bluuebunny/crossref_metadata_2025 huggingface dataset:
Acquired and inherited disorders of cobalamin and folate in children
Authors: Michael Whitehead V.
Published: May 2006

Cobalamin deficiency in the newborn usually results from cobalamin deficiency in the mother. Megaloblastic anaemia, pancytopenia and failure to thrive can be present, accompanied by neurological deficits if the diagnosis is delayed. Most cases of spina bifida and other neural tube defects result from maternal folate and/or cobalamin insufficiency in the periconceptual period. Polymorphisms in a number of genes involved in folate and cobalamin metabolism exacerbate the risk. Inborn errors of cobalamin metabolism affect its absorption, (intrinsic factor deficiency, Imerslund‐Gräsbeck syndrome) and transport (transcobalamin deficiency) as well as its intracellular metabolism affecting adenosylcobalamin synthesis (cblAandcblB), methionine synthase function (cblEandcblG) or both (cblC,cblDandcblF). Inborn errors of folate metabolism include congenital folate malabsorption, severe methylenetetrahydrofolate reductase deficiency and formiminotransferase deficiency. The identification of disease‐causing mutations in specific genes has improved our ability to diagnose many of these conditions, both before and after birth.
The surgeon's view of the anterior ethmoid artery
Authors: D. Simmen , U. Raghavan , H.R. Briner , M. Manestar , B. Schuknecht , P. Groscurth , N.S. Jones
Published: May 2006

Objectives:  To define the relationship of the anterior ethmoid artery to the frontal recess and secondly whether the degree of pneumatisation of the suprabullar recess/supraorbital cell correlates with the distance between the anterior ethmoid artery and the skull base thus making it more vulnerable to damage during surgery.

Method:  Thirty‐four cadaver head sides were perfused with pink latex. All specimens had high‐resolution computed tomography (CT) scans using bone windows in the axial, coronal and sagittal planes. The specimen's nasal septum was removed and the ethmoid sinuses dissected to locate the anterior ethmoid artery. Calipers were used to measure distance between the artery and the frontal recess and from the skull base.

Results:  The anterior ethmoid artery was found in all the specimens and scans. The distance between the anterior ethmoid artery and the posterior wall of the frontal recess was 11 mm (range 6–15 mm). In all specimens, the artery was seen between the second and third lamella. The commonest location of the artery was in the suprabullar recess (85.3%). Supraorbital cells were seen in 16 specimens. The ethmoid sinuses were well pneumatised with a large supraorbital cell in 10 of these specimens and in these the artery was lying 3.7 mm (range 1–8 mm) away from the skull base. Six specimens had poor pneumatisation and a small supraorbital cell and in these the artery was found close to or with in the skull base. In specimens without a supraorbital cell, the artery lay at the skull base in all but one.

Conclusions:  The position of the anterior ethmoidal artery is very variable. The artery is found between the second and third lamella. When the ethmoid sinuses are more pneumatised and in particular when there is a supraorbital cell, the artery lies below the skull base. A good strategy is to identify the degree of pneumatisation of the ethmoid sinuses from CT scans preoperatively to see if the artery is at an increased risk of being damaged.
What we call them: the nomenclature of head and neck paragangliomas
Authors: Martin T.P.C
Published: May 2006

Keypoints

• Historically, paragangliomas have been referred to by a number of different terms (‘glomus’ tumours of different sorts, ‘carotid body tumour’).

• WHO classification (2005) refers to these tumours as paragangliomas, with further anatomical detail (‘vagal paraganglioma’, ‘carotid body paraganglioma’).

• This system recognises the commonality between these tumours and aids understanding of their pathogenesis and clinical management.
Ultrasound guidance improves the adequacy of our preoperative thyroid cytology but not its accuracy
Authors: Mehrotra P. , Viswanathan H. , Johnson S. J. , Wadehra V. , Richardson D. L. , Lennard T. W. J.
Published: May 2006

Aims:  Our thyroid cytology audit results of 1990–1995 showed an unsatisfactory rate of 43.1% and prediction of neoplasia with a sensitivity of 86.8%. Increasingly, ultrasound scan (USS)‐guided core sampling for cytology is proving a valuable tool instead of freehand fine needle aspiration (FNA) or following unsatisfactory freehand FNA. We present the results of freehand FNA and USS‐guided core samples for cytology in two separate patient groups in our centre.

Methods:  Patients who had a thyroid resection and preoperative thyroid cytology in our institution between 1996 and 2002 were included. The histological diagnoses were correlated with the preceding cytology results.

Results:  A total of 450 FNAs were performed on 394 patients. Freehand FNAs were performed for 348 (77.3%) samples and USS‐guided core for 102 (22.7%) samples; 121 (26.8%) were repeat aspirates performed on 45 patients. Using aspiration cytology (AC) grading, freehand FNA was cytologically inadequate (AC0 or AC1) in 34.8% cases whereas USS‐guided core was inadequate in 17.6% cases (P = 0.001). Freehand FNA (AC3, AC4, AC5) predicted neoplasia with a sensitivity of 83.2%, specificity of 46.6%, accuracy of 63.0%, positive predictive value of 56.0% and negative predictive value of 77.1%. USS‐guided core sample for cytology (AC3, AC4, AC5) predicted neoplasia with a sensitivity of 93.5%, specificity of 26.0%, accuracy of 51.9%, positive predictive value of 43.9% and negative predictive value of 86.7%.

Conclusions:  Although USS‐guided core provides more satisfactory specimens than freehand FNA, in our centre it does not provide increased accuracy.
Review of cervical smears from 76 women with invasive cervical cancer: cytological findings and medicolegal implications
Authors: Coleman D. V. , Poznansky J. J. R.
Published: May 2006

Objective:  To review cervical smears from 76 women which were taken prior to the diagnosis of invasive cervical cancer and to determine the appropriateness of the cytology reports issued on the smears.

Methods:  Cervical smears, clinical records, cervical smear history and cytology reports from 76 women with invasive cervical cancer were reviewed. After microscopic review of the cervical smears, the cases were divided into two groups: Group 1 comprised 50 women who were found to have had at least one false‐negative (F/N) smear report prior to the diagnosis of invasive cervical cancer. Group 2 comprised 26 women for whom no evidence of F/N reporting was found.

Results:  A total of 209 cervical smears from the 50 women in group 1 were available for review (range 2–12 smears per woman); 100 of the 209 smears were considered to have been reported appropriately. Ninety‐seven smears which had been reported originally as negative or inadequate were found, on review, to contain numerous severely dyskaryotic cells and were reclassified as F/N smears. All of the 50 women had at least one F/N smear and 29 had two or more. Twelve smears from eight women contained only a few (<200 severely dyskaryotic cells). Forty women developed invasive squamous carcinoma and 10 developed invasive adenocarcinoma. The stage at diagnosis ranged from 1A to stage 4. Seventy‐one smears from the 24 women in group 2 were available for review (range 1–15 smears per woman). In two cases included in group 2, no smears were provided for review as the smears had been lost or mislaid. Review of the 71 smears confirmed the accuracy of the original cytological classification of the smear. Nineteen women were diagnosed with squamous cancer, two microinvasive cancer, one glassy cell, two adenocarcinomas, and one with adenosquamous carcinoma. One women was found to have an embryonal rhabdomyosarcoma of the corpus uteri involving the cervix.

Discussion/Conclusion: The medicolegal implications are discussed in the light of the above findings. Evidence of breach of duty of care was presented in all 50 cases in group I although causation was not established in every case. There was no evidence of failure of duty of care in terms of the standard of the cervical cytology reports issued or standard of clinical management in 17 of the 26 cases in group 2. However, in seven of the 26 cases in group 2, clinical management of the case was substandard due to failure to investigate symptoms of irregular bleeding regardless of a negative cytology report (two cases), failure to act upon a suspicious smear report or consecutive inadequate smear reports (two cases), failure of follow‐up after treatment of CIN3 (two cases) and histological misdiagnosis (one case).
Evaluation of 100% rapid rescreening of negative cervical smears as a quality assurance measure
Authors: Manrique E. J. C. , Amaral R. G. , Souza N. L. A. , Tavares S. B. N. , Albuquerque Z. B. P. , Zeferino L. C.
Published: May 2006

Objective:  The objective of this study was to compare the performance of 100% rapid rescreening, 10% random rescreening and the review of smears selected on the basis of clinical criteria, as a method of internal quality control of cervical smears classified as negative during routine screening.

Methods:  A total of 3149 smears were analysed, 173 of which were classified as positive and 2887 as negative, while 89 smears were considered unsatisfactory. The smears classified as negative were submitted to 100% rapid rescreening, 10% random rescreening, and rescreening based on clinical criteria. The rescreening stages were blinded and results were classified according to the Bethesda 2001 terminology. Six cytologists participated in this study, two of whom were responsible for routine screening while the other four alternated in carrying out rescreening so that no individual reviewed the same slide more than once.

Results:  The 100% rapid rescreening method identified 92 suspect smears, of which 42 were considered positive at final diagnosis. Of the 289 smears submitted to the 10% rescreening method, four were considered abnormal but only one was confirmed positive in the final diagnosis. Of the 690 smears rescreened on the basis of clinical criteria, 10 were considered abnormal and eight received a positive final diagnosis.

Conclusions:  The 100% rapid rescreening method is more efficient at detecting false‐negative results than 10% random rescreening or rescreening on the basis of clinical criteria, and is recommended as an internal quality control method.
Long‐term retention of coded wire tags in juvenile Arctic charr Salvelinus alpinus
Authors: KOLARI I. , HIRVONEN E.
Published: May 2006

Abstract  A hatchery experiment was organised to find out if the high loss rate of coded wire tags, noticed in connection with an Arctic charr Salvelinus alpinus (L.) restocking programme, was size‐dependent and also to test head moulds for future taggings. Six moulds made by Northwest Marine Technology Inc. and five moulds made at the Finnish Game and Fisheries Research Institute were used. A total of 100 charr were tagged with standard‐length coded wire tags using each mould. One‐summer old charr at tagging were held for 534 days and two‐summer old charr for 320 days. The tag loss rate varied between 0% and 54% and was negatively related to the size of the charr at tagging. The high loss rate was connected with the poor alignment of some moulds, such that a large proportion of the tags were located in the nasal cavity instead of the nasal cartilage. Testing of the moulds and careful grading of the fish for tagging is emphasised, especially if Arctic charr smaller than 20 g in weight are to be tagged.
Culture‐based fisheries in non‐perennial reservoirs of Sri Lanka: influence of reservoir morphometry and stocking density on yield
Authors: JAYASINGHE U. A. D. , AMARASINGHE U. S. , DE SILVA S. S.
Published: May 2006

Abstract  Culture‐based fish yield in non‐perennial reservoirs of Sri Lanka was related to reservoir morphometry and stocking density. The reservoirs were stocked mainly with fingerlings of one Chinese and three Indian major carp species, common carp, Cyprinus carpio L., and the genetically improved farmed tilapia strain of Nile tilapia, Oreochromis niloticus (L.), at four pre‐determined species combinations and a range of stocking densities [SD (fingerlings ha−1)]. Twenty‐three reservoirs were harvested successfully at the end of the culture period of 2002–2003. Basic limnological and morphometric parameters, including shoreline development (DL) and shoreline area ratio (RLA), were estimated for each of the 23 reservoirs. Bray–Curtis similarity and non‐metric multidimensional scaling using mean values of limnological data revealed that reservoirs could be ordinated into two major clusters, one with intact sample distribution due to similar trophic characteristics and the other with scattered sample distribution. Reservoirs in the cluster with similar trophic characteristics showed significant correlation (P < 0.05) between RLA and total fish yield (Y). A multiple regression equation, Y = −693 + 4810 RLA + 0.484 SD, was generated to estimate fish harvest in relation to SD.
Downstream passage of silver eels at a small hydroelectric facility
Authors: BOUBÉE J. A. T. , WILLIAMS E. K.
Published: May 2006

Abstract  A 100‐mm diameter bypass was installed in the dam face at a small hydropower station on the Mokau River, New Zealand, and its use by downstream migrating silver eels, Anguilla spp., was monitored by trapping at the outlet in autumn 2002 and 2003. In addition, a passive integrated transponder system was used to monitor passage over the spillway. Migrant eels were able to find the bypass, with 544 and 744 eels recorded using it in 2002 and 2003 respectively. Although the bypass was the sole means of safe passage at low flow, migrant eels passed down the spillway in preference to the bypass when the dam was overtopped during floods. A combination of spilling and small diameter bypasses would provide safe downstream passage at hydroelectric facilities for silver eels, so long as entrainment and impingement at the intake screens can be prevented.
Validation of the accuracy of household reporting of subsistence fishing catch and effort: a Fijian case study
Authors: KUSTER C. , VUKI V. C. , ZANN L. P.
Published: May 2006

Abstract  The accuracy of household reporting of subsistence fishing catch and effort and seafood consumption on the Fijian island of Ono‐i‐Lau was studied. A creel survey was carried out concurrently to validate the household survey data. Reported estimates of fishing participation, effort, and fish consumption were not significantly different to the creel survey estimates. Householder's appeared to overestimate the number of fish from the most abundant family Lethrinidae, and underestimate rarer fish. However, there was no significant difference between the reported and observed contribution of the majority of finfish families and invertebrate taxa. The reported and observed catch rate estimates were not significantly different, indicating that Ono‐i‐Lau villagers are relatively accurate in their estimation of the number and size of fish from recalled catches.
Dynamics of fishing gear allocation by fishers in small‐scale coastal fisheries of Pelabuhanratu Bay, Indonesia
Authors: WIYONO E. S. , YAMADA S. , TANAKA E. , ARIMOTO T. , KITAKADO T.
Published: May 2006

Abstract  Fishing gear usage in small‐scale coastal fisheries of Pelabuhanratu Bay, Indonesia was explained by two approaches: temporal fishing gear allocation analysis and adaptive responses of fishers to external factors, especially climate and abundance of target species. Gear usage, with the exception of hand lines and seine nets, was more intensive during the dry season than the rainy season. The decision to use seine nets was governed by seasonal variability in the abundance of Auxis thazard, Lacepède, and Trichiurus spp. to the catch. Sustainable management of fishing activities in Pelabuhanratu Bay requires proportional reductions in the use of lift nets and fixed gillnets across the seasons rather than gear specific effort reductions.
The effects of stocking Atlantic salmon, Salmo salar, in a Norwegian regulated river
Authors: SALTVEIT S. J.
Published: May 2006

Abstract  Stocking is undertaken in the River Suldalslågen, western Norway, to compensate for an estimated annual loss of 20 000 Atlantic salmon smolts, Salmo salar L., caused by regulating the river for hydropower production. The annual contribution to angling catches from stocked hatchery fish varied from 7 to 334 kg, or <15% of the total number caught. Between 160 000 and 250 000 one‐summer old fish were stocked, but only between 6 and 10 (<0.005%) were recaptured as adults in the river. Recaptured stocked fish never exceeded 0.03% by number, despite smolts dominating the stocking material in recent years. It is not certain whether the slight increase in catches comes in addition to or at the expense of natural reproduction. In most years more adults were used as parent stock than were caught as offspring. The lack of positive response to stocking is possibly due to lesser age, smaller size and later migration of hatchery smolts, and that seawater tolerance of hatchery smolts is poorly developed, all factors increasing mortality at sea.
Observer variation in immunohistochemical analysis of protein expression, time for a change?
Authors: Kirkegaard T , Edwards J , Tovey S , McGlynn L M , Krishna S N , Mukherjee R , Tam L , Munro A F , Dunne B , Bartlett J M S
Published: May 2006

Aim : Immunohistochemical analysis of protein expression is central to most clinical translational studies and defines patient treatment or selection criteria for novel drugs. Interobserver variation is rarely analysed despite recognition that this is a key area of potential inaccuracy. Therefore our aim was to examine observer variation and suggest the revision of current standards.

Methods and results : We analysed inter‐ and intra‐observer variation, by interclass correlation coefficient (ICCC) and κ statistics, in 8661 samples. Intra‐observer assessment of nuclear, cytoplasmic and membrane staining for seven proteins in 1323 samples resulted in an ICCC of 0.94 and a κ‐value of 0.787. Interobserver reproducibility, assessed on 28 proteins by seven observer pairs in 8661 carcinomas, gave an ICCC of 0.90 and a κ‐value of 0.70. No significant effect of either antibody or cellular compartmentalization was observed.

Conclusion : We have demonstrated that ICCC is a consistent method to assess observer variation when a continuous scoring system is used, compared with κ statistics, which depends on a categorical system. Given the importance of accurate assessment of protein expression in diagnostic and experimental medicine, we suggest raising thresholds for observer variation: ICCC of 0.7 should be regarded as the minimum acceptable standard, ICCC of 0.8 as good and ICCC of ≥ 0.9 as excellent.
Unequivocal morphological diagnosis of fungi in morphologically abnormal nails
Authors: Cabral A , Berger T H D , Middag‐Broekman J H F F , Boon M E
Published: May 2006

Aims : To analyse the prevalence of fungi in abnormal nails by morphological diagnosis. Prevalence studies of onychomycoses in temperate climate zones have yielded widely varying rates, possibly reflecting the confounding effects of referral bias, sampling specificity and intrinsic sensitivity of the diagnostic techniques employed.

Methods and results : The method employed to identify fungi in nails entailed primary fixation using a non‐formaldehyde‐based coagulative fixative (BoonFix®; Finetec, Japan) and microwave‐enhanced processing to histology, followed by staining the paraffin sections with periodic acid–Schiff, using haematoxylin as a routine counterstain. The results of 990 nail samples were tabled for statistical analysis related to gender, patient age and diabetes mellitus status. In four of the 990 (< 1%) analysed cases the diagnosis was found to be equivocal using the method employed. These cases were jointly reviewed for definitive diagnosis. The overall prevalence of invasive hyphal structures was found to be 606/990 (≈ 61%). The relative risk for fungal infection in morphologically abnormal nails was found to be higher for persons < 20 years old or diabetic patients aged ≥ 71 years.

Conclusions : The 61% positivity rate for fungi found justifies systematic direct submission of samples from abnormal nails for histological confirmation in order to avoid unwarranted treatment.
Invasive growth of hepatic angiomyolipoma; a hitherto unreported ominous histological feature
Authors: Nonomura A , Enomoto Y , Takeda M , Tamura T , Kasai T , Yosikawa T , Nakamime H
Published: May 2006

Aims : Although histological features of hepatic angiomyolipoma (AML) are highly variable, true malignant change is extremely rare. The aim was to review the histological features of invasive growth and clinical outcomes in 39 cases of hepatic AML.

Methods and results : An invasive growth pattern into surrounding hepatic parenchyma, portal triads and/or around hepatic veins was found in 24 of 39 tumours (62%). One variant showed tumour cells replacing hepatocytes within the liver cell cords. The other consisted of portal or perivascular invasive growth along blood vessels. In the former pattern, small isolated tumour cell clusters were occasionally found in the vicinity of the main mass, showing a sprouting pattern. Although these histological features suggest malignancy, distant metastases were not found in any of the cases within a mean follow‐up period of 6.8 years.

Conclusions : A previously unrecognized histological feature of an invasive growth pattern, which suggests malignancy and might promote an erroneous diagnosis, was frequently found in hepatic AMLs. However, among about 180 reported hepatic AMLs, including the present cases, only one hepatic AML with distant metastasis has been reported to date and nearly all hepatic AMLs behave in a benign fashion. Therefore, pathologists should not overdiagnose malignancy based solely on the histological invasive growth patterns described in this paper.
Subcellular shift of the hepatic growth hormone receptor with progression of hepatitis C virus‐related chronic liver disease
Authors: Vespasiani Gentilucci U , Perrone G , Galati G , D'Avola D , Zardi E M , Rabitti C , Bianchi A , De Dominicis E , Afeltra A , Picardi A
Published: May 2006

Aims : To evaluate the cytoplasmic and nuclear expression of hepatic growth hormone receptor (GHR) in different stages (S0, S1, S3 and S4, according to Knodell's classification) of chronic liver disease (CLD) and in hepatocellular carcinoma (HCC).

Methods and results : Liver specimens from 31 patients with hepatitis C virus‐related CLD, five patients with HCC and nine controls were examined for expression of hepatic GHR by immunohistochemistry with MAb 263. Cytoplasmic and nuclear staining were evaluated as a percentage of positively stained cells. The cytoplasmic expression of GHR was comparable between normal liver and S0 hepatitis, while it progressively decreased in S1, S3 and S4 CLD (P < 0.01). Conversely, nuclear GHR showed increased expression in S3 and S4 CLD (P < 0.05). No differences were observed between HCC and normal liver in terms of GHR immunoreactivity.

Conclusions : This is the first study to show that the subcellular expression of hepatic GHR changes with the progression of CLD. The increase in nuclear expression of GHR with advanced stages of CLD suggests that GH may act directly at the nuclear level to promote hepatocyte proliferation/regeneration.
Cell proliferation marker MCM2, but not Ki67, is helpful for distinguishing between minimally invasive follicular carcinoma and follicular adenoma of the thyroid
Authors: Mar K Cho , Eimoto T , Nagaya S , Tateyama H
Published: May 2006

Aims : To compare cell proliferation markers, minichromosome maintenance protein 2 (MCM2) and Ki67, in minimally invasive follicular carcinoma (MIFC) and follicular adenoma (FA) of the thyroid and among MIFCs with different diagnostic criteria.

Methods and results : Twenty‐two MIFCs and 20 FAs were immunohistochemically stained for MCM2 and Ki67. The MIFCs were subdivided into six Group 1 tumours with both capsular and vascular invasions, seven Group 2 tumours with vascular invasion only and nine Group 3 tumours with capsular invasion only. The MCM2 and Ki67 indices were calculated, counting more than 1000 tumour cells in the most frequently positive areas. In total and Groups 1–3 MIFCs and in FAs, the average MCM2 index was 26.7 ± 11.0, 28.4 ± 8.6, 26.3 ± 14.8, 25.9 ± 8.4 and 10.7 ± 4.5, respectively, whereas the average Ki67 index was 2.07 ± 1.65, 1.93 ± 2.02, 2.49 ±1.38, 1.84 ± 1.5 and 1.78 ± 0.92, respectively. There was a significant difference in the MCM2 index, but not in the Ki67 index, between each category of MIFCs and FA (P < 0.01). However, neither the MCM2 index nor the Ki67 index showed a statistically significant difference among the subgroups of MIFC.

Conclusions : MCM2, but not Ki67, is a helpful marker for differentiating MIFC from FA. The tumour cell proliferative activity supports the histological criteria based on diagnosing MIFC by either capsular or vascular invasion only.
Ets‐1 is up‐regulated together with its target gene products matrix metalloproteinase‐2 and matrix metalloproteinase‐9 in atypical and anaplastic meningiomas
Authors: Okuducu A F , Zils U , Michaelis S A M , Michaelides S , Von Deimling A
Published: May 2006

Aims : Matrix metalloproteinases (MMPs) are a pivotal enzyme system involved in extracellular matrix (ECM) degradation and are considered to be important in the development and invasion of human tumours. Little is known about the regulation of MMPs in meningioma development and prognosis. The transcription factor Ets‐1 is the main regulator of several MMPs, including MMP‐2 and ‐9. The aim of this study was to determine the relationship between the expression of Ets‐1, MMP‐2 and ‐9 and the malignant potential of meningiomas.

Methods and results : Seventy‐four meningiomas of different histological grades were investigated immunohistochemically. Up‐regulation of Ets‐1, MMP‐2 and MMP‐9 expression was observed in atypical and anaplastic meningiomas. Invasive meningiomas showed increased immunohistochemical expression of these proteins compared with non‐invasive meningiomas. We also observed a correlation between the expression of Ets‐1 and of its target genes MMP‐2 and MMP‐9.

Conclusions : Ets‐1 may be involved in the transcriptional regulation of MMP‐2 and MMP‐9 as well as in the invasive process in meningiomas. Evaluation of these expressions might be of prognostic value for meningiomas.
Human pancreatic mucinous cystadenoma is characterized by distinct mucin, cytokeratin and CD10 expression compared with intraductal papillary‐mucinous adenoma
Authors: Handra‐Luca A , Fléjou J‐F , Rufat P , Corcos O , Belghiti J , Ruszniewski P , Degott C , Bedossa P , Couvelard A
Published: May 2006

Aims : To examine cytokeratin, epithelial glycoprotein (mucin) and glycoprotein CD10 expression in benign mucinous cystdenomas (MCAs) in comparison with intraductal papillary mucinous adenomas (IPMAs).

Methods and results : Thirty MCAs of the pancreas were analysed for immunohistochemical expression of cytokeratin (CK) 7, CK20, MUC1, MUC2, MUC5AC and CD10 and were compared with 16 IPMAs. CK7 was expressed in all neoplasms. CK20 was significantly more frequent in MCAs compared with IPMAs (56.66% versus 18.75%, P = 0.027). MUC1 was more frequent in MCAs (40% versus 12.5%, P = 0.0915), whereas MUC5AC was significantly less frequent in MCAs (33.33% versus 100%). MUC2 was expressed in goblet cells of seven MCAs. In MCAs, CD10 was observed both in epithelial cells and in the ovarian‐type stromal cells (24/30). Epithelial expression of CD10 was significantly lower in IPMAs (66.66% versus 6.25%, p = 0.0001).

Conclusions : MCA is characterized by a significantly greater frequency of expression of CK20 and CD10 when compared with IPMA, which preferentially expresses MUC5AC.
Iron‐induced mucosal injury to the upper gastrointestinal tract
Authors: Haig A , Driman D K
Published: May 2006

Aims : To define the causes and associations of mucosal iron deposition in upper gastrointestinal biopsy specimens and to describe the morphological features of iron‐related injury.

Methods : The histological pattern, intensity and distribution of iron in biopsies obtained from 1991 to 2005 were recorded and correlated with endoscopic and clinical findings.

Results : Twenty‐five biopsies (16 gastric, four duodenal, five oesophageal) were accrued. Iron deposition was seen in two groups: 10 cases showed erosive injury, with brown‐black crystalline material overlying eroded epithelium. These patients were taking oral iron tablets. The remaining 15 cases showed variable iron deposition in the surface epithelium, lamina propria and glands. In nine patients, there was a history of oral iron intake and at least eight had had blood transfusions. The most intense iron deposition was noted in patients with end‐stage liver disease. The mean age of patients with erosive injury was 43% higher than in the iron overload group (76 versus 53 years). Iron stains were also performed on 15 normal gastric biopsies and five biopsies with chronic, non‐specific gastritis; all were negative for haemosiderin deposition.

Conclusions : Iron‐related erosive injury is related to oral iron pill ingestion and occurs in older patients. Mucosal iron deposition is also associated with iron overload disorders.
Enhanced prolidase activity and decreased collagen content in breast cancer tissue
Authors: Cechowska‐Pasko Marzanna , Pałka Jerzy , Wojtukiewicz Marek Z.
Published: May 2006

Adherent interactions between integrins and extracellular matrix (ECM) proteins play an important role in tumorigenicity and invasiveness. The major component of ECM is collagen that plays a central role in the interaction with integrins. The expression of certain collagenases (gelatinases) by tumour cells is one of the characteristic features of the so‐called metastatic phenotype, presumably by breaking down ECM barriers as well by altering the ECM–cell interaction. Although extracellular collagenases initiate the breakdown of collagen, the final step of collagen degradation is catalysed by intracellular prolidase. Collagen deposition, gelatinolytic and prolidase activities, expression of β1‐integrin receptor and their possible relationships were studied in seven operable breast cancer cases. In breast cancer tissue, we have found significant decrease in the amount of collagen. The decrease in collagen deposition in breast cancer tissue was accompanied by increase in the tissue gelatinolytic and prolidase activities. Simultaneously, a slight decrease in the expression of β1‐integrin receptor in breast cancer tissue was observed. These results suggest that alteration in collagen metabolism in breast cancer tissue may reflect tissue remodelling, characteristic for invasive phenotype of cancer cells. Increased gelatinolytic and prolidase activities in breast cancer tissue may enhance stromal matrix degradation and thus may promote metastatic dissemination. On the basis of the data, it seems that compounds endowed with gelatinolytic and prolidase inhibitory activities may be considered as a potential drug candidates for breast cancer therapy.
The freezer defrosting: global warming and litter decomposition rates in cold biomes
Authors: AERTS R.
Published: May 2006

Decomposition of plant litter, a key component of the global carbon budget, is hierarchically controlled by the triad: climate > litter quality > soil organisms. Given the sensitivity of decomposition to temperature, especially in cold biomes, it has been hypothesized that global warming will lead to increased litter decomposition rates, both through direct temperature effects and through indirect effects on litter quality and soil organisms.

A meta‐analysis of experimental warming studies in cold biomes (34 site‐species combinations) showed that warming resulted in slightly increased decomposition rates. However, this response was strongly dependent on the method used: open top chambers reduced decomposition rates, whereas heating lamps stimulated decomposition rates. The low responsiveness was mainly due to moisture‐limited decomposition rates in the warming treatments, especially at mesic and xeric sites. This control of litter decomposition by both temperature and moisture was corroborated by natural gradient studies.

Interspecific differences in litter quality and decomposability are substantially larger than warming‐induced phenotypic responses. Thus, the changes in the species composition and structure of plant communities that have been observed in medium‐term warming studies in cold biomes will have a considerably greater impact on ecosystem litter decomposition than phenotypic responses.

Soil fauna communities in cold biomes are responsive to climate warming. Moreover, temperature‐driven migration of the, hitherto absent, large comminuters to high‐latitude sites may significantly increase decomposition rates. However, we do not know how far‐reaching the consequences of changes in the species composition and structure of the soil community are for litter decomposition, as there is a lack of data on functional species redundancy and the species’ dispersal ability.

Global warming will lead to increased litter decomposition rates only if there is sufficient soil moisture. Hence, climate scenario and experimental studies should focus more onbothfactors and their interaction. As interspecific differences in potential decomposability and litter chemistry are substantially larger than phenotypic responses to warming, the focus of future research should be on the former. In addition, more light should be shed on the below‐ground ‘darkness’ to evaluate the ecological significance of warming‐induced soil fauna community changes for litter decomposition processes in cold biomes.
Fracture strength of two oxide ceramic crown systems after cyclic pre‐loading and thermocycling
Authors: VON STEYERN P. VULT , EBBESSON S. , HOLMGREN J. , HAAG P. , NILNER K.
Published: May 2006

summary  The aim of the present study was to investigate the fracture resistance of zirconia crowns and to compare the results with crowns made of a material with known clinical performance (alumina) in away that reflects clinical aspects. Sixty crowns were made, 30 identical crowns of alumina and 30 of zirconia. Each group of 30 was randomly divided into three groups of 10 crowns that were to undergo different treatments: (i) water storage only, (ii) pre‐loading (10 000 cycles, 30–300 N, 1 Hz), (iii) thermocycling (5–55°, 5000 cycles) + pre‐loading (10 000 cycles, 30–300 N, 1 Hz). Subsequently, all 60 crowns were subjected to load until fracture occurred. There were two types of fracture: total fracture and partial fracture. Fracture strengths (N) were: group 1, alumina 905/zirconia 975 (P = 0·38); group 2, alumina 904/zirconia 1108 (P < 0·007) and group 3, alumina 917/zirconia 910 (P > 0·05). Total fractures were more frequent in the alumina group (P < 0·01). Within the limitations of this in vitro study, it can be concluded that there is no difference in fracture strength between crowns made with zirconia cores compared with those made of alumina if they are subjected to load without any cyclic pre‐load or thermocycling. There is, however, a significant difference (P = 0·01) in the fracture mode, suggesting that the zirconia core is stronger than the alumina core. Crowns made with zirconia cores have significantly higher fracture strengths after pre‐loading.
Reflections on the process of change on acute psychiatric wards during the City Nurse Project
Authors: FLOOD C. , BRENNAN G. , BOWERS L. , HAMILTON B. , LIPANG M. , OLADAPO P.
Published: May 2006

The intention of this paper is to discuss the process of therapeutic change on two acute psychiatric wards during a research project that aimed to reduce conflict and containment. Analysis of fieldwork notes, reflection, team discussion and supervision. The City Nurse Project successfully reduced patient aggression, self‐harm and absconding. This paper reports on the reflections made over the course of the year as changes and developments to acute wards took place. Specifically discussed are the beneficial effects of an action research approach, the role of the City Nurse, support for ward managers, education and training, clinical supervision as well as difficulties and barriers to the overall process of change. At an interim stage of the project, the staff have shown a willingness to engage in efforts to change and improve two acute wards. This paper shows the potential to improve acute wards and produce positive outcomes using a working model.
The meaning of depression: Swedish nurses’ perceptions of depressed inpatients
Authors: LILJA L. , HELLZÉN M. , LIND I. , HELLZÉN O.
Published: May 2006

People suffering from depressive disorder are affected by one of the western world’s largest medical groups of disorders in both psychiatric and general medicine. Drug treatment is usually the first‐line intervention and has been shown to be an effective treatment. Other therapies, including nursing interventions that could be implemented in care, are infrequently used. It is therefore important to understand whether nurses’ perceptions of depressed people could be explained from the medical model by defining the nurses’ view of psychiatric inpatients. Therefore, the aim of this study was, with the clinical picture as the starting point, to investigate the nurses’ view of hospitalized patients with a diagnosis of depression. In this prospective study, 155 nurses’ opinion of depression among depressive inpatients was assessed using a questionnaire based on the Montgomery–Åsberg Depression Rating Scale. To elucidate the relationship between the variables in the questionnaire, factor analysis rotated by the Varimax method with Kaiser’s normalization was used. The factor analysis identified five factors. The number of variables was reduced from 61 to 34. Based on the factor interpretation, an initial factor structure for the depressive inpatient was defined. The identified factors were interpreted and labelled to create the nurses’ fused ‘picture’ or meaning of the depressed inpatient as an individual who experienced feelings of annihilation, alienation, fatigue, emptiness and affliction, an individual who is disconnected from the whole of temporality.
Newspaper representations of mental illness and the impact of the reporting of ‘events’ on social policy: the ‘framing’ of Isabel Schwarz and Jonathan Zito
Authors: PATERSON B.
Published: May 2006

Concerns have been raised internationally about the role of the media in influencing public opinion and by implication, social policy on mental health issues. In particular, anxieties have been expressed that an ‘excessive’ focus by the news media on violence in association with mental illness may reinforce pre‐existing stereotypes and by escalating public concerns lead to the adoption of policies which place a high priority on the safety of the public. Such assertions are often contained in the numerous studies that record a seemingly disproportionate number of stories featuring violence in association with mental health. What is, however, almost invariably lacking is a developed theory of agency that explains how or why such depictions of mental illness might exert an influence on social policy. This paper critically examines the potential significance of the way in which responsibility for events is constructed for social policy by means of a discourse analysis, inspired by the genealogical work of Michel Foucault. It uses the device of ‘frames’ originally developed by Goffman to explore the nature of newspaper coverage of two deaths to which causal responsibility for changes in the nature of English social policy in mental health has been attributed. Results presented suggest that attempts to assert a causal influence between media coverage and changes in the nature of social policy must engage with the question of agency.
From psychiatric ward to the streets and shelters
Authors: FORCHUK C. , RUSSELL G. , KINGSTON‐MACCLURE S. , TURNER K. , DILL S.
Published: May 2006

The issue of discharge from hospital ward to the streets is seldom explored in the literature, but all too commonly experienced by individuals experiencing psychiatric disorders. The Community University Research Alliance on Housing and Mental Health sought to determine how frequently people were discharged from psychiatric wards to shelters or the street in London, Ontario, Canada. A number of data sources were accessed to determine instances of discharges to shelters or the street. Data were analysed to determine the number of moves occurring between hospital and shelter or no fixed address. All datasets revealed the problem of discharge to shelters or the street occurred regularly. All data sources used have the difficulty of likely underestimating the extent of the problem. This type of discharge occurred at least 194 times in 2002 in London, Ontario, Canada. Policies that contribute to this problem include income‐support policies, the reduction in psychiatric hospital beds and the lack of community supports. Without recognition, this problem is at risk of remaining invisible with no further improvements to the situation.
The nurse’s role in the management of aggression
Authors: IRWIN A.
Published: May 2006

Although research into the phenomenon of aggression within psychiatric inpatient settings has established a strong casual link with mental illness, there is widespread agreement that diagnostic or demographic characteristics cannot accurately predict such behaviours. In addition, studies have consistently failed to establish how nursing management responses influence the course of aggression within these environments. Therefore, an assumption can be made that specific contextual factors are significant, and that management responses have an effect on outcomes. This review examines the nurses’ impact on inpatient aggression and how management strategies affect the therapeutic value of intervention.
Psychiatric nurses perceptions of the constituents of the therapeutic relationship: a grounded theory study
Authors: SCANLON A.
Published: May 2006

Psychiatric nursing is invariably linked with a therapeutic role; however, the question remains unanswered in relation to the extent psychiatric nurses perceive the importance of the constituents of the therapeutic relationship. The aim of this research is to ascertain the nature and comprehension psychiatric nurses assign the development of this therapeutic relationship. Grounded theory methodology was utilized to develop these conceptualizations to elicit a theory relating to what comprises the therapeutic relationship. Semi‐structured depth interviews were conducted with 6 registered psychiatric nurses who have 2–10 years of experience. The main findings of the research related to how psychiatric nurses learn to form these relationships and what skills are utilized within the relationship. The research discovered that the therapeutic relationship is therapeutic, but the degree of positive change is difficult to measure. The results of the study indicate that the process of developing therapeutic relationships is a combination of a learned experience through the acquiring of interpersonal skills; however, these skills are redundant if the individual has not acquired sufficient life experience to intuitively appreciate the therapeutic aspect of the relationship.
Nurse–client processes in mental health: recipients’ perspectives
Authors: COATSWORTH‐PUSPOKY R. , FORCHUK C. , WARD‐GRIFFIN C.
Published: May 2006

An ethnonursing method was selected to explore and describe nursing support relationships, from the perspectives of recipients, within the mental health subculture. Data sources consisted of three semi‐structured client interviews (n = 14) and field notes. When nurses were described as nice and friendly, and validated the client as a person by listening, three overlapping phases of development emerged from the data. These included: a glimmer of help, exploring and problem solving, and saying goodbye. When clients had negative experiences with nurses, they felt a lack of trust towards nurses and felt that their feelings were left unexplored. As a result, the relationships deteriorated. Deterioration began immediately in the first phase called withholding, and continued through the phases of avoiding and ignoring, and struggling with and making sense of. These findings raise healthcare providers’ awareness about developing and deteriorating nurse–client relationships, and support the value of the therapeutic relationship as an instrument to restore and promote clients’ health.
Psychiatric nurses’ perspectives of spirituality and spiritual needs during an amalgamation
Authors: RAY S. L. , McGEE D.
Published: May 2006

The purpose of this study was to explore the meaning of spirituality and how the spiritual needs of psychiatric nurses could be supported at work during a hospital amalgamation. Forty‐six nurses completed the General Information Questionnaire and described the meaning of spirituality and how their spiritual needs could be supported. Data were analysed by the double‐coding qualitative method. The themes identified for the meaning of spirituality included: being hopeful, having belief/belief systems, maintaining relatedness/connectedness and the expression of spirituality. The major themes identified to support nursing staffs’ spiritual needs at work included communication, offering hope, being valued and support from spiritual sources. Nurses expressed the importance of spirituality in their lives and the need for spiritual support at work. Data for addressing staff spiritual needs are reported; however, further studies are needed to understand the spiritual needs of nursing staff at work during hospital amalgamations.
An evaluation of a combined education and multi‐project practice development programme in mental health
Authors: CHAMBERS M. , CONNOR S. L. , DAVREN M.
Published: May 2006

This paper describes a unique mental health practice development programme, which aims to integrate education, research, clinical practice and culture change, and promote collaboration between academics, researchers and healthcare practitioners to meet current government policy needs. The programme combines academic qualifications within the context of practice development and aims to produce practitioners who are dynamic leaders, capable of critical thinking, influencing culture change and challenging the nature of conventional practice. The aim of the evaluation was to give insight into participants’ experience of the programme using a qualitative approach. Open‐ended questionnaires obtained participant’s views on facilitation and module content. Focus groups discovered the views and experiences of participants of the programme. The findings showed that the programme was well‐received and impacted positively on both patient care and the personal and professional development of participants. The findings were used to modify the programme for the next intake of participants. The research complements the existing body of knowledge on practice development and highlights the benefits for staff, nurses and service users, and the challenges of implementation. The framework and design has the potential to be applied to other areas of practice beyond mental health.