bluuebunny/crossref_metadata_2025 huggingface dataset:
GIANT GASTRIC ULCERS IN CHRONIC SPINAL CORD INJURY PATIENTS
Authors: Park Walter G. , Rouse Robert V. , Kahng Lyn Sue , Bastidas J. Augusto , Meinke Laura , Soetikno Roy M.
Published: December 2006

Gastric ulcers cause significant morbidity and mortality to patients with spinal cord injuries. Case reports of three patients with gastric ulcers and chronic spinal cord injuries. Review of the medical literature using MEDLINE ranging from 1975 to 2004. We describe three cases of severe, complicated gastric ulcers in this population. Two cases involve gastric ulcers that eroded into major mesenteric arteries, leading to one fatality. One of these cases revealed a gastric ulcer that looked like a mass because of intralumenal herniation of serosal fat. Diagnosis of ulcer disease is challenging in this patient population as they often do not endorse focal symptoms. Gastroenterologists and other practitioners evaluating chronic spinal cord injury patients should be aware of the potential for giant gastric ulcers, even with benign clinical presentations.
CASE OF FASCIOLIASIS: EXTRACTION WITH ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY
Authors: Akarsu Mesut , Meral Murat , Bahceli Sakine , Solmaz Dilek , Kayahan Hasan , Soyturk Mujde , Akpinar Hale
Published: December 2006

Fascioliasis is a worldwide zoonotic infection with fasciola hepatica and fasciola gigantica. The zoonoses are particularly endemic in sheep‐raising countries and are also endemic in Turkey. Clinical features of fascioliasis relate to the stage and intensity of infection. Fasciola hepatica infection comprises two stages: hepatic and biliary, with different signs and symptoms. Cholestatic symptoms may be sudden, but, in some cases, they may be preceded by a long period of fever, eosinophilia and vague gastrointestinal symptoms. We reported a case with fever and upper‐quadrant abdominal pain since 3 months that comes from an area endemic for fasciola hepatica, with suspected imaging about fasciola hepatica in common bile duct on ultrasonography. After that, fasciola hepatica was extracted with endoscopic retrograde cholangiography.
COLLAPSE‐SUBMERGENCE METHOD: SIMPLE COLONOSCOPIC TECHNIQUE COMBINING WATER INFUSION WITH COMPLETE AIR REMOVAL FROM THE RECTOSIGMOID COLON
Authors: Mizukami Takeshi , Yokoyama Akira , Imaeda Hiroyuki , Kumai Koichiro
Published: December 2006

Colonoscopy is a difficult examination to conduct for inexperienced examiners. In an attempt to improve the view, there is often a tendency to overinsufflate air, which causes elongation or acute angulations of the colon and makes passage of the scope difficult. Sakai et al. were the first to describe a simple colonoscopic technique using water infusion instead of air insufflation. We have modified this technique to simplify the procedure further by combining water infusion using disposable syringes with complete air suction from the rectum to the descending colon. With the resultant elimination of the boundary lines between water and air, a good view of the lumen is obtained though the transparent water. With the patient in the left lateral position, this procedure allows the water to flow straight down into the descending colon through the ‘collapsed’ lumen, and the scope to be easily negotiated through the straightened recto‐sigmoid colon and sigmoid‐descending colon junction with minimum discomfort. Measurements of the patients’ abdominal circumference during colonoscopy showed that colonic distension hardly occurred. Under supervision by the author, six complete novices were allowed to insert the colonoscope within 10 min by this method for one patient per week, as long as the patients did not complain of pain. The average trial number for the first cecal intubation within 10 min was 3.3, and the average success rate during the first 3 months was 58.6%. We believe that this ‘collapse‐submergence method’ is easy to master, even for inexperienced examiners.
CAN DENTAL TREATMENT BE THE INFECTION ROUTE OF H. PYLORI TRANSMISSION IN ADULTS? THREE CASES OF ACUTE GASTRIC MUCOSAL LESIONS AFTER DENTAL TREATMENT
Authors: Kamada Tomoari , Hata Jiro , Manabe Noriaki , Kusunoki Hiroaki , Fujii Masafumi , Hashimoto Hisakatu , Haruma Ken
Published: December 2006

Acute gastric mucosal lesions (AGML) comprise a typical clinical entity in patients with acute gastritis, which is characterized by severe erosion, hemorrhage, and ulceration. It is thought that most Helicobacter pylori (H. pylori) infections are established during childhood through human‐to‐human contact. Initial H. pylori infection in an adult is rare, and the transmission route is unknown. The first patient was a 27‐year‐old woman whose chief complaint was epigastric pain. She underwent dental treatment for 30 min and developed sudden epigastric pain 6 h after the treatment. Endoscopic examination revealed multiple hemorrhagic erosions in the antrum. Rapid urease test and histology for H. pylori were positive, but serum anti‐H. pylori IgG antibody was negative at the onset. Serology and urea breath test were positive for H. pylori 2 months after the dental treatment. The second and third patients were diagnosed as having AGML 2 and 4 days after dental treatment, respectively. Culture for H. pylori was positive and serology was negative at the onset, but serology showed seroconversion 2 months after the dental treatment in both patients. These findings indicate that dental treatment is a possible route for H. pylori infection in patients with AGML.
POLYPOID COLONIC HAMARTOMATOUS INVERTED POLYP
Authors: Tanaka Shouichi , Iwamuro Masaya , Kubota Junichi , Goubaru Motohiro , Ohta Takeyuki , Ogata Masatoshi , Murakami Ichiro
Published: December 2006

We herein present a unique polyp diagnosed as polypoid colonic hamartomatous inverted polyp. Colonoscopic examination revealed a clover‐like submucosal tumor about 30 mm in size with a long stalk at the mid‐transverse colon. The polyp consisted of elongated crypts with cystic dilatation located in the submucosal layer. To the best of our knowledge, there have been no previous reports of the same type of pedunculated colonic polyp, similar in appearance to inflammatory myoglandular polyps but covered with a layer of normal mucosa possessing the muscularis mucosae at the uppermost surface of the polyp.
INTRADUCTAL ULTRASONOGRAPHY OF THE GALLBLADDER IN APPLICATION OF THE ENDOSCOPIC NASO‐GALLBLADDER DRAINAGE
Authors: Masuda Daisuke , Arisaka Yoshifumi , Takii Michiaki , Fujiwara Shinya , Miyaji Katsuhiko , Hongo Yasushi , Shimamoto Chikao , Katsu Ken‐ichi
Published: December 2006

Background:  Although endoscopic naso‐gallbladder drainage (ENGBD) for gallbladder disease is useful, the procedure is difficult and investigations involving many cases are lacking. Furthermore, reports on transpapillary intraductal ultrasonography (IDUS) of the gallbladder using a miniature probe are rare.

Methods:  A total of 150 patients (119 suspected of having gallbladder carcinoma, 24 with acute cholecystitis (AC), and seven with Mirizzi’s syndrome (MS)) were the subject. (i) ENGBD: We attempted to put ENGBD tube into the GB. (ii) IDUS of the gallbladder: Using the previous ENGBD tube, we attempted to insert the miniature probe into the gallbladder and perform transpapillary IDUS of the gallbladder. In five patients, we attempted three‐dimensional intraductal ultrasonography (3D‐IDUS).

Results:  (i) ENGBD: Overall success rate was 74.7% (112/150); the rate for the patients suspected of having gallbladder carcinoma was 75.6% (90/119), and was 71.0% (22/31) for the AC and MS patients. Inflammation and jaundice improved in 20/22 successful patients with AC and MS. Success rate was higher when cystic duct branching was from the lower and middle parts of the common bile duct than from the upper part, and was higher when branching was upwards than downwards. (ii) IDUS of the gallbladder: Success rate for miniature probe insertion into the gallbladder was 96.4% (54/56). Lesions could be visualized in 50/54 patients (92.6%). Of these, detailed evaluation of the locus could be performed in 41. In five patients attempted 3D‐IDUS, the relationship between the lesion and its location was readily grasped.

Conclusion:  IDUS of the gallbladder is superior for diagnosing minute images. Improvement on the device will further increase its usefulness.
BURIED BUMPER SYNDROME AS A COMPLICATION OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN CANCER PATIENTS: THE BRAZILIAN EXPERIENCE
Authors: Meine Gilmara , Lukashok Hannah , Mello Gustavo , Mansur Gilberto , Guimarães Denise , Carvalho Roberto
Published: December 2006

Background:  Buried bumper syndrome (BBS) is a major complication of percutaneous endoscopic gastrostomy (PEG) in which the internal bumper migrates from the gastric lumen into the gastrostomy tract. The aim of the present study was to describe the frequency and characteristics of BBS in cancer patients.

Methods:  Retrospective chart review of cancer patients submitted to PEG placement.

Results:  Thirteen cases of BBS were diagnosed among 213 PEG procedures, with an incidence of 6.1%. The interval between PEG and BBS varied from 7 to 630 days (mean 217.5 days). All patients were treated on an outpatient basis. There were six partial, four subtotal and three total BBS. Three partial and four subtotal BBS were treated by external traction and replacement with a balloon‐tipped tube. In three cases of partial BBS the PEG tube was not removed, just repositioned. In three cases of total BBS it was necessary to redo the PEG procedure.

Conclusion:  BBS is an uncommon and usually late complication of PEG. Most of our cases were detected early, due to instructions provided to patients and caregivers and regular follow up. Early diagnosis permits simple treatment consisting of replacement of the original PEG tube by a balloon‐tube or repositioning the original system.
APPROPRIATE MIXTURE OF HYALURONIC ACID, GLUCOSE AND GLYCERIN FOR A SUBMUCOSAL FLUID CUSHION DURING ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE DOG STOMACH
Authors: Fujishiro Mitsuhiro , Kakushima Naomi , Kodashima Shinya , Kashimura Koji , Matsuura Toyokazu , Muraki Yosuke , Tateishi Ayako , Omata Masao
Published: December 2006

Background:  A mixture of a 1% 1900 KDa hyaluronic acid (HA) preparation (Suvenyl) and a 10% glycerin with 5% fructose and 0.9% saline preparation (Glyceol) to make a 0.125% HA is considered to be the best ready‐made submucosal fluid cushion (SFC). When the concentration of glycerin is changeable, a more appropriate SFC may be created.

Methods:  For two beagles, 1 mL of 10%, 15%, 20%, 25%, and 50% glycerin per stomach was submucosally injected to investigate mucosal damage. After the results, 1 mL of a mixture of 0.125% 1900 KDa HA, 10% glucose, and glycerin of the recommended concentration was submucosally injected onto each stomach of two additional beagles to investigate mucosal lifting and damage. 10% glucose was added to increase the viscoelasticity of HA. Furthermore, endoscopic submucosal dissection (ESD) was performed using the mixture in the rest of the stomachs and the feasibility was investigated.

Results:  20% or more concentration of glycerin showed apparent damage and 10% was considered to be a recommended concentration. The mixture of HA and glucose with 10% glycerin showed sufficient mucosal lifting without damage. ESD was completed successfully and no apparent damage was observed in the ESD specimens and its related ulcers.

Conclusion:  Although the mixture of 0.125%1900 KDa HA, 10% glucose, and 10% glycerin may create a more appropriate SFC than ready‐made ones, the fact that 10% is a recommended concentration of glycerin may mean the usefulness of alternative use of a commercially available glycerin solution, Glyceol, as an appropriate mixture with HA.
Enhanced cochlear acoustic sensitivity and susceptibility to endotoxin are induced by adrenalectomy and reversed by corticosterone supplementation in rat
Authors: Siaud Philippe , Maurel Daniel , Lucciano Michel , Kosa Erzebet , Cazals Yves
Published: December 2006

Glucocorticoid receptors are widely distributed in the cochlea but their role remains poorly known. Previous studies provided contradictory reports on a possible cochlear acoustic hypersensitivity induced by adrenal insufficiency, while several experiments agree on a significant action of glucocorticoid receptors in adverse conditions such as acoustic trauma and restraint stress. The present experiments confirmed a cochlear acoustic hypersensitivity induced by adrenalectomy and reversed by corticosterone supplementation. These observations point to a significant role of corticosteroids in basal cochlear functioning. The glucocorticoids are known to be essential for limiting and resolving inflammatory processes. The endotoxin Escherichia coli lipopolysaccharide is widely used to induce inflammatory reactions. However, in various organs several toxic processes of this endotoxin are not influenced by glucocorticoids. From previous experiments on the cochlea there is no evidence that glucocorticoids are an essential factor against endotoxin cochlear toxicity. In the present experiments it was found that adrenalectomy greatly increased the cochlear susceptibility to endotoxin; the effect was reversed by providing corticosterone supplementation. This shows the essential role of corticosterone in this cochlear inflammation model. In previous studies local administration (at the cochlear base) of endotoxin was used and losses of cochlear acoustic sensitivity were found predominantly at high frequencies; in contrast, the systemic injection used in this study produced a cochlear loss of acoustic sensitivity at all frequencies, indicating a uniform cochlear sensitivity to the toxic effects of endotoxin.
Differential expression of otoferlin in brain, vestibular system, immature and mature cochlea of the rat
Authors: Schug Nicola , Braig Claudia , Zimmermann Ulrike , Engel Jutta , Winter Harald , Ruth Peter , Blin Nikolaus , Pfister Markus , Kalbacher Hubert , Knipper Marlies
Published: December 2006

Mutations of the human otoferlin gene lead to an autosomal recessive nonsyndromic form of prelingual, sensorineural deafness (deafness autosomal recessive 9, DFNB9). Several studies have demonstrated expression of otoferlin in the inner ear and brain, and suggested a role of otoferlin in Ca2+‐triggered exocytosis. So far, otoferlin expression profiles were solely based on the detection of mRNA. Here, we analysed the expression of otoferlin protein and mRNA using immunohistochemistry, in situ hybridization and RT‐PCR in neonatal and mature Wistar rat tissue. In agreement with previous studies, otoferlin expression was found in the brain and in inner and vestibular hair cells. Otoferlin mRNA and protein was, however, also detected in mature outer hair cells of low‐frequency processing cochlear turns and in auditory nerve fibres. In outer, inner and vestibular hair cells, otoferlin was subcellularly localized at a considerable distance from the presumed active release sites. Double‐staining with the synaptic ribbon marker, C‐terminal binding protein 2 (CtBP2), or the presynaptic Ca2+‐channel, Cav1.3, both assumed to mark the sites of vesicle fusion and transmitter release, did not colocalize with otoferlin expression and thus do not necessarily support a selected role of otoferlin in Ca2+‐triggered exocytosis. The widespread distribution of otoferlin in neurons, nerve fibres and hair cells, and its subcellular distribution extending beyond the regions of synaptic vesicle fusion, i.e. coenrichment with the cytosolic Golgi matrix protein 130 (GM130) in inner hair cells or the early endosomal autoantigen 1 (EEA1) in outer hair cells support instead the idea of a more ubiquitous role of otoferlin in early/recycling endosome trans‐Golgi network dynamics.
Modulation of singing‐related activity in the songbird ventral tegmental area by social context
Authors: Yanagihara Shin , Hessler Neal A.
Published: December 2006

Successful reproduction depends critically on social interactions. To understand the neural mechanisms underlying such interactions, the study of courtship singing of songbirds has many advantages. Male zebra finches produce a similar song during courtship of a female and while alone. However, singing‐related neural activity in the anterior forebrain pathway (AFP), a basal ganglia–forebrain circuit, is markedly dependent on the social context in which singing occurs. Thus, the AFP should receive a signal of social context from outside the song system. Here, we have begun to investigate the neural source of such a signal by recording from neurons in the ventral tegmental area (VTA), which provides dopaminergic input to Area X, a striatal nucleus of the AFP. The level of activity of most VTA neurons we recorded (32/35) was clearly modulated during singing, especially when males sang to a female bird. Modulation of the level of activity could occur in the presence of a female without singing, but typically was further increased when males sang to the female. In addition, activity of some neurons was patterned in relation to song elements, and appeared related to motor output. These results suggest that VTA activity could carry signals related to motivational aspects of singing, as well as more primary sensory and motor signals.
Cooperative effects of bcl‐2 and AAV‐mediated expression of CNTF on retinal ganglion cell survival and axonal regeneration in adult transgenic mice
Authors: Leaver Simone G. , Cui Qi , Bernard Ora , Harvey Alan R.
Published: December 2006

We used a gene therapy approach in transgenic mice to assess the cooperative effects of combining anti‐apoptotic and growth‐promoting stimuli on adult retinal ganglion cell (RGC) survival and axonal regeneration following intraorbital optic nerve injury. Bi‐cistronic adeno‐associated viral vectors encoding a secretable form of ciliary neurotrophic factor and green fluorescent protein (AAV‐CNTF‐GFP) were injected into eyes of mice that had been engineered to over‐express the anti‐apoptotic protein bcl‐2. For comparison this vector was also injected into wildtype (wt) mice, and both mouse strains were injected with control AAV encoding GFP. Five weeks after optic nerve injury we confirmed that bcl‐2 over‐expression by itself promoted the survival of axotomized RGCs, but in contrast to previous reports we also saw regeneration of some mature RGC axons beyond the optic nerve crush. AAV‐mediated expression of CNTF in adult retinas significantly increased the survival and axonal regeneration of RGCs following axotomy in wt and bcl‐2 transgenic mice; however, the effects were greatest in the transgenic strain. Compared with AAV‐GFP‐injected bcl‐2 mice, RGC viability was increased by about 50% (mean, 36 738 RGCs per retina), and over 1000 axons per optic nerve regenerated 1–1.5 mm beyond the crush. These findings exemplify the importance of using a multifactorial therapeutic approach that enhances both neuroprotection and regeneration after central nervous system injury.
Chronic treatment with high doses of corticosterone decreases cytoskeletal proteins in the rat hippocampus
Authors: Cereseto Marina , Reinés Analía , Ferrero Alejandro , Sifonios Laura , Rubio Modesto , Wikinski Silvia
Published: December 2006

Hypercortisolism is a common trait of Cushing's disease and depression. These two disorders also share hippocampal volume decrease and cognitive deficits. However, experimentally induced hypercortisolism induces neuronal atrophy, which has been proposed to be the phenomenon underlying the hippocampal shrinkage. We hypothesized that the above‐mentioned atrophy is due to a deleterious effect of high concentrations of glucocorticoids on cytoskeletal proteins. One or two pellets (100 mg each) of corticosterone were subcutaneously implanted in adult rats. Twenty‐one days later, light, medium and heavy subunits of intermediate neurofilaments (NFL, NFM and NFH) and the microtubule‐associated protein 2 (MAP2) were quantified by immunohistochemistry in Ammon's horn and dentate gyrus. We also evaluated the in vitro glutamate release in hippocampal slices. Both doses of corticosterone induced a decrement of NFL, NFM and NFH in both hippocampal areas but only 200 mg decreased MAP2. This dose also diminished the potassium‐stimulated glutamate release. All of these changes seemed not to be due to neuron loss, as no decrement in neuron‐specific nuclear protein‐positive cells was found. With the exception of NFL, the above‐mentioned diminution was not observed in the globus pallidus, one of the brain regions with the lowest glucocorticoid receptor density. These results provide a subcellular insight into the trophic changes found in experimental models of hypercortisolism. The coincidence between decrements in MAP2 and glutamate release suggests possible links between high glucocorticoid levels, dendritic atrophy and the cognitive impairment reported in patients suffering from Cushing's disease and depression.
Neurogenic correlates of an olfactory discrimination task in the adult olfactory bulb
Authors: Mandairon Nathalie , Sacquet Joëlle , Garcia Samuel , Ravel Nadine , Jourdan François , Didier Anne
Published: December 2006

In the main olfactory bulb, stimuli are coded within the spatio‐temporal pattern of mitral cells' activity. Granule cells are interneurons that shape the mitral cells' activity, and are continuously generated in the adult main olfactory bulb. However, the role of granule cell renewal remains elusive. We show here that an associative olfactory discrimination task reduces the survival of newborn neurons. However, when the olfactory task involves perceptually related odorants, the learning process is slower and does not induce such a reduction in the number of new neurons. Mapping newborn cells within the granule cell layer of the main olfactory bulb reveals a clustered distribution that evolves with learning as a function of odorant similarity and partly overlaps with the immediate‐early gene Zif268 expression pattern. These data provide insight into the functional mechanisms underlying olfactory discrimination learning, and promote the importance of neurogenesis as a cellular basis for the restructuring of odor images in the main olfactory bulb.
Bandwidth determines modulatory effects of centrifugal pathways on cochlear hearing desensitization caused by loud sound
Authors: Rajan R.
Published: December 2006

Centrifugal olivocochlear (OC) pathways modulate cochlear hearing losses induced in cats by loud sounds varying in bandwidth from tones to clicks and noise bands, in a variety of conditions. The general effect, always to reduce hearing damage, can be a net effect resulting from complex interactions between OC subcomponents (crossed and uncrossed OC pathways). The interactions between these subcomponents vary with type of loud sound, suggesting that sound bandwidth may be important in determining how OC pathways modulate loud sound‐induced hearing loss. This dependency was examined and here it is reported that OC pathways do not alter cochlear hearing losses caused by loud noise with a 2‐kHz‐wide bandwidth intermediate between the loud sounds of previous studies. Increasing stimulus bandwidth even slightly more, to use a loud 3.5‐kHz‐wide bandwidth noise as the damaging sound, once again revealed OC modulation of cochlear hearing loss. The fact that OC pathways do not modulate cochlear hearing losses induced by loud 2‐kHz‐wide noise was demonstrated in three very different test conditions in which OC pathways modulate hearing losses caused by narrower or broader bandwidth sounds. This confirmed that the absence of centrifugal modulation of hearing loss to this particular sound was a robust phenomenon not related to test condition. The absence of overall centrifugal effects was also true at the level of subcomponent pathways; neither crossed nor uncrossed OC pathways individually modulated cochlear hearing losses to the loud 2‐kHz‐wide noise. This surprising frequency dependency has general implications for centrifugal modulation of cochlear responses.
Bradycardia with sevoflurane in siblings with branchio‐oto‐renal syndrome
Authors: TAYLOR MATTHEW H.G. , WILTON NIALL C.T.
Published: December 2006

Branchio‐oto‐renal syndrome (BOR, Melnick–Fraser syndrome, MIM#113650) refers to a rare autosomal dominant disorder characterized by branchial cysts or fistulas, hearing loss, external ear malformation, preauricular pits and renal abnormalities. The authors present three episodes of significant bradycardia in two siblings diagnosed with BOR syndrome during the sevoflurane general anesthesia. There is no published experience of anesthesia with this syndrome. Bradycardia occurred variously at induction, maintenance and immediately prior to emergence and required surgical stimulation, atropine, or epinephrine to treat. We seek to raise awareness of the potential for bradycardia during the procedures in patients with this syndrome requiring volatile anesthesia, especially sevoflurane.
Selective colonization of insoluble substrates by human faecal bacteria
Authors: Leitch E. Carol McWilliam , Walker Alan W. , Duncan Sylvia H. , Holtrop Grietje , Flint Harry J.
Published: December 2006

Insoluble plant polysaccharides and endogenous mucin are important energy sources for human colonic microorganisms. The object of this study was to determine whether or not specific communities colonize these substrates. Using faecal samples from four individuals as inocula for an anaerobic in vitro continuous flow system, the colonization of wheat bran, high amylose starch and porcine gastric mucin was examined. Recovered substrates were extensively washed and the remaining tightly attached bacterial communities were identified using polymerase chain reaction‐amplified 16S rRNA gene sequences and fluorescent in situ hybridization. The substrate had a major influence on the species of attached bacteria detected. Sequences retrieved from bran were dominated by clostridial cluster XIVa bacteria, including uncultured relatives of Clostridium hathewayi, Eubacterium rectale and Roseburia species. Bacteroides species were also detected. The most abundant sequences recovered from starch were related to the cultured species Ruminococcus bromii, Bifidobacterium adolescentis, Bifidobacterium breve and E. rectale. The most commonly recovered sequences from mucin were from Bifidobacterium bifidum and uncultured bacteria related to Ruminococcus lactaris. This study suggests that a specific subset of bacteria is likely to be the primary colonizers of particular insoluble colonic substrates. For a given substrate, however, the primary colonizing species may vary between host individuals.
Detection of bacteria associated with harmful algal blooms from coastal and microcosm environments using electronic microarrays
Authors: Barlaan Edward A. , Furukawa Seiji , Takeuchi Kazuhisa
Published: December 2006

With the global expansion of harmful algal blooms (HABs), several measures, including molecular approaches, have been undertaken to monitor its occurrence. Many reports have indicated the significant roles of bacteria in controlling algal bloom dynamics. Attempts have been made to utilize the bacteria/harmful algae relationship in HAB monitoring. In this study, bacterial assemblages monitored during coastal HABs and bacterial communities in induced microcosm blooms were investigated. Samples were analysed using denaturing gradient gel electrophoresis (DGGE) of the 16S rRNA gene. DGGE bands with peculiar patterns before, during, and after algal blooms were isolated and identified. Probes for six ribotypes representing organisms associated with Chatonella spp., Heterocapsa circularisquama, or Heterosigma akashiwo were used for analysis on NanoChip electronic microarray. In addition, a new approach using cultured bacteria species was developed to detect longer (533 bp) polymerase chain reaction‐amplified products on the electronic microarray. The use of fluorescently labelled primers allowed the detection of individual species in single or mixed DNA conditions. The developed approach enabled the detection of the presence or absence and relative abundance of the HAB‐related ribotypes in coastal and microcosm blooms. This study indicates the ability of electronic microarray platform to detect or monitor bacteria in natural and induced environments.
Effect of banning vancomycin analogue avoparcin on vancomycin‐resistant enterococci in chicken farms in Taiwan
Authors: Lauderdale Tsai‐Ling , Shiau Yih‐Ru , Wang Hui‐Ying , Lai Jui‐Fen , Huang I‐Wen , Chen Pei‐Chen , Chen Hong‐Yi , Lai Shiow‐Suey , Liu Ya‐Fang , Ho Monto
Published: December 2006

Avoparcin, a vancomycin analogue, was banned as a feed additive in Taiwan in 2000. A nationwide surveillance was conducted to study the prevalence of vancomycin‐resistant enterococci (VRE) on chicken farms between 2000 and 2003. Among the 1021 E. faecalis and 967 E. faecium isolates studied, resistance to tetracycline, erythromycin, high‐level aminoglycosides, ciprofloxacin and chloramphenicol either increased or remained high except vancomycin. The proportion of VRE decreased, between 2000 and 2003, from 13.7% (22/161) to 3.7% (11/299) for E. faecalis, and 3.4% (4/119) to 0% (0/300) for E. faecium. Only 8.8% (7/80) of the chicken farms surveyed harboured VRE in 2003 compared with 25% (15/60) in 2000. All VRE were resistant to tetracycline and erythromycin. All VRE possess the vanA gene but nearly all (79 of 83 isolates) were susceptible to teicoplanin, indicating VanB phenotype. Some clones were detected from different farms in various regions over the years. We conclude that the frequency of VRE in chicken farms decreased in association with a ban on avoparcin; and the continued presence of VRE may be due to the ability of some strains to persist in the farms, transfer of vancomycin resistance determinants or co‐selection by the continued use of other antibiotics.
Distribution of specific tetracycline and erythromycin resistance genes in environmental samples assessed by macroarray detection
Authors: Patterson Andrea J. , Colangeli Roberto , Spigaglia Patrizia , Scott Karen P.
Published: December 2006

A macroarray system was developed to screen environmental samples for the presence of specific tetracycline (TcR) and erythromycin (ermR) resistance genes. The macroarray was loaded with polymerase chain reaction (PCR) amplicons of 23 TcR genes and 10 ermR genes. Total bacterial genomic DNA was extracted from soil and animal faecal samples collected from different European countries. Macroarray hybridization was performed under stringent conditions and the results were analysed by fluorescence scanning. Pig herds in Norway, reared without antibiotic use, had a significantly lower incidence of antibiotic resistant bacteria than those reared in other European countries, and organic herds contained lower numbers of resistant bacteria than intensively farmed animals. The relative proportions of the different genes were constant across the different countries. Ribosome protection type TcR genes were the most common resistance genes in animal faecal samples, with the tet(W) gene the most abundant, followed by tet(O) and tet(Q). Different resistance genes were present in soil samples, where erm(V) and erm(E) were the most prevalent followed by the efflux type TcR genes. The macroarray proved a powerful tool to screen DNA extracted from environmental samples to identify the most abundant TcR and ermR genes within those tested, avoiding the need for culturing and biased PCR amplification steps.
Prospective randomized, double‐blind, placebo‐controlled study of pre‐ and postoperative administration of a COX‐2‐specific inhibitor as opioid‐sparing analgesia in major colorectal surgery
Authors: Sim R. , Cheong D. M. , Wong K. S. , Lee B. M. K. , Liew Q. Y.
Published: December 2006

Purpose  To demonstrate the opioid‐sparing effect and reduction in postoperative ileus obtained with valdecoxib 40 mg administered pre‐ and postoperatively in patients undergoing colorectal resection.

Methods  Patients for elective colorectal resection from December 2002 to June 2004 were randomized to receive either valdecoxib or placebo with standard patient‐controlled analgesia (PCA) morphine. In the study arm, the first dose of valdecoxib 40 mg was administered orally as close as possible to 1 h prior to the start of surgery. Each subsequent dose was administered at 24‐h intervals up to 120 h. Patients in the control arm were served placebos at the same time‐points.

Results  Forty patients were enrolled in the study arm and 39 (excluding one protocol violation) in the control arm. The groups were comparable in age, sex, American Society of Anesthesiology status, body mass index, incision length, and duration and types of operations. Mean PCA doses at 12 and 24 h were 18.6 and 28.3 mg in the study arm vs 26.2 and 41.2 mg in controls, representing a one‐third opioid reduction. Bowel sound and movement first appeared at medians of 12 and 72 h in the study arm vs 24 and 84 h, respectively, in controls (P < 0.05). Tolerance of solid diet was at a median of 60 h and discharge at a median of 4 days in the study arm vs 72 h and 6 days in controls (P < 0.05 and P < 0.01, respectively). Seven (18%) morbidities occurred in the control vs six (15%) in the study arm.

Conclusions  Patients treated with a cyclo‐oxygenase 2‐specific inhibitor have a shorter recovery time when compared with patients on a standard postoperative PCA morphine‐only regimen after colorectal resection.
The effect of surgery on quality of life in patients with faecal incontinence of obstetric origin
Authors: Pla‐Martí V. , Moro‐Valdezate D. , Alos‐Company R. , Solana‐Bueno A. , Roig‐Vila J. V.
Published: December 2006

Objective  To evaluate the results of surgery in the treatment of faecal incontinence of obstetric origin and assess the effect of treatment on the quality of life of these patients.

Patients and methods  A consecutive series of 43 patients, who had undergone surgery for severe faecal incontinence of obstetric aetiology between March 1990 and March 2004, was studied. The following studies were carried out: clinical evaluation, anorectal manometry, anal endosonography (from 1996 on) and measurement of the pudendal nerve terminal motor latency. The degree of incontinence, both preoperative and at the end of follow‐up was evaluated using the Cleveland Clinic Score (CCS). Quality of life assessment was made using the Fecal Incontinence Quality of Life Scale (FIQL).

Results  The study was completed on 35 (87%) of the 43 patients. The mean age in the series was 53 years, (range 28–73). After an average follow‐up of 50.4 months (range 4–132) the mean CCS had reduced significantly, passing from 16 (range 8–20) to 6 (range 0–18; P < 0.001). Pudendal neuropathy was found to be a factor of poor prognosis. The results of the quality of life questionnaire at the end of follow‐up were: lifestyle 3.5 (SD 0.65), coping/behaviour 3.1 (SD 0.81), depression/self perception 3.7 (SD 0.75) and embarrassment 3.3 (SD 0.91). There is a statistically significant linear relationship between incontinence measured on the CCS and quality of life. For the 14 patients undergoing surgery since the publication of the FIQL questionnaire, it was possible to complete the questionnaire preoperatively, with significant improvement found on each of the four scales (lifestyle 1.7 vs 3.5; coping/behaviour 1.4 vs 3.2; depression 2.2 vs 3.8; embarrassment 1.8 vs 3.2; P < 0.001).

Conclusion  Surgical treatment of faecal incontinence of obstetric origin achieves good results in a high percentage of patients and has a positive effect on their quality of life. The existence of prolonged preoperative pudendal nerve motor latency indicates a poor prognosis.
Validity of prostate‐specific antigen as a tumour marker in men with prostate cancer managed by watchful‐waiting: correlation with findings at serial endorectal magnetic resonance imaging and spectroscopic imaging
Authors: Coakley Fergus V. , Chen Irene , Qayyum Aliya , Westphalen Antonio C. , Carroll Peter R. , Hricak Hedvig , Chen Mei‐hsiu , Kurhanewicz John
Published: December 2006

OBJECTIVE

To investigate the validity of prostate‐specific antigen (PSA) as a tumour marker in men with clinically localized prostate cancer who have selected watchful waiting, by determining if serial PSA level measurements are correlated with findings of malignancy or benign prostatic hyperplasia (BPH) at serial endorectal magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI).

PATIENTS AND METHODS

We retrospectively identified 69 men with biopsy‐proven prostate cancer being managed by watchful waiting, who underwent serial endorectal MRI/MRSI and who had contemporaneous serial PSA measurements. The mean (range) follow‐up was 392 (294–571) days. A panel of three experienced readers reviewed the initial and follow‐up MRI/MRSI studies, and classified findings of prostate cancer as stable or progressive. Another reader assessed BPH by calculating total gland and central gland volumes on all studies.

RESULTS

At the follow‐up MRI/MRSI, 51, 17 and one patient had stable, progressive, or unevaluable prostate cancer, respectively. The mean PSA velocity was significantly greater in patients with radiologically progressive disease (1.42 vs 0.42 ng/mL/year, P = 0.04). A PSA velocity of >0.75 ng/mL/year identified those with radiologically progressive disease with a true‐positive fraction of 0.71 and a false‐positive fraction of 0.39. PSA levels were not correlated with changes in total or central gland volumes (P > 0.05).

CONCLUSIONS

In men with clinically localized prostate cancer who select watchful waiting, serial PSA levels are correlated with findings of malignancy but not BPH at serial endorectal MRI/MRSI, suggesting that PSA is a useful longitudinal tumour marker in this population.
Diabetes and the urologist: a growing problem
Authors: Goldstraw Miles A. , Kirby Michael G. , Bhardwa Jeetesh , Kirby Roger S.
Published: December 2006

The incidence of diabetes continues to increase dramatically; this incidence is predominantly of the type‐2 form which clusters together with other comorbidities of hypertension and lipid abnormalities, to form the metabolic syndrome. These conditions will have an increasing impact on urological practice, with erectile dysfunction, hypogonadism, voiding difficulties and urinary tract infections all more common in these patients. These symptoms might be the initial presentation of previously undiagnosed diabetes and it is important to recognise this condition early to avoid later complications including end‐stage renal failure.
Sildenafil inhibits the up‐regulation of phosphodiesterase type 5 elicited with nicotine and tumour necrosis factor‐α in cavernosal vascular smooth muscle cells: mediation by superoxide
Authors: Hotston Matthew R. , Jeremy Jamie Y. , Bloor Jonathan , Koupparis Anthony , Persad Raj , Shukla Nilima
Published: December 2006

OBJECTIVES

To determine whether there is an association between vascular phosphodiesterase type 5 (PDE‐5) and NADPH oxidase (NOX) in cavernosal vascular smooth muscle cells (CVSMCs), and to study the actions of the PDE‐5 inhibitor sildenafil; the pro‐erectile actions of nitric oxide (NO) are reduced by PDE‐5 which hydrolyses cGMP to inactive GMP, thus an up‐regulation of PDE‐5 and over‐production of O2‐derived from NOX might promote erectile dysfunction (ED).

MATERIALS AND METHODS

To study the effects of nicotine and tumour necrosis factor‐α (TNF‐α) on superoxide (O2‐) production and PDE‐5 expression, CVSMCs from rabbit penis were incubated with nicotine or TNF‐α, and superoxide dismutase (SOD), catalase, sildenafil citrate, or apocynin (NADPH inhibitor) for 16 h. The expression of PDE‐5 and of glyceraldehyde‐3‐phosphate dehydrogenase (internal standard) was assessed using Western blotting. O2‐was measured spectrophotometrically.

RESULTS

After a 16‐h incubation, both nicotine (maximal at 10 µm) and TNF‐α (10 ng/mL) significantly increased O2‐formation in CVSMCs; this effect was blocked by co‐incubating with SOD, catalase, and sildenafil (1 µm). Apocynin also inhibited O2‐formation when added after 16‐h incubation with nicotine (10 µm) or TNF‐α. PDE‐5 expression was also significantly increased in CVSMCs incubated with nicotine and TNF‐α. This effect was negated by 16‐h co‐incubation with SOD, catalase, apocynin, and sildenafil.

CONCLUSIONS

Nicotine and TNF‐α up‐regulate PDE‐5 expression in CVSMCs through ana prioriup‐regulation of NOX and formation of O2‐. As PDE‐5 hydrolyses cGMP, this effect might ‘blunt’ the pro‐erectile actions of NO. Sildenafil inhibits O2‐formation, and ‘normalizes’ PDE‐5 expression. This represents a novel pathogenic mechanism underlying ED, and a novel mechanism of action of sildenafil.
Redefining response in overactive bladder syndrome
Authors: Payne Christopher K. , Kelleher Con
Published: December 2006

OBJECTIVE

To evaluate three potential definitions of treatment response in overactive bladder (OAB) syndrome, based on the International Continence Society (ICS) definition of OAB, using pooled data from two large clinical trials of the antimuscarinic agent solifenacin succinate.

PATIENTS AND METHODS

As the ICS definition of OAB does not rely on urodynamic observations for a diagnosis, the use of composite endpoints, such as in the definitions examined here, might provide a more relevant measure of patient benefits. Each definition was tested to assess the impact of pharmacotherapy, comparing treatment response rates based on composite endpoints. Responder definitions were validated based on the impact on quality of life (QoL). Pooled data from two 12‐week multinational, multicentre, double‐blind randomized studies of solifenacin, a once‐daily oral antimuscarinic for treating OAB symptoms, were used for this analysis. Based on the symptom data from these studies (episodes of urgency, incontinence, nocturia and voiding frequency per 24 h), response was defined as being: (i) a reduction by half or more in all baseline symptoms; (ii) a reduction by half or more in urgency and at least one other symptom; or (iii) resolution of urgency episodes and at least one other symptom. Health‐related QoL changes were recorded using the King’s Health Questionnaire (KHQ).

RESULTS

Solifenacin at 5 mg or 10 mg once daily resulted in significantly higher response rates than with placebo, irrespective of the definition of a responder (P ≤ 0.001). When assessing the most challenging definition of response (resolution of urgency and at least one other symptom), solifenacin at 5 mg and 10 mg resulted in 20% and 25% of patients, respectively, meeting the response criteria, vs 12% of placebo‐treated patients (P ≤ 0.001 for both solifenacin doses). For all three definitions of response, responders showed greater improvements in all KHQ domains than did nonresponders, and the differences were statistically significant.

CONCLUSIONS

The two strictest definitions of response (halving or more in all baseline symptoms or resolution of urgency and more than one other symptom) appeared to capture QoL changes most effectively. Establishing the most appropriate definition to assess treatment‐related changes in OAB will require further investigation, but it is clear from this analysis that composite clinical endpoints, based on the ICS definition of OAB, are a valid approach for assessing the effect of treatments for OAB.
A prospective evaluation of the short‐term impact and recovery of health‐related quality of life in men undergoing radical prostatectomy
Authors: Kouba Erik , Hubbard J. Slade , Moore Dominic , Wallen Eric M. , Pruthi Raj S.
Published: December 2006

OBJECTIVE

To prospectively evaluate the acute and short‐term effects of radical retropubic prostatectomy (RRP) on health‐related quality of life (HRQoL) using a validated generic HRQoL instrument that measures overall health status, as although there is increasing interest in the HRQoL of patients being treated for prostate cancer, most studies have focused on long‐term outcomes.

PATIENTS AND METHODS

In all, 121 men undergoing RRP for clinically localized prostate cancer were prospectively evaluated for short‐term HRQoL using an acute Short Form‐12 version‐2 Physical and Mental Health Survey Acute Form before and serially each week from 1 to 6 weeks after RRP. The physical (PCS) and mental component score (MCS) were calculated from the questionnaires at each time and the data analysed by random coefficient modelling. Separate models were fitted for MCS and PCS using covariates of race, age, estimated blood loss (EBL), time after RRP, and their interaction terms.

RESULTS

The PCS initially declined and improved linearly. and the baseline level was not achieved by 6 weeks, but modelling lines showed an expected return to baseline at 7–8 weeks for all patients. Age had a significant relationship with the PCS; older men (>60 years) scored higher, and their PCS remained significantly higher after RRP than younger men (≤60 years) until 5 weeks. EBL also had a significant relationship with PCS; men with an EBL of >500 mL had a significantly lower PCS at 1 week and this remained significantly lower than for men with an EBL of ≤ 500 mL until ≈ 7 weeks. The MCS improved immediately after RRP and remained higher throughout the study than at baseline. Race was the only covariate for which there were significant differences in the MCS. The MCS was significantly lower at baseline for African‐Americans than for Caucasian Americans, and remained lower until 6 weeks after RRP.

CONCLUSIONS

There were significant changes in HRQoL during in the short‐term after RRP. Younger men and those with a higher EBL might have a slower recovery of the PCS after RRP. African‐Americans had a slower increase in MCS and might have a different initial emotional or mental health response to RRP than have Caucasians.
Digital three‐dimensional modelling of the male pelvis and bicycle seats: impact of rider position and seat design on potential penile hypoxia and erectile dysfunction
Authors: Gemery John M. , Nangia Ajay K. , Mamourian Alexander C. , Reid Scott K.
Published: December 2006

OBJECTIVE

To digitally model (three‐dimensional, 3D) the course of the pudendal arteries relative to the bony pelvis in the adult male, and to identify sites of compression with different bicycle riding positions as a potential cause of penile hypoxia and erectile dysfunction.

SUBJECTS AND METHODS

3D models were made from computed tomography scans of one adult male pelvis (a healthy volunteer) and three bicycle seats. Models were correlated with lateral radiographs of a seated rider to determine potential vascular compression between the bony pelvis and seats at different angles of rider positioning.

RESULTS

Pelvis/seat models suggest that the most likely site of compression of the internal pudendal artery is immediately below the pubic symphysis, especially with the rider leaning forward. For an upright rider, the internal pudendal arteries do not appear to be compressed between the seat and the bony pelvis. Leaning partly forward with arms extended, the seat/symphysis areas were reduced to 73 mm2 with standard seat and 259 mm2 with a grooved seat. Leaning fully forward, the seat/symphysis areas decreased (no space with standard seat; 51 mm2 with a grooved seat) and both the ischial tuberosities and the pubic symphysis might be in contact with the seat.

CONCLUSION

A grooved seat allows better preservation of the seat/symphysis space than a standard seat, but the rider’s position is more important for preserving the seat‐symphysis space (and reducing compression) than is seat design alone. Any factors which influence the seat‐symphysis space (including an individual’s anatomy, seat design and rider position) can increase the potential for penile hypoxia and erectile dysfunction/perineal numbness.