bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of SCORAD and beyond. Towards a standardized evaluation of severity?
Authors: Gelmetti C. , Colonna C.
Published: July 2004

The clinical scoring systems of atopic dermatitis were analysed and compared. Some biological parameters that can correlate with the clinical score were also reviewed. After the definition of the disease based on validated clinical criteria, the second necessity was the availability of reliable severity scores to allow clinicians to verify the course of the disease and the efficacy of treatments. After many proposals, the SCORAD (SCORing Atopic Dermatitis), that required more than three years of work, was the first one that was validated. SCORAD is freely available from an internet site and can be easily calculated using dedicated software. EASI (Eczema Area and Severity Index) score has also been validated but it has been modified twice. Simpler systems include SASSAD (Six Area, Six Sign Atopic Dermatitis) and TIS score (Three‐Item Severity score). In parallel, biological parameters were investigated. Eosinophil cationic protein, circulating basophils, major basic protein, soluble E‐selectin, antistaphylococcal enterotoxin B, immunoglobulin E titres and macrophage‐derived chemokine, can correlate significantly with the clinical score. The clinicians will not benefit directly from laboratory techniques and will employ clinical scores.
Macrovascular disease after simultaneous pancreas and kidney transplantation
Authors: Nordén Gunnela , Carlström Jan , Wramner Lars , Nyberg Gudrun
Published: July 2004

Abstract:  The objective of this study was to evaluate the outcome of simultaneous pancreas and kidney transplantation (SPK) with focus on cardiovascular mortality and morbidity in relation to graft function. From January 1985 through 1999, 87 SPK were performed in the unit. Sixty recipients were males, median age at diabetes onset 13 yr (1–40) and age at transplantation 39 yr (29–54). No case was lost to follow‐up. Morbidity and mortality during median 8 yr of follow‐up (range 1–15 yr) were recorded. Major macrovascular disease (MVD) was defined as myocardial infarction or sudden death (AMI), stroke or peripheral gangrene requiring amputation of leg, foot or fingers. At the evaluation, 26 of 87 patients (30%) had died, 19 after loss of the pancreas graft and 20 after loss of the kidney. MVD was the dominant cause of death. Non‐lethal MVD had previously been recorded in 62%. Of the 61 patients alive, 22 had lost their pancreas graft and 12 the concomitant kidney. MVD had occurred in 32%. Whereas 89% of the concomitant kidneys functioned when the pancreas graft did so, only 37% of the kidneys functioned if the pancreas had been lost, p < 0.0001. The mortality rate was significantly higher among patients who lost both grafts (16/26) than in those who lost only the pancreas graft (3/15), p = 0.01. Progressive MVD is a major clinical problem for SPK transplant patients, particularly if the kidney fails.
Assessment by flow cytometry of intracellular cytokine production in the peripheral blood cells of renal transplant recipients
Authors: Magee Colm C , Denton Mark D , Womer Karl L , Khoury Samia J , Sayegh Mohamed H
Published: July 2004

Abstract:  Introduction:  There is accumulating evidence that non‐invasive immune monitoring may be useful in the early period after renal transplant, particularly with regard to predicting the presence of acute rejection. It is less clear whether chronic allograft nephropathy (CAN) is also associated with consistent changes in peripheral blood or urine cells. We hypothesized that patients with CAN would manifest different patterns of cytokine production (compared with non‐CAN controls), detectable in peripheral blood mononuclear cells (PBMCs).

Methods:  Flow cytometry was used to quantify production within PBMCs of multiple cytokines.

Results:  A pilot study showed significant differences in cytokine production between healthy controls and transplanted subjects. However, differences between transplanted patients with and without CAN were small and non‐significant.

Discussion:  Flow cytometry is a potentially useful method for quantifying cytokine production by PBMCs of renal transplant recipients. The technique is sensitive enough to detect differences between distinct test groups but could not find differences between recipients with and without CAN. This probably reflects the lack of a true difference because pathological changes within the long‐term allograft may simply not be reflected or detected in the total population of PBMCs. Further studies should explore the usefulness of this technique in assaying more defined populations of PBMCs (such as those activated by donor allopeptides) and in serial monitoring of individual patients.
Hypercoagulable state associated with kidney–pancreas transplantation. Thromboelastogram‐directed anti‐coagulation and implications for future therapy
Authors: Burke George W , Ciancio Gaetano , Figueiro Jose , Buigas Rafael , Olson Les , Roth David , Kupin Warren , Miller Joshua
Published: July 2004

Abstract: Background: The clinical consequences of type 1 diabetes mellitus (IDDM) include diabetic triopathy: retinopathy, nephropathy, and neuropathy, as well as microangiopathy, accelerated atherosclerotic disease, and hypercoagulability. The etiology of the hypercoagulability is multifactorial, involving various clotting factors or pathways (for example platelets, fibrinogen, individual components of the clotting system and/or fibrinolysis in different studies). The development of end‐stage renal disease (ESRD), with the uremia‐related platelet effect has the potential to protect from the existing hypercoagulable state. This has important implications for surgery, particularly simultaneous pancreas–kidney (SPK) transplantation, where the pancreas has historically been prone to thrombosis. This has led us to perform intra‐operative thromboelastograms (TEG's) to evaluate the patient's current coagulation status.

Methods: A TEG was performed in 85 SPK recipients along with a control group of 54 non‐diabetic kidney transplant (KT) recipients.

Results: For each of the 4 TEG coagulation parameters, the SPK recipients were significantly more hypercoagulable than the non‐diabetic KT recipients. The use of intra‐operative heparin is based on the degree of hypercoagulability by TEG and degree of operative hemostasis. There has been one PT lost to thrombosis (1%) in the first week following transplantation during this time.

Conclusion: The use of TEG is a helpful adjunct to SPK surgery, demonstrating the patient's current coagulation status. Nearly all SPK recipients (type 1 IDDM with ESRD) have been demonstrated to be hypercoagulable. The TEG allows the judicious use of anti‐coagulation at the time of surgery, and beyond.
Pre‐transplant elevations of interleukin‐12 and interleukin‐10 are associated with acute rejection after renal transplantation
Authors: Fitzgerald Jason T , Johnson Jeremy R , Perez Richard V
Published: July 2004

Abstract:  Background:  Methods for predicting patients at higher risk for rejection before transplantation may help improve outcomes. We hypothesized that pre‐transplant elevations of serum interleukin‐12 (IL‐12), a pro‐inflammatory cytokine, would predict acute rejection, while pre‐transplant IL‐10, an immunoregulatory cytokine, would be down‐regulated in patients subsequently experiencing acute rejection.

Materials and methods:  Thirty patients experiencing acute rejection after cadaveric renal allograft transplantation and a control group of 30 patients, undergoing the same procedure but without the occurrence of rejection, were identified. Serum samples taken before transplantation from each patient were then analyzed quantitatively for IL‐12 and IL‐10 using ELISA assays.

Results:  The mean pre‐transplant serum IL‐12 level was higher in patients who subsequently underwent acute rejection vs. those who did not (181 ± 143 pg/mL vs. 81.2 ± 71.5 pg/mL, respectively, p = 0.007). Unexpectedly, pre‐transplant serum IL‐10 levels were also elevated in patients who underwent rejection (559 ± 293 pg/mL vs. 332 ± 163 pg/mL, respectively, p = 0.002). Multivariate analysis demonstrated that elevations of IL‐12 and IL‐10 were independent risk factors for rejection when adjusted for confounding variables.

Conclusions:  Pre‐transplant elevations of IL‐12 and, unexpectedly, IL‐10 are associated with acute rejection after cadaveric renal transplantation and may be useful in predicting which patients are at increased immunological risk at the time of transplantation. Further studies are necessary to assess the role of occult systemic inflammation in contributing to poor outcomes after transplantation.
Two‐year incidence of malignancy in sirolimus‐treated renal transplant recipients: results from five multicenter studies*
Authors: Mathew Timothy , Kreis Henri , Friend Peter
Published: July 2004

Abstract:  We examined the rates of malignancy at 2 yr after transplantation in renal allograft patients receiving sirolimus (SRL) in continuous combination with cyclosporine (CsA), SRL as base therapy or SRL maintenance therapy after early withdrawal of CsA. A total of 1295 patients were enrolled in two double‐blind studies comparing SRL with azathioprine (AZA) or placebo administered in continuous regimens with CsA. In two other trials (n = 161), SRL given as base therapy was compared with CsA. In the fifth trial, patients were randomly assigned at 3 months to either remain on CsA + SRL therapy (n = 215) or to have CsA eliminated with SRL being continued in concentration‐controlled doses (n = 215). At 2 yr after transplantation, patients receiving SRL in continuous combination with CsA had a significantly lower incidence of skin cancer compared with patients receiving placebo. Patients receiving SRL as base therapy had no malignancies compared with a 5% incidence in those receiving CsA. The incidence of malignancy was significantly lower in patients receiving concentration‐controlled SRL with elimination of CsA compared with those who remained on CsA + SRL. Based on the currently available data, patients receiving SRL‐based therapy without CsA or SRL maintenance therapy after early CsA withdrawal have lower rates of malignancy in the first 2 yr after renal transplantation. SRL immunotherapy may be beneficial in protecting renal transplant patients from skin cancer even when given in combination with CsA.
Can the outcome of older donor kidneys in transplantation be predicted? An analysis of existing scoring systems
Authors: Singh Dharm , Kiberd Bryce , Lawen Joseph
Published: July 2004

Abstract:  The use of older cadaveric donors in kidney transplantation is increasing. The transplant outcome of the single older kidney is generally inferior prompting some to recommend dual kidney transplantation. The ability to predict the outcome of the solitary marginal kidney becomes clinically important. Such insight might allow for better allocation strategies that would minimize poorer outcomes while permitting optimal rationalization of this scarce resource. A retrospective, single center review of 79 single kidney transplants from 50 donors aged ≥55 yr was performed. We tested the validity of published scoring strategies to predict subsequent recipient kidney function. Receiver operating characteristic curve analysis was used to quantify the donor strategies separating good and poor outcomes based upon recipient creatinine clearance (CrCl) <30 mL/min. Two pre‐transplant donor assessment strategies, Nyberg score and donor CrCl (dCrCl) were found to predict subsequent kidney function in recipients. When Nyberg variables (cold ischemia time, donor diabetes and hypertension status, incremental donor age >55 yr and cause of death) in conjunction with the dCrCl were considered, they were no better than dCrCl alone. Although dCrCl had a reasonable negative predictive ability, the positive predictive value was <50%. Our analysis suggests that a dCrCl of ≥70 mL/min is a better discriminator of subsequent kidney function outcomes than a dCrCl of 90 mL/min as recommended by the Dual Transplant Registry.
Haplotype variation at the IBD5/SLC22A4 locus (5q31) in coeliac disease in the Irish population
Authors: Ryan A.W. , Thornton J.M. , Brophy K. , Daly J.S. , O'Morain C. , McLoughlin R.M. , Kennedy N.P. , Abuzakouk M. , Stevens F.M. , Feighery C. , Kelleher D. , McManus R.
Published: July 2004

Abstract In addition to the well‐established association of coeliac disease (CD) with HLA‐DQ (6p21) and possibly CTLA4 (2q33), there is considerable evidence for a susceptibility locus on chromosome 5q, which contains many potential candidates for inflammatory disease, including a cluster of cytokine genes in 5q31. CD cases and controls were genotyped for four single‐nucleotide polymorphism (SNP) markers that together characterize >90% of the haplotype variation at the IBD5 locus encoding, among others, the SLC22A4 gene. IBD5 and SLC22A4 map to 5q31 and have recently been associated with Crohn's disease and rheumatoid arthritis. Haplotype frequencies do not differ significantly between CD cases and controls in the Irish population, and therefore the chromosome  5 CD susceptibility locus most likely lies elsewhere on 5q.
A novel HLA‐DRB1*13 allele (DRB1*1357) identified by polymerase chain reaction with sequence‐specific primers and direct sequencing*
Authors: Danzer M. , Leitner D. , Gangl E. , Fae′ I. , Fischer G.F. , Gabriel C.
Published: July 2004

Abstract We describe the identification of a new DRB1*13 allele, DRB1*1357*, found in two Austrian Caucasian individuals. The novel allele was initially suspected because analysis with sequence‐specific primers resulted in an unusual pattern of amplification. Thereafter, exon 2 was further characterized by sequence‐based typing. The nucleotide sequence of DRB1*1357 is identical to DRB1*1319 except for a single substitution in codon 47 (TAC to TTC) leading to a change from phenylalanine to tyrosine.
Investigation of killer cell immunoglobulin‐like receptor gene diversity III. KIR2DL3
Authors: Keaney L. , Williams F. , Meenagh A. , Sleator C. , Middleton D.
Published: July 2004

Abstract The allelic variation of one of the chromosome 19 KIR genes, KIR2DL3, has been investigated using a polymerase chain reaction sequence‐specific oligonucleotide probe‐based methodology. The procedure has been applied to a healthy Northern Irish control group in order to establish phenotype and genotype frequencies in this Caucasian population. In addition, cell line DNA and Centre d’Etude du Humaine (CEPH) families, both from the 13th International Histocompatibility Workshop have been investigated, establishing control data for this gene.
Polymorphism of HLA class I genes in the Brazilian population from the Northeastern State of Pernambuco corroborates anthropological evidence of its origin
Authors: Nigam P. , Dellalibera E. , Maurício‐da‐Silva L. , Donadi E.A. , Silva R.S.
Published: July 2004

Abstract The allelic distribution of human leukocyte antigen (HLA) class I genes (HLA‐A, HLA‐B, and HLA‐Cw) of the population from the State of Pernambuco in Northeastern Brazil was studied in a sample of 101 healthy unrelated individuals. Low to medium resolution HLA class I typing was performed using polymerase chain reaction‐amplified DNA hybridized to sequence specific primers (PCR‐SSPs). Twenty allele groups were detected for HLA‐A, 28 for HLA‐B, and 14 for HLA‐Cw. The most frequent alleles were HLA‐A*02(0.2871), HLA‐B*15(0.1238), and HLA‐Cw*04(0.2277), and the most frequent genotypes were A*02/A*02(0.0990), B*15/B*15(0.0594), and Cw*04/Cw*04 and Cw*07/Cw*07, both with a frequency of 0.0792. The observed heterozygosity for the studied loci was 79.21% for HLA‐A, 87.13% for HLA‐B, and 77.23% for HLA‐Cw. The most frequent haplotype was A*02‐Cw*04‐B*35(0.0485), which is also present in Western European, Amerindian, and Brazilian Mulatto populations, but absent in African populations. Taken together, these data corroborate the historic anthropological evidences of the origin of the Northeastern Brazilian population from Pernambuco.
Arginine vasopressin and serum nitrite/nitrate concentrations in advanced vasodilatory shock
Authors: Dünser M. W. , Werner E. R. , Wenzel V. , Ulmer H. , Friesenecker B. E. , Hasibeder W. R. , Mayr A. J.
Published: July 2004

Background:  Arginine‐vasopressin (AVP) can successfully stabilize hemodynamics in patients with advanced vasodilatory shock. It has been suggested that inhibition of cytokine‐induced nitric oxide production may be an important mechanism underlying AVP‐induced vasoconstriction. Therefore, serum concentrations of nitrite/nitrate (NOx), the stable metabolite of nitric oxide, were measured in patients suffering from advanced vasodilatory shock treated with either AVP in combination with norepinephrine (NE) or NE alone.

Methods:  This trial was a separate study arm of a previously published prospective, randomized, controlled study on the effects of AVP in advanced vasodilatory shock. Thirty‐eight patients were prospectively randomized to receive a combined infusion of AVP (4 U h−1) and NE, or NE infusion alone. Serum NOx concentrations were measured at baseline, 24, and 48 h after randomization. The increase in mean arterial pressure during the first hour after study enrollment was documented in all patients.

Results:  No difference in NOx concentrations was found between groups throughout the study period. AVP patients demonstrated a significantly greater increase in mean arterial pressure than NE patients (22 ± 10 vs. 5 ± 9 mmHg; P < 0.001). The magnitude of pressure response to AVP was not correlated with NOx concentrations before start of AVP infusion (Pearson's correlation coefficient, −.009; P = 0.971).

Conclusion:  Cardiovascular effects of AVP infusion in advanced vasodilatory shock are not mediated by a clinically relevant reduction in serum NOx concentrations. Therefore, hemodynamic improvement of patients in advanced vasodilatory shock during continuous infusion of AVP has to be attributed to other mechanisms than inhibition of nitric oxide synthase. In addition, the magnitude of pressure response to AVP is not correlated with baseline concentrations of NOx.
Effectiveness and efficiency of intensive care medicine: variable costs in different diagnosis groups
Authors: Iapichino G. , Radrizzani D. , Simini B. , Rossi C. , Albicini M. , Ferla L. , Colombo A. , Pezzi A. , Brazzi L. , Melotti R. , Rossi G. ,   for the GiViTI group (Italian Group for the Evaluation of Interventions in Intensive Care Medicine)
Published: July 2004

Background:  To establish the effectiveness of ICU treatment and the efficiency in the use of resources in patients stratified according to 10 diagnosis and two levels‐of‐care. To propose strategies aimed at reducing costs and improving efficiency in each patient group.

Methods:  Multicentre prospective observational study. ICUs enrolled two cohorts of up to 10 consecutive patients with ICU stay ≥48 h. Each with one of these diagnoses: trauma, brain‐trauma, brain‐hemorrhage, stroke, acute‐on‐chronic‐obstructive‐pulmonary disease, lung‐injury/acute respiratory distress syndrome, heart failure, and scheduled/unscheduled abdominal surgery. The presence of active‐life support divides high from low level‐of‐care treatments. Variable ICU costs were collected daily (bottom‐up) for 21 days. We evaluated effectiveness (hospital survival) and efficiency (hospital‐survivors variable‐cost as a ratio of overall cost).

Results:  Forty‐two Italian general ICUs recruited 529 patients in 5 months. Mean ICU variable‐costs significantly differed with diagnosis and level‐of‐care. Costs were positively affected by ICU length‐of‐stay, by duration of active‐treatment. Outcome variably influenced costs. Medians of variable‐costs per patient (1715 Euro) and patient‐groups efficiencies (60.7%) identified four possible combinations between (low and high) cost and (low and high) efficiency groups. Moreover, efficiency was better than effectiveness in stroke, brain‐hemorrhage and trauma, while it was worse in heart failure, acute‐on‐COPD or acute‐lung injury. Overall ICU cost attributed only to survivors ranged from 699 (scheduled surgical) to 5906 (unscheduled surgical) Euro. Cost of non‐survivors distributed to all patient was between 95 (scheduled‐surgical) to 1633 (unscheduled‐surgical) Euro.

Conclusions:  Analysis of variable patient‐specific cost was used as a tool to assess intensive care performance in patient subgroups with different diagnosis and levels‐of‐care.
Pulmonary net release of tissue‐type plasminogen activator during porcine primary and secondary acute lung injury
Authors: Nyberg A. , Fagerberg A. , Ahlqvist M. , Jern C. , Seeman‐Lodding H. , Åneman A.
Published: July 2004

Background:  Tissue‐type plasminogen activator (tPA) is a key mediator of fibrinolysis. Matching of pulmonary perfusion and ventilation is a critical denominator of oxygenation in acute lung injury (ALI). This study investigates pulmonary venoarterial plasma tPA gradients in association with acute ALI induced by bronchoalveolar lavage (BAL) and endotoxinemia (ETX).

Methods:  Twenty‐one anaesthetized, ventilated pigs were allocated to control (CTRL, n=5), bronchoalveolar saline lavage (BAL, n=8) or infusion of Escherichia coli endotoxin (ETX, n=8). Total tPA was analyzed in plasma (ELISA calibrated for porcine tPA). The inflammatory response was assessed by TNFa levels (ELISA). All variables were assessed at baseline and 2 h following ALI.

Results:  Bronchoalveolar lavage and ETX induced similar increases in pulmonary shunt whereas pulmonary vascular resistance was significantly more increased in ETX animals. Cardiac output remained stable in BAL animals but decreased in ETX animals. The pulmonary venoarterial tPA plasma gradient increased in ETX animals, yielding a positive pulmonary net flux of tPA, which was absent in BAL animals. TNFα levels increased in ETX, but not in BAL, animals. A significant correlation was observed between TNFα and tPA plasma levels in ETX animals. All variables remained unchanged in CTRL animals.

Conclusion:  Plasma changes of tPA levels support a pulmonary release of tPA in early experimental ALI induced by acute ETX but not lavage, and are related to the inflammatory response. Despite increased vascular fibrinolytic capacity in ETX animals, pulmonary dysfunction was not different from BAL animals. The results demonstrate the close relation between inflammation and coagulation in early ALI.
Glucocorticoid regulation of the inflammatory response to injury
Authors: Yeager M. P. , Guyre P. M. , Munck A. U.
Published: July 2004

During the first half of the 20th century, physiologists were interested in the adrenal glands primarily because adrenalectomized animals failed to survive even mild degrees of systemic stress. It eventually became clear that hormones secreted by the adrenal cortex were critical for survival and, in this context, adrenal cortical hormones were widely considered to support or stimulate important responses to stress or injury. With the purification and manufacture of adrenal cortical hormones in the 1930s and 1940s, clinicians suddenly discovered the potent anti‐inflammatory actions of glucocorticoids (GCs). This dramatic, and unexpected, discovery has dominated clinical and laboratory research into GC actions throughout the second half of the 20th century.

More recent research is again reporting GC‐induced stimulatory effects on a variety of inflammatory response components. These effects are usually observed at low GC concentrations, close to concentrations that are observed in vivo during basal, unstimulated states. For example, GC‐mediated stimulation has been reported for the hepatic acute‐phase response, for cytokine secretion, expression of cytokine/chemokine receptors, and for the pro‐inflammatory mediator, macrophage migration inhibition factor. It seems clear that the long‐held clinical view that GCs act solely as anti‐inflammatory agents needs to be re‐assessed. Varying doses of GCs do not lead simply to varying degrees of inflammation suppression, but rather GCs can exert a full range of effects from permissive to stimulatory to suppressive.
Is a double‐injection technique superior to a single injection in posterior subgluteal sciatic nerve block?
Authors: Taboada M. , Álvarez J. , Cortés J. , Rodríguez J. , Atanassoff P. G.
Published: July 2004

Bckground and objectives:  Currently, no information is available on the effects of a double‐injection technique on onset time and efficacy following subgluteal sciatic nerve blockade. We hypothesized that the success rate and time to onset of subgluteal nerve block following a double‐injection technique would be superior to that after a single injection.

Methods:  Fifty ASA I or II patients undergoing foot or ankle surgery randomly received a single or double injection subgluteal sciatic nerve block. Group S (n=25) received a single injection of 30 ml of 0.75% ropivacaine to the sciatic nerve. In Group D (n = 25), 15 ml of the same solution was injected to each sciatic nerve component. Completion of sensory and motor blockade, and patient acceptance, was evaluated by a blinded anesthesiologist.

Results:  Complete sensory and motor blockade of the foot was achieved faster with the double injection (7.4 [5.9–8.8] min and 12.3 [10.4–14.2] min, respectively) than with the single‐injection technique (12.5 [10.7–14.3] min and 18.8 [16.7–21.0] min, respectively) (P<0.001 and P<0.001, respectively). Success rate and acceptance were similar in both groups. Severe or moderate discomfort during the procedure was less frequent after a single injection (P = 0.013).

Conclusions:  Both the single‐ and double‐injection technique for subgluteal sciatic nerve blockade resulted in acceptable anesthesia in most patients. The double injection generated a faster onset of anesthesia than the single injection. However, the double‐injection technique caused more patient discomfort during establishment of the nerve block.
Robust estimation of breeding values in a random regression test‐day model
Authors: Yang R. , Schaeffer L. R. , Jamrozik J.
Published: July 2004

Two robust estimation procedures were applied to a random regression test‐day model to reduce the effects of test‐day records that are generally labelled as outliers. One robust procedure consisted of estimating residuals (actual observation minus predicted) from the genetic evaluation model, computing the standard deviation of residuals across all records, and restricting the outlier residuals to be within k standard deviations. Thus, a new observation is created for use in the genetic evaluation model. The process is part of the iterations on data to obtain solutions to mixed model equations until no more outliers beyond k standard deviations exist. Four different values of k were examined. The second robust procedure utilizes different weights with each test‐day record. Weights are estimated from the residuals for all observations. Outliers tend to receive smaller weights, and thus, their influence tends to be reduced. In this study, eleven different weight formulas were compared. The objectives were to apply the robust procedures to test‐day milk yield records of Canadian Jersey cattle and to determine the effects on estimated breeding values (EBVs) and rankings of animals. Results were compared to usual best linear unbiased prediction (BLUP) ignoring the outlier problem.
Modelling the effect of nutritional status on pre‐asymptotic and relative growth rates in a random‐bred chicken population
Authors: Aggrey Samuel E.
Published: July 2004

This study was undertaken to use the spline linear regression to model pre‐asymptotic body weight measurements from an unselected random‐bred chicken population fed two different protein diets. The spline linear regression model is a compound function comprising of series of linear models. It was used to compartmentalize growth into segments. The birds raised under the low‐protein diet had four compartments, whereas those raised under the high‐protein diet had three compartments. Whereas the protein level defined the number of splines or compartments, the growth potential demonstrated by the sexes were different. The males under low‐protein diet grew faster than the females under high‐protein diet. Even though both sexes responded to high‐protein diet, a high‐protein diet in females was not enough to raise their growth potential to that of males under low protein levels. The efficiency of growth under the two protein levels were assessed with relative growth. Relative growth rate is the increase in body weight per unit of body weight per unit of time, and it represents the efficiency of an animal as a producer of new body mass material. The maximum relative growth modeled by the Gompertz function for both sexes under the two protein levels were observed at day 6 and hereafter, declined proportionally to a proponent of the amount of growth remaining. Despite the high absolute growth of the birds fed a high‐protein diet compared with their counterparts fed a low‐protein diet, the relative growth rates of the two groups were comparable. Modelling both absolute and relative growth show that the maximum absolute and relative growth rates occur within different time frame, as a result, selecting on absolute growth rate for improved relative growth within the same time frame or vice versa may not achieve the desired selection goal. The use of the spline regression and relative growth models would have practical application for commercial broilers and broiler breeders where growth is either truncated before the asymptote or controlled by dietary and other environmental factors to prevent excessive obesity.
The value of sexed bovine semen
Authors: Madalena F. E. , Junqueira F. S.
Published: July 2004

Semen sexing may be used in a variety of practical situations, where part (or all) of the herd may be inseminated with X‐ and Y‐chromosome‐enriched semen. Expressions are presented to calculate the net present value of progeny derived from a semen dose, dependent on the values of females and males, and on the efficiency of sexing. Sexed semen allows selling a higher proportion of the more valuable sex and also increases the value of animals retained for breeding through more intense selection. The expressions to economically evaluate sexed semen are quite general but numerical examples are presented for several practical situations of interest in Brazil.
WHAT IS THE STANDARD OF EUS GUIDED FNA IN JAPAN?
Authors: Kida Mitsuhiro , Saito Yoshitake
Published: July 2004

After the reports by Vilmann and Grimm, endoscopic ultrasonography (EUS) guided fine needle aspiration (FNA) has become popular in the clinical fields, especially in the western world. However, EUS guided FNA is still a special examination in Japan, although it is also becoming popular. At the moment there is no standardization of EUS guided FNA in Japan. According to the questionnaire we put together, most experienced Japanese endosonographers commonly employed a 22 or 21 guage needle for EUS guided FNA. Optimally, EUS guided FNA is repeated to obtain enough tissue and to be confirmed histologically on site; however, it is confirmed macroscopically in more than half of the institutions included in the survey. All institutions used stylet, which is generally pulled back 1–3 cm during the puncture of the center of target lesion and commonly changed the pass way at each stroke. Negative pressure by the suction of 20 cc syringe has been used in most of institutions. Times of strokes varies from less than 10–30 in each institution. About pushing out the sample tissue, half of institutions used a stylet. As mentioned above, on site histo‐cytologist with diff quick staining is optimal for EUS guided FNA; however, most of institutions do not allow this at the moment.

In order to widen EUS guided FNA we conducted multicenter study on the standardization of EUS guided FNA with statistical evidence.
INSERTION OF METALLIC STENTS FOR MALIGNANT GASTRIC OUTLET AND DUODENAL STENOSES
Authors: Uno Koji , Tanaka Kiyohito , Cho Eisai , Yasuda Kenjiro , Nakajima Masatsugu
Published: July 2004

Recently, an indication of gastrointestinal stenting is not only esophageal stenosis but it extends from the esophagus to the gastric outlet and duodenum. However, there are some problems such as shortness of the device for esophageal stenting, angulations of stenotic sites, and so on, when we perform the stenting for stenoses of the gastric outlet and duodenum. Until now, some refinements of stent insertion technique have been attempted to solve these problems. In this paper, we report three cases in which self‐expanding metallic stents were placed for stenoses of the gastric outlet and duodenum with refinements of stent insertion technique. Our attempts in these patients were an extension of stenting device to insert stents easily, and placement of covered metallic stent inside non‐covered metallic stent or a fixation of covered metallic stent to the gastrointestinal wall by means of endoclips to avoid dislocation of stents. Stents were inserted successfully in all patients, and the nutrition of these patients was improved after the placement of stents. Further refinements of stents and stent insertion technique are expected to achieve easy manipulation.
IS IT DIFFICULT FOR ENDOSCOPISTS WHO HAVE DONE CONVENTIONAL ENDOSCOPIC MUCOSAL RESECTION TO PERFORM SUBMUCOSAL DISSECTION?
Authors: Yagi Kazuyoshi , Nakamura Atsuo , Sekine Atsuo
Published: July 2004

Submucosal resection is a very useful method of endoscopic mucosal resection (EMR) for en bloc resection. We began using this method in March 2003 and have resected lesions in 16 patients with gastric cancer. We describe the procedure times and complications associated with submucosal resection from a beginner's point of view. Our first five patients experienced bleeding and perforation. With the aid of a range of instruments and the advice of expert endoscopists, our complication rate became very low and the procedure time much shorter. Endoscopists who seek to perform submucosal dissections easily and safely should avail themselves of training and education from experts in the method. A program for training endoscopists in submucosal dissection is essential.
A STUDY OF PHYSICAL EFFICACY OF DIFFERENT SNARES FOR ENDOSCOPIC MUCOSAL RESECTION
Authors: Yamano Hiro‐o , Matsushita Hiro‐o , Yamanaka Kousei , Maeda Satoshi , Nakazato Masaru , Sato Kentaro , Fujita Kazuhiko , Satake Shinya
Published: July 2004

There are various types of snares for endoscopic mucosal resection (EMR). Some endoscopists may choose the snare according to their feeling, but we supposed that there were some physical reasons behind each choice. In this paper, we raise the questions, ‘What is the best snare chosen for EMR?’, and ‘Why do we have to do it?’. From the theory of dynamics, we thought that the most important element was vertical force, which we could add against mucosa through the snare. First, we made two situations; one was keeping horizontal faced position of loop of snare (we defined it as HPW; horizontal faced position weight), and the other was rising up position of it (we defined it as RPW). We inspected these forces for the representative and different seven snares, and calculated the ‘Effective Range’, which was a RPW minus a HPW in average. The results demonstrated that both the spiral snare and the smaller ‘Snare Master’ showed higher than other snares in HPW, RPW, and the Effective Range. Based on our study, we judged them as the most adequate snares for EMR in physics and logicality.
STANDARD IMAGING TECHNIQUES IN THE PANCREATOBILIARY REGION USING RADIAL SCANNING ENDOSCOPIC ULTRASONOGRAPHY
Authors: Inui Kazuo , Kida Mitsuhiro , Fujita Naotaka , Maguchi Hiroyuki , Yasuda Kenjiro , Yamao Kenji
Published: July 2004

Standard imaging techniques using a radical scanning echoendoscope are summarized to facilitate the attainment of expertise in biliopancreatic endoscopic ultrasonography and to promote the widespread use of this diagnostic tool. Typical images of the biliopancreatic system and neighboring organs obtained by scanning from the stomach, duodenal bulb, and descending portion of the duodenum are shown in a sequential manner. Two methods of scanning from the descending portion of the duodenum, which is considered to be the most difficult, are presented (i.e. the Longitudinal Method and the Transverse Method). In addition, settings of the image control functions and the monitor are also detailed.
ENDOSCOPIC MANAGEMENT OF BILIARY STRICTURES
Authors: Kubota Yoshitsugu
Published: July 2004

Endoscopic stenting, due to being less invasive, is feasible for most patients with biliary strictures; however, presumed efficacy should be balanced against the procedure‐related morbidities for an individual patient. Self‐expandable metallic stents have a longer patency, but are not retrievable. Therefore, the use of self‐expandable metallic stents should be limited to those with unequivocal findings of unresectable malignancy. Plastic stents are indicated for strictures due to benign etiologies and equivocal malignancy. Endoscopic stenting for hilar biliary stricture is challenging. Bilateral hepatic drainage seems ideal but is often demanding to achieve with endoscopic technique, and contrast injection into undrained segments may pose a substantial risk for cholangitis and aggravate prognosis. Therefore, the extent of drainage should be balanced against the procedure‐related complications. Preoperative magnetic resonance cholangiopancreatography may help determine feasibility of bilateral drainage or an ‘intended and selective drainage’ with a single stent and might obviate the possible morbidities.
STRATEGY FOR CLINICAL MANAGEMENT OF BENIGN BILIARY STRICTURES
Authors: Aiura Koichi , Imaeda Hiroyuki , Kumai Koichiro
Published: July 2004

Benign biliary strictures (BBS) can present serious challenges in clinical management. We present a strategy for selecting therapeutic approaches to BBS based on our institute experience. Stricture etiology is important for developing a treatment plan, as it often determines the anatomical sites and structure of the stricture. If the initial passage of a guidewire through the stricture fails, surgical correction becomes the only option. Otherwise, non‐surgical endoscopic procedures such as percutaneous transhepatic or transpapillary balloon dilation with or without stent insertion provides a good outcome in most cases. However, patients with BBS of Bismuth type III/IV or those due to pancreatitis tend to present more difficulty for successful treatment by endoscopic procedures. The placement of double stents across the stricture may be beneficial to maintain greater diameter after dilation. In addition, endoscopic sphincterotomy required for stent emplacement could increase the chance of reflux cholangitis, especially in patients with bile duct strictures.
PLASTIC STENT PLACEMENT FOR UNRESECTABLE MALIGNANT BILIARY STRICTURE
Authors: Ito Kei , Fujita Naotaka , Noda Yutaka , Kobayashi Go , Kimura Katsumi
Published: July 2004

Background:  Endoscopic stent placement is an efficacious treatment for patients with malignant biliary stricture. We investigated the indications for plastic stent placement in patients with unresectable malignant biliary stricture.

Patients and methods:  Eighty‐three patients with unresectable malignant biliary stricture who had undergone endoscopic placement of either a plastic stent or a covered metal stent in our department between February 1997 and September 2002 were reviewed retrospectively.

Results:  Metal stents had significantly longer patency (273 ± 99 days) than plastic stents (155 ± 52 days) (P = 0.0292). The two groups showed similar patency curves up to 150 days.

Conclusions:  The indication for plastic stent placement as palliative therapy for unresectable malignant biliary stricture is drainage for patients with an expected survival of less than 5 months.
Screening for colorectal cancer
Authors: LAU Patrick , SUNG Joseph
Published: July 2004

Screening for a disease is an important concept in modern day preventive medicine. The aim is early disease detection and treatment of both asymptomatic individuals and those at risk of the disease, with the goal of better survival. The WHO published a set of essential criteria for screening in 1968 and colorectal cancer has been identified as a candidate disease. Three methods of screening are evaluated here: fecal occult blood test, flexible sigmoidoscopy and colonoscopy. Newer techniques are still being studied and preliminary results are encouraging. The incidence of colorectal cancer in Asia has been increasing in association with changes in lifestyle and therefore, designing efficient, acceptable screening programs for these populations is an important issue in the prevention of this common malignant disease.
Changes in the expression of angiotensin II type 1 receptor in the development of liver fibrosis
Authors: WANG Wei Wei , YANG Xi Shan , LI Xu , WANG Jie , TIAN Ye , YANG Chuan Hong , LAI Huang Wen
Published: July 2004

OBJECTIVE:  To detect the expression of angiotensin II type 1 receptor (AT1R) in the different stages of human liver fibrosis.

METHODS:  The morphology and ultrastructure of hepatic stellate cells (HSC) in hepatic sinusoids were studied by transmission electron microscopy, collagen I (col I) was tested by immunohistochemical method, an indirect immunofluorescence labeling method was used to detect AT1R, and semiquantitative RT‐PCR was used to detect AT1R mRNA.

RESULTS:  Positive expression of AT1R was mainly distributed in the periphery of hepatic lobules and in the cytoplasm of HSC in the sinusoids. In normal liver tissue from 12 cases, positive expression of AT1R was seen in 8, whereas in 18 fibrotic livers, all showed positive expression. Cells that positively expressed AT1R were significantly more abundant in the fibrotic liver group than in the normal liver group (P < 0.001), and were significantly increased with an increase in the collagenous surface area. The relative expression level of AT1R mRNA in the fibrotic liver group was also higher than in the normal liver group (P < 0.01).

CONCLUSIONS:  The expressions of both AT1R and AT1R mRNA increased significantly with the degree of liver fibrosis, so angiotensin II and its receptor are probably important in the development of liver fibrosis.
Categorization of dysmotility in patients with chronic constipation and its significance for management
Authors: GUO Xiao Feng , KE Mei Yun , WANG Zhi Feng , FANG Xiu Cai , WU Bing , TU Yin Ping
Published: July 2004

BACKGROUND:  Chronic constipation is a common gastrointestinal symptom with different patterns of dysmotility for which there is not one simple and effective diagnostic method for categorization. The present study assessed the diagnostic method used in patients with chronic constipation and its significance for clinical management.

METHODS:  The study group comprised 210 consecutive patients with chronic constipation who underwent history, digital anorectal examination (DARE), gastrointestinal transit test (GITT) and anorectal manometry (ARM) to determine the pattern of dysmotility. Symptoms and the examinations were summarized for establishing the diagnostic method and evaluation of the role of the examinations.

RESULTS:  Outlet obstructive constipation (OOC), slow transit constipation (STC) and mixed constipation (MC) accounted for 50.8%, 10.2% and 39.0% of cases, respectively. The stool was harder in STC or MC than in OOC (P = 0.036). The presence of a paradoxical inverse contraction of anal sphincter when straining to defecate during DARE or ARM was significant for the diagnosis of OOC (P < 0.001). The distribution of the residual markers on abdominal plain film after 48 h GITT was significant for the diagnosis of STC (P < 0.001). The sensitivity of DARE, GITT and ARM was 82.5%, 89.1% and 94.4%, and specificity was 95.2%, 87.9% and 82.6%, respectively. Clinical management was modified in 69.5% of patients after categorizing the constipation pattern.

CONCLUSIONS:  The symptoms, DARE, GITT and ARM are effective methods of evaluating the dysmotility patterns in patients with chronic constipation. DARE and ARM could improve the diagnostic rate of OOC, and GITT assists in diagnosis of STC. Proper categorization of the dysmotility pattern is important for the clinical management of chronic constipation.
Study of visceral hypersensitivity in irritable bowel syndrome
Authors: DONG Wen Zhu , ZOU Duo Wu , LI Zhao Shen , ZOU Xiao Ping , ZHU Ai Yong , XU Guo Ming , YIN Ning , GONG Yan Fang , SUN Zhen Xing , MAN Xiao Hua
Published: July 2004

OBJECTIVE:  Visceral hypersensitivity is highly prevalent in most functional bowel disorders, such as irritable bowel syndrome (IBS), and activation of intestinal mast cells (MC) may play a role because they have been found in close proximity to gastrointestinal mucosal sensory nerve terminals containing neuropeptides and a bi‐directional pathway connecting the central nervous system, gut, and MC has been demonstrated. The current study appraised the status of rectal visceral perception, as well as the changes in the MC and substance P (SP) in the intestinal mucosa of patients with IBS.

METHODS:  The study group comprised 42 patients with IBS and 19 healthy subjects who underwent anorectal manometry and rectal perception thresholds to balloon distension. The MC and the SP‐ergic terminals in the mucosa were stained for respective histochemical and immunohistochemical investigations. The results were presented both qualitatively and quantitatively by color image analyzer, based on analysis of the intensity and area of stained fibrils. The structural relationship between the MC and nerve terminals was studied by electron microscopy, using an in situ embedding technique.

RESULTS:  The anorectal resting pressure, squeezing pressure and relaxation pressure were normal in both groups. The sensation threshold, defecation threshold and pain threshold in diarrhea‐predominant IBS and the pain thresholds in constipation‐predominant IBS were much lower than in the controls. Rectal compliance decreased in IBS. The number of MC in the terminal ileum, the ileocecal junction and the ascending colon was significantly elevated in IBS (P < 0.01), and the MC showed great variation. A significantly increased concentration of SP was found in the colon of the IBS patients compared with the controls. There was a positive correlation between the profiles of mucosal MC and the SP‐ergic terminals, and MC were closely adjacent to SP‐ergic terminals in the lamina propria.

CONCLUSION:  As altered rectal perception is present in almost all patients with IBS, it might be a reliable biological characteristic of the disease. Alterations in the MC and SP of the intestinal mucosa may be important factors in visceral hypersensitivity.