in the bladder sparing approach.
LAPAROSCOPIC COMPOSITE‐MESH REPAIR OF AN ADULT MORGAGNI HERNIA
Authors: Matsui Hideo , Itano Osamu , Igarashi Naoki , Koyama Yasumasa , Miyakita Makoto
Published: September 2007

Congenital Morgagni hernia is a rare clinical condition. We present a 72‐year‐old man with epigastric discomfort and hematemesis who was diagnosed with hernia of Morgagni with an incarceration of the stomach and colon. The patient was treated electively by laparoscopic composite‐mesh repair without excising the hernial sac or approximating the edges of the defect, which was 10 × 6 cm in diameter. He was discharged on the seventh postoperative day without any complications. At a 1‐year follow‐up examination he had no recurrence nor clinical symptoms, although the large hernial sac contained fluid. Laparoscopic composite‐mesh repair is a less‐invasive and tension‐free method for Morgagni hernia that results in an excellent clinical outcome.
PYOGENIC GRANULOMA IN THE ILEUM
Authors: Tanaka Aki , Kamada Tomoari , Hirakawa Katsuya , Koga Hideki , Fujimura Yoshinori , Iida Mitsuo , Tsunoda Tsukasa , Sadahira Yoshito , Haruma Ken
Published: September 2007

Pyogenic granuloma, a polypoid form of capillary hemangioma, commonly occurs on the skin and mucosal surfaces but only rarely in portions of the gastrointestinal (GI) tract other than the oral cavity. We report the case of a 75‐year‐old woman who suffered from recurring fatigue and had anemia. Double‐contrast radiography revealed a sessile tumor of the ileum, and endoscopy during surgery revealed a polypoid lesion in the ileum, 150 cm from Bauhin's valve. The histological features were consistent with those of pyogenic granuloma.
MULTIPLE INFLAMMATORY MYOGLANDULAR POLYPS OF THE COLON
Authors: Yamane Tateki , Uchiyama Kan , Hata Daigo , Nakamura Makoto , Ishii Takayuki , Koido Shigeo , Omura Mitsuhiro , Fujise Kiyotaka , Tajiri Hisao
Published: September 2007

The patient was a 35‐year‐old man who was observed after bone marrow transplantation for acute lymphocytic leukemia. Polyps were found by colonoscopy performed after a positive fecal occult blood test, and the patient was admitted for polypectomy. There were three polyps, which were all reddened and pedunculated and were, respectively, located in the transverse, descending, and sigmoid colons. Polypectomy was performed, and all lesions were histopathologically diagnosed to be inflammatory myoglandular polyps. Inflammatory myoglandular polyps have been reported to occur solitarily only, and this is the first report of multiple occurrence.
GASTRIC CANCER DETECTED AFTER HELICOBACTER PYLORI ERADICATION
Authors: Tashiro Jun , Miwa Jun , Tomita Takashige , Matsubara Yasuo , Oota Yasuhiko
Published: September 2007

Background:  Helicobacter pylori is associated with progression to gastric cancer. However, it is still unclear whether eradication therapy can prevent the development of gastric cancer.

Methods:  Subjects were 242 patients in whom success in eradication of Helicobacter pylori had been continuous for more than 3 years. Clinical, endoscopic and histological findings were compared retrospectively between those who developed gastric cancer (cancer group) and those who did not (non‐cancer group). Clinical features of each cancer case were also evaluated.

Results:  Gastric cancer was found in six of the 242 subjects (2.5%) during a mean follow‐up period of 4.6 years (range: 3.0–7.0). The mean age of the cancer group tended to be higher than that of the non‐cancer group. Endoscopy revealed a more severe grade of gastric corpus atrophy in the cancer group, and histological findings showed that the degree of intestinal metaplasia in the upper corpus was higher in the cancer group. Four of the six cancers were located in the gastric antrum. All were early cancers and five were of 0‐IIc type endoscopically. All were intestinal type histologically.

Conclusions:  Gastric cancer was discovered at a rate of 2.5% during the mean follow‐up period of 4.6 years after H. pylori eradication. Careful endoscopic follow up is necessary even after successful eradication, especially in cases characterized by an endoscopically high grade of gastric atrophy and pathologically severe intestinal metaplasia at the upper corpus.
NODULAR GASTRITIS WITH HELICOBACTER PYLORI INFECTION IS STRONGLY ASSOCIATED WITH DIFFUSE‐TYPE GASTRIC CANCER IN YOUNG PATIENTS
Authors: Kamada Tomoari , Tanaka Aki , Yamanaka Yoshiyuki , Manabe Noriaki , Kusunoki Hiroaki , Miyamoto Masaki , Tanaka Shinji , Hata Jiro , Chayama Kazuaki , Haruma Ken
Published: September 2007

Background:  Nodular gastritis (NG), a particular type of gastritis, is now defined as antral nodularity. Recent studies have shown that NG is strongly associated with Helicobacter pylori infection, and we recently showed that it may be associated with diffuse‐type gastric cancer of the corpus. We retrospectively investigated the relation between NG and gastric cancer in patients aged 29 years or less.

Patients and Methods:  The study group comprised 150 patients (48 males, 102 females; mean age, 27.7 years) who were endoscopically diagnosed with NG and were less than 29 years of age; 3939 sex‐ and age‐matched patients without NG who were H. pylori‐positive served as the control group (1184 males, 2755 females; mean age, 27.5 years). We estimated the risk of gastric cancer development in patients with NG relative to that of patients without NG.

Results:  The prevalence of gastric cancer was significantly higher in patients with NG than in the control patients (7/150; 4.7% vs 3/3939; 0.08%, P < 0.001). The odds ratio for the risk of gastric cancer in patients with NG was found to be 64.2 (95% confidence interval; 16.4–250.9). The seven cases of gastric cancer with NG showed the same characteristics: all were diagnosed histologically as the diffuse type and were located in the corpus with H. pylori infection.

Conclusion:  NG with H. pylori infection is strongly associated with diffuse‐type gastric cancer of the corpus in young patients.
MANAGEMENT OF ANTIPLATELET THERAPY FOR ENDOSCOPIC PROCEDURES: OPTIMAL CESSATION PERIOD OF ANTIPLATELET THERAPY FOR JAPANESE
Authors: Tamai Yoshiko , Komatsu‐Ishizawa Tomoko , Takami Hideki , Nakajima Hitoshi , Fukuda Shinsaku , Munakata Akihiro
Published: September 2007

Although antiplatelet agents are widely used for the treatment and prevention of thrombotic diseases, only a few studies have reported the validity of the cessation period prior to endoscopic procedures. In 2002, the American Society for Gastrointestinal Endoscopy (ASGE) published a reference on the management of anticoagulation and antiplatelet therapy for endoscopic procedures, but it should be confirmed as appropriate for use in Asian patients. To evaluate the optimal cessation period of antiplatelet agents prior to endoscopic procedures for Japanese, we have studied: (i) the current clinically adopted cessation period of antiplatelet agents prior to invasive endoscopic procedures in Japan; (ii) the relationship between the cessation period of antiplatelet agents and complications around the invasive endoscopic procedures; (iii) colonic mucosal bleeding time after aspirin ingestion; and (iv) the time course of primary hemostasis after cessation of antiplatelet agents. We conclude that 3 days cessation period for aspirin, 5 days cessation for ticlopidine and 7 days cessation for aspirin + ticlopidine administration should be sufficient for Japanese.
EVALUATION OF THE RISK FACTORS OF LYMPH NODE METASTASIS IN PT1 STAGE COLORECTAL CARCINOMA: INDICATION FOR AN ENDOSCOPIC MUCOSAL RESECTION
Authors: Nakajo Kazuo , Tamura Satoru , Hiroi Makoto , Onishi Saburo , Yasuda Nobufumi
Published: September 2007

Aim:  In the present study, we aimed to clarify the parameters that can be used for clinically relevant treatment decisions.

Patients and methods:  During the period from July 1985 to April 2005, 283 pT1 cancers were selected for this study. Risk factors for lymph node (LN) metastasis were evaluated as follows: endoscopic appearance, tumor size, location, lymphatic permeation, venous invasion, patterns of cancer invasion into the submucosal layer, and depth of vertical invasion in the submucosal layer.

Results:  Results of the logistic regression analysis from these significant parameters were as follows: infiltrating growth pattern (odds ratio: 12.63); lymphatic permeation positive (odds ratio: 5.726); sigmoid colon (odds ratio: 4.585); tumor size (odds ratio: 1.718). However, the leading edge of only one cancer with LN metastasis in the expanding growth group was also cribriform pattern.

Conclusion:  The invasive growth patterns of infiltrating growth, lymphatic permeation, tumor location of the sigmoid colon, and maximum tumor size were independent and significant risk factors for LN metastasis in our logistic regression analysis. In particular, the former three factors (infiltrating growth, lymphatic permeation and sigmoid colon) revealed high odds ratio and covered all cases of LN metastasis. From the results of our study, the indication for operative intervention after EMR in pT1 cancer is those lesions which possess at least one factor among the three (infiltrating growth, lymphatic permeation and sigmoid colon). Also, assessment of the leading edge with a cribriform pattern should be dealt with carefully.
TEACHING DEEP CANNULATION OF THE BILE DUCT DURING ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY
Authors: Tamada Kiichi , Wada Shinichi , Nakazawa Katsuyuki , Hatanaka Hisashi , Tomiyama Takeshi , Ohashi Akira , Sugano Kentaro , Ido Kenichi
Published: September 2007

When performing endoscopic retrograde cholangiopancreatography (ERCP), the smooth introduction of the duodenoscope into the papilla of Vater, an appropriate view of the papilla of Vater, and deep cannulation of the bile duct are essential. The operator must know the difference between the side‐viewing endoscope and the forward‐viewing endoscope. The rotation of the body and the left arm of the operator, switching with the left wrist, and dialing of the endoscope are essential for appropriately viewing the papilla of Vater. When training operators to do ERCP, a model is useful for helping them understand basic handling. The approach to deep cannulation of the bile duct should be selected based on the type of papilla (slit type, onion type, tongue protrusion type, flat type, and tumor type). Cannulation is more difficult in patients with the tongue protrusion‐type of papilla than with a slit type, onion type, or tumor type. According to previous reports, therapeutic ERCP requires the ability to cannulate the common bile duct deeply 80% of the time; 180 to 200 supervised ERCP are necessary to achieve this success rate.
EN BLOC REMOVAL OF A GASTRIC CARCINOID TUMOR USING ENDOSCOPIC SUBMUCOSAL DISSECTION TECHNIQUES
Authors: Itaba Soichi , Sumida Yorinobu , Nakamura Kazuhiko , Murao Hiroyuki , Goto Ayako , Kumashiro Yumiko , Yao Takashi , Takayanagi Ryoichi
Published: September 2007

Endoscopic submucosal dissection (ESD) has recently been applied to the resection of gastric submucosal tumors other than carcinoid tumors. We describe a case of gastric carcinoid tumor enucleated with ESD. An 82‐year‐old woman was referred for treatment of a gastric tumor. Upper gastrointestinal endoscopy revealed a solitary submucosal tumor in the greater curvature of the gastric body. We diagnosed a carcinoid tumor by histological examination of biopsy specimens. Endoscopic ultrasound revealed a hypoechoic mass in the submucosal layer. Neither lymph node nor liver metastasis was recognized. The serum gastrin level was normal, and this tumor was classified as a type III (sporadic) carcinoid tumor. Endoscopic resection was decided on considering her age, general status, and wishes. We used ESD techniques, because the tumor was too large to be resected by conventional endoscopic mucosal resection. En bloc resection was performed. Histological examination of the 13 × 19 × 11 mm resected specimen showed that the cut end was free of tumor cells. Type III carcinoid tumor is usually treated by surgical resection with lymph node dissection. However, in high‐risk elderly patients we consider ESD to be a therapeutic option for local control of gastric carcinoid tumors.
Weibull analysis, extrapolations and implications for condition assessment of cast iron water mains
Authors: BELMONTE H. M. S. , MULHERON M. , SMITH P. A.
Published: September 2007

The applicability of Weibull statistics to the condition assessment of cast iron water distribution pipes has been considered. The effect of Weibull modulus, characteristic strength, sample size and mode of loading (tension or flexure) on the strength of cast iron water distribution pipes is investigated. The strength distribution of cast iron samples cut from sections of five different water distribution pipes recovered from the ground have been characterized. Strengths have been measured in flexure, at two different temperatures (ambient and 0 °C), and in tension at ambient temperature using two different sample sizes. It is shown that characteristic strength values in flexure decrease with increasing size of graphite flake and that there is no significant difference between the results at the two temperatures investigated. For samples of the same volume tested in tension and flexure, the reduced strength measured in tension is consistent with Weibull predictions. However, the strength of large samples tested in tension was not significantly different from the small samples, perhaps because the samples were of the same thickness and conventional Weibull scaling is not applicable. Finally, using a method which treats a large pipe as an assembly of small samples, the strength distributions from the small samples tested in tension are used to make a prediction of the strengths of 1 m span sections of pipe loaded in three‐point bending, which were reported in previous work. The predicted pipe strengths are close to the lower end of the measured pipe strength distribution. Overall, this work suggests that Weibull analysis is a useful tool to examine the strength distribution of removed from cast iron water pipes and so has the potential to contribute in the assessment of asset condition.
Phylogenetic concordance analysis shows an emerging pathogen is novel and endemic
Authors: Storfer Andrew , Alfaro Michael E. , Ridenhour Benjamin J. , Jancovich James K. , Mech Stephen G. , Parris Matthew J. , Collins James P.
Published: September 2007

Distinguishing whether pathogens are novel or endemic is critical for controlling emerging infectious diseases, an increasing threat to wildlife and human health. To test the endemic vs. novel pathogen hypothesis, we present a unique analysis of intraspecific host‐pathogen phylogenetic concordance of tiger salamanders and an emergingRanavirusthroughout Western North America. There is significant non‐concordance of host and virus gene trees, suggesting pathogen novelty. However, non‐concordance has likely resulted from virus introductions by human movement of infected salamanders. When human‐associated viral introductions are excluded, host and virus gene trees are identical, strongly supporting coevolution and endemism. A laboratory experiment showed an introduced virus strain is significantly more virulent than endemic strains, likely due to artificial selection for high virulence. Thus, our analysis of intraspecific phylogenetic concordance revealed that human introduction of viruses is the mechanism underlying tree non‐concordance and possibly disease emergence via artificial selection.
Sanio’s laws revisited. Size‐dependent changes in the xylem architecture of trees
Authors: Mencuccini Maurizio , Hölttä Teemu , Petit Giai , Magnani Federico
Published: September 2007

Early observations led Sanio [Wissen. Bot.,8, (1872) 401] to state that xylem conduit diameters and lengths in a coniferous tree increase from the apex down to a height below which they begin to decrease towards the tree base. Sanio’s law of vertical tapering has been repeatedly tested with contradictory results and the debate over the scaling of conduit diameters with distance from the apex has not been settled. The debate has recently acquired new vigour, as an accurate knowledge of the vertical changes in wood anatomy has been shown to be crucial to scaling metabolic properties to plant and ecosystem levels. Contrary to Sanio’s hypothesis, a well known model (MST, metabolic scaling theory) assumes that xylem conduits monotonically increase in diameter with distance from the apex following a power law. This has been proposed to explain the three‐fourth power scaling between size and metabolism seen across plants. Here, we (i) summarized available data on conduit tapering in trees and (ii) propose a new numerical model that could explain the observed patterns. Data from 101 datasets grouped into 48 independent profiles supported the notions that phylogenetic group (angiosperms versus gymnosperms) and tree size strongly affected the vertical tapering of conduit diameter. For both angiosperms and gymnosperms, within‐tree tapering also varied with distance from the apex. The model (based on the concept that optimal conduit tapering occurs when the difference between photosynthetic gains and wall construction costs is maximal) successfully predicted all three major empirical patterns. Our results are consistent with Sanio’s law only for large trees and reject the MST assumptions that vertical tapering in conduit diameter is universal and independent of rank number.
Grinnellian and Eltonian niches and geographic distributions of species
Authors: Soberón Jorge
Published: September 2007

In the recent past, availability of large data sets of species presences has increased by orders of magnitude. This, together with developments in geographical information systems and statistical methods, has enabled scientists to calculate, for thousands of species, the environmental conditions of their distributional areas. The profiles thus obtained are obviously related to niche concepts in the Grinnell tradition, and separated from those in Elton’s tradition. I argue that it is useful to define Grinnellian and Eltonian niches on the basis of the types of variables used to calculate them, the natural spatial scale at which they can be measured, and the dispersal of the individuals over the environment. I use set theory notation and analogies derived from population ecology theory to obtain formal definitions of areas of distribution and several types of niches. This brings clarity to several practical and fundamental questions in macroecology and biogeography.
Variation in gene content among geographically diverse Sulfolobus isolates
Authors: Grogan Dennis W. , Ozarzak Melissa A. , Bernander Rolf
Published: September 2007

The ability of competitive (i.e., comparative) genomic hybridization (CGH) to assess similarity across entire microbial genomes suggests that it should reveal diversification within and between natural populations of free‐living prokaryotes. We used CGH to measure relatedness of genomes drawn from Sulfolobus populations that had been shown in a previous study to be diversified along geographical lines. Eight isolates representing a wide range of spatial separation were compared with respect to gene‐specific tags based on a closely related reference strain (Sulfolobus solfataricus P2). For the purpose of assessing genetic divergence, 232 loci identified as polymorphic were assigned one of two alleles based on the corresponding fluorescence intensities from the arrays. Clustering of these binary genotypes was stable with respect to changes in the threshold and similarity criteria, and most of the groupings were consistent with an isolation‐by‐distance model of diversification. These results indicate that increasing spatial separation of geothermal sites correlates not only with minor sequence polymorphisms in conserved genes of Sulfolobus (demonstrated in the previous study), but also with the regions of difference (RDs) that occur between genomes of conspecifics. In view of the abundance of RDs in prokaryotic genomes and the relevance that some RDs may have for ecological adaptation, the results further suggest that CGH on microarrays may have advantages for investigating patterns of diversification in other free‐living archaea and bacteria.
Surgery for fistula‐in‐ano: an audit of practise of colorectal and general surgeons1
Authors: Nwaejike N. , Gilliland R.
Published: September 2007

Objective  Some conditions, previously managed by general surgeons, may be treated more successfully by colorectal specialists. This argument is well established for rectal cancer but does it also apply to benign conditions? This study compares the treatment strategies and outcomes for fistulae‐in‐ano by general and colorectal surgeons in a district general hospital.

Method  Patients who had surgery for fistula‐in‐ano from January 1992–October 2003 were identified from theatre records. Case notes were reviewed for data on type of fistula, aetiology, surgery performed and recurrence. All patients were sent a questionnaire requesting details of recurrence and incontinence. The severity of incontinence was assessed using the Faecal Incontinence Quality of Life Scale (FIQOLS) and the Faecal Incontinence Severity Index (FISI).

Results  Eighty four patients (male = 53) were identified. Colorectal surgeons performed surgery in 34 and general surgeons in 50 patients. These groups were comparable with terms of age, gender, aetiology (colorectal: IBD = 5, cryptoglandular = 21: general IBD = 14, cryptoglandular = 24; P = 0.28; Chi‐squared test), and type of fistulae (colorectal: inter‐sphincteric = 20, trans‐sphincteric = 13: general inter‐sphincteric = 30, trans‐sphincteric = 18: P = 1.0; Fisher's exact test). Colorectal surgeons carried out fewer fistulotomies (47.1%vs 84.0%; P < 0.001; Fisher's exact test), more staged fistulotomies with Setons (44.1%vs 10.0%: P < 0.001; Fisher's exact test), and had fewer recurrences (9.7%vs 30.0%: P < 0.05; Fisher's exact test) when compared with general surgeons. Five patients with recurrence from the general surgery group were subsequently referred to the colorectal surgeons; four patients had further surgery (fistulotomy = 2; staged fistulotomy = 2) with no recurrence to date; one patient required proctectomy. Forty seven (64.4%) patients answered the questionnaire. There was no difference between patients operated on by colorectal or general surgeons with regards the frequency (43.5%vs 62.5%: P = 0.25; Fisher's exact test) or severity [FISI 26 (21–38); median (inter‐quartile range) vs 26 (17–38); median (inter‐quartile range: P = 0.85; Mann–Whitney test) of faecal incontinence. There was no difference between the groups with regards any of the four scales that comprised the FIQOLS.

Conclusions  The number of included patients is far too low to draw any conclusions but there were some interesting trends. For similar patient samples, colorectal surgeons seem to adopt a more conservative approach and have fewer recurrences than general surgeons. These differences are not reflected in the frequency or severity of postoperative incontinence.
Molecular phylogeny of the genus Alticola (Cricetidae, Rodentia) as inferred from the sequence of the cytochrome b gene
Authors: Lebedev Vladimir S. , Bannikova Anna A. , Tesakov Alexey S. , Abramson Natalia I.
Published: September 2007

Central Asian mountain voles Alticola is one of the least known groups of voles both in evolution and life history. This genus includes three subgenera Alticola s.str., Aschizomys and Platycranius, and belongs to the tribe Clethrionomyini comprising also red‐backed voles Clethrionomys and oriental voles Eothenomys. In order to elucidate the phylogenetic relationships within Alticola and to examine its position within the tribe, mitochondrial cytochrome b (cyt b) gene variation was estimated, and the results were compared with morphological and palaeontological data. Maximum likelihood (ML), neighbor‐joining (NJ), maximum parsimony (MP) and Bayesian phylogenetic analyses show that the genus Alticola does not appear to be a monophyletic group since the representatives of Aschizomys branch within Clethrionomys, whereas two other subgenera (Alticola and Platycranius) form a separate monophyletic clade. Flat‐headed vole Alticola (Platycranius) strelzowi is nested within the nominative subgenus showing close association with A. (Alticola) semicanus. Surprisingly, the two species of Aschizomys do not form a monophyletic group. The results of the relaxed‐clock analysis suggest that the Alticola clade splits from the Clethrionomys stem in early Middle Pliocene while basal cladogenetic events within Alticola s.str. dates back to the late Middle to early Late Pliocene. A scenario of evolution in Clethrionomyini is put forward implying rapid parallel morphological changes in different lineages leading to the formation of Alticola‐like biomorphs adapted to mountain and arid petrophilous habitats.

Corresponding author: Vladimir S. Lebedev, Zoological Museum, Moscow State University, B. Nikitskaya 6, 125009 Moscow, Russia. E‐mail: wslebedev@hotmail.com

Anna A. Bannikova, Lomonosov Moscow State University, Vorobievy Gory, 119992 Moscow, Russia. E‐mail: hylomys@mail.ru

Alexey S. Tesakov, Geological Institute RAS, Pyzhevsky 7, 119017 Moscow, Russia. E‐mail: tesak@ginras.ru

Natalia I. Abramson, Zoological Institute RAS, Universitetskaya nab. 1, 199034 St Petersburg, Russia. E‐mail: lemmus@zin.ru