bluuebunny/crossref_metadata_2025 huggingface dataset:
Healing: Analysis of the concept
Authors: Glaister Judy A
Published: March 2003

Healing, a concept familiar to many nurses has recently gained wide recognition and use in both professional and lay circles. In spite of the wide use and scrutiny of the term, the concept remains confusing and inexact. Lack of clarity in meaning leads to multiple definitions, communication problems and difficulties in measurement and theory development. Continued discussion and examination of healing and related concepts will help nurses more clearly define this important concept. The Walker and Avant method of concept analysis can be applied to the concept healing for exploring and clarifying its meaning. Healing, as defined here, is a natural, active and multidimensional process that is individually expressed with common patterns. Body condition, personal attitudes and relationships influence healing.
Lifestyle pattern change in males following percutaneous transluminal coronary angioplasty/intracoronary stenting
Authors: Eastwood Glenn M
Published: March 2003

Utilizing a naturalistic inquiry approach, a semi‐structured interview schedule and non‐probability purposive sampling, this study provided detail on the rationale and influences behind the decisions of four males participants to change or not change their lifestyle patterns 3 months after a percutaneous transluminal coronary angioplasty/intracoronary stent procedure. One of the participants made a noticeable lifestyle pattern change in this period. The remaining participants failed to exhibit any discernible lifestyle pattern change or had continued with their previous behaviours. Results suggest a new ‘positive’ psychological health perspective, family considerations, return‐to‐work issues and a reluctance to participate in cardiac rehabilitation as the major factors influencing lifestyle pattern change. Because nurses spend the greatest amount of time with percutaneous transluminal coronary angioplasty/intracoronary stent patients during hospitalization, they have the best opportunity to provide up‐to‐date and relevant information to patients that will enable them to then make decisions concerning cardiac healthy lifestyle changes.
Safety and comfort work of nurses glimpsed through patient narratives
Authors: Walker Annette Clare
Published: March 2003

The everyday work done by nurses in hospital has a taken‐for‐granted character, yet it has great significance for patient safety, comfort and satisfaction with care. Perceptions of how adequately this work is done have a bearing on the public image of, and the community’s confidence in, the professional nurse. A qualitative exploration of patients’ perceptions and experiences of comfort and discomfort provided glimpses of the safety and comfort work of nurses. This work was conceptualized as ‘anticipating, managing and limiting threat and vulnerability.’ Safety work, which is clearly intended to protect and to comfort, was generally recognizable to informants, but was at other times unobtrusive and puzzling. In addition, nurses’ work could take on a routine character, which was disconcerting and uncomfortable for informants. Nursing interventions described by informants as comforting were predominantly physical, psychological, emotional and social. Informants felt safe and comforted when their nurses knew what they were doing and seemed to care.
How does an implantable cardioverter defibrillator (ICD) affect the lives of patients and their families?
Authors: Eckert Marion , Jones Tina
Published: March 2003

This study aimed to identify the lived experience of patients with implantable cardioverter defibrillators (ICD) and their families. The methodology used was interpretative phenomenology. Unstructured interviews were conducted with three family members and three ICD recipients. Using a methodological approach outlined by van Manen, the participants transcribed texts were analysed looking for similar concepts and ideas that developed into themes that explicated the meaning of this phenomena. The themes that emerged were: dependence, which encompassed their perceptions about the life‐saving device; the memory of their first defibrillation experience; lifestyle changes, which incorporated modification techniques; lack of control, which highlighted feelings such as fear, anxiety and powerlessness; mind game, which illustrated psychological challenges; and the issue of security, demonstrating how ‘being there’ and not ‘being there’ impacted on their everyday lives. The long‐term outcomes of living with an ICD are important considerations for all health‐care providers. This research highlights the everyday activities of recipients, the lifestyle changes they have made, the emotional significance of the device and the psychological coping strategies that the participants have adopted. The findings of this research will allow health‐care professionals to be better prepared to provide education and support for ICD recipients and their families in regards to issues related to insertion of the device during the postinsertion recovery period and for long‐term management after hospital discharge.
Older patients’ first 72 hours in hospital
Authors: Lyytinen Hannele , Liippo Tiina , Routasalo Pirkko , Arve Seija
Published: March 2003

The aim of this study was to determine what kind of care older patients receive in hospital during the first 72 h after admission. This was examined through four categories: patient's arrival on the hospital ward; patient's daily schedule on the ward; information and guidance; and interaction during the hospital stay. The focus was on five patients aged over 70 who had been admitted for prescribed examinations and care, including starting insulin medication, colonoscopy and a computed tomography scan of the colon. The data were collected by means of non‐participant observation; interpretation was based on the method of content analysis. The results showed that the patients’ arrival on the ward consisted of routine procedures and periods of waiting. The patients’ daily schedule was determined by the ward's routines. They had very little control or influence over their own care, and limited privacy. Interaction between the patient and personnel was minimal, and lasted for only short periods of time. Patients were important sources of information for one another. There was also good cooperation among patients, helping one another to cope with minor everyday problems. It is concluded that nursing staff on the ward were preoccupied by their own routines and largely failed to take into account the views of their patients.
Motivation as a crucial predictor of good compliance in adolescents with rheumatoid arthritis
Authors: Kyngäs Helvi
Published: March 2003

The purpose of this study was to identify the predictors of compliance shown by adolescents with juvenile rheumatoid arthritis (JRA). Three hundred individuals aged 13–17 years were randomly selected from the Finnish Social Insurance Institution's register. The questionnaires were sent to the adolescents selected from the register to be returned directly to the researcher in a self‐addressed envelope. Ninety‐one per cent (n = 274) returned the questionnaire. Logistic regression was used to find the factors that predicted compliance with health regimens. The compliance of adolescents with JRA was predicted on the basis of motivation, fear of acute problems, support from nurses, energy and willpower, and threat to social well‐being. The most powerful predictor was motivation. The likelihood of the adolescents who had good motivation to comply with health regimens was 29.13‐fold compared to the adolescents who did not have good motivation. The next powerful predictor was fear of acute problems. The adolescents who felt fear of acute problems complied with health regimens with a 20.35‐fold likelihood compared to the adolescents who did not have fears. The third powerful predictor was support from nurses. The likelihood of adolescents supported by nurse to comply with health regimens was 17.03‐fold compared to the adolescents who did not receive support from nurses. The likelihood of adolescents who had energy and willpower to comply with health regimens was 7.56‐fold compared to the adolescents who did not have energy and willpower. Also, the threat to social well‐being predicted good compliance.
Zircon U–Pb sensitive high mass‐resolution ion microprobe dating of granitoids in the Ryoke metamorphic belt, Kinki District, Southwest Japan
Authors: Watanabe Teruo , Ireland Trevor , Tainosho Yoshiaki , Nakai Yutaka
Published: March 2003

Abstract Zircon U–Pb sensitive high mass‐resolution ion microprobe dating was carried out on three types of granitic rock (gneissose biotite granodiorite, biotite granite and two‐mica granite) from the Cretaceous Ryoke belt of the Kinki district, Southwest Japan. The results give the ages of granitic magmatism in the Shigi‐san area of between 87 and 78 Ma and suggest extensive melting of the Cretaceous Ryoke granitic crust to form the two‐mica granite, probably at ca 80 Ma. Discrimination into older and younger granites based on development of gneissosity does not appear to represent the sequence of magma generation, although there is some scope in the interpretation of the zircon U–Pb data that would allow all three granites to form at 83 Ma. Compilation of chemical Th‐U‐total Pb isochron dating method ages, whole rock Rb–Sr isotope ages and U–Pb isotope ages indicates that most Ryoke plutonism occurred from ca 70 Ma to ca 100 Ma. Younger (85 Ma–70 Ma) plutonism with the formation of two‐mica granite occurred only in the eastern sector of the Ryoke belt, including the Kinki District.
Gastro‐oesophageal reflux in infancy
Authors: Badriul Hegar , Vandenplas Yvan
Published: March 2003

Gastro‐oesophageal reflux (GOR) is a common phenomenon in infants, which may occur with or without accompanying symptoms. Although most infants presenting with regurgitation have a normal physical examination, it is now recognized that infants may also present with a wide variety of symptoms. Oesophagitis is associated with increased oesophageal acid exposure. The determination of cause and effect is difficult, as there are many aspects of reflux disease where cause and effect relationships are cyclic. Reflux disease is present when there is an imbalance between a number of factors that can contribute to a decrease, as well as an increase, of GOR. Oesophageal pH monitoring with a semi‐disposable monocrysant antimony pH catheter with three sensors is very good at documenting oesophageal acidification and gastric buffering and, therefore, quantifies acid reflux frequency and duration. However, the interpretation of the data is complex as they are influenced by numerous factors, such as position, activity (sleep, crying), feeding (frequency and composition) or medication. The duration of buffering of gastric acidity during pH monitoring might, in the future, appear to be a relevant factor in the interpretation of oesophageal pH data.
Anticoagulant therapy, anti‐platelet agents and gastrointestinal endoscopy
Authors: Miller Ashley , Mcgill Darryl , Bassett Mark
Published: March 2003

Background: The increasing use of anticoagulant therapy and anti‐platelet agents in the primary and secondary prevention of cardiovascular, cerebrovascular and venous thromboembolic disease has increased the need for guidelines for managing these agents prior to gastrointestinal endoscopy, particularly if therapeutic manoeuvres are required. The continuation of anticoagulant therapy increases the risk of haemorrhagic complications of gastrointestinal endoscopy. Temporary suspension of anticoagulant therapy exposes the patient to the risk of thromboembolism associated with the underlying condition requiring anticoagulant treatment.

Conclusions: This article reviews the literature and proposes guidelines for the management of patients taking anticoagulant and anti‐platelet agents who require gastrointestinal endoscopy.
CASE REPORT: Effect of venesection on bone mineral density in an eugonadal woman with haemochromatosis
Authors: Hibbert EJ , Fulcher GR , Coyle L , Gates F , Clifton‐Bligh P , Stiel D
Published: March 2003

Background: A 41‐year‐old premenopausal woman with newly diagnosed haemochromatosis was found to have osteopenia on screening bone mineral densitometry.

Methods and Results: Liver biopsy showed grade 3 haemochromatosis with an hepatic iron index of 4. Investigation for secondary factors for osteopenia revealed no cause. The patient was clinically and biochemically eugonadal. Following venesection of 8 L blood (4 g iron) over 17 months and calcium supplementation, her bone density rose significantly. Neck of femur bone density increased by 6.0% over 13 months and lumbar vertebral bone density increased by 7.2%. There are no previous reports of response of bone density to venesection in eugonadal patients or in women with haemochromatosis.
Progressive familial intrahepatic cholestasis
Authors: Jacquemin Emmanuel
Published: March 2003

Abstract Progressive familial intrahepatic cholestasis (PFIC), also known as Byler disease, is an inherited disorder of childhood in which cholestasis of hepatocellular origin often presents in the neonatal period and leads to death from liver failure before adolescence. The pattern of appearance of affected children within families is consistent with autosomal recessive inheritance. Several studies have provided support for the heterogeneity of this clinical entity suggesting the existence of different types due to different disorders affecting the hepatocyte and related to defects of bile acid secretion or bile acid metabolism. Recent molecular and genetic studies have identified genes responsible for three types of PFIC and have shown that PFIC was related to mutations in hepatocellular transport system genes involved in bile formation. These findings now provide specific diagnostic tools for the investigation of children with PFIC and should allow prenatal diagnosis in the future. Genotype–phenotype correlations performed in patients treated with ursodeoxycholic acid or biliary diversion should allow those PFIC patients who could benefit from these therapies to be precisely identified. In the future, other therapies, such as cell and gene therapies, might be considered and could also represent an alternative to liver transplantation.

© 1999 Blackwell Science Asia Pty Ltd
Coincident increase in periportal expression of iron proteins in the iron‐loaded rat liver
Authors: Basclain Kerrie , Jeffrey Gary
Published: March 2003

Background: The liver is the major iron storage organ in the body and, as a result, total body iron stores closely regulate hepatocyte iron uptake, storage and release. Transferrin, transferrin receptor and ferritin facilitate these processes.

Methods: Expression of the three proteins was localized by immunohistochemistry and in situ hybridization on normal, iron‐loaded and iron‐deficient rat livers. Gel shift assays were used to determine iron regulatory protein (IRP) binding activity.

Results: In the normal rat liver, all three proteins and mRNA were evenly distributed throughout the hepatic lobule. In iron‐loaded liver, increased iron stores were found in a periportal distribution, coinciding with increased periportal protein levels of each protein. Periportal transferrin and ferritin mRNA levels were also increased. Hepatic transferrin and transferrin receptor expression was increased in iron deficiency compared with controls; however, despite no change in ferritin mRNA levels being found, ferritin protein was not detected. Hepatic IRP2 binding activity was decreased in iron loading and increased in iron deficiency.

Conclusion: The combined findings of this study were that, in the dietary iron‐loaded rat model, increased iron stores were localized to periportal hepatocytes and that these same hepatocytes also had increased ferritin, transferrin receptor and transferrin protein expression. This response suggests that additional, non‐IRP control mechanisms may be involved in the regulation or stability of these proteins. In iron deficiency the inverse post‐transcriptional regulation of ferritin and transferrin receptor was consistent with IRP regulation.
Peptic ulcer and gastritis in uraemia, with particular reference to the effect of Helicobacter pylori infection
Authors: Kang Jy , Ho Ky , Yeoh Kg , Guan R , Wee A , Lee E , Lye Wc , Leong So , Tan Cc
Published: March 2003

Aims
: To determine: (i) the prevalence of histological gastritis and peptic ulcer; and (ii) the clinical features of peptic ulcer, in patients with end‐stage renal failure.

Methods
: Upper endoscopy was performed by a single observer in 268 patients with end‐stage renal failure over a 6‐year period. Gastric histology and Helicobacter pylori status were studied in 40 consecutive subjects in whom there were no contraindications for gastric biopsy and who had not used antibacterial drugs in the preceding 4 weeks. As there are only limited data for healthy volunteers in Singapore, 33 age‐, sex‐ and race‐matched patients with functional dyspepsia from an earlier drug trial and 18 healthy volunteers who were not age‐matched were used as controls. The clinical features of 43 consecutive uraemic patients with peptic ulcer were compared with those of 118 consecutive non‐uraemic peptic ulcer patients seen by the same author.

Results
: Among uraemic patients, histological gastritis was less common, compared with healthy volunteers and functional dyspepsia patients. Helicobacter pylori infection as assessed by histology was also less common among uraemic patients compared with functional dyspepsia patients, but the difference was not statistically significant on serological assessment. Uraemic patients with ulcer had an equal sex ratio, in contrast to a male preponderance among peptic ulcer patients with normal renal function. Uraemic patients with ulcer were more likely to be pain‐free, to present with haemorrhage, to have multiple ulcers and postbulbar duodenal ulcers, but were less likely to have H. pylori infection. Among uraemic subjects, the prevalence of H. pylori infection was similar whether or not peptic ulcer was present.

Conclusions
: The prevalence of histological gastritis was lower in uraemic patients when compared with patients with functional dyspepsia and healthy volunteers. Peptic ulcers in uraemic subjects have different clinical characteristics from peptic ulcer in non‐uraemic subjects.
Gastric juice ascorbic acid is related to Helicobacter pylori infection but not ethnicity
Authors: Fraser Alan G , Woollard Gerald A
Published: March 2003

Background
: Maori and Pacific Island ethnic groups in New Zealand have a high risk for gastric cancer. Low levels of gastric juice ascorbic acid (vitamin C) have been suggested to be a risk factor for gastric cancer. Previous studies have shown that gastric juice ascorbic acid may be independently associated with both ethnicity and Helicobacter pylori infection. This study aimed to examine the interrelationship between H. pylori and ethnicity in New Zealand.

Methods
: Gastric juice was collected into 70% perchloric acid preservative and stored at –80°C. Ascorbic acid was analysed by high‐performance liquid chromatography using ion‐pair chromatography and electrochemical detection. Inflammation and atrophy was graded from biopsies from multiple sites in the antrum and body. Gastric juice was collected from 89 patients during routine endoscopy.

Results
: There was a wide range of measured gastric juice ascorbic acid from 0.001 to 410 μg/mL. The median concentration of ascorbic acid for H. pylori‐negative patients was 1.78 μg/mL (n = 57) and 0.12 μg/mL (n = 32) for H. pylori‐positive patients (P = 0.001). Gastric juice ascorbic acid concentration was not associated with age, endoscopic diagnosis or intestinal metaplasia, but was significantly associated with the degree of acute inflammation (P = 0.01) and the presence of atrophy (P = 0.04). The median ascorbic acid concentration for European patients was 0.92 μg/mL (n = 44) and 0.09 μg/mL (n = 38) for Maori and Pacific Island ethnic groups combined (P = 0.1). Multiple step‐wise regression analysis showed that only H. pylori infection was a significant factor for predicting ascorbic acid concentrations (r2 = 0.12).

Conclusions
: This study has confirmed that gastric juice ascorbic acid concentration is lower in the presence of H. pylori infection.

© 1999 Blackwell Science Asia Pty Ltd
Congenital hepatic fibrosis in Indian children
Authors: Poddar Ujjal , Thapa Babur R , Vashishta Rakesh K , Girish Chakkodbail S , Singh Kartar
Published: March 2003

Background
: Congenital hepatic fibrosis (CHF) is an uncommon cause of portal hypertension in children. So far, there is no report of this from the subcontinent. We have studied the clinical spectrum of CHF in North Indian children.

Methods
: Fifteen children were diagnosed with CHF on the basis of their liver histology over a period of 6.5 years. Their clinical details were recorded. Oesophagogastroduodenoscopy and abdominal ultrasonography were performed in all cases. All siblings were examined clinically; and ultrasonography, endoscopy and liver biopsy were performed if there was firm hepatomegaly. Children with variceal bleeding were managed by endoscopic sclerotherapy. The median age of these children was 8 years with a male to female ratio of 1.5:1.

Results
: Only one sibling (of 33) was diagnosed as having CHF. The predominant presentations were variceal bleeding in six, abdominal distension in seven and incidental detection of organomegaly in two. Hepatomegaly was present in all patients and splenomegaly in all but one. Liver function and renal function tests were normal in all children, except for a raised serum alkaline phosphatase in six. Two children had associated renal cysts, two had choledochal cysts, one each had Caroli’s disease and biliary atresia and two children had portal vein thrombosis. Variceal obliteration was achieved in five children after an average 4.8 sclerotherapy sessions and one required a mesocaval shunt. On follow up (median 41 months, range 1–80 months) all are doing well.

Conclusions
: Congenital hepatic fibrosis is mainly sporadic in India and associated renal lesions are uncommon. Endoscopic sclerotherapy is effective in controlling variceal bleed and the prognosis is universally good in the absence of renal diseases.

© 1999 Blackwell Science Asia Pty Ltd
Hepatocyte growth factor/scatter factor enhances the thrombopoietin mRNA expression in rat hepatocytes and cirrhotic rat livers
Authors: Yamashita Kiyoshi , Matsuoka Hitoshi , Ochiai Toshimasa , Matsushita Ryuji , Kubuki Youko , Suzuki Muneou , Tsubouchi Hirohito
Published: March 2003

Background: Although thrombopoietin (TPO) is mainly produced in the liver, the regulatory mechanism ofTPOgene expression in hepatocytes remains unclear. The role of TPO in thrombocytopenia associated with liver cirrhosis has not been identified.

Methods: We examined the effects of various growth factors and cytokines on TPO mRNA expression in adult rat hepatocytes in primary cultures using a semiquantitative reverse transcription‐polymerase chain reaction assay.

Results: Among them, only hepatocyte growth factor/scatter factor (HGF/SF) enhanced TPO mRNA expression; other growth factors (epidermal growth factor and transforming growth factor‐β) and cytokines (erythropoietin, granulocyte‐colony stimulating factor, granulocyte‐macrophage‐colony stimulating factor, interleukin (IL)‐3, IL‐6 and interferon‐γ) did not. Next, we examined TPO mRNA expression in the livers of rats with CCl4‐induced cirrhosis, the effects of HGF/SF on hepatic TPO mRNA expression and peripheral platelet and bone marrow megakaryocyte counts in the cirrhotic rats. In the cirrhotic rats, both the peripheral platelet count and TPO mRNA expression in the livers were markedly decreased compared with those of the normal rats. The administration of HGF/SF to the cirrhotic rats stimulated TPO mRNA expression in the livers and resulted in significant increases of peripheral platelets and bone marrow megakaryocytes.

Conclusions: These results suggest that HGF/SF is a possible regulatory factor for TPO gene expression and that HGF/SF increases platelet production through an enhancement of TPO mRNA expression in the livers of cirrhotic rats.
Apoptosis in the intestinal epithelium: Its relevance in normal and pathophysiological conditions
Authors: Ramachandran Anup , Madesh Muniswamy , Balasubramanian Kunissery A
Published: March 2003

Apoptosis is now recognized as an important process responsible for maintenance of the cellular balance between proliferation and death. Apoptosis is distinct from necrosis in that it is a programmed form of cell death and occurs without any accompanying inflammation. This form of cell death can be induced by a wide range of cellular signals, which leads to activation of cell death machinery within the cell and is characterized by distinct morphological changes. Apoptosis is especially relevant in the gastrointestinal tract, as the mammalian intestinal mucosa undergoes a process of continual cell turnover that is essential for maintenance of normal function. Cell proliferation is confined to the crypts, while differentiation occurs during a rapid, orderly migration up to the villus. The differentiated enterocytes, which make up the majority of the cells, then undergo a process of programmed cell death (apoptosis). Although apoptosis is essential for the maintenance of normal gut epithelial function, dysregulated apoptosis is seen in a number of pathological conditions in the gastrointestinal tract. The cellular mechanisms regulating this tightly regimented process have not been clearly defined and this topic represents an area of active investigation as delineation of this process will lead to a better understanding of normal gut mucosal growth.
Amino acid substitutions in codons 9–11 of hepatitis C virus core protein lead to the synthesis of a short core protein product
Authors: Yeh Chau‐Ting , Lo Shih‐Yen , Dai Dar‐In , Tang Jui‐Hsiang , Chu Chia‐Ming , Liaw Yun‐Fan
Published: March 2003

Background
: Previous in vitro experiments have indicated that if the ninth codon of the hepatitis C virus (HCV) core gene is mutated from arginine to lysine, a short 16‐kDa (P16) instead of a 21‐kDa (P21) core protein will be produced. In this study, we aimed to investigate whether similar mutations existed in patients with chronic HCV infection and whether such mutations led to the expression of P16.

Methods
: The core gene was isolated from patients’ sera by reverse transcription–polymerase chain reaction and sequenced.

Results
: Three of 10 patients with hepatocellular carcinoma were found to have mutant viruses with missense mutations at codons 9–11: arginine‐to‐glycine mutation at codon 9 (case 1); lysine‐to‐glutamine mutation at codon 10 (case 5); and lysine‐to‐asparagine/threonine‐to‐alanine double mutations at codons 10 and 11 (case 8). Site‐directed mutagenesis and in vitro translation experiments revealed that P16 was expressed by all three mutants. Using gel‐purified P21 and P16 proteins obtained from transformed Escherichia coli, the serum titres of anti‐P21 and anti‐P16 were assayed. Unequal titres of anti‐P16 and anti‐P21 were found in only cases 1, 5 and 8. A rabbit antibody directed against P16 but not P21 was thus generated for immunohistochemical analysis. P16 was detected in the nuclei of hepatocytes in the peri‐hepatoma tissue of a single case (case 1).

Conclusions
: These data indicate that missense mutations at codons 9–11 can occur during chronic HCV infection, which results in the expression of P16 core protein.
Pathophysiology of the intrahepatic biliary epithelium
Authors: Strazzabosco Mario , Spirlì Carlo , Okolicsanyi Lajos
Published: March 2003

The intrahepatic bile duct epithelium modulates the fluidity and alkalinity of the primary hepatocellular bile from which it reabsorbs fluids, amino acids, glucose and bile acids, while secreting water, electrolytes and immunoglobulin A. The transport function of the intrahepatic biliary epithelium is finely regulated by a number of gastrointestinal hormones, neuropeptides and neurotransmitters that promote either secretion or absorption. The intrahepatic biliary epithelium appears to be a primary target in a broad group of chronic cholestatic disorders that represent an important cause of morbidity and mortality. The spectrum of cholangiopathies ranges from conditions in which a normal epithelium is damaged by disordered autoimmunity, infectious agents, toxic compounds or ischaemia, to genetically determined disorders arising from an abnormal bile duct biology, such as cystic fibrosis or biliary atresia. Probably as a result of the known heterogeneity in cholangiocyte function, different portions of the biliary tree appear to be preferentially affected in specific cholangiopathies. From a pathophysiological point of view, cholangiopathies are characterized by the coexistence of cholangiocyte loss (by apoptotic or lytic cell death) with cholangiocyte proliferation and various degrees of portal inflammation, fibrosis and cholestasis. These basic disease mechanisms are discussed in detail. Better understanding of cholangiocyte pathophysiology, in particular the immune regulation of cholangiocyte function, will help in designing newer genetic or pharmacological approaches to treat cholangiopathies.

© 2000 Blackwell Science Asia Pty Ltd
Dysphagia after prophylactic endoscopic injection sclerotherapy for oesophageal varices: Not fatal but a distressing complication
Authors: Nozoe Tadahiro , Matsumata Takashi , Sugimachi Keizo
Published: March 2003

Background
: Although dysphagia resulting from oesophageal strictures induced by endoscopic injection sclerotherapy (EIS) is not a fatal complication, it is often quite distressing for the patients. The aim of the current study was to clarify the relationship between dysphagia resulting from oesophageal stricture following prophylactic EIS and the volume of sclerosant consumed in the EIS series.

Methods
: Fifty‐two patients with oesophageal varices, who had been treated by prophylactic EIS, were selected as the subjects.

Results
: Seventeen (32.7%) patients developed dysphagia following prophylactic EIS, and five patients with a severe stricture required bougie dilatation to take meals. The volume of sclerosant used in the initial session of EIS for patients with subsequent dysphagia (24.9 ± 4.0 mL) was significantly larger than that for patients without dysphagia (18.4 ± 5.1 mL; P < 0.001). The mean volume of sclerosant consumed per session during the EIS series for patients with dysphagia (16.5 ± 3.0 mL) was also significantly larger than that for patients without dysphagia (13.1 ± 3.8 mL; P < 0.01).

Conclusions
: The injection of a superfluous amount of sclerosant in prophylactic EIS brings about distressing dysphagia with oesophageal stricture in the patients with oesophageal varices who had no such complaint or symptoms before the therapy.

© 2000 Blackwell Science Asia Pty Ltd
Helicobacter pylori infection and gastric carcinoma in animal models
Authors: Fujioka Toshio , Honda Shoji , Tokieda Masashi
Published: March 2003

Many epidemiological studies have shown a strong association between chronic Helicobacter pylori infection and the subsequent development of gastric carcinoma in humans. To confirm this link more clearly, it is necessary to use this bacterium in experimental studies to develop gastric carcinoma in suitable experimental animals. Persistent H. pylori infection has recently been achieved in the Mongolian gerbil model, with results demonstrating that the sequential histopathological changes in the gastric mucosa closely mimic the gastric mucosal changes caused by H. pylori infection in humans. These studies have demonstrated that H. pylori infection enhances gastric carcinogenesis in combination with known carcinogens, such as N‐methyl‐N‐nitroso‐urea and N‐methyl‐N‐nitro‐N′‐nitrosoguanidine and have also demonstrated that H. pylori infection alone can result in the development of gastric carcinoma. These important results provide a starting point for further studies to clarify the mechanism of gastric carcinogenesis as a result of H. pylori infection and assist the planning of eradication therapy to prevent gastric carcinoma.
Wilson’s disease with superimposed autoimmune features: Report of two cases and review
Authors: Milkiewicz Piotr , Saksena Sushma , Hubscher Stefan G. , Elias Elwyn
Published: March 2003

We describe two females, 15 and 23 years old, respectively, who presented with classical features of Wilson’s disease (WD) and several features of autoimmune hepatitis (AIH). The first patient was initially diagnosed as AIH and treated with prednisolone which caused clinical improvement, with an increase of serum albumin from 22 to 30 g/L, and a decrease of aspartate aminotransferase from 103 to 47 U/L. Subsequent diagnosis of WD and introduction of penicillamine gave excellent improvement and complete normalization of liver function tests. The second patient, at first also diagnosed as having AIH, was treated with steroids and azathioprine with initial improvement, but subsequent deterioration. The diagnosis of WD was made 2 years after initial diagnosis of AIH, as the patient reached end‐stage liver disease and required a transplant. Therefore, d‐penicillamine treatment was not attempted. We conclude that, in patients with AIH, a thorough screening for WD is necessary, particularly when the response to steroid therapy is poor. Conversely, in patients suffering from WD with superimposed features of AIH, a combination of steroids and penicillamine may be of benefit.
Renovascular resistance assessed by color Doppler ultrasonography in patients with chronic liver diseases
Authors: Koda Masahiko , Murawaki Yoshikazu , Kawasaki Hironaka
Published: March 2003

Background and Aims

Renal arterial vasoconstriction is known to be related to renal hemodynamic derangement in patients with liver cirrhosis. Using color Doppler ultrasonography in patients with chronic liver diseases, abnormal resistance in the renal artery was examined non‐invasively both cross‐sectionally and longitudinally to clarify the relationship between renal vascular resistance and liver function to neurohumoral factors.

Methods

The study comprised 118 patients with cirrhosis, 23 patients with chronic hepatitis, and 35 healthy controls. Pulsatility and resistive indices that were derived from renal artery velocity analysis were used as parameters of renal arterial resistance.

Results

Both the pulsatility and resistive indices were significantly higher in cirrhotic patients (1.29 ± 0.37, P < 0.001 and 0.69 ± 0.07, P < 0.001, respectively) compared to controls (1.00 ± 0.12 and 0.62 ± 0.05, respectively) and compared to patients with chronic hepatitis (0.97 ± 0.13 and 0.60 ± 0.05, respectively). Both indices showed significant correlation with increased Child–Pugh grade. Each correlated significantly with plasma renin activity and plasma aldosterone and norepinephrine levels. Multivariate analysis of the relationship between neurohumoral factors and renal arterial resistance disclosed that plasma renin activity was a significant independent predictor. The longitudinal change in pulsatility index, resistive index and neurohumoral factors were examined in the cirrhotic patients who were followed‐up for longer than 6 months. Pulsatility and resistive indices increased according to the deterioration of liver function and the changes in both indices were closely related to the change in plasma renin activity.

Conclusions

Pulsatility index and resistive index as measured by color Doppler ultrasonography were closely related to the severity of cirrhosis and to the levels of neurohumoral factors, especially plasma renin activity, in this cross‐sectional and longitudinal study. Therefore, they are useful indices for assessing renal hemodynamics in patients with cirrhosis.
Molecular therapy with recombinant antisense c‐myc adenovirus for human gastric carcinoma cells in vitro and in vivo1,2
Authors: Chen Jie‐Ping , Lin Chen , Xu Cai‐Pu , Zhang Xue‐Yan , Fu Ming , Deng You‐Ping , Wei Yue , Wu Ming
Published: March 2003

Abstract Background and Aims: This study used a recombinant antisense c‐myc adenovirus (Ad‐ASc‐myc) to evaluate how alterations of c‐myc expression in the SGC7901 human gastric carcinoma cells could influence the proliferation, apoptosis and the growth of human gastric tumors in nude mice.

Methods: The human gastric carcinoma cell line, SGC7901, treated with Ad‐ASc‐myc or adenovirus recombinants carrying LacZ gene (Ad‐LacZ) were analyzed by using X‐gal stain, MTT, DNA ladder, TUNEL assay, flow cytometric analysis, polymerase chain reaction and western blot in vitro. The tumorigenicity and experimental therapy in nude mice models were assessed in vivo.

Results: The Ad‐ASc‐myc could strongly inhibit cell growth and induce apoptosis in SGC7901 cells. The proliferation of the Ad‐ASc‐myc‐infected SGC7901 cells was reduced by 44.1%. The mechanism of killing gastric carcinoma cells by Ad‐ASc‐myc was found to be apoptosis, which was detected by the use of a DNA ladder, TUNEL and flow cytometric analysis. Infection of Ad‐ASc‐myc in nude mice showed that all three mice failed to form tumors from the 7 to 30 day period, compared with injection of Ad‐LacZ and parent SGC7901 cells. Experimental therapy on the nude mice bearing subcutaneous tumors of SGC7901 cells showed that intratumor instillation of Ad‐ASc‐myc inhibited the growth of the tumors. Recombinant antisense c‐myc adenovirus‐treated tumors were inhibited by 68.9%, compared with tumors injected with Ad‐LacZ and control (LacZ and phosphate‐buffered saline).

Conclusion: The expression of Ad‐ASc‐myc can inhibit growth and induce apoptosis of gastric cancer cells in vitro and in vivo and thus is a potential clinical utility in gene therapy for the treatment of gastric carcinoma.
Portal hypertensive response to bradykinin in inflamed or cirrhotic rat livers is mediated by B2‐type receptors
Authors: Loureiro‐Silva MaurÍcio R , Molina HercÍlia M , Borges Durval R
Published: March 2003

Background: We have shown that the portal hypertensive response to bradykinin in normal rats is mediated by B2 receptors.

Methods: By using isolated and exsanguinated rat liver perfusion, we studied the portal hypertensive response to bradykinin or des‐Arg9‐bradykinin (B1 agonist) in inflamed or cirrhotic rat livers. Livers were perfused with bovine serum albumin Krebs–Henseleit buffer (pH 7.4; 37°C) at a constant flow rate, in the absence or presence of des‐Arg9[Leu8]‐bradykinin or HOE 140 (B1 and B2 receptor antagonists, respectively). Bradykinin (140 nmol) or des‐Arg9‐bradykinin was injected as a bolus via the afferent route to the liver.

Results: Basal perfusion pressure in liver‐cirrhotic rats was higher than in normal rats. In normal, inflamed, or liver‐cirrhotic rats, the presence of the B1 antagonist did not change the portal hypertensive response to bradykinin, while the B2 antagonist abolished this response. A 140‐nmol dose of des‐Arg9‐bradykinin did not change the perfusion pressure; 700 nmol of this B1 agonist produced an insignificant perfusion pressure increase. The perfusion pressure increase induced by bradykinin in cirrhotic livers was lower than in normal livers.

Conclusions: The portal hypertensive response to bradykinin in inflamed or cirrhotic rat livers is mediated by B2 receptors, but not B1 receptors, and there is a contracting hyporeactivity to bradykinin in cirrhotic rat livers.
Strategy for retreatment of therapeutic failure of eradication of Helicobacter pylori infection
Authors: Nagahara Akihito , Miwa Hiroto , Ohkura Ryuichi , Yamada Toshio , Sato Kenji , Hojo Mariko , Sato Nobuhiro
Published: March 2003

Background and Aim:

A proton pump inhibitor (PPI)‐based triple therapy consisting of a PPI, amoxicillin (A) and clarithromycin (C) or metronidazole (M) provides an eradication rate ranging from 80 to 90%. However, there have been few controlled studies with regard to the most effective regimen to re‐treat patients after failure of the first‐line therapy. Accordingly, we retrospectively reviewed our experiences and compared regimens with different combinations of antimicrobials to determine the optimal retreatment regimen.

Methods:

Out of 133 patients who had received second‐line therapy after failure of first‐line PPI/AC therapy, we selected, for review, patients who took the prescribed drugs for first‐line therapy equal to, or more than 80%. As a result, data on 114 patients (83 males and 31 females; mean age 49.1 ± 13.0 years; peptic ulcer n = 89; non‐ulcer dyspepsia, n = 25) were eligible for evaluation. They had either repeated the PPI/AC regimen (n = 34; 5–14 days), or had been administered the PPI/AM regimen (n = 80; 10 days). The cure rates of the two regimens were compared.

Results:

The eradication rates for second‐line therapy with the PPI/AC regimen versus the PPI/AM regimen were 52.9% (95% CI, 35–70) versus 81.3% (95% CI, 71–89) by intention‐to‐treat analysis (P < 0.01), and 62.1% (95% CI, 42–79) versus 91.4% (95% CI, 81–97) by per‐protocol analysis (P < 0.01).

Conclusion:

The eradication rate for the PPI/AM retreatment regimen was significantly higher than for the repeated PPI/AC regimen, suggesting that a 10‐day PPI/AM regimen can be recommended as a retreatment regimen for patients who had first‐line eradication therapy by PPI/AC regimens.
Physiological small bowel malabsorption of carbohydrates protects against large bowel diseases in Africans
Authors: SEGAL ISIDOR
Published: March 2003

Abstract In African black people there is a paucity of ‘developed society’ large bowel diseases such as diverticular disease, colorectal adenomas and carcinomas, ulcerative colitis and Crohn’s disease. Appendicitis has an incidence of about 5–10% of the number likely to be observed in a white population. The conundrum is that the disparity exists despite many Africans having adopted an urbanized lifestyle with major changes in their dietary pattern. Dietary fiber intake, which was previously 30–35 g, has decreased to 12–14 g daily. Studies on small bowel function in black people have shown that physiological malabsorption of lactose, fructose, sucrose and maize (the staple food) occurs. It is hypothesized that the increased concentration of substrate available for fermentation in the colon compensates for the low dietary fiber intake, is protective to the large bowel and is a factor in the prevention of ‘developed society’ large bowel diseases in the African population.

© 2002 Blackwell Science Asia Pty Ltd
Escherichia coli as a cause of diarrhea
Authors: Robins‐Browne Roy M , Hartland Elizabeth L
Published: March 2003

Abstract 
Escherichia coli is the best‐known member of the normal microbiota of the human intestine and a versatile gastrointestinal pathogen. The varieties of E. coli that cause diarrhea are classified into named pathotypes, including enterotoxigenic, enteroinvasive, enteropathogenic and enterohemorrhagic E. coli. Individual strains of each pathotype possess a distinct set of virulence‐associated characteristics that determine the clinical, pathological and epidemiological features of the diseases they cause. In the present brief review, we summarize the key distinguishing features of the major pathotypes of diarrheagenic E. coli. Knowledge of the pathogenic mechanisms of these bacteria has led to the development of rational interventions for the treatment and prevention of E. coli‐induced diarrhea. In addition, investigations into E. coli virulence are providing useful insights into the origins and evolution of bacterial pathogens more generally.

© 2002 Blackwell Publishing Asia Pty Ltd
Apoptosis and cell proliferation in the development of gastric carcinomas: Associations with c‐myc and p53 protein expression
Authors: Ishii Hideaki H , Gobé Glenda C , Pan Wenshen , Yoneyama Juichi , Ebihara Yoshiro
Published: March 2003

Background and Aim:
Patients with gastric carcinomas have a poor prognosis and low survival rates. The aim of the present paper was to characterize cellular and molecular properties to provide insight into aspects of tumor progression in early compared with advanced gastric cancers.

Methods:
One hundred and nine graded gastric carcinomas (early or advanced stage, undifferentiated or differentiated type) with paired non‐cancer tissue were studied to define the correlation between apoptosis (morphology, terminal deoxyribonucleotidyl transferase‐mediated dUTP–digoxigenin nick end‐labeling), cell proliferation (Ki‐67 expression, morphology) and expression and localization of two proteins frequently having altered expression in cancers, namely p53 and c‐myc.

Results:
Overall, apoptosis was lower in early stage, differentiated and undifferentiated gastric carcinomas compared with advanced‐stage cancers. Cell proliferation was comparatively high in all stages. There was a high level of p53 positivity in all stages. Only the early‐ and advanced‐stage undifferentiated cancers that were p53 positive had a significantly higher level of apoptosis (P < 0.05). Cell proliferation was significantly greater (P < 0.05) only in the early undifferentiated cancers that had either c‐myc or p53‐positivity.

Conclusions:
The results indicate that low apoptosis and high cell proliferation combine to drive gastric cancer development. The molecular controls for high cell proliferation of the early stage undifferentiated gastric cancers involve overexpression of both p53 and c‐myc. Overexpression of p53 may also control cancer development in that its expression is associated with higher levels of apoptosis in early and late‐stage undifferentiated, cancers.

© 2002 Blackwell Publishing Asia Pty Ltd
Hepatitis C risk factors in Iranian volunteer blood donors: A case–control study
Authors: Alavian Seyed Moayed , Gholami Bardia , Masarrat Sadegh
Published: March 2003

Background: In order to evaluate some possible risk factors for the spread of hepatitis C infection a case–control study was undertaken.

Methods: The study population consisted of first time blood donors referred to the Iranian Blood Transfusion Organization. Enzyme‐linked immunosorbent assay and recombinant immunoblot assay anti‐hepatitis C virus (HCV) tests were performed for all samples. Risk factors were evaluated using a questionnaire. A stepwise forward logistic regression analysis was used.

Results: The case group consisted of 193 HCV‐positive donors, and 196 HCV‐negative donors comprised the control group. Transfusion, undergoing endoscopy, extramarital sexual activities, non‐intravenous (i.v.) drug abuse, i.v. drug abuse, and receiving wounds at war were found to be independent risk factors of being HCV‐positive (Odds ratio: 17, 4, 42.2, 34.4, 52.8 and 5.2, respectively). No apparent risk factors could be demonstrated in 24.5% of the positive cases.

Conclusion: This study could be of particular interest because of the low seroprevalence of hepatitis C and the religious culture of the study population. There are certain medical procedures, lifestyle patterns, and customs and cultural matters in Iran that predispose people to a number of HCV risk factors.