bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term effectiveness of an inpatient pulmonary rehabilitation program for elderly COPD patients: Comparison between young‐elderly and old‐elderly groups
Authors: KATSURA Hideki , KANEMARU Akiko , YAMADA Kouichi , MOTEGI Takashi , WAKABAYASHI Ritsuko , KIDA Kozui
Published: May 2004

Objective:  To evaluate the long‐term effects of pulmonary rehabilitation in elderly COPD patients, we monitored patients for 1 year after they completed a 2‐week inpatient pulmonary rehabilitation program. We also compared the effects of pulmonary rehabilitation on young‐elderly (age 65–74 years) and old‐elderly (age 75 years or over) COPD patients.

Methodology:  Fifty‐nine elderly COPD patients (mean age 72.8 years) were studied. They underwent a comprehensive 2‐week inpatient pulmonary rehabilitation program incorporating 10 exercise sessions, each of which included endurance training of the lower extremities, peripheral muscle conditioning training of the upper and lower extremities, and stretching, along with various education sessions. The effects of pulmonary rehabilitation were evaluated at 3, 6, and 12 months after completion of the program.

Results:  Overall, patient health‐related quality of life (HRQoL) as assessed by a QoL scale, and dyspnoea as assessed by an oxygen cost diagram, improved significantly over the 12‐month period. Exercise capacity assessed by a 6‐min walking distance test (6MWD) was similarly significantly improved. However, there was some fall‐off in terms of the distance walked 12 months after pulmonary rehabilitation. The improvements in exercise capacity, dyspnoea, and HRQoL did not differ between the two groups, with the exception that the 6MWD (P < 0.01) and the QoL scale (P < 0.05) at 3 months post‐pulmonary rehabilitation were significantly higher in the old‐elderly group.

Conclusions:  Pulmonary rehabilitation is an effective treatment in terms of improving dyspnoea, exercise capacity and HRQoL in elderly COPD patients, and the benefits are almost comparable for young‐elderly and old‐elderly patients.
Pneumothorax
Authors: BAUMANN Michael H. , NOPPEN Marc
Published: May 2004

Abstract:  Spontaneous pneumothoraces can occur without obvious underlying lung disease (primary) or in patients with known underlying lung disease (secondary). Management guidelines for spontaneous pneumothorax have been published by major professional organizations, but awareness and application among clinicians seems poor. First episodes of primary spontaneous pneumothorax can be managed with observation if the pneumothorax is small. If the pneumothorax is large or if the patient is symptomatic, manual aspiration via a small catheter or insertion of a small‐bore catheter coupled to a Heimlich valve or water‐seal device, should be performed. In general, definitive measures to prevent recurrence are recommended after the first recurrence of the pneumothorax, and can be achieved by medical (e.g. talc) or surgical (video‐assisted thoracic surgery) pleurodesis. Secondary pneumothoraces should be treated with chest tube drainage followed by pleurodesis after the first episode to minimize any risk of recurrence. Traumatic pneumothoraces may be occult (not seen on an initial CXR) or non‐occult. The majority are treated by placement of a chest tube. Selected patients may be treated conservatively, with approximately 10% of these patients eventually requiring chest tube placement. Iatrogenic pneumothoraces have a myriad of causes with transthoracic lung needle biopsy being most common. Transthoracic needle biopsy‐related pneumothoraces have CT findings that can predict their occurrence and the need for chest tube  placement.  Iatrogenic  pneumothoraces,  regardless  of  cause,  may  be  managed  by  observation  or small bore chest tube placement, depending upon patient stability and the size of the pneumothorax.
The process of introducing a tobacco curriculum in medical school
Authors: RICHMOND Robyn
Published: May 2004

Abstract:  Medical students have poor knowledge of cigarette‐related diseases and tend to increase tobacco use as they progress through their course. The aims of this review are to describe the process of developing a tobacco curriculum, present a model of implementation, and apply the model to China. The process of developing, revising and implementing a tobacco curriculum called the Smokescreen Education Program (SEP) for medical students is described. It comprises a lecture and six‐part tutorial. Dissemination of the SEP occurred through doctors who translated and introduced the tobacco curriculum into different countries and through the conduct of workshops. A six‐point model of implementation was developed that included defining the extent of the tobacco problem in medical schools, developing a flexible curriculum on tobacco, developing networks in countries, working as a resource, and following up after training and evaluating success. The model is applied to China. The SEP was developed over a decade and has led to the development of a practical model of dissemination.
Outcome of coronavirus‐associated severe acute respiratory syndrome using a standard treatment protocol
Authors: LAU Arthur Chun‐Wing , SO Loletta Kit‐Ying , MIU Flora Pui‐Ling , YUNG Raymond Wai‐Hung , POON Edwin , CHEUNG Thomas Man‐Tat , YAM Loretta Yin‐Chun
Published: May 2004

Objective:  There is so far no consensus on the optimal treatment strategy for the coronavirus‐associated severe acute respiratory syndrome (SARS). We aimed to analyse the outcomes of a standard treatment strategy comprising antibiotics, a combination of ribavirin, a 3‐week step‐down course of corticosteroids, and the possibility of pulsed methylprednisolone rescue in the event of deterioration.

Methodology:  This was a prospective cohort study performed at a major public‐funded hospital in Hong Kong. Eighty‐eight World Health Organisation/Centers for Disease Control and Prevention probable cases of SARS (97% laboratory‐confirmed) were treated with a standard protocol previously reported. Seventy‐one patients treated de novo were analysed in detail with regard to time to clinical stabilization after combination treatment, requirement of additional therapy (pulsed methylprednisolone; assisted ventilation); and final outcomes (recovery, mortality).

Results:  The mean age was 42. Twenty‐one patients (24%) had comorbidities. Three of 71 treated de novo recovered with antibiotics alone. The remaining 68 received combination treatment at a mean of 5.8 days after symptom onset, of whom 30 subsequently required pulsed methylprednisolone rescue (independent predictors: older age and higher LDH) and 18 required assisted ventilation (independent predictors: older age, higher oxygen requirement and creatinine level). Their median time to clinical stabilization was 8.0 days after combination treatment (independent predictor for longer time to stabilization: median age of 41 or above). Common complications were hyperglycaemia (58%), pneumo‐mediastinum/thoraces (13%), psychiatric manifestations (7%) and ventilator‐associated pneumonia (2%). One patient (1%) died of SARS‐related respiratory failure. All‐cause mortality was 3.4%, occurring in patients aged > 65 years only. None of the discharged survivors required continuation of oxygen therapy.

Conclusions:  This standard treatment protocol resulted in overall satisfactory outcomes. Randomized controlled trial is suggested to confirm its efficacy.
Physical and mental development of children after in vitro fertilization and embryo transfer
Authors: NAKAJO YUKIKO , FUKUNAGA NORITAKA , FUCHINOUE KOHEI , YAGI AKIKO , CHIBA SETSUYO , TAKEDA MIHO , KYONO KOICHI , ARAKI YASUHISA
Published: May 2004

Objective:  To evaluate the physical and mental development of children after in vitro fertilization (IVF) and frozen embryo transfer (FET).

Methods:  Between July 1995 and November 2003, 506 patients delivered 658 babies after IVF and ET treatment at our clinic (intracytoplasmic sperm injection (ICSI), 418; conventional IVF, (C‐IVF) 125; FET, 115). A survey of the physical and mental developmental of the children was conducted by mailing questionnaires to parents. Comparisons were made between three treatment procedures, and development of singleton, twin and triplet delivery.

Results:  The response rate was 73.4% (483/658) for 324 children born after ICSI, 78 born after C‐IVF, and 81 born after FET. The height and weight of assisted reproductive technology (ART) children at birth were significantly lower than that of naturally conceived babies (ART children: natural delivery; 46.8 cm, 49.0 cm and 2524 g, 3040 g, respectively). However, there was no significant difference between the singletons alone and naturally conceived children irrespective of the ART method. In addition, mental development was the same between singletons and naturally conceived children. The ART group tended to delay body development such as ‘holding their head up’, ‘sitting up’, ‘crawl’ to moving growth in multiple births.

Conclusion:  The physical and mental development of twins or triplets was significantly more delayed than that of naturally conceived babies, but had improved to a similar extent of the singletons after the age of 6 months. (Reprod Med Biol 2004; 3: 63–67)
Randomized study comparing day 2 versus day 3 elective transfer of two good‐quality embryos
Authors: SUZUKI TATSUYA , SHIBAHARA HIROAKI , HIRANO YUKI , OHNO AKIKO , TAKAMIZAWA SATORU , SUZUKI MITSUAKI
Published: May 2004

Objective:  The number of embryos transferred is very important to avoid multiple pregnancies without compromising pregnancy rates in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)–embryo transfer (ET). We established criteria for the elective transfer of two embryos (age <40, first treatment cycle, good‐quality embryos ≥3) to avoid high‐order multiple pregnancies, and reported their usefulness. In the current study, we compared the clinical outcome of day 2 versus day 3 elective transfer of two good‐quality embryos, in order to investigate the day of preferential transfer.

Methods:  A total of 228 cycles were treated with IVF/ICSI–ET from August 1999 to August 2002. From this total, 114 patients who were less than 40 years old and also had a first treatment cycle were enrolled in the present study (50.0%). The elective transfer of two good‐quality embryos was carried out in 36 cycles (31.6%). Patients were randomized for transfer on either day 2 or day 3 after oocyte retrieval.

Results:  The pregnancy rate of women who received two good‐quality embryos was 44.4% (16 out of 36). The multiple pregnancy rate was 12.5% (two out of 16) and all pregnancies outcomes were twins. There were no significant differences between day 2 and day 3 ET for the following criteria: the number of cycles (24, 12); age (32.8 ± 3.4 years, 32.5 ± 2.7 years); number of oocytes retrieved (10.0 ± 3.3, 9.0 ± 6.0); number of embryos developed (7.6 ± 3.5, 6.9 ± 3.7); and number of good‐quality embryos cryopreserved (3.5 ± 2.7, 3.6 ± 2.1). Higher pregnancy and implantation rates were obtained in day 3 ET than day 2 ET (37.5 and 20.8% in day 2 ET vs 58.3 and 33.3% in day 3 ET); however, there were no significant differences.

Conclusion:  Day 3 ET appears to be preferable to achieve more viable embryos than day 2 ET. (Reprod Med Biol 2004; 3: 99–104)
Pregnancy complicated by adenomyosis resulted in miscarriage in three cases of in vitro fertilization–embryo transfer
Authors: SHIMIZU YASUSHI , FUKUDA JUN , KUMASAWA YUKIYO , TANAKA TOSHINOBU
Published: May 2004

Three women with adenomyosis conceived by in vitro fertilization–embryo transfer (IVF–ET), but miscarried in the second trimester. The uterus in each case was inflamed post‐partum and one patient underwent total abdominal hysterectomy as treatment for the severe inflammation. Although the mechanism of the miscarriages is unclear, these cases strongly suggest that it is related to the inflammation of the myometrium associated with adenomyosis, and that such pregnancies have a high risk of not continuing to term. Preventing inflammation could result in a live birth. (Reprod Med Biol 2004; 3: 95–98)
Oral ketamine premedication can prevent emergence agitation in children after desflurane anaesthesia*
Authors: Kararmaz Alper , Kaya Sedat , Turhanoglu Selim , Ozyilmaz Mehmet Ali
Published: May 2004

Background : The purpose of the present study was to determine whether oral ketamine premedication affected the incidence of emergence agitation in children.

Methods : Thirty minutes before induction of anaesthesia, 80 children who were undergoing adenotonsillectomy with or without bilateral myringotomy and insertion of tubes received either ketamine 6 mg·kg−1 per oral in group K or sour cherry juice alone in group C. Anaesthesia was maintained with desflurane. Emergence and recovery times were recorded. Tramadol was used for postoperative analgesia. Fentanyl (1 μg·kg−1) was administered for the treatment of emergence agitation or severe pain that still continued after tramadol administration. Postoperative behaviour was evaluated using a 5‐point agitation scale.

Results : The incidence of emergence agitation was 56% in group C, and 18% in group K (P = 0.001). There was no significant difference with respect to emergence times except from time to eye opening that was significantly longer in group K (P < 0.0001).

Conclusion : Oral ketamine premedication reduced the incidence of postanaesthesia emergence agitation in children without delaying recovery.
A comparison between single‐ and double‐breath vital capacity inhalation induction with 8% sevoflurane in children
Authors: Ho Kok‐Yuen , Chua Wee‐Leng , Lim Serene ST , Agnes SB NG
Published: May 2004

Background : This study was conducted to determine if a double‐breath (DB) vital capacity (VC) rapid inhalation induction using immediate high‐inspired concentration of sevoflurane is as well tolerated as a single‐breath (SB) technique and if it results in a shorter induction time.

Methods : A total of 104 children, ASA I‐II, 6 year and above, undergoing elective surgery were randomly assigned to two groups: SB VC inhalation induction or DB VC inhalation induction with 8% sevoflurane in 66% nitrous oxide. The induction time, complications (cough, laryngospasm, breath‐hold, movement, salivation) and level of satisfaction were documented.

Results : Induction was significantly faster in the DB group (41 ± 9 s) compared with the SB group (50 ± 14 s). DB inhalation induction was associated with fewer complications (15.4%) than the SB technique (50%).

Conclusions : Double‐breath VC inhalation induction with 8% sevoflurane is as well tolerated as a SB technique and results in a faster onset of anaesthesia.
Manikin training for neonatal resuscitation with the laryngeal mask airway
Authors: Gandini Donna , Brimacombe Joseph
Published: May 2004

Background : We describe our experience of brief (≤15 min) manikin‐only training with the laryngeal mask airway (LMATM) for neonatal resuscitation in 80 health care workers.

Methods : Prior to training, 31% had not heard of the LMA, 57% did not know the LMA could be used for neonatal resuscitation and 88% thought it was a disposable device.

Results : The mean (sd) range time to insert the LMA after training was 5 (2, 5–16) s and there were no failed insertions. The preferred technique for neonatal resuscitation, before vs after training, changed from 72 to 14% for the face mask (P < 0.00001), from 6 to 80% for the LMA (P < 0.00001), from 5 to 0% for laryngoscope‐guided tracheal intubation (P = 0.04) and from 16 to 5% for unknown (P = 0.02). All considered that training was adequate and the LMA should be available on neonatal resuscitation carts. Confidence in using the LMA increased from 8 to 97% (P < 0.0001).

Conclusions : We conclude that LMA insertion success rates are high and confidence increases after brief manikin‐only training.
A case of propofol toxicity: further evidence for a causal mechanism
Authors: Withington Davinia E. , Decell Mary K. , Ayed Tareq Al
Published: May 2004

Summary A 5‐month‐old boy required sedation after a cleft lip repair. He was sedated with propofol and intermittent fentanyl, requiring escalating doses over the subsequent 48 h. On the second post‐operative day he developed a metabolic acidosis followed by multiple cardiac dysrhythmias, hepatic and renal failure. Propofol was stopped. His multisystem organ failure gradually resolved after initiation of charcoal haemoperfusion. Further investigation demonstrated an abnormality in acylcarnitine metabolism, similar to that found in one previous case report.
The 24‐h frequency‐volume chart in adults reporting no voiding complaints: defining reference values and analysing variables
Authors: Van Haarst E.P. , Heldeweg E.A. , Newling D.W. , Schlatmann T.J.
Published: May 2004

OBJECTIVE

To determine the variables (e.g. voiding frequency, voided volumes, urine production) and their mutual relationships and differences between age groups and genders, using a frequency‐volume chart (FVC) in an adult population (representing all age groups) who denied having any voiding complaints.

SUBJECTS AND METHODS

In all, 1152 men and women aged > 20 years completed a 24‐h FVC; registration started with the first voided volume in the morning and concluded with the first voided volume the next morning. The time of voiding and volume were both recorded, and bedtime hours noted. Each participant claimed to have no voiding complaints. The statistical analysis was aimed at discerning the relationships between the FVC variables, gender and age.

RESULTS

There was a linear increase in mean 24‐h voiding frequency and nocturia in men, from 6.0 and 0.5 in the third decade to 8.5 and 1.6 in those aged > 70 years. Contrary to men, in women the mean 24‐h frequency declined slightly in the older decades; it increased from 6.9 in the third to 8.2 in the sixth, declining to 7.8 in those aged > 70 years. Nocturia in women increased linearly, although slower than in men, from 0.7 in the third decade to 1.4 in those aged > 70 years. The mean volume/void decreased significantly in both genders, from 313 to 209 mL in men, and from 274 to 240 mL in women. The mean 24‐h volume was 1718 and 1762 mL in men and women, respectively. For both genders there was a strong linear association between 24‐h urine production and voided volumes.

CONCLUSION

The volume/void and maximum voided volume decreased significantly with age in both sexes, but more prominently in men. As a result, in men the frequency increased with age, probably reflecting subclinical changes associated with the development of prostatic enlargement. In contrast to men the frequency in women increased initially and decreased in the older groups. A higher 24‐h urine production was associated with a higher mean volume/void.
Does the cause of obstructive azoospermia affect the outcome of intracytoplasmic sperm injection: a meta‐analysis
Authors: Nicopoullos J.D.M. , Gilling‐Smith C. , Ramsay J.W.A
Published: May 2004

OBJECTIVE

To define whether the outcome of intracytoplasmic sperm injection (ICSI) using sperm surgically retrieved from men with obstructive azoospermia (OA) depends on the cause of obstruction.

PATIENTS AND METHODS

We first analysed our data and then used a meta‐analysis of published data (including ours) to compare the outcome of ICSI in OA, classified in terms of congenital and acquired causes. The present study comprised 82 couples who underwent 127 ICSI cycles using surgically retrieved sperm. The cause was classified as congenital bilateral absence of vas deferens (CBAVD, in 20), after vasectomy (56), infective/inflammatory (21), noninfective (24) and ejaculatory (five). Five reports (687 cycles) including the present were identified as suitable for meta‐analysis.

RESULTS

Analysis of the present data showed that fertilization and live‐birth rates were highest in men with a previous vasectomy and no infective cause (vasectomy 51% and 23%; not infective 53% and 29%, respectively) and lowest in men with infective or inflammatory causes. There was no difference in outcome if the sperm was fresh or frozen, or whether epididymal or testicular. Meta‐analysis comparing congenital (CBAVD) and acquired causes showed a significantly increased fertilization rate (95% confidence interval, 0.84–1) with acquired causes. Meta‐analysis of the three papers reporting delivery outcome showed no difference in live‐birth rate but a significantly higher miscarriage rate in the congenital group (relative risk 2.67).

CONCLUSION

In ICSI cycles in men with OA the cause appears to influence the outcome, but outcome is not affected by whether the retrieved sperm is fresh, frozen, epididymal or testicular. The meta‐analysis suggested a higher fertilization rate and lower miscarriage rate in acquired causes of OA.
Phosphodiesterase‐linked inhibition of nonmicturition activity in the isolated bladder
Authors: Gillespie J.I.
Published: May 2004

Over the past few months Gillespie has published several papers in the BJU International investigating the overactive bladder and BOO, using novel models and theories. This next paper continues these concepts and shows that the mechanisms influencing the frequency of agonist‐induced phasic activity in the isolated bladder model is slowed by cAMP. These findings will have important implications in future pharmacological strategies in the overactive bladder.

OBJECTIVE

To explore the influence of intracellular cAMP on phasic activity in the isolated bladder (phasic rises in intravesical pressure associated with waves of contraction and local stretches that can be activated by muscarinic or nicotinic agonists), as it has been argued that this activity underlies nonmicturition contractions, and that it contributes to the generation and modulation of afferent nerve activity.

MATERIALS AND METHODS

Isolated whole bladders from female guinea pigs (270–300 g) were cannulated via the urethra and suspended in a chamber containing oxygenated Tyrode solution at 33–35 °C. Bladder pressure was recorded and pharmacological agents added to the solution bathing the abluminal surface of the bladder.

RESULTS

Forskolin (1–3 µmol/L), an activator of adenyl cyclase, reduced the frequency and amplitude of the phasic activity induced by the muscarinic agonist arecaidine (300 nmol/L). There were similar changes in frequency and amplitude in bladders exposed to the nonspecific phosphodiesterase (PDE) inhibitor iso‐butyl‐methyl‐xanthene (IBMX). The actions of specific PDE inhibitors were explored to assess which isoenzymes might be responsible for regulating phasic activity. ENHA (PDE‐2), zaprinast (PDE‐5, ‐6, ‐8, ‐9 and ‐11) and siguazodan (PDE‐3) had no effect. Zardavarine (PDE‐3, ‐4) and Ro 20‐1724 (PDE‐4) reduced both the frequency and amplitude of the phasic activity. Nerve‐mediated rises in intravesical pressure were also inhibited by Ro 20‐1724, and the inhibition was more pronounced at 6.5 Hz than at 30 Hz stimulation. Ro 20‐1724 inhibited nerve‐mediated fluctuations induced by prolonged (200 s) stimulation at 6.5 Hz.

CONCLUSION

The mechanisms influencing the frequency of agonist‐induced phasic activity in the isolated bladder are slowed by cAMP. Degradation of intracellular cAMP in the cells responsible for phasic activity appears to involve primarily PDE‐4. The importance of these observations in relation to the overall physiological regulation of the bladder are discussed, and the possible importance of these findings in the development of pharmacological strategies to modulated bladder activity reviewed.
Relationship of erythrocyte membrane polyunsaturated fatty acids and prostate‐specific antigen levels in Jamaican men
Authors: Ritch C.R. , Brendler C.B. , Wan R.L. , Pickett K.E. , Sokoloff M.H.
Published: May 2004

OBJECTIVE

To investigate the relationship between erythrocyte membrane polyunsaturated fatty acid (PUFA) and serum prostate‐ specific antigen (PSA) levels in Jamaican men, as there may be an association between prostate cancer incidence and dietary fatty acids, and prostate cancer incidence in Jamaica is among the highest in the world.

PATIENTS AND METHODS

Blood from 107 Jamaican men was analysed for 32 individual fatty acids and PSA levels. Special attention was given to correlations between Ω3 and Ω6 PUFAs and PSA. Data were analysed using standard linear regression methods.

RESULTS

The mean PSA was 18.6 ng/mL (normal 0–4.0); for age groups of 51–60, 61–70 and 71–80 years the levels were 14, 26 and 23 ng/mL, respectively. Eicosapentaenoic acid (Ω3) levels decreased as PSA exceeded 10 ng/mL (P = 0.02). Arachidonic acid (Ω6) levels decreased as PSA was < 2 ng/mL (P = 0.02). Linoleic acid (Ω6) levels decreased in men with PSA levels of 2–10 ng/mL (P = 0.04). In men with a PSA of > 10 ng/mL there was a positive correlation between the ratio of Ω6 to Ω3 PUFAs and PSA (P = 0.036); there was also a negative correlation between the ratio of Ω3 to Ω6 PUFAs and PSA (P = 0.08). When the ratio of Ω3 PUFAs over the products of Ω6 PUFAs were used, this trend was significant (P= 0.03).

CONCLUSIONS

Increased levels of Ω6 PUFAs and the ratio of Ω6/Ω3 PUFAs in Jamaican men are associated with an increased mean PSA level and risk of prostate cancer. Additional studies are needed to establish a causal link between dietary fatty acid intake and the development of prostate cancer in Jamaican men.
Patients with bladder and lung cancer: a long‐term outcome analysis
Authors: El‐Hakim A. , Smith A.D. , Weiss G.
Published: May 2004

OBJECTIVES

To report on patient characteristics, stage of disease and long‐term outcome and prognosis of patients with dual bladder and lung cancers, as there is an established increased risk of smoking‐related second primary cancers, especially lung cancer, developing in patients with bladder cancer.

PATIENTS AND METHODS

We reviewed our hospital tumour registry database from 1990 to 2002, and identified 27 patients who had both bladder and lung cancers among 1038 with bladder cancer and 2427 with lung cancer. Seventeen patients had bladder cancer detected before lung cancer (group 1), and the remaining 10 had lung cancer diagnosed first (group 2).

RESULTS

Group 1 and 2 were comparable in terms of patients’ characteristics, mean interval between cancer detection and their use of tobacco. Group 1 patients had a tendency towards more invasive lung cancer at diagnosis than had group 2 patients (11/17 vs 2/10 stage ≥ IIB, respectively; P = 0.082). The mean follow‐up was 49.8 and 64.5 months for groups 1 and 2, respectively (not significant). The mean (sd) interval to death from the date of diagnosis of lung cancer was 18 (17) months for group 1 and 65 (42) months for group 2 (P < 0.05).

CONCLUSIONS

Patients with bladder and lung cancer who have lung cancer detected first have a lower lung cancer stage and higher overall survival rate than patients diagnosed with bladder cancer first.
Comparison of clinical and pathological features in African‐American and Caucasian patients with localized prostate cancer
Authors: Kang J.S. , Maygarden S.J. , Mohler J.L. , Pruthi R.S.
Published: May 2004

OBJECTIVE

To examine patient characteristics, prostate specific antigen (PSA) levels, and established preoperative and pathological prognostic factors to determine differences between Caucasian and African‐American patients with localised prostate cancer, as it remains controversial whether African‐American men present with more aggressive disease.

PATIENTS AND METHODS

One hundred consecutive patients (aged 53–76 years) undergoing radical retropubic prostatectomy (RRP) at an equal‐access tertiary‐care centre were retrospectively reviewed. All patients had preoperative PSA levels, a physical examination (including clinical staging), and sextant biopsy. Insurance information was also collected. The same urological oncologist determined clinical staging and performed all the RRPs, and the same genitourinary pathologist determined the Gleason grade for biopsies and surgical specimens, pathological stage, percentage of tumour involvement, and specimen weight. African‐American and Caucasian patients were compared for PSA, clinical stage, pathological stage, biopsy and pathological Gleason grade, organ confinement, margin status and specimen weight. Using preoperative and pathological data, both groups were also compared for over‐ and under‐staging and ‐grading. The Wilcoxon rank test with P < 0.05 was used to determine statistically significant differences.

RESULTS

African‐American patients were more likely to be Medicaid or self‐insured than Caucasian patients. Age, biopsy grade and clinical stage were not significantly different between the groups. African‐American patients presented with a mean PSA level of 11.9 ng/mL and Caucasians with a mean of 8.5 ng/mL (P = 0.03). When clinical and biopsy data were compared with pathological data there were no differences between the groups in under/over‐grading or under/over‐staging. African‐American patients had larger prostates per surgical specimen than their Caucasian counterparts (59.3 g vs 51.6 g, respectively; P = 0.04).

CONCLUSIONS

In a referred, equal‐access system, African‐American patients presented with higher serum PSA levels and had larger prostates in the surgical specimen. However, African‐American patients did not present at an earlier age or with higher Gleason grade or clinical stage, nor were pathological grade and stages higher. Other pathological features were no different. African‐American patients were not under‐ or over‐staged or under‐ or over‐graded more than their Caucasian counterparts. This retrospective study does not suggest that African‐American men present with more aggressive disease.
Effect of peripheral biopsies in maximising early prostate cancer detection in 8‐, 10‐ or 12‐core biopsy regimens
Authors: Philip J. , Ragavan N. , Desouza J. , Foster C.S. , Javlé P.
Published: May 2004

OBJECTIVE

To assess the cancer detection rate per individual core biopsy in a 12‐core protocol and develop an optimal biopsy regimen for detecting early prostate cancer.

PATIENTS AND METHODS

The study included 445 new patients who had a 12‐core transrectal ultrasonography (TRUS)‐guided prostatic biopsy over a 40‐month period. The 12‐ core biopsy protocol included parasagittal sextant and six peripheral biopsies. The cancer detection rate per individual core was evaluated to give an optimal biopsy protocol.

RESULTS

Prostate cancer was detected in 142 patients (31.9%). Parasagittal sextant biopsy would have failed to detect 40 (28.2%) of the cancers. Among the various possible biopsy protocols, the optimum 10‐core biopsy strategy excluding the parasagittal mid‐zone biopsies from the 12‐core protocol achieved a cancer detection rate of 98.6%.

CONCLUSION

The cancer detection rate increased from 71.8% for parasagittal sextant biopsies to 88.7% by adding peripheral basal biopsies (8‐biopsy protocol); 98.6% of cancers in the series would have been detected with a 10‐biopsy strategy omitting the parasagittal mid‐zone biopsies. Thus we recommend a 10‐core protocol incorporating six peripheral biopsies in patients with elevated age‐ specific prostate‐specific antigen levels (2.6–10.0 ng/mL) for maximising cancer detection.
Ureteric calculi in children: preliminary experience with holmium:YAG laser lithotripsy
Authors: Al‐Busaidy S.S. , Prem A.R. , Medhat M. , Al‐Bulushi Y.H.K.
Published: May 2004

OBJECTIVE

To determine the efficacy and safety of holmium:YAG laser lithotripsy in children with ureteric calculi.

PATIENTS AND METHODS

Between 1999 and 2003, 28 ureteroscopic laser procedures were carried out on 26 children (14 boys and 12 girls, mean age 6.5 years) with ureteric calculi. The mean (range) stone size was 1.21 (0.4–2.2) cm. At ureteroscopy the calculi were in the upper ureter in six (23%), mid‐ureter in five (19%) and lower ureter in 15 (58%) patients. A rigid 8 F ureteroscope was used and the Ho:YAG laser energy delivered at 0.6–1.4 J and 6–10 Hz. All patients were evaluated after 3 months with intravenous urography to confirm stone clearance and to exclude ureteric stricture formation.

RESULTS

The overall stone‐free rate was 92% (24 children) after 28 ureteroscopic procedures. Stones were completely cleared in 83%, 80% and 100% of the procedures in the upper, mid‐ and lower ureters, respectively. In two children the procedure failed; they were salvaged by ureterolithotomy in one and extracorporeal shockwave lithotripsy in the other. During the procedures, a ureteric perforation was caused by several factors, including a technically difficult procedure and higher laser energy. At the mean (range) follow‐up of 18 (3–39) months, low grade vesico‐ureteric reflux was detected in two children, and there were no ureteric strictures in any.

CONCLUSION

Holmium:YAG laser lithotripsy is an efficient and safe treatment for ureteric calculi in children.
New Integrable Equations of Nonlinear Schrödinger Type
Authors: Calogero F. , Degasperis A.
Published: May 2004

New integrable matrix nonlinear evolution partial differential equations in (1 + 1)‐dimensions are derived, via a treatment which starts from an appropriate matrix generalization of the Zakharov–Shabat spectral problem. Via appropriate parametrizations, multi‐vector versions of these equations are also exhibited. Generally these equations feature solitons that do not move with constant velocities: they rather behave as boomerons or as trappons, namely, up to a Galileian transformation, they typically boomerang back to where they came from, or they are trapped to oscillate around some fixed position determined by their initial data. In this paper, meant to be the first of a series, we focus on the derivation and exhibition of new coupled evolution equations of nonlinear Schrödinger type and on the behavior of their single‐soliton solutions.
Caring for Nature: From Fact to Value, from Respect to Reverence
Authors: Rolston Holmes
Published: May 2004

Abstract. Despite the classical prohibition of moving from fact to value, encounter with the biodiversity and plenitude of being in evolutionary natural history moves us to respect life, even to reverence it. Darwinian accounts are value‐laden and necessary for understanding life at the same time that Darwinian theory fails to provide sufficient cause for the historically developing diversity and increasing complexity on Earth. Earth is a providing ground; matter and energy on Earth support life, but distinctive to life is information coded in the genetic molecules that superintends this matter‐energy. Life is generated and regenerated in struggle, persists in its perishing. Such life is also a gift; nature is grace. Biologists and theologians join in celebrating and conserving the genesis on Earth, awed in their encounter with this creativity that characterizes our home planet.
Reductionism's Demise: Cold Comfort
Authors: Wacome Donald H.
Published: May 2004

Abstract.Nonreductive physicalism, as opposed to reductionism, enjoys wide popularity by virtue of being regarded as comporting with the traditional image of human beings as free and ontologically unique without the difficulties of mind‐body dualism. A consideration of reasons, both good and bad, for which reductionism is rejected suggests instead that the move to nonreductive physicalism does nothing to mitigate the implications of a physicalist account of human nature.
Emergence, Probability, and Reductionism
Authors: Budenholzer Frank E.
Published: May 2004

Abstract. Philosopher‐theologian Bernard J. F. Lonergan defines emergence as the process in which “otherwise coincidental manifolds of lower conjugate acts invite the higher integration effected by higher conjugate forms” (Insight, [1957] 1992, 477). The meaning and implications of Lonergan's concept of emergence are considered in the context of the problem of reductionism in the natural sciences. Examples are taken primarily from physics, chemistry, and biology.
What we must Accomplish in the coming Decades
Authors: Csikszentmihalyi Mihaly
Published: May 2004

Abstract. In order to survive as a species and grow in complexity, humanity must adopt a new image of what it means to be human, rediscover a reward system beyond the merely material, and see that young people find joy in challenges and in cooperating with others.
“Writing the Agenda,” Summary and Response to the Panel Participants: V. V. Raman, Grace Wolf‐Chase, Ian Barbour, Vítor Westhelle
Authors: Pederson Ann Milliken
Published: May 2004

Abstract. This essay highlights the basic issues, goals, and questions for the future of ZCRS.
Future Directions for the Zygon Center
Authors: Barbour Ian G.
Published: May 2004

Abstract. A brief comparison of the Zygon Center for Religion and Science and the Center for Theology and the Natural Sciences is given. The work and emphases of the two Centers overlap but also differ in significant ways. Without neglecting the physical sciences or the Christian tradition, ZCRS would do well to continue to give high priority to the biological sciences and the dialogue with the major world religions.
Science and Religion in the Twenty‐First Century
Authors: Raman Varadaraja V.
Published: May 2004

Abstract. To achieve peace on our planet we must bridge the gap not only between science and religion but also among faith traditions. Accepting the doctrine of multiple paths can reduce interreligious tensions. Every view of the Divine is partial, every faith system rests upon supreme spiritual experiences, and each one provides fulfillment in the yearning to connect with the Cosmic Mystery.
Introduction to the Symposium
Authors: Moore James F.
Published: May 2004

Abstract. The articles in this section were presented at the conference “Toward a Theology of Disease” sponsored by the Zygon Center in October, 2002. This was a second conference designed to address the question of what the science‐religion dialogue could contribute to the larger discussion of the rapid spread of HIV/AIDS. The conference brought a wide range of perspectives to this question from different religious traditions. I draw them together here around the idea that Philip Hefner introduced in his keynote address: our fragmented experience of the world. The notion of fragmentation opens the door for both a recognition of several possible approaches to building a theology of disease and the pluralism of religious traditions, as well as providing a framework for integrating our full awareness that HIV/AIDS is a problem without solutions and requiring a level of humility in posing any real answers. The essays clearly suggest that the question remains perplexing but that our efforts do show that a multifaith, multidisciplinary religion‐science dialogue can contribute significantly to the larger discussion.
A Pandemic of Terror and Terror of a Pandemic: American Cultural Responses to HIV/AIDS and Bioterrorism
Authors: Strassberg Barbara Ann
Published: May 2004

Abstract. The cultural construction of American societal responses to the HIV/AIDS pandemic and terrorism is addressed. The use of metaphors of war, survival, extinction, and of those related to God in public narratives is analyzed. Issues of gender, sexuality, money, and power are also discussed within the context of the religion‐science dialogue. Suggestions are made about a possibility for a global ethic of survival based on an ethic of care.
Assessment of Anti-Migraine Potential of a Novel α-Adrenoceptor Agonist S19014: Effects on Porcine Carotid and Regional Haemodynamics and Human Coronary Artery
Authors: Kapoor K , Willems EW , MaassenVanDenBrink A , Heiligers JPC , Cordi AA , Vayssettes-Courchay C , Verbeuren TJ , Villalón CM , Saxena PR
Published: May 2004

Taking into account the drawbacks associated with the use of triptans, attempts are being made to explore other avenues for the treatment of migraine. Recently, it has been shown that both α1- and α2-adrenoceptors mediate the constriction of porcine carotid arteriovenous anastomoses, which has effectively served as an experimental model predictive of anti-migraine activity. The present study investigated the effects of a novel α-adrenoceptor agonist S19014 {spiro[(1,3- diazacyclopent-1-ene)-5 : 2′-(4′,5′-dimethylindane)] fumarate} on carotid and systemic haemodynamics in anaesthetized pigs, and on human isolated coronary arteries. Increasing doses of S19014 (1-30 μg/kg, i.v.) produced a dosedependent initial short-lasting vasopressor response and a decrease of total carotid blood flow and conductance. The carotid blood flow and conductance changes were exclusively due to constriction of carotid arteriovenous anastomoses (capillary blood flow increased) and were accompanied by an increase in arterio-jugular venous oxygen saturation difference. Whereas prazosin (100 μg/kg, i.v.) was ineffective, rauwolscine (300 μg/kg, i.v.) attenuated the responses to S19014. The compound did not much affect the distribution of cardiac output to peripheral organs when compared with the vehicle group. Furthermore, S19014 only slightly contracted the human isolated coronary artery and its contractions, contrary to those of sumatriptan, were not increased in blood vessels precontracted with U46619. These results suggest that (i) the systemic and carotid vascular effects of S19014 are mainly mediated by α2-adrenoceptors, and (ii) S19014 could be effective in the treatment of migraine with an improved cardiovascular tolerance.
Lack of Interaction between a Polymorphism in the Dopamine D2 Receptor Gene and the Clinical Features of Migraine
Authors: Rebaudengo N , Rainero I , Parziale A , Rosina F , Pavanelli E , Rubino E , Mazza C , Ostacoli L , Furlan PM
Published: May 2004

The purpose of this study was to evaluate whether a particular genotype of the dopamine D2 receptor (DRD2) gene would affect the clinical features of migraine. In a group of 118 migraineurs (55 migraine with aura and 63 migraine without aura patients), we tested the association of the biallelic C/T NcoI DRD2 polymorphism with several characteristics of the disease. Genotype and allele frequencies resulted similarly distributed in migraine with aura and migraine without aura patients (χ2 = 1.58, P = 0.45 and χ2 = 0.09, P = 0.77, respectively). The different DRD2 genotypes (C/C, C/T and T/T) had no significant effects on age at onset of migraine, presence of premonitory phenomena, frequency of headache attacks, associated symptoms, psychological features and quality of life of our migraine patients. The results of our study do not support a role for the DRD2 gene in modifying the clinical features of migraine.
Attitudes and Burden of disease among Self-Considered Migraineurs — a Nation-wide Population-based Survey in Sweden
Authors: Linde M , Dahlöf C
Published: May 2004

The authors have earlier reported a 1-year prevalence of 13.2 ± 1.9% for migraine in Sweden. This is a subsequent extensive postal survey of the burden of disease and attitudes among migraineurs in a sample ( n = 423, 23% men and 77% women, aged 18-74 years) randomly recruited from all main regions of the country, representative of adults in the general Swedish population with self-considered migraine. Results are presented only from participants who after analysis of symptoms were found to fulfil the International Headache Society's migraine criteria. In order to assess headache duration open-mindedly, the strict time criterion 4-72 h was deliberately disregarded as an inclusion criterion. Individuals who did not consider themselves to have migraine were excluded. Less than half of the group (45%) had received a diagnosis of migraine from a physician. Accordingly, a large number of individuals that would not have come to attention in a clinic-based study have been included. The mean attack frequency was 1.3 per month, and the number of attacks per year in Swedish adults is approximately 10 million. A minority (27%) of sufferers have a majority (68%) of all attacks. The mean attack duration was 19 h. A considerable number of individuals reported attacks < 4 h (15.8%) or > 72 h (6.4%). Less than half of the individuals recovered completely between the attacks. Despite this, only every fourth (27%) participant was currently consulting a physician (6% regularly; 21% occasionally). Most of the migraineurs reported absence from school or work, a negative influence of migraine on the most important aspects of life, and an interest in testing other treatments for migraine during the last year. Of those ( n = 231) migraineurs who had consulted a physician, about 60% were satisfied with information given or treatment offered. This implies, however, that there is still room for improvement in the management of migraine in Sweden.
Telomere shortening in human fibroblasts is not dependent on the size of the telomeric‐3′‐overhang
Authors: Keys Barbara , Serra Violeta , Saretzki Gabriele , Von Zglinicki Thomas
Published: May 2004

Telomeres shorten in human somatic cells with each round of DNA replication, and this shortening is thought to ultimately trigger replicative senescence. Telomere shortening is caused partly by the inability of semiconservative DNA replication to copy a linear strand of DNA to its very end. Post‐replicative processing of telomeric ends, producing single‐stranded G‐rich 3′ overhangs, has also been suggested to contribute to telomere shortening. This suggestion implies that a positive correlation should exist between the length of 3′ overhangs and the rate of telomere shortening. We confirmed shortening of overhangs as human lung (MRC5) and foreskin (BJ) fibroblasts approach senescence by measuring overhang length using in‐gel hybridization. However, a large study of fibroblast strains from 21 donors maintained under conditions which lead to two orders of magnitude of variation in telomere shortening rate failed to show any correlation between telomere overhang length and shortening rate, suggesting that overhang length is neither a cause nor a correlate of telomere shortening.
Clinicopathological Aspects of 18 Kaposi's Sarcoma among 1055 Greek Renal Transplant Recipients
Authors: Zavos George , Bokos John , Papaconstantinou Ioannis , Boletis John , Gazouli Maria , Kakisis John , Zografidis Anastassios , Kostakis Alkiviadis
Published: May 2004

Abstract:  The incidence of Kaposi's sarcoma (KS) in transplant recipients is 400–500 times greater than that in the general population, and is rising within the transplant population. In this study, between March 1983 and December 2001, 1055 cases were recorded where KS developed in 18 patients (1.7%) who were treated with AZA + CsA + MP, MMF + CsA + MP, MMF + Tac + MP, CsA + MP, or AZA + MP therapy (AZA, azathioprine; CsA, cyclosporine A; MP, methylprednisolone; MMF, mycophenolate mofetil; Tac, Tacrolimus). In the present study, 18 renal transplant recipients who developed KS and were followed and analyzed. Analysis revealed that a continuous state of immunodeficiency is important for the development of KS. Prognosis in patients with KS limited to the skin is favorable, while visceral involvement is associated with high mortality. Transplant function is well preserved in most of the cases. The association, previously described, between human herpesvirus 8 (HHV8) and transplant‐associated KS also exists in the studied population.