bluuebunny/crossref_metadata_2025 huggingface dataset:
Mesoscale distribution patterns of Amazonian understorey herbs in relation to topography, soil and watersheds
Authors: COSTA FLÁVIA R. C. , MAGNUSSON WILLIAM E. , LUIZAO REGINA C.
Published: September 2005

Many authors have suggested that topography and soils are the major determinants of species distributions and community patterns at small or regional scales, but few studies addressed the patterns at mesoscales. We used Reserva Ducke (100 km2) as a model to analyse the effects of soil, topography and watersheds on the variation of the herb community composition, and to determine the relative importance of the environmental factors on species composition.

Taxonomic groups are frequently used as surrogates in studies of biodiversity distribution and complementarity, but their efficacy is controversial. We therefore studied the correlations between the distributional patterns of three different herb groups (Marantaceae, pteridophytes and ‘others’) and their responses to environmental predictors.

Terrestrial herbs were sampled in 59 plots of 250 × 2 m, systematically distributed over the reserve. Plots followed isoclines of altitude, to minimize the internal variation of soil. Composition of the total herb community and of the three herb groups was summarized with PCoA.

Soil structure, represented by PCA axes, was the main determinant of the variation in herb composition for all groups, but slope affected only pteridophytes. Soil and topography explained less than one‐third of the variance in community data. Herb composition was significantly different between watersheds, but watersheds differ only slightly in soil parameters. Our results indicate high turnover in species composition, on spatial scales of 5–10 km in central Amazonia, which is not necessarily associated with soil change.

Compositional patterns of the three groups analysed were significantly correlated, but with low values for the correlation coefficient. Although composition was correlated, the responses to environmental predictors differed among groups, and the use of one group as a surrogate will miss around 50% of the variation in other groups.

Although important, soil and topography alone cannot predict herb community structure. Knowledge of geographical, historical or other landscape features, such as watershed morphology, may therefore be necessary to predict the turnover patterns over mesoscales. Moreover, the same factors may not have the same effectiveness as predictors of the structure of seemingly similar biological groups.
Rapid responses of high‐mountain vegetation to early Holocene environmental changes in the Swiss Alps
Authors: TINNER WILLY , KALTENRIEDER PETRA
Published: September 2005

The Early Holocene sediment of a lake at tree line (Gouillé Rion, 2343 m a.s.l.) in the Swiss Central Alps was sampled for plant macrofossils. Thin (0.5 cm) slices, representing time intervals of c. 50 years each from 11 800 to 7800 cal. year bp, were analysed and the data compared with independent palaeoclimatic proxies to study vegetational responses to environmental change.

Alpine plant communities (e.g. with Salix herbacea) were established at 11 600–11 500 cal. year bp, when oxygen‐isotope records showed that temperatures increased by c. 3–4 °C within decades. Larix decidua trees reached the site at c. 11 350 cal. year bp, probably in response to further warming by 1–2 °C. Forests dominated by L. decidua persisted until 9600 cal. year bp, when Pinus cembra became more important.

The dominance of Larix decidua for two millennia is explained by dry summer conditions, and possibly low winter temperatures, which favoured it over the late‐successional Pinus cembra. Environmental conditions were a result of variations in the earth's orbit, leading to a maximum of summer and a minimum of winter solar radiation. Other heliophilous and drought‐adapted species, such as Dryas octopetala and Juniperus nana, could persist in the open L. decidua forests, but were out‐competed when the shade‐tolerant P. cembra expanded.

The relative importance of Larix decidua decreased during periods of diminished solar radiation at 11 100, 10 100 and 9400 cal. year bp. Stable concentrations of L. decidua indicate that these percentage oscillations were caused by temporary increases of Pinus cembra, Dryas octopetala and Juniperus nana that can be explained by increases in moisture and/or decreases in summer temperature.

The final collapse of Larix decidua at 8400 cal. year bp was possibly related to abrupt climatic cooling as a consequence of a large meltwater input to the North Atlantic. Similarly, the temporary exclusion of Pinus cembra from tree line at 10 600–10 200 cal. year bp may be related to slowing down of thermohaline circulation at 10 700–10 300 cal. year bp.

Our results show that tree line vegetation was in dynamic equilibrium with climate, even during periods of extraordinarily rapid climatic change. They also imply that forecasted global warming may trigger rapid upslope movements of the tree line of up to 800 m within a few decades or centuries at most, probably inducing large‐scale displacements of plant species as well as irrecoverable biodiversity losses.
Manipulation of nutrients and grazing levels on heather moorland: changes inCallunadominance and consequences for community composition
Authors: HARTLEY S. E. , MITCHELL R. J.
Published: September 2005

Experimental studies of the combined effects of herbivory and the availability of nutrients on semi‐natural communities remain relatively scarce. Here we report the effects of 6 years of nutrient addition (N, P and K) and protection from grazing on moorland plant communities in the Scottish uplands, particularly on the cover of the dominantCalluna vulgaris. We also recorded the cover of vascular plants and bryophytes, to assess the impact of changes inCallunadominance on competing species.

Grazing in combination with nitrogen addition caused the greatest decline inCallunacover, typically 40–50%, but nitrogen addition did not cause a significant decline inCallunaon plots protected from grazing. MoreCallunashoots were browsed on nitrogen‐treated plots than on unfertilized ones, presumably because grazing animals preferred fertilizedCalluna.

Nitrogen addition allowed grasses to increase in cover, especially on grazed plots. However,Nardus stricta,Festuca ovinaandAgrostissp. all declined in fenced areas but increased in grazed plots, whereasDeschampsia flexuosaandFestuca rubraincreased in fenced plots.

The effects of grazing and nutrient addition varied markedly between sites, possibly because of differences in soil moisture and organic matter. Nitrogen addition, however, increased soil nitrogen mineralization rates in both glens.

Fencing increased the cover of grazing‐intolerant plants with low nutrient demands (as classified by Ellenberg and suited species scores) that were categorized as competitive plants by Grime's CSR model. Plots receiving nitrogen and phosphorus had more nutrient‐demanding plants able to tolerate high grazing pressure that were often classified as ruderals.

The impact of nitrogen addition on the cover ofCallunaand on competing grass species in the community critically depends on the level of grazing. Changes in community composition caused by grazing and fertilizer addition can be explained in terms of the ecological tolerances of individual species, allowing us to predict the types of plants that are likely to increase or decrease in cover.
Effects of competition, resource availability and invertebrates on tree seedling establishment
Authors: LADD BRENTON M. , FACELLI JOSÉ M.
Published: September 2005

We studied the establishment of tree seedlings in Mediterranean‐type old fields in South Australia in different biotic environments and under different levels of resource availability. Specifically we wanted to: (a) test for a logarithmic relationship between the relative intensity of competition (RCI) and resource availability; (b) assess the potential of confounding resource competition with invertebrate herbivory; and (c) assess whether the architecture of the plant community had any qualitative or quantitative effects upon the relationship between resource availability and RCI.

Our glasshouse experiment showed that RCI increased with resource availability at low levels of resources, but not at higher levels, consistent with a logarithmic relationship.

The effects of resource competition and invertebrate herbivory were heavily confounded in the field experiment.

Plant architecture significantly affected the behaviour and abundance of invertebrates and we therefore conclude that it has the potential to modify the relationship between resource availability and competitive intensity.

Although the habitat templet/C‐S‐R model appears reasonably robust, modification of its general framework may be required because one of its basic underlying assumptions is most accurate when competition is defined phenomenologically.
Establishment of an emerging generalist pathogen in redwood forest communities
Authors: MALONEY P. E. , LYNCH S. C. , KANE S. F. , JENSEN C. E. , RIZZO D. M.
Published: September 2005

Phytophthora ramorum (causal agent of sudden oak death) is an emerging generalist pathogen in coastal forests of California and Oregon, USA, that causes lethal stem infections on oaks (Quercus spp.) and tanoak (Lithocarpus densiflorus) as well as non‐lethal foliar infections on a broad range of trees and shrubs.

We studied P. ramorum over its known range in coastal redwood forests to determine forest compositional variables that are important to its epidemiology within the geographical area that it has already invaded. Redwood forests are dominated by coast redwood (Sequoia sempervirens), tanoak and California bay laurel (Umbellularia californica).

A total of 120 permanent plots (500 m2 each) were established in redwood forests at 12 sites within the main epidemic area in California. Over 5000 trees were mapped and examined for the presence of P. ramorum during spring 2002 and resampled in spring 2003.

Mean incidence of P. ramorum across all plots was 0.17 ± 0.01 in 2002 and 0.24 ± 0.02 in 2003. The highest infection levels by P. ramorum were found on California bay laurel (range 0.42–0.69) and tanoak (0.32–0.45). The highest levels of mortality were associated with tanoak and ranged from 0 to 66%, with 62.5% of that mortality associated with P. ramorum infection.

Disease incidence above 30% was most often associated with bay laurel importance value. In plots with few bay laurel stems, high disease levels were associated with the presence of understorey tanoaks. Bay laurel and small tanoaks are thought to represent the main source of inoculum for further spread of P. ramorum.

Differential host mortality due to this emerging generalist pathogen will exert considerable influence on redwood forest dynamics, with potentially dramatic shifts in forest composition and structure and subsequent cascading ecological and evolutionary effects.
Interactions among tree‐line conifers: differential effects of pine on spruce and larch
Authors: DULLINGER S. , DIRNBÖCK T. , KÖCK R. , HOCHBICHLER E. , ENGLISCH T. , SAUBERER N. , GRABHERR G.
Published: September 2005

Plant–plant interactions are increasingly considered as complex phenomena involving both negative and positive components. Within a community, the relative importance of these components is probably species‐specific and may also vary among life‐history stages and along environmental gradients.

We used the tree line of the north‐eastern Calcareous Alps of Austria, composed of shrubbyPinus mugoand uprightPicea abiesandLarix decidua, as a simple system in which to investigate these interactions. We focused on the largely unknown effects of pines on spruce and larch, rather than onP. mugo, which is known to be competitively displaced by the two tree species.

We used regression models on observational data to analyse the responses of the trees to a gradient of pine cover in terms of recruitment, growth, fecundity and browsing damage, and to determine whether effects involved both competitive and facilitative components, if they depended on the life‐history stage of the trees and if they were species‐specific.

We detected a pronounced negative effect of pine cover on recruitment and growth of both spruce and larch, whereas seed production was unaffected. Larch turned out to be more sensitive to pine competition: its recruitment and growth are superior to that of spruce in open habitats but this advantage vanishes in dense pine thickets.

Contrary to expectations, the effects of pine cover on growth rates of spruce and larch did not depend on the life‐history stage of the trees.

Pine cover is a major determinant of browsing damage for both spruce and larch, indicating that it does have a positive effect in providing shelter against herbivores.

The differential effects of pines on spruce and larch are likely to favour spruce at the expense of larch in realizing potential habitat expansion as a result of climate change. Disregarding the complex details of plant–plant interactions may thus result in unrealistic predictions of species responses to environmental changes.
Audit of nutritional guidelines for head and neck cancer patients undergoing radiotherapy
Authors: Wood K.
Published: September 2005

Background  Head and neck cancer patients being treated with radiotherapy are at an increased risk of malnutrition due to the severe side‐effects, e.g. mucositis, odynophagia and xerostomia, impacting on the ability to eat and drink (Lees, Eur. J. Cancer Care 1997;6:45). Effective dietetic management involves identifying those patients malnourished or at risk of becoming so and incorporating nutritional intervention into their treatment plan (Lees, 1997). The use of gastrostomy tubes in this patient group has been shown to be acceptable (Lees, 1997; Magne et al., Eur. Arch. Otorhinololaryngol. 2001;258:89). By placing them prophylactically, the aim is to prevent a disruption to treatment and avoid an unnecessary admission for feeding. This audit was carried out to determine whether the implementation of locally produced nutritional guidelines improved the dietetic management of this patient group.

Method  A prospective audit tool was used to collect data on 32 head and neck cancer patients undergoing radiotherapy. Data was collected weekly during the course of treatment and compared with data from previous audits. Weight change was the nutritional outcome measured.

Results  More patients underwent combined treatment (radiotherapy postoperatively or with concurrent weekly chemotherapy) when compared with previous audits. However, implementation of the guidelines appeared to contribute to an improvement in dietetic management, as fewer patients lost weight over the course of radiotherapy and there were no admissions for feeding. The presence of a dietitian at the multidisciplinary head and neck clinic improved access and communication and this is also likely to have contributed to the improved management.

Conclusions  Implementation of the guidelines led to an improvement in the nutritional management of this patient group. Implementation may be more likely if a dietitian is present at the combined head and neck clinic.
Body mass index and waist circumference in non‐alcoholic fatty liver disease
Authors: Rocha R. , Cotrim H. P. , Carvalho F. M. , Siqueira A. C. , Braga H. , Freitas L. A.
Published: September 2005

Objective  To evaluate the association of anthropometric indexes (body mass index and waist circumference) in patients with non‐alcoholic fatty liver disease (NAFLD), and its association with insulin resistance (IR), metabolic syndrome (MS) and histological findings.

Methods  From August 2003 to July 2004 a case series of 81 outpatients with clinic and/or histological diagnosis of NAFLD were selected at the Bahia University Gastro‐Hepatology Clinic, Brazil. Liver function tests, lipid profile, glucose and insulin were performed in all patients. Body mass index (BMI) and waist circumference (WC) were determined according to WHO criteria. IR was measured by means of the homeostasis model assessment (HOMA) and IR was considered with HOMA ≥3. MS was defined according to the Adult Treatment Panel III (ATP III). Liver biopsy was performed in 37 cases.

Results  Body mass index ≥ 30 kg m−2 (obesity) was found in 39% of the cases and BMI ≥ 25–29.9 kg m−2 (overweight) in 53%. BMI was correlated with IR (r = 0.29; P = 0.02) and WC with ALT (r = 0.02; P = 0.03). Increased WC also was related to IR and to MS. The presence of steatohepatitis with fibrosis on liver biopsy was associated with overweight (68%) and increase of WC (41%).

Conclusions  Body mass index and WC are frequent associated with MS, IR and histological findings (steatohepatitis and fibrosis) in patients with NAFLD.
Confirmation of nasogastric tube position by pH testing
Authors: Taylor S. J. , Clemente R.
Published: September 2005

Introduction  In 2004, the Medicines and Healthcare products Regulatory Agency (MHRA) advised that nasogastric (NG) tube position should be confirmed using pH strips or paper. However, gastric pH is raised by the use of H2‐blockers and proton‐pump inhibitors (PPIs) potentially producing false negative pH tests resulting in delayed feeding. In addition, colorimetric differentiation using pH strips may be more prone to bias and inaccuracy than direct pH measurements largely used to establish the threshold.

Method  To quantify this problem a 1 day survey of all the patients requiring NG and nasointestinal (NI) feeding was undertaken, to establish the numbers of patients receiving H2‐Blockers or PPIs, with or without a safe swallow and the methods currently being used to confirm tube positioning. A second observational study was performed to establish the accuracy of six pH strips available to NHS trusts against four unlabelled pH solutions.

Results  Forty‐two per cent of patients receiving NG feeding were on H2‐blockers or PPIs, including 13% who had a safe swallow for acidic drinks that could be subsequently aspirated to confirm position. In the second study ‘testers’ correctly identified pH's 3, 4, 5 and 6 with Mackery–Nagel 0–6, BDH 0–6 and 0–14 strips but overestimated pH 4 as pH 5 with Johnson 0–11 paper, underestimated pH 6 as pH 5 with Pehanon 0–12 paper and with Litmus classified pH 3–5 as acid (all), but half also classified pH 6 as acid.

Conclusion  Theoretically 29% of NG tube positions could not be confirmed by pH testing because of the usage of PPIs or H2‐blockers and lack of swallow. Some pH strips are either inaccurate or their result misinterpreted by staff. Large surveys and trials of the actual efficacy and accuracy of pH testing are required.
Contribution of foods to trans unsaturated fatty acid intake in a group of Irish adults
Authors: Cantwell M. M. , Flynn M. A. T. , Cronin D. , O'Neill J. P. , Gibney M. J.
Published: September 2005

Objective  To assess fat intake with particular focus on trans unsaturated fatty acid (TUFA) intake and the major sources of TUFA among Irish individuals using a Fat Intake Questionnaire (FIQ), designed specifically for an Irish context.

Subjects and methods  A total of 105 healthy volunteers (43 females, 62 males; aged 23–63 years) were recruited from Dublin Airport Medical centre, Republic of Ireland. Dietary intake was assessed using an 88 food item/food group semi‐quantitative FIQ, which was developed and validated for the Irish population.

Results  Mean energy intake was 10.6 MJ day−1, and 34% was provided by fat. Saturated, monounsaturated, polyunsaturated, trans unsaturated fatty acids and linoleic acid contributed 13%, 10%, 6%, 2% and 5% of energy respectively. Mean TUFA intake was 5.4 g day−1 (range 0.3–26). Margarine spreads provided the majority of TUFAs (1.93 g day−1), but the contribution was significantly greater for men compared with women (2.35 g day−1 versus 1.33 g day−1; P = 0.024). Milk and meat also contributed more to TUFA intake for men compared with women, but confectionery was a significantly greater contributor for women (8.6% versus 3.1% respectively, P = 0.01).

Conclusions  Although the mean TUFA intake of the total group was 5.4 g day−1 and was within current dietary recommendations (2% energy intake), some individuals had intakes as high as 26 g day−1. Public health efforts are therefore required to reduce TUFA intake in those individuals with high intakes.
Cytokine responses in immunized and non‐immunized calves after Ostertagia ostertagi infection
Authors: CLAEREBOUT E. , VERCAUTEREN I. , GELDHOF P. , OLBRECHTS A. , ZARLENGA D. S. , GODDEERIS B. M. , VERCRUYSSE J.
Published: September 2005

The objective of this study was to evaluate abomasal cytokine responses in helminth‐naive calves and calves vaccinated with protective antigen fractions from Ostertagia ostertagi after an experimental challenge infection with infective third stage (L3) larvae. Abomasal lymph nodes and/or abomasal mucosa were collected and messenger RNA for the Th1 cytokines (IFN‐γ, IL‐2, IL‐12 p40 subunit), the Th2 cytokines (IL‐4, IL‐5, IL‐6, IL‐10, IL‐13, IL‐15) and the Th3/Tr cytokine TGF‐β was quantified by real‐time RT‐PCR. Vaccination had no effect on cytokine profiles in either the abomasal lymph nodes or the abomasal mucosa. However, following infection all calves showed a significant decrease in the Th1 cytokines, IFN‐γ and IL‐12 p40, and a significant increase in the Th2 cytokines, IL‐4, IL‐5, IL‐10 and IL‐13 in the lymph nodes, compared to non‐infected calves. No correlation between the Th2 response and protection induced by vaccination could be demonstrated. In contrast, a Th2 pattern was not observed in the mucosa of the infected calves, which exhibited an increase in IFN‐γ as well as in the Th2 cytokines IL‐4, IL‐5 and IL‐10 mRNA. No significant association was observed in the abomasal mucosa between any examined cytokine mRNA level and immune effector responses such as parasite‐specific antibodies or the number of mucosal mast cells or eosinophils.
Leishmania (Viannia) braziliensis: Interaction of mannose‐binding lectin with surface glycoconjugates and complement activation. An antibody‐independent defence mechanism
Authors: AMBROSIO A. R. , DE MESSIAS‐REASON I. J. T.
Published: September 2005

The activation of complement on the surface of Leishmania promastigotes appears to be an important factor for parasite infectivity in the mammalian host, allowing their attachment and the invasion of macrophages via complement receptors. Mannose‐binding lectin (MBL) is a well‐known complement activator and an efficient opsonine. We have investigated here whether serum and purified MBL bind to and promote lysis of live promastigotes of L. braziliensis; and evaluated the deposition of MBL, C1q, C4 and C3 on the parasite surface after interaction with non‐immune normal human serum (NHS). We observed that both serum MBL and the purified MBL–MASP complex bind to the surface of L. braziliensis and that this binding occurred via the carbohydrate recognition domains of MBL. The binding of MBL, however, did not affect the lytic effect of complement on the parasites. The deposition of C1q, C4, C3 and parasite lysis was observed after incubation with NHS. EDTA but not EGTA abolished C3 deposition on the parasite surface, indicating the involvement of the alternative pathway in this process. Our results indicate that MBL binds to L. braziliensis and that this is mediated by a specific carbohydrate on the surface of parasites and provides evidence for antibody‐independent mechanisms that complement activation on the parasite surface.
Repigmentation of vitiligo with punch grafting and narrow‐band UV‐B (311 nm) – a prospective study
Authors: Lahiri Koushik , Malakar Subrata , Sarma Nilendu , Banerjee Uttam
Published: September 2005

Background  Phototherapy is already established as an effective mode of therapy in vitiligo. An evidence‐based study was carried out of the effect of narrow‐band (311 nm) ultraviolet‐B (NB‐UV‐B) radiation in 66 surgically treated patients with recalcitrant vitiligo in whom autologous mini‐punch grafting was deployed.

Methods  A total of 2613 grafts were placed over 108 lesions on 17 regions in 66 individuals (39 females and 27 males) with stable, refractory vitiligo. The age range was 21–48 years. Postsurgically, they were exposed to a suberythemal dose of NB‐UV‐B (311 nm). Different parameters of surgical repigmentation were documented.

Results  Successful repigmentation was achieved in 57 (86.36%) cases. The appearance of repigmentation (AOR) time in different regions varied between 14 and 32 days, with an overall average of approximately 20.6 days. Maximum pigment spread (MPS) reached 12 mm with an average of 6.5 mm. The relationship between the donor graft area and area of surgical repigmentation was also calculated. Cobblestoning was the most common (31.8%) complication, but improved with time and/or interference.

Conclusions  Punch grafting in combination with phototherapy (NB‐UV‐B, 311 nm) was found to be an easy, safe, inexpensive, and effective method of repigmenting static and stubborn vitiligo. Different facets of punch grafting‐induced and phototherapy‐aided surgical repigmentation were taken into consideration. The area of repigmentation, MPS, and relationship between the donor graft area and area of surgical repigmentation were documented.
The low‐dose (1 μg) adrenocorticotropin stimulation test in kidney and kidney–pancreas transplant patients: a potential guideline for steroid withdrawal
Authors: Baz‐Hecht M , Osher E , Yachnin T , Nakache R , Nakache G , Tordjman K , Stern N
Published: September 2005

Abstract:  Chronic steroid treatment is known to impair the hypothalamic–pituitary adrenal axis (HPA) but the need to assess HPA function prior to withdrawal of steroid therapy in post‐transplant patients has not been uniformly accepted. We evaluated the status of the HPA axis in 48 kidney or kidney–pancreas transplant patients who were considered for possible discontinuation of glucocorticoid therapy using a recently validated dynamic test of HPA integrity, the low‐dose (1 μg) adrenocorticotropin (ACTH) test. HPA suppression was detected in 29 (60%) of the patients, four of which had severe hypoadrenalism prohibitive of steroid withdrawal. Neither the duration of steroid treatment nor 8:00 am serum cortisol was a useful marker of hypoadrenalism. 8:00 am cortisol in subjects with normal HPA reserve and subjects with partial hypoadrenalism overlapped considerably but levels <5 μg/dL were indicative of severe hypoadrenalism. Pre‐withdrawal diagnosis of partial hypoadrenalism allowed the identification of subjects requiring no further steroid replacement under regular daily circumstances. However glucocorticoid supplementation was prescribed in the event of stress such as infection, exceptional effort, trauma or surgery. Individuals with partial HPA impairment, but not patients with severe HPA suppression, improved upon retesting 3 months later. Patients exhibiting normal response to 1 mcg ACTH enjoyed an uneventful course following steroid withdrawal. Since hypoadrenalism is extremely common in post‐transplant patients, we recommend the use of the low‐dose ACTH test as a convenient method to identify patients with various degrees of hypoadrenalism prior to steroid withdrawal.
Mycobacterium avium complex infection in kidney transplant patients
Authors: Haas S. , Scully B. , Cohen D. , Radhakrishnan J.
Published: September 2005

Abstract: Mycobacterium avium complex (MAC) infections have been reported rarely in renal transplant patients. Consequently the clinical course and optimal treatment of these patients are not well understood. We present 3 patients with MAC infections after receiving a renal transplant (2 with generalized and 1 with localized infection). All patients were treated with combination antibiotic therapy and reduction of immunosuppression. One patient experienced clinical control of disease but a mild cellular rejection that was successfully treated with high‐dose corticosteroids. One patient died of disseminated MAC infection. The patient with localized infection died of unrelated causes. In summary, MAC infection, although rare in renal transplant patients, may respond to combination antimicrobial therapy and reduction of immunosuppression.
Occult hepatitis B in renal transplant patients
Authors: Peres A.A. , Dias E.A. , Chesky M. , Alvares‐da‐Silva M.R. , Jobim L.F. , Gonçalves L.F. , Manfro R.C.
Published: September 2005

Abstract: Background. Occult hepatitis B (HB) is characterized by the presence of HBV‐DNA in patients who do not have HB surface antigen (HBsAg) detectable in sera, and is frequently described in patients with hepatitis C virus (HCV) infection. These viral liver diseases are common and may have a negative impact on the survival of renal transplant patients, especially if they are both present. In this study we aimed to evaluate the prevalence of occult HB in renal transplant patients either with or without HCV infection.

Patients and methods. In a cross‐sectional survey 101 HbsAg‐negative renal transplant patients were evaluated; 51 were anti‐HCV positive. Sera were analyzed for the presence of the S and core genes of the HBV‐DNA by a nested polymerase chain reaction technique. Markers of HBV infection and liver function tests were also analyzed.

Results. The core gene was identified in 1 HCV‐infected patient and 1 anti‐HCV‐negative patient who also presented the S gene (prevalence: 2% and 1% for each gene, respectively). HCV‐infected patients had longer pre‐transplant dialysis time (50.8±34.6 vs. 32.0±20.9; P<0.001). Liver function tests were also increased in the HCV‐infected group: alanine aminotransferase (P<0.001), aspartate aminotransferase (P<0.05), γ‐glutamyl transpeptidase (P<0.02), and alkaline phosphatase (P<0.04). Multivariate analysis revealed that HCV infection was the only determinant of the altered results of the liver function tests.

Conclusion. We found that occult HB is a condition present in our population of renal transplant patients and that HCV infection does not seem to be associated with occult HB infection in this setting.
Localized cecal zygomycosis following renal transplantation
Authors: Echo A. , Hovsepian R.V. , Shen G.K.
Published: September 2005

Abstract: Zygomycosis occurs as an opportunistic infection following organ transplantation and immunosuppressive therapy. Gastrointestinal zygomycosis is an exceedingly rare and usually fatal presentation of this infection. We discuss the case of a renal transplant recipient who survived cecal perforation from zygomycosis. The successful treatment consisted of aggressive surgical resection, intensive course of antifungal therapy, and rapid withdrawal of anti‐rejection medications.
Impact of targeted oral ganciclovir prophylaxis for transplant recipients of livers from cytomegalovirus‐seropositive donors
Authors: Shah T. , Lai W.K. , Mutimer D.
Published: September 2005

Abstract: Objectives. Symptomatic cytomegalovirus (CMV) infection can cause significant morbidity and occasional mortality after liver transplantation. In a previous audit, we showed that donor CMV seropositivity (D+) was a risk factor for symptomatic infection, and we estimated the likely clinical and financial impact of 14 weeks of oral ganciclovir prophylaxis given to recipients of CMV‐seropositive organs. In August 2001, we adopted this policy of targeted oral ganciclovir prophylaxis for recipients of CMV‐seropositive livers.

Method. The additional costs of adopting targeted prophylaxis policy for 1 year, patient and doctor compliance with the new strategy, and its clinical impact were analysed.

Results. Targeted prophylaxis reduced the incidence of symptomatic CMV infection from 9.5% (in the earlier cohort that did not receive prophylaxis) to 5.8% (P=NS). Symptomatic infection was not observed in CMV‐seropositive recipients of CMV‐seropositive donor livers (P=0.06 for comparison of the 2 cohorts), but the incidence of symptomatic infection in the CMV‐seronegative recipients of CMV‐seropositive organs did not change. However, symptomatic infection appeared to be less severe and was delayed by ganciclovir prophylaxis (median time from transplantation to symptom onset 96 vs. 39 days without prophylaxis). Death attributable to CMV infection was not observed in the cohort that received prophylaxis. The additional cost associated with implementation of the prophylaxis strategy was £108,068.

Conclusion. Targeted CMV prophylaxis with oral ganciclovir reduces the incidence and severity of symptomatic infection and appears to be a cost‐effective means of improving outcome following liver transplantation.
Comparing cytomegalovirus prophylaxis in renal transplantation: single center experience
Authors: Varga M. , Remport Á. , Hídvégi M. , Péter A. , Kóbori L. , Telkes G. , Fazakas J. , Gerlei Z. , Sárváry E. , Sulyok B. , Járay J.
Published: September 2005

Abstract: Background: Cytomegalovirus (CMV) presents a serious threat to CMV‐seronegative recipients (R−), who have received an organ from a seropositive donor (D+).

Objectives: We compared the effectiveness of three different prophylactic protocols in CMV D+/R− patients and reviewed data on patients who received no prophylaxis.

Patients and methods: We reviewed 1137 kidney transplantations from 1995 to 2004. Of these, 147 recipients were CMV negative (D+/R−); 125 patients received CMV prophylaxis. Group I received CMV hyperimmune gammaglobulin only, group II received CMV hyperimmune gammaglobulin plus oral ganciclovir, and group III received prophylaxis with oral ganciclovir only.

Results: In group I, CMV infection was observed in 31 of 53 patients (59%), and CMV disease was diagnosed in 9 (17%) during the prophylaxis. In the first year post transplant, a total of 41 of 53 patients (77.5%) had primary CMV infection. In group II, CMV infection occurred in 7 of 30 patients (23%), and CMV disease was diagnosed in only 2 (7%) during prophylaxis. In the first year post transplant, a total of 9 of 30 patients (30%) had primary CMV infection. In group III, 9 of 42 patients (21%) developed CMV infection during prophylaxis, and CMV disease was not observed. In the first year post transplant, a total of 13 of 42 patients (30%) had primary CMV infection. In contrast, all 22 CMV D+/R− patients without prophylaxis developed CMV infection (100%); CMV disease was diagnosed in 10 (45%), and 1 patient died.

Conclusions: Prophylaxis with hyperimmune gammaglobulin and/or oral ganciclovir significantly reduces CMV infection and disease. Prophylaxis with ganciclovir was significantly more effective than hyperimmune gammaglobulin monoprophylaxis, and more cost effective than combined prophylaxis.
Cellulitis as a manifestation of miliary tuberculosis in a renal transplant recipient
Authors: Seyahi N. , Apaydin S. , Kahveci A. , Mert A. , Sariyar M. , Erek E.
Published: September 2005

Abstract: Cutaneous involvement is an unusual presentation of tuberculosis (TB) and is rarely reported in renal transplant recipients. We describe a 37‐year‐old renal transplant recipient with disseminated Mycobacterium tuberculosis infection that presented as cellulitis. The organism was isolated from tissue and blood cultures. The patient was treated with quadruple anti‐TB therapy for 12 months. Anti‐TB therapy led to a complete resolution of TB lesions. We also provide a review of the literature on cutaneous TB in renal transplant recipients. Skin TB in renal transplant recipients usually occurs with nontuberculous mycobacteria. The spectrum of the skin lesions can be quite different and can mimic bacterial infections. Mycobacteriosis should always be included in the differential diagnosis of a skin lesion in renal transplant recipients.
Necrotizing fasciitis during de novo minimal change nephrotic syndrome in a kidney transplant recipient
Authors: Audard V. , Pardon A. , Claude O. , Jablonski M. , Remy P. , Desvaux D. , Lantieri L. , Lang P. , Grimbert P.
Published: September 2005

Abstract: Skin infections and particularly necrotizing fasciitis (NF) represent a rare but serious complication after transplantation. Optimal management depends on prompt diagnosis with identification of the causative organisms to allow appropriate antibiotic therapy in association with surgical debridement. We report a case of a methicillin‐resistant Staphylococcus aureus (MRSA) NF as the single pathogen in a renal transplant recipient, during the course of a de novo minimal‐change nephrotic syndrome, treated with high‐dose steroids. Antibiotic therapy together with surgical debridement and discontinuation of immunosuppressive treatment led to a complete recovery, despite persistence of the nephrotic syndrome. The development of de novo minimal‐change nephrotic syndrome after renal allograft transplantation should alert physicians to the possibility of MRSA NF during an increase in the immunosuppressive regimen.
Guillain–Barré syndrome associated with cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation
Authors: Hernández‐Boluda J.‐C. , Lis M.‐J. , Goterris R. , Arbona C. , Terol M.‐J. , Tormo M. , Solano C.
Published: September 2005

Abstract: The association between cytomegalovirus (CMV) infection and the development of Guillain–Barré syndrome (GBS) in the setting of allogeneic hematopoietic stem cell transplantation (alloSCT) has been reported only occasionally. We describe here a 23‐year‐old patient diagnosed with acute myelogenous leukemia who underwent a partially HLA‐mismatched alloSCT and soon after developed GBS along with a CMV infection. Serum autoantibodies to several ganglioside antigens were concomitantly detected. Despite therapy with ganciclovir and plasma exchanges, the patient's clinical condition rapidly deteriorated, and he died 3 weeks later with persisting CMV antigenemia. Although a coincidental association cannot be excluded, it could be speculated that a pathogenetic link exists between the 2 disorders. In this sense, molecular mimicry between viral antigens and neural host tissues could be postulated as the hypothetical mechanism underlying the triggering of the autoimmune disease in the present case.
Obstructive jaundice increases sensitivity to lipopolysaccharide via TLR4 upregulation: Possible involvement in gut‐derived hepatocyte growth factor‐protection of hepatocytes
Authors: MIYASO HIDEAKI , MORIMOTO YOSHINORI , OZAKI MICHITAKA , HAGA SANAE , SHINOURA SUSUMU , CHODA YASUHIRO , IWAGAKI HIROMI , TANAKA NORIAKI
Published: September 2005

Background:  Patients with obstructive jaundice are prone to sepsis after biliary tract surgery. The present study was designed to determine the effect of biliary obstruction on cytokine responses to lipopolysaccharide (LPS).

Methods:  Wister rats were allocated into two groups; the BDL group underwent bile duct ligation, followed 2 weeks later by administration of LPS into the duodenum. The control group underwent sham operation, and similarly received enteral LPS. Specimens were collected serially, and applied for the assays.

Results:  Serum aspartate aminotransferase and alanine aminotransferase levels were significantly increased in BDL rats. High tumor necrosis factor alpha (TNF‐α) and interleukin (IL)‐6 levels in peripheral blood were observed 2 h after LPS administration in BDL rats. In contrast, no increases in both cytokines were noted in peripheral and portal blood in control rats. Baseline HGF levels in portal and peripheral blood in BDL rats were significantly higher than in control rats. LPS significantly increased hepatocyte growth factor (HGF) levels in portal blood and decreased in peripheral blood in BDL rats, but not in control rats. Immunohistochemical analysis revealed that BDL increased expressions of Toll‐like receptor (TLR)4, CD14 and CD68 both in the small intestine and liver. Both TLR4 and CD14 mRNAs were upregulated in the small intestine and liver after LPS administration in BDL rats.

Conclusion:  Obstructive jaundice and LPS stimulation induced TLR4 upregulation both in the liver and small intestine, which led to increased TNF‐α and IL‐6 production in liver and HGF production in the small intestine. The upregulation of TLR4 may lead to pathological and host defense reactions in obstructive jaundice complicated with Gram‐negative bacterial infection.
Spontaneous bacterial peritonitis in cirrhotic patients: Is prophylactic propranolol therapy beneficial?
Authors: CHOLONGITAS EVANGELOS , PAPATHEODORIDIS GEORGE V , MANESIS EMANUEL K , BURROUGHS ANDREW K , ARCHIMANDRITIS ATHANASIOS J
Published: September 2005

Background and Aim:  It has been suggested that propranolol may have a protective effect on the development of spontaneous bacterial peritonitis by increasing the motility of the bowel and lowering the pressure of the portal vein. The aim of this study is to evaluate the association between the use of propranolol and development of spontaneous bacterial peritonitis in patients with cirrhosis and ascites.

Methods:  We retrospectively evaluated 134 patients with cirrhosis and ascites admitted consecutively for a period of 2 years. Diagnosis of spontaneous bacterial peritonitis was based on an ascitic fluid neutrophilic count of >250/mm3 and/or a positive culture without evidence of secondary peritonitis.

Results:  Spontaneous bacterial peritonitis was diagnosed in 39 of 134 (29%) patients and 12 of 39 (31%) patients died in hospital compared to only 4% (four of 95) of those without spontaneous bacterial peritonitis (P < 0.001). At admission, patients with spontaneous bacterial peritonitis, as compared to those without, had significantly more encephalopathy (28 vs 11%, P = 0.02) or fever (18 vs 4%, P = 0.01) and less frequently tense ascites (33 vs 57%, P = 0.02). Spontaneous bacterial peritonitis was diagnosed in six of 33 (18%) patients who did and in 33 of 101 (33%) who did not receive propranolol therapy (OR = 0.46, 95% CI: 0.17–1.22, P = 0.17).

Conclusion:  Our data indicate that spontaneous bacterial peritonitis significantly increases mortality in patients with cirrhosis. Propranolol therapy was not found to be associated with a significantly lower risk for spontaneous bacterial peritonitis, but a Type II statistical error cannot be definitely excluded. The potential protective effect of propranolol on the incidence of spontaneous bacterial peritonitis might deserve evaluation in properly designed prospective studies.
Curcumin ameliorates acute thioacetamide‐induced hepatotoxicity
Authors: SHAPIRO HAIM , ASHKENAZI MICHAL , WEIZMAN NIR , SHAHMUROV MARK , AEED HUSSEIN , BRUCK RAFAEL
Published: September 2005

Background and Aim: Increased production of reactive oxygen species and nitric oxide and activation of nuclear factor κ B are implicated in the pathogenesis of various liver diseases, including fulminant hepatic failure. Curcumin is a naturally occurring anti‐oxidant that reduces oxidative stress and inhibits nuclear factor κ B and nitric oxide formation. The aim of the present study is to assess curcumin's therapeutic potential in acute thioacetamide hepatotoxicity, a rat model of fulminant hepatic failure.

Methods: Fulminant hepatic failure was induced by two intraperitoneal (i.p.) injections of 300 mg/kg thioacetamide (TAA) at 24‐h intervals. The experimental groups received a low‐dose (200 mg/kg per day, i.p.) or a high‐dose (400 mg/kg per day) of curcumin, initiated 48 h prior to the first TAA injection. A fourth group was administered neither TAA nor curcumin and served as a control.

Results: The survival rate was higher in both curcumin‐treated groups compared to the TAA only treated group. Biochemical parameters of liver injury, blood ammonia and hepatic necroinflammation were lower in the low‐dose curcumin group compared to TAA controls, and were further reduced in the high‐dose group (P < 0.05 andP < 0.01, respectively). Curcumin treatment also reduced the TAA‐induced elevated hepatic levels of thiobarbituric acid‐reactive substances (TBARS), and inhibited the nuclear binding of nuclear factor κ B (NFκB) and inducible nitric oxide (iNOS) protein expression.

Conclusions: Curcumin improved survival and minimized oxidative stress, hepatocellular injury and hepatic necroinflammation, NFκB binding and iNOS expression in a rat model of FHF. These findings support the role of ROS, NFκB and iNOS in mediating liver insult due to TAA, and that of curcumin as a hepato‐protectant.
Morbidity and mortality after percutaneous endoscopic gastrostomy in children with neurological disability
Authors: CATTO‐SMITH ANTHONY G , JIMENEZ SUSAN
Published: September 2005

Background and Aim:  Gastrostomy placement has become an integral mechanism for delivering nutritional support to children with severe neurological disability. Its impact on gastroesophageal reflux and mortality remains contentious. We examined the morbidity and long‐term mortality of a group of children with severe neurological disability after percutaneous endoscopic gastrostomy (PEG).

Methods:  We retrospectively identified all children with severe neurological disability who had a PEG at the Royal Children's Hospital in Melbourne between 1990 and 1997. Data were obtained from medical records.

Results:  Ninety‐eight children with neurological disability (M:F 1.8:1.0; median age 3.5 years, interquartile range 1.1–8.7 years) had an initial PEG in this period and were able to be followed for 6–14 years. As a group, they were underweight for their age with a Z score at PEG of −3.52 (SD 3.33), but had increased weight‐for‐age Z scores by 1.05 after a mean period of 6.1 months. Fourteen subsequently required fundoplication for reflux. Mortality rates were 11% after 1 year, 21% after 2 years, 27% after 3 years and 39% after 13 years. Mortality was increased in those children who were older at the time of PEG (P = 0.06). Gastroesophageal reflux, underweight‐for‐age and gender were not significantly related to mortality.

Conclusion:  Children with severe neurological dysfunction who require gastrostomy feeding have a substantial long‐term mortality, but this may be unrelated to PEG placement.
Efficacy and tolerability of pegylated‐interferon alpha‐2a in hemodialysis patients with chronic hepatitis C
Authors: KOKOGLU OMER FARUK , UÇMAK HASAN , HOSOGLU SALIH , CETINKAYA ALI , KANTARCEKEN BULENT , BUYUKBESE MEHMET AKIF , ISIK ISMET ONDER
Published: September 2005

Background and Aim:  Hepatitis C virus (HCV) is prevalent in hemodialysis (HD) patients. These patients experience more side‐effects with antiviral treatment. The aim of the present study was to evaluate the efficacy and tolerability of pegylated interferon (PEG‐IFN) α‐2a in chronic hemodialysis patients with chronic hepatitis C.

Methods:  Twenty‐five patients were included into the study. All of the patients were interferon naive, anti‐HCV antibodies positive and polymerase chain reaction HCV‐RNA positive. Twelve of the patients received PEG‐IFN α‐2a at a dose of 135 µg weekly for 48 weeks (Group 1). The remaining 13 patients who received no specific treatment were used as controls (Group 2). The patients were prospectively followed up for a period of 18 months. Biochemical and virological responses were evaluated at the end of the study period (end‐of‐treatment response) and 6 months after the completion of therapy (sustained response).

Results:  Virological end‐of‐treatment response was observed in 10 patients (83.4%) in Group 1 and one patient (7.7%) in Group 2 (P < 0.001). Sustained virological response was observed in nine patients (75%) in Group 1 and one patient (7.7%) in Group 2 (P < 0.001). Alanine aminotransferase (ALT) levels were initially increased in seven patients in Group 1 and normalized in five of these patients at the end of the treatment and sustained biochemical response was 71.4%. In contrast, ALT levels in Group 2 were initially high in five patients and normalized in two of them (40%) at the end of the 48 weeks. Even if most of the patients experienced several side‐effects (anemia 75%, fatigue 58.3%, thrombocytopenia 33.3% and leukopenia 33.3%), they did not impose the discontinuation of the treatment.

Conclusion:  The present study showed that PEG‐IFN α‐2a for 48 weeks is efficacious and well tolerated in hemodialysis patients with HCV.