bluuebunny/crossref_metadata_2025 huggingface dataset:
Perceptions and expectations of Baccalaureate‐prepared nurses in Jordan: Community survey
Authors: Petro‐Nustas Wasileh , Mikhail Blanche I , Baker Omar G
Published: March 2003

The overall purpose of this paper is to describe the process of utilizing community participation for curriculum design to develop a new school of nursing. A brief Community Needs Assessment Survey was carried out in order to explore community perceptions and expectations of Baccalaureate‐prepared nurses in Jordan. The sample consisted of 152 participants who were staff nurses, nurse administrators, nurse supervisors, nurse educators, physicians, pharmacists and consumers of services. Data were collected through a self‐administered survey form using open‐ended questions. Participants were asked to describe their perceptions of nursing and nurses, the desired professional skills and personal characteristics of the Baccalaureate‐prepared nurse, important curriculum contents and to provide suggestions or comments for improving the preparation of Bachelor of Science in Nursing (BSN) nurses. The findings indicated that nursing was viewed as a caring profession where nurses care for the person both in sickness and health. Several professional skills and personal characteristics emerged as being important for the BSN nurse, including clinical competence, the desire to continue learning, communication skills, ethical and moral character, critical thinking, assessment skills, and computer and English‐language skills. The participants provided the desired curriculum contents and suggestions related to the expected skills. Implications for nursing education were discussed.
Systematic review of nursing management of urinary tract infections in the cognitively impaired elderly client in residential care: Is there a hole in holistic care?
Authors: Brown Sue
Published: March 2003

A systematic review of the current literature available exposed the deficit in nursing research as a resource for planning strategies and procedures in the care of a urinary tract infection. The cognitively impaired older client living in residential care is at particular risk because of their inability to articulate their problems, the subtle presentation of symptoms and the overuse of antibiotic therapy that has led to an increase in resistant organisms. The fiscal responsibility now required by health authorities highlights the need for a more enlightened approach to this distressing condition from those registered nurses in the front line of care.
Children's postoperative pain at home: Family interview study
Authors: Rn Päivi M Kankkunen , Rn Katri M Vehviläinen‐Julkunen , Rn Anna‐Maija K Pietilä
Published: March 2003

The purpose of this study was to: (i) describe the methods that are used in the identification and management of postoperative pain in children aged 1–7 years after minor outpatient surgery at home; (ii) to identify parents' perceptions regarding children's pain and pain medication; and (iii) to examine parents' perceptions of discharge advice. Family interviews with inductive content analysis were used to gather information from families of 17 Finnish children undergoing minor outpatient surgery at a university hospital in Finland. Versatile methods were employed by the parents in the identification and management of children's postoperative pain subsequent to discharge from the hospital. The children expressed that they had experienced pain relief through the administration of pain medication, eating ice‐cream and playing. The results indicate a need for further research in order to identify what elements of parents' perceptions of children's pain and pain medication should receive additional attention. In addition, the content, methods of providing and timing of discharge advice need to be developed in order to help parents with their efforts to achieve maximum pain relief in children after surgery.
Hyperuricaemia and its related factors in Taiwanese middle‐aged adults
Authors: Lai Shih‐Wei , Li Tsai‐Chung , Ng Kim‐Choy
Published: March 2003

This study used data collected in Chung‐Hsing Village to evaluate the relationship between hyperuricaemia and cardiovascular risk factors in Taiwanese middle‐aged adults in May 1998. All of the government employees working at the Taiwan Provincial Government in Chung‐Hsing Village aged 40–64 years were candidates for this study. Only 708 volunteers underwent blood tests. To study the significant related factors of hyperuricaemia, thet‐test, χ2analysis and multivariate logistic regression were used. The results showed that the significant related factors of hyperuricaemia are sex, obesity, hypertriglyceridaemia and renal function impairment. Hyperuricaemia is more common in middle‐aged men than in middle‐aged women. It is important to determine serum uric acid values if obesity, hypertriglyceridaemia or renal function impairment are apparent.
Influences of spatial practices on pressure ulcer management in the context of spinal cord injury
Authors: Wellard Sally , Rushton Carole
Published: March 2003

Nursing practice is significantly influenced by the type and use of space in which nursing is practised. While investigating current patterns of service delivery for the management of pressure ulcers from the perspective of people with spinal cord injuries and their families, the space in which care was delivered was identified as a central determinant of care. Qualitative methods were used to investigate consumer perspectives among patients residing in both metropolitan and rural communities who had been hospitalized for the management of pressure ulcers. Issues related to the spatial practices of the hospital are discussed, demonstrating a link between well‐being and the creation of an appropriate caring milieu. It is concluded that service could be improved markedly if health‐care professionals placed more consideration on the impact of space on their service delivery.
Relationship between psychosocial factors and health behaviours for women experiencing menopause
Authors: Anderson Debra , Posner Natasha
Published: March 2003

This study investigated the psychosocial factors related to the health behaviours of women at menopause. These health behaviours included choice of intervention by women for menopause, particularly consultation of health professionals, use of hormone replacement therapy and preferred information sources. A postal questionnaire was distributed to a structured random population‐based sample of 400 women in the 45–54 years age group living in south‐east Queensland, Australia. Explanatory variables were: attitudes to menopause, social functioning, mental health, vitality, preventive health practices and lifestyle factors. This study found that information, preventive health practices, attitudes towards menopause, exercise, number of children living at home, years of formal education and working in paid employment, were related to the health behaviours of women at menopause. The study concludes that a number of related psychosocial factors not associated with hormonal changes may influence the health behaviours of menopausal women. It will be important for nurses, other health professionals and counsellors to decide how best to respond to these findings in consultation with the women affected by their decisions.
Upper Silurian–Middle Devonian radiolarian zones of the Yokokurayama and Konomori areas in the Kurosegawa Belt, Southwest Japan
Authors: Umeda M.
Published: March 2003

Five radiolarian zones, from the Upper Silurian to Middle Devonian, are discriminated from the tuffaceous successions of the Joryu and Nakahata Formations of the Yokokurayama Group of the Yokokurayama area and the Konomori area in the Kurosegawa Belt, Southwest Japan. The definition of the zones is based on the first appearance biohorizon of the characteristic species. The zones are the Pseudospongoprunum sagittatum, Futobari solidus, Trilonche (?) sp. A, Glanta fragilis and Protoholoeciscus hindea zones, in ascending order. The preliminary age assignments for the zones are discussed on the basis of the comparison with other previous documented faunas. The age determination of the formations suggests the presence of unconformities and the episodic sedimentation of the tuffaceous strata in the Yokokurayama Group.
Tectonic setting of porphyry Cu–Au, Mo and related mineralization associated with contrasted Neogene magmatism in the Western Sulawesi Arc
Authors: Soeria‐Atmadja R. , Priadi B. , Van Leeuwen T. M. , Kavalieris I.
Published: March 2003

The Neogene Western Sulawesi Arc, from the south going northwards, can be divided into three magmatic provinces of K alkaline–shoshonitic (AK‐SH), high‐K calc‐alkaline (KCA), and low‐K–normal calc‐alkaline (TH‐CA) affinity, referred to, respectively, as South, Central and North Sulawesi. The origin of this magmatism in terms of subduction and collision processes is contentious. Four widely spaced Cu–Au porphyry, and one Mo porphyry district(s) occur along the Western Sulawesi Arc, with the North Sulawesi province being the most mineralized. This porphyry mineralization is part of a regional belt that extends north into the Philippines and possibly south to the Sunda Arc. In western Sulawesi, common features that define the porphyry belt are obscure because the porphyry districts cannot be simply related, either in terms of their magmatic affinity, nature of basement, or tectonic setting. Nevertheless, it can be suggested that the generation of porphyry Mo systems requires involvement of continental crust in terms of magma source, while Au‐rich porphyry systems are independent of the nature of the crust, and are derived from a mantle source.
Strike–slip fault tectonics and basin formation during the Cretaceous in the Korean Peninsula
Authors: Lee Dong‐Woo
Published: March 2003

An integrated description and interpretation of depositional, magmatic, and tectonic development of the Cretaceous sedimentary basins is presented in the present paper to reveal the role of strike–slip faults in basin formation. Non‐marine Cretaceous sedimentary basins in the Korean Peninsula originated from an oblique subduction of the Kula–Pacific oceanic plates beneath the Asian plate. The obliqueness of the subduction developed northeast–southwest‐trending sinistral strike–slip faults along the margin of the Asian continent. In the continental plate, short‐lived intra‐arc basins developed during the Cretaceous which were destroyed by polyphase tectonic force during the Tertiary. Strands of en echelon strike–slip faults produced grabens and they coalesced into composite grabens, forming large sedimentary basins from place to place in the Korean Peninsula. The basins are characterized by abundant volcanic sediments, terrigenous sediments, and were formed by similar tectonic environments. Oblique consumption of ridge during the subduction of the Kula–Pacific plate beneath the Asian plate produced eastward migration of volcanic activity during the Cretaceous. Volcanic activity was confined in central China, then migrated to the east, yielding a temporal and spatial volcanic gap between China and Korea. The Cretaceous sedimentary basins in the Korean Peninsula can be explained in terms of continuous and intermittent trans‐tensional tectonic movements of the sinistral strike–slip faults.
Sm–Nd, Rb–Sr and K–Ar geochronology of the Higo metamorphic terrane, west‐central Kyushu, Japan
Authors: Hamamoto Takuji , Osanai Yasuhito , Kagami Yhiroo
Published: March 2003

The Higo metamorphic terrane situated in west‐central Kyushu island, southwest Japan, is composed of greenschist‐ to granulite‐facies metamorphic rocks. The southern part of the metamorphic terrane consists mainly of garnet–biotite gneiss and garnet–cordierite–biotite gneiss, and orthopyroxene or cordierite‐bearing S‐type tonalite with subordinate amounts of hornblende gabbro. Rb–Sr, Sm–Nd and K–Ar isotopic ages for these rocks have been determined here. The garnet–biotite gneiss gives an Sm–Nd age of 227.1 ± 4.9 Ma and a Rb–Sr age of 101.0 ± 1.0 Ma. The hornblende gabbro has an Sm–Nd age of 257.9 ± 2.5 Ma and a K–Ar age of 103.4 ± 1.1 Ma. These age differences of the same samples are due to the difference in the closure temperature for each system and minerals. The garnet‐cordierite–biotite gneiss contains coarse‐grained garnet with a zonal structure conspicuously distinguished in color difference (core: dark red; rim: pink). Sm–Nd internal isochrons of the garnet core and the rim give ages of 278.8 ± 4.9 Ma (initial 143Nd/144Nd ratio = 0.512311 ± 0.000005) and 226.1 ± 28.4 Ma (0.512277 ± 0.000038), respectively. These ages are close to formation of the garnet core and the rim. It has been previously suggested that the Higo metamorphic terrane belongs to the Ryoke metamorphic belt. But Sr and Nd isotopic features of the rocks from the former are different from those of the Ryoke metamorphic rocks, and are similar to those of the granulite xenoliths contained in the Ryoke younger granite.
Geology and thermochronometry of the east edge of the Median Batholith (Median Tectonic Zone): a new perspective on Permian to Cretaceous crustal growth of New Zealand
Authors: Mortimer Nick , Gans Phil , Calvert Andy , Walker Nick
Published: March 2003

Abstract We report new field, petrological and isotopic data and interpretations from one of New Zealand’s major basement geological boundaries, the contact between the east side of the Median Batholith (formerly Median Tectonic Zone) and the allochthonous Mesozoic terranes of the Eastern Province. In the Nelson and Hollyford–Eglinton areas this contact is a Cenozoic fault, the Median Tectonic Line of earlier workers. However, in the Longwood Range, unfaulted pre‐Cenozoic geological relations are preserved intact. Our new Ar–Ar, U–Pb and isotopic data show that the Median Batholith in the Longwood Range consists of two suites. (i) Eastern, isotopically primitive (87Sr/86Sri = 0.702 to 0.703; ɛNdT = + 7 to + 8) trondhjemite and gabbroic rocks of Permian age that we believe are part of the intraoceanic Brook Street arc of the Eastern Province. (ii) Western, isotopically more evolved (87Sr/86Sri = 0.703 to 0.704; ɛNdT = + 3 to + 5) quartz diorites, quartz monzodiorites and rare granites of Middle Triassic to Early Jurassic age that we correlate with a pulse of magmatism elsewhere in the Median Batholith. Field observations in the Longwood Range indicate intrusive, not faulted, contacts between these units and constrain accretion of the Brook Street Terrane to Gondwana to have occurred 230–245 Ma. Intra‐batholith shear zones (T ~ 600°C and P ~ 0.2–0.3 GPa) were active at approximately 220 Ma. Modelling of K‐feldspar Ar incremental heating ages indicate that most of the Longwood Range had cooled below 175°C by the Middle Jurassic and experienced no subsequent reheating. Significant additional post‐accretionary Early Cretaceous and Cenozoic thermotectonic activity in Median Batholith in the Hollyford‐Eglinton area is indicated by a new 140 ± 2 Ma U‐Pb zircon date on a Largs ignimbrite, as well as by Cenozoic K‐feldspar Ar–Ar ages in the Middle Triassic Mistake Diorite.
Regional occurrence of orthopyroxene‐bearing basic rocks in the Yanai district, southwest Japan: Evidence for granulite‐facies Ryoke metamorphism
Authors: Ikeda Takeshi
Published: March 2003

Abstract  The present paper is reporting on the regional occurrence of orthopyroxene‐bearing basic rocks from the Ryoke Metamorphic Belt in the Yanai district, southwest Japan. Their localities are confined to the highest‐grade zone of the area (i.e. the garnet–cordierite zone, where garnet coexists with cordierite, K‐feldspar and biotite in pelitic rocks). Orthopyroxene coexists with quartz and hydrous minerals such as biotite, cummingtonite and hornblende, and in some cases with clinopyroxene, suggesting that the highest grade of the Ryoke metamorphism reached a low‐temperature subfacies of the granulite facies, contrary to the upper amphibolite facies as previously asserted.
Bile acids inhibit tumour necrosis factor α‐induced interleukin‐8 production in human colon epithelial cells
Authors: SAITOH OSAMU , NAKAGAWA KEN , SUGI KAZUNORI , MATSUSE RYOICHI , UCHIDA KAZUO , KOJIMA KEISHI , TANAKA SEIGOU , TERANISHI TSUTOMU , HIRATA ICHIRO , KATSU KEN‐ICHI
Published: March 2003

To clarify the regulatory mechanism of the production of various inflammatory mediators by intestinal epithelial cells, the effect of bile acids (tauroursodeoxycholate, TUDC; taurochenodeoxycholate, TCDC; and taurocholate, TC) on the cytokine‐induced production of interleukin (IL)‐8 in a human colon epithelial cell line (HT‐29) was examined. HT‐29 cells were incubated for 24 h in a culture medium containing tumour necrosis factor α (TNFα; 1 ng/mL) and/or interleukin (IL)‐1 β (1 ng/mL) in the presence or absence of bile acids. The IL‐8 concentration in the medium was measured by an enzyme‐linked immunosorbent assay. The binding assay of TNFα was performed using [125I]‐TNFα (100 pmol/L). Interleukin‐8 production during incubation with TNFα was markedly reduced in the presence of 0.5 and 1 mmol/L TUDC, 0.5 and 1 mmol/L TCDC and 0.5 and 1 mmol/L TC, by 56, 85, 86, 91, 37 and 70%, respectively. The IL‐8 production during incubation with IL‐1ß was not significantly reduced in the presence of these bile acids. The specific binding of TNFα to cells was inhibited 33, 47, and 14% by 1 mmol/L TUDC, TCDC and TC, respectively. These findings suggest that bile acids inhibit TNFα‐induced IL‐8 production by the colonic cells. The suppression may be partly due to inhibition of TNFα binding to the cells by bile acids.
Assessment of long‐term outcomes of hepatitis C virus infection in a cohort of patients with acute hepatitis in 1971–1975: Results of a pilot study
Authors: Rodger Alison , Thomson Jennifer , Thompson Sandra , Jolley Damien , Mijch Anne , Lanigan Anna , Crofts Nick
Published: March 2003

Background: To examine the long‐term effects of hepatitis C virus (HCV) infection in a cohort of patients admitted to Fairfield Hospital with hepatitis from 1971 to 1975. The availability of stored sera from this time enabled testing to identify those who were anti‐HCV positive on admission.

Methods: Sixteen per cent (n = 230) of the cohort tested positive for HCV antibody (anti‐HCV). The ‘unexposed’ group was selected from those who were anti‐HCV negative. Systematic approaches were used to locate the cohort and health outcomes assessed by a study specific questionnaire and clinical review with repeat serology and liver function tests.

Results: Complete follow up has been achieved on a subset of 35 HCV‐seropositive and 70 seronegative individuals. The seropositive group was significantly more likely to have given a history of injecting drug use, the presumed route of infection. The seropositive group was also more likely to have elevated serum alanine aminotransferase levels, but only two (6%) were known to have progressed to cirrhosis.

Discussion: The anti‐HCV‐positive individuals followed up to date are at increased risk of liver‐related pathology, but few had progressed to cirrhotic liver disease. This differs from findings of transfusion‐related studies and suggests, within the limitations of the study, that the natural history of community acquired HCV may be more benign.
Effect of anaemia on haemodynamics in patients with cirrhosis
Authors: Lee Wui‐Chiang , Lin Han‐Chieh , Hou Ming‐Chih , Lee Fa‐Yauh , Chang Full‐Young , Tsai Yang‐Te , Lee Shou‐Dong
Published: March 2003

Background: It has been suggested that increased blood haemoglobin attenuates splanchnic vasodilatation in portal‐hypertensive rats by nitric oxide inactivation. However, the haemodynamic effect of anaemia in cirrhotic patients of varying severity has been rarely discussed. The aim of this study was to evaluate the influence of anaemia on systemic and splanchnic haemodynamics in cirrhotic patients of differing severity.

Methods: Two hundred and twenty‐five cirrhotic patients were included in this study. All biochemical and haemodynamic results were utilized for analysis. Anaemia was defined as a haemoglobin level below the cut‐off value of 12g/dL, which might best predict low systemic vascular resistance.

Results: Compared with non‐anaemic patients, anaemic patients had decreased mean arterial pressure (90 ± 1 vs 95 ± 1 mmHg, P = 0.002), and decreased systemic vascular resistance (1022 ± 25 vs 1227 ± 30, P < 0.0001), and increased cardiac index (4.3 ± 0.1 vs 3.8 ± 0.1 L/min per m2, P < 0.0001) and increased hepatic venous pressure gradient (16.7 ± 0.5 vs 14.4 ± 0.6 mmHg, P = 0.006). Haemoglobin concentration exerted an influence on the degree of vasodilatation in cirrhotic patients, with Child–Pugh’s A class (but not in Child–Pugh’s B and C classes), and in patients without ascites (but not in patients with ascites).

Conclusions: It was concluded that anaemia has a negative effect on hyperdynamic circulation in patients with early cirrhosis which is not observed in patients with advanced cirrhosis.
Effect of temperature and mechanical strain on gastric epithelial cell line GSM06 wound restoration in vitro
Authors: Osada Taro , Iijima Katsuyori , Tanaka Hiroshi , Hirose Miyoko , Yamamoto Junko , Watanabe Sumio
Published: March 2003

Background: The influence of the degree of cell differentiation and of physical stimulation on gastric mucosal wound healing is not completely understood.

Methods: A gastric mucosal cell line, GSM06, derived from the gastric mucosal cells of transgenic mice harbouring the simian virus 40 large T antigen, was cultured at 33°C to make a confluent cell sheet. Artificial wounds of constant size were created. Wound healing was monitored at different temperatures (33, 37 and 39°C), which altered the degree of differentiation. Cell proliferation was detected by bromodeoxyuridine staining. Mechanical strain was applied to adherent GSM06 cells after wounding in order to increase their length by an average of 5 or 10% at 5 cycles/min for 60 h. Repair of the wound was monitored every 12 h.

Results: Differentiated gastric epithelial cells showed a higher speed of migration. The number of proliferating cells around the wound was greatest at 33°C and barely detectable at 39°C. Under conditions of mechanical strain, the migration speed of differentiated cells (at 39°C) slowed in a strain strength‐dependent manner.

Conclusions
: It is suggested that cell differentiation status and physical stimulants might play a role in gastric wound healing in vivo by modifying cellular migration.
Limitation of cholangiography in assessing longitudinal spread of extrahepatic bile duct carcinoma to the hepatic side
Authors: Tamada Kiichi , Yasuda Yoshikazu , Nagai Hideo , Tomiyama Takashi , Tano Shigeo , Kanai Nobuyuki , Ohashi Akira , Aizawa Toshiyuki , Ido Kenichi , Kimura Ken
Published: March 2003

Background: Preoperative assessment of longitudinal spread of bile duct carcinoma (BDC) to the hepatic side remains a difficult problem for diagnostic imaging.

Methods: We studied the accuracy of cholangiography in assessing BDC. In 54 patients with extrahepatic bile duct cancer, cholangiographic findings were compared retrospectively with the histological findings of the resected specimens.

Results: Histological examination of specimens indicated longitudinal spread of the tumour to the hepatic side in 22 of 54 patients. The accuracy of cholangiography in assessing the extent of the longitudinal spread was only 34/54 (63%). When the cholangiographic images showed a main tumour with a collapsed edge, there was a significantly higher frequency of longitudinal spread compared with tumours with sharp edges (P < 0.05). In contrast, the accuracy of mapping biopsy under percutaneous transhepatic cholangioscopy (n = 24) was 83%.

Conclusions: Cholangiography cannot accurately assess the extent of the longitudinal spread of bile duct cancer. When cholangiographic images show a tumour with a collapsed edge, preoperative or intraoperative histological examination is essential to determine a suitable surgical line.
Effects of ammonia solution on the gastric mucosa in cirrhotic rats and therapeutic effects of geranylgeranylacetone
Authors: Sugimoto Motonobu , Machida Yota , Ito Kinji
Published: March 2003

Background
: We designed an animal model in order to clarify whether Helicobacter pylori infection causes the gastric mucosal lesion frequently seen in cirrhotic patients.

Methods
: Ammonia (NH3) solution was given to rats with carbon tetrachloride‐induced cirrhosis. The gastric mucosal hexosamine (Hx) content and histopathological findings in the cirrhotic rats were analysed and compared with those of the intact liver rats. Moreover, the usefulness of geranylgeranylacetone (GGA) was investigated in both rat groups. Both rat groups were subdivided according to the treatment as follows: a control group, an NH3 (0.02% solution) group, and an NH3 + GGA (400 mg/kg per day) group; and fed for 4 weeks.

Results
: The gastric mucosal Hx content of the control group of the cirrhotic rats (16.7 ± 5.2 Μg/mg) was significantly lower than that of the control group of the intact liver rats (26.6 ± 4.5 Μg/mg, P < 0.05). In the cirrhotic rats, the Hx content of both the NH3 (31.9 ± 13.1 Μg/mg) and the NH3 + GGA group (31.9 ± 9.8 Μg/mg) was significantly higher than the Hx content of the control group (P < 0.05). Microscopically, in the cirrhotic rats, while scattered mucosal erosions were recognized in three of five rats of the NH3 group, there were no erosions in any rats of the NH3 + GGA group.

Conclusions
: These data suggest that the gastric mucosal defence mechanism is defective in liver cirrhosis and that NH3 enhances this defensive mechanism by acting as mild irritant; however, in some cirrhotics this results in gastric erosion due to excessive irritation. Geranylgeranylacetone protects the gastric mucosa against NH3 irritation in cirrhotics without enhancing the Hx content. Thus, H. pylori infection may be a possible cause of the gastric mucosal lesion in patients with liver cirrhosis. The mechanism of the therapeutic effect of GGA is not due to an enhancement of the gastric mucosal Hx content.

© 1999 Blackwell Science Asia Pty Ltd
Effect of pancreastatin on cerulein‐stimulated pancreatic blood flow and exocrine secretion in anaesthetized rats
Authors: Migita Yoshikatsu , Nakano Itsuro , Goto Masayoshi , Ito Tetsuhide , Nawata Hajime
Published: March 2003

Background
: Pancreastatin (PST) is an inhibitor of pancreatic exocrine secretion in vivo but not in vitro, which suggests that the inhibitory effect of PST is indirect, that is, not mediated by a specific receptor on pancreatic acinar cells. In this study, we investigated the effects of PST on pancreatic exocrine secretion and local pancreatic blood flow in anaesthetized rats to elucidate the participation of PST in indirect regulation of pancreatic exocrine function through blood supply.

Methods
: Pancreastatin (100, 200 or 500 pmol/kg per h) was administered intravenously under background infusion of cerulein (0.5 μg/kg per h), a cholecystokinin analogue. Pancreatic exocrine secretion was monitored by volume and protein output of the pancreatic juice and local pancreatic blood flow was measured by the hydrogen gas clearance method.

Results
: Pancreastatin significantly reduced cerulein‐induced local pancreatic blood flow in a dose‐dependent manner. Pancreatic exocrine secretion was also reduced significantly by PST dose‐dependently. Pancreastatin did not change systemic blood pressure. These results suggested that the reduction of pancreatic blood flow is associated with the reduction of pancreatic exocrine secretion.

Conclusions
: We conclude that the mechanism of PST‐induced inhibition of pancreatic exocrine secretion is, at least, partly mediated by the reduction of local pancreatic blood flow through blockade, caused by the action of cerulein on pancreatic blood flow.

© 1999 Blackwell Science Asia Pty Ltd
Liver fibrogenesis and the role of hepatic stellate cells: New insights and prospects for therapy
Authors: Li Dan , Friedman Scott
Published: March 2003

Hepatic fibrosis is a wound‐healing response to chronic liver injury, which if persistent leads to cirrhosis and liver failure. Exciting progress has been made in understanding the mechanisms of hepatic fibrosis. Major advances include: (i) characterization of the components of extracellular matrix (ECM) in normal and fibrotic liver; (ii) identification of hepatic stellate cells as the primary source of ECM in liver fibrosis; (iii) elucidation of key cytokines, their cellular sources, modes of regulation, and signalling pathways involved in liver fibrogenesis; (iv) characterization of key matrix proteases and their inhibitors; (v) identification of apoptotic mediators in stellate cells and exploration of their roles during the resolution of liver injury. These advances have helped delineate a more comprehensive picture of liver fibrosis in which the central event is the activation of stellate cells, a transformation from quiescent vitamin A‐rich cells to proliferative, fibrogenic and contractile myofibroblasts. The progress in understanding fibrogenic mechanisms brings the development of effective therapies closer to reality. In the future, targeting of stellate cells and fibrogenic mediators will be a mainstay of antifibrotic therapy. Points of therapeutic intervention may include: (i) removing the injurious stimuli; (ii) suppressing hepatic inflammation; (iii) down‐regulating stellate cell activation; and (iv) promoting matrix degradation. The future prospects for effective antifibrotic treatment are more promising than ever for the millions of patients with chronic liver disease worldwide.
A selective cyclo‐oxygenase‐2 inhibitor, NS‐398, may improve portal hypertension without inducing gastric mucosal injury
Authors: Tsugawa Kouji , Hashizume Makoto , Migou Shinichirou , Kishihara Fumiaki , Kawanaka Hirofumi , Tomikawa Morimasa , Sugimachi Keizo
Published: March 2003

Background and Aims: Prostacyclin has been shown to play a role in hyperdynamic circulation in portal hypertension. Recently, a new subtype of cyclo‐oxygenase (COX), COX‐2, which acts as an inducible synthase in response to various stimuli. The aim of this study was to investigate whether COX‐2 contributes to portal hypertension and whether a COX‐2 blockade induces the same sort of gastric mucosal injury as a COX‐1 blockade.

Methods: Portal hypertension (PHT) in rats was induced by a two‐step ligation of the portal vein. The mean arterial pressure (MAP), portal pressure (PP), visceral blood flow volume (BFV), serum levels of 6‐keto‐prostaglandin F1α (PGF1α), thromboxane B2 (TXB2) and gastric mucosal injury induced by pure ethanol were all measured in PHT rats receiving different inhibitors (indomethacin, a highly selective COX‐1 inhibitor; NS‐398, a highly selective COX‐2 inhibitor). Control rats treated by a sham operation were also studied.

Results: The NS‐398 administration significantly decreased PP to the same extent as indomethacin at doses of 5 and 10 mg/kg in PHT rats after a 60 min administration, while neither inhibitor affected the control rats. Both inhibitors significantly increased PP after a 30 min administration in the PHT and control rats at a dose of 5 mg/kg while both inhibitors significantly decreased PP after 60 min administration only in the PHT rats. Portal vein ligation treatment induced a significant increase in PP and BFV of the portal vein, gastric mucosa, oesophageal mucosa and the serum levels of 6‐keto‐PGF1α and TXB2, while portal vein ligation treatment induced a significant decrease in BFV of the liver. Both blockades increased MAP and decreased PP and BFV in the splanchnic area and decreased the serum level of 6‐keto‐PGF1α and TXB2 in the PHT rats, while neither blockade modified any parameters in the control rats, except that indomethacin administration significantly decreased the BFV of the gastric mucosa. Indomethacin administration significantly increased the ulcer index (UI). The NS‐398 had no effect on UI in either the PHT or control rats. Only indomethacin significantly increased the number of rats demonstrating gastric mucosal long lesions (> 2 cm) in the PHT rats.

Conclusion: In the PHT rats, prostaglandin seemed to contribute to portal hypertension. Both COX blockades reduced PP and BFV of the portal vein and gastric mucosa. NS‐398, a selective COX‐2 inhibitor, may, therefore, improve portal hypertension without inducing gastric mucosal injury.
Parenchymal echo patterns of cirrhotic liver analysed with a neural network for risk of hepatocellular carcinoma
Authors: Fukuda Hiroyuki , Ebara Masaaki , Kobayashi Akira , Sugiura Nobuyuki , Yoshikawa Masaharu , Saisho Hiromitsu , Kondo Fukuo , Yahagi Takashi
Published: March 2003

Background
: To objectively evaluate the parenchymal echo patterns of the liver in cirrhosis, an image analysing system in which a neural network is used has been found capable of numerically calculating coarse score (CS). Using this system, we analysed whether or not CS can serve as a predictive factor for the development of hepatocellular carcinoma (HCC).

Methods
: The risk factors for HCC were evaluated in 95 patients with liver cirrhosis with an average follow‐up period of 2041 ± 823 days. We used a three‐layer feed‐forward neural network and a back‐propagation algorithm to calculate CS.

Results
: There were strong correlations between CS, alanine aminotransferase (ALT) and α‐fetoprotein (AFP) and the average cumulative incidence rate of HCC evaluated by the Cox’s proportional hazards model. The adjusted rate ratios were estimated to be 3.00, 2.80 and 2.01, respectively. The cumulative risks of HCC were significantly higher with an initial CS ≥ 1.5 than with an initial CS < 1.5, with ALT ≥ 80 IU/L than with initial ALT < 80 IU/L and with AFP ≥ 20 ng/mL than with initial AFP < 20 ng/mL, all analysed by the log‐rank test.

Conclusions
: Coarse score is a useful predictor for development of HCC.
Germinated barley foodstuffs attenuate colonic mucosal damage and mucosal nuclear factor kappa B activity in a spontaneous colitis model
Authors: Kanauchi Osamu , Andoh Akira , Iwanaga Toshihiko , Fujiyama Yoshihide , Mitsuyama Keiichi , Toyonaga Atsushi , Bamba Tadao
Published: March 2003

Background
: Germinated barley foodstuffs (GBF), which are derived from brewer’s spent grain and are a highly safe food substance, increased butyrate production in the lower intestine and prevented mucosal damage and bloody diarrhoea in an acute experimental colitis model. As human histocompatibility leucocyte antigen (HLA)‐B27 transgenic rats develop spontaneous and chronic intestinal inflammation resembling ulcerative colitis, we investigated the mechanisms underlying the preventive effects of GBF against a spontaneous and chronic colitis model. Specifically, the production of bacterial butyrate and the regulation of proinflammatory cytokine production were examined.

Methods
: A GBF diet and a cellulose (CE) diet were fed to HLA‐B27 transgenic rats for 13 weeks. The presence of faecal occult blood, colonic mucosal protein, DNA and RNA content, colonic myeloperoxidase activity, nuclear factor kappa B (NFκB) DNA binding activity, the depth of the crypts and serum inflammatory parameters were then evaluated. Butyrate production in the caecal contents was also determined.

Results
: Feeding GBF significantly increased bacterial butyrate production and simultaneously attenuated the presence of faecal occult blood and colonic mucosal hyperplasia. Colonic mucosal NFκB‐DNA binding activity and the production of interleukin‐8 were also suppressed by the butyrate produced from GBF.

Conclusions
: Germinated barley foodstuffs feeding promotes bacterial butyrate production and attenuated inflammation in both spontaneous and chronic colitis in HLA‐B27 transgenic rats.

© 1999 Blackwell Science Asia Pty Ltd
Secondary oesophageal peristalsis in gastro‐oesophageal reflux disease
Authors: Pai C Ganesh
Published: March 2003

Background and Aims
: To evaluate the status of secondary oesophageal peristalsis in gastro‐oesophageal reflux disease (GORD) and the effect of healing of oesophagitis on these abnormalities.

Methods
: Twenty‐one patients diagnosed with GORD and 10 control subjects in the same age group were studied. Primary peristalsis was elicited by 10 5 mL water boluses and secondary peristalsis by 10 20 mL boluses of air injected 15 cm above the lower oesophageal sphincter.

Results
: The pattern of primary peristalsis was normal in a significantly lower number of patients compared with control subjects, six patients (28.6%) versus seven controls (70%), (P < 0.05). Similarly, the number of subjects with a normal pattern of secondary peristalsis was also lower in the patient group (zero vs three; P < 0.05). A normal primary peristaltic response occurred with 71 (33.8%) of the 210 water boluses in the patients and 73 (73%) of the 100 water boluses in the control subjects, respectively (P < 0.001). A normal secondary peristaltic response was seen with 15 (7.1%) of 210 air boluses in patients and 32 (32%) of 100 air boluses in the control subjects (P < 0.001). The amplitude of secondary peristaltic waves and the duration of contraction (mean ± SEM) were significantly lower in patients compared with the control subjects (43.5 ± 4.7 vs 89.0 ± 13.1 and 3.4 ± 0.8 vs 3.9 ± 0.3, respectively; P = < 0.05). In the 13 patients in whom repeat evaluation was performed after healing of oesophagitis, there was no significant change in the number of patients with normal peristaltic response, number of normal responses to air and water boluses, or amplitude, duration and velocity of peristalsis.

Conclusion
: Significant abnormalities of secondary oesophageal peristalsis occur in patients with GORD and these are not reversed by healing of oesophagitis.
Heartburn: Community perceptions
Authors: Bolin Terry D , Korman Melvyn G , Hansky Jack , Stanton Rosemary
Published: March 2003

Background and Aims
: To determine the prevalence of heartburn in the Australian community, and document factors precipitating it and medications used in treatment.

Methods
: Telephone interviews with 1200 individuals aged 18 years or more were conducted one weekend in 1996. Each respondent was asked four questions about heartburn, its severity, factors causing it and current therapy.

Results
: Fifty‐six per cent of respondents reported that they had suffered from heartburn at some time in the past and 37% had symptoms at least once every 4–6 months. The frequency of heartburn increased with age and was more common in men (40.7%) than women (32.6%). There was no difference in frequency between city and rural dwellers, or between white‐ and blue‐collar workers. Almost half the individuals experienced mild pain or discomfort, one‐third had moderate discomfort and 15% reported severe pain or discomfort. Women were more likely to report greater problems than men. Aggravating factors included spicy foods, greasy/rich foods, stress, alcohol, overeating, pregnancy, smoking, food allergy and coffee. More than half the respondents relied on antacids to control symptoms, 20% used prescription medications and a similar number did not use any medication.

Conclusion
: Heartburn is common in the Australian community and sufferers attribute symptoms to various lifestyle events, including diet and stress. Antacid usage is the commonest mode of therapy.
Effect of intragastric pH on control of peptic ulcer bleeding
Authors: Li Yuyuan , Sha Weihong , Nie Yuqiang , Wu Huisheng , She Qingzhu , Dai Shoujun , Jia Lin , Yu Weixiong
Published: March 2003

Background: We have performed series studies to investigate the effect of intragastric pH on control of peptic ulcer bleeding. In laboratory and animal studies, both platelet aggregation and gastric mucosal bleeding time were shown to be extremely sensitive to different pH levels. Platelet aggregation decreased significantly at pH ≥ 6.8 and gastric mucosal bleeding time fell significantly at pH ≥ 6.4. In a prospective clinical trial, primed infusions of different dosages of omeprazole (8 or 4 mg/h) after a bolus (40 mg) produced consistently high intragastric pH values in patients with bleeding duodenal ulcer. These results were not significantly different from that obtained from omeprazole 40 mg bolus treatment every 12 h (P> 0.05). However, primed injection with cimetidine (800 mg/12 h) was less effective (P< 0.05).

Methods: In a retrospective analysis, 303 patients with bleeding peptic ulcer who were treated with cimetidine and 326 patients who were treated with omeprazole were compared.

Results: The emergency surgery (4.91%) and mortality rates (1.84%) in the omeprazole group were not significantly different (P> 0.05) from those (7.28 and 1.99%) in the cimetidine group. However, the standardized emergency surgery rate of the omeprazole group (3.28%) was significantly lower than that (9.28%) of the cimetidine group (P< 0.05).

Conclusion: We conclude that increased intragastric pH to at least 6.4 with omeprazole is helpful in controlling peptic ulcer bleeding. Chinese patients require a lower dose of omeprazole than their Western counterparts to control ulcer bleeding.
Cytokine profile of liver‐infiltrating CD4+ T cells separated from murine primary biliary cirrhosis‐like hepatic lesions induced by graft‐versus‐host reaction
Authors: Itoh Shinichi , Matsuzaki Yasushi , Kimura Takeshi , Ikegami Tadashi , Shoda Junichi , Fujiwara Michio , Tanaka Naomi
Published: March 2003

Background and Methods
: We have previously reported that CD4+ T cells induced primary biliary cirrhosis (PBC)‐like hepatic lesions in mice with graft‐versus‐host reaction due to major histocompatibility complex class II disparity. To clarify the relationship between the cytokine profile produced by CD4+ T cells and the formation of hepatic lesions, we sorted CD4+ T cells from the liver by using flow cytometry and examined their cytokine mRNA expression at various times after GVHR induction. We also examined the associated changes in the serum levels of antimitochondrial antibodies (AMA).

Results
: Histologically, the infiltration of CD4+ T cells around the bile ducts was observed from day 5, and the lesions deteriorated gradually until day 14. On day 14, CD8+, B220+ and Mac‐1+ cells, as well as CD4+ T cells were seen around the bile ducts. In the liver‐infiltrating CD4+ T cells, the expression level of interferon‐γ (IFN‐γ) mRNA was observed to increase at an early phase (day 3), whereas that of interleukin (IL)‐10 mRNA was elevated at a later phase (day 14). The elevation of IFN‐γ mRNA expression at an early phase before the appearance of non‐suppurative destructive cholangitis suggests that IFN‐γ may be related to the pathogenesis of PBC in this model. Serum levels of AMA on day 14 were significantly higher than those on day 5. Interleukin‐10 was considered to stimulate antibody production, to show an inhibitory effect upon the function of T helper 1 cells, and to inhibit fibrosis.

Conclusion
s: Interferon‐γ may play an important role in the pathogenesis of this model. Moreover, delayed expression of IL‐10 mRNA may control PBC‐like hepatic lesions.
Complete disappearance of recurrent hepatocellular carcinoma with peritoneal dissemination and splenic metastasis: A unique clinical course after surgery
Authors: Terasaki Takamitsu , Hanazaki Kazuhiro , Shiohara Eiichi , Matsunaga Yuji , Koide Naohiko , Amano Jun
Published: March 2003

Spontaneous regression of hepatocellular carcinoma (HCC) is a rare phenomenon. We report a case of complete disappearance of intrahepatic, peritoneal and splenic metastases in HCC after hepatectomy using treatment with tegafur and uracil (UFT). The effect of UFT alone was not likely to have caused the disappearance of this tumour because HCC recurrence advance markedly within 5 months of surgery despite oral administration of UFT. This case demonstrates a unique postoperative clinical course that suggests spontaneous regression of HCC. This is the first case of complete disappearance of unresectable HCC with peritoneal seeding and splenic metastasis.

© 2000 Blackwell Science Asia Pty Ltd
Natural history of chronic hepatitis B virus infection
Authors: Yuen Man‐Fung , Lai Ching‐Lung
Published: March 2003

In chronic hepatitis B virus (HBV) infection acquired during adulthood, which is the type mostly seen in the Caucasian population, there is biochemical and histologic regression after HBeAg seroconversion, and the risk of death from hepatitis B‐related causes is low. In chronic HBV infection acquired during birth or early childhood, which is the type most commonly seen in the Asian population, there is a prolonged phase of immunotolerance. The immune clearance phase is characterized by multiple acute exacerbations preceeded by elevations in serum HBV DNA levels, HBeAg concentration and HBeAg/anti‐HBe immune complexes. Of these patients, 2.4% may develop hepatic decompensation during the stage of HBeAg seroconversion. The development of cirrhosis occurs more frequently in patients with episodes of decompensation and with repeated severe acute exacerbations. However progression to cirrhosis can be relatively silent and can occur even in children. After HBeAg seroconversion, precore and core promotor mutations occur frequently in the Asian population. However, there is little correlation between the occurrence of these mutations and alanine aminotransferase elevation in patients who are positive for anti‐HBe. Although cirrhosis develops during the process of HBeAg seroconversion, 68% of the complications of cirrhosis and of hepatocellular carcinoma occur after HBeAg seroconversion. These complications may still occur even after HBsAg seroclearance.
Aspartate aminotransferase : alanine aminotransferase ratio in chronic hepatitis C infection: Is it a useful predictor of cirrhosis?
Authors: Park Gordon J‐H , Lin Betty Pc , Ngu Meng C , Jones D Brian , Katelaris Peter H
Published: March 2003

Background
: The clinical usefulness of the ratio of serum aspartate aminotransferase (AST) to alanine aminotransferase (ALT) has been explored in several liver disorders. It has been suggested that in patients with chronic hepatitis C virus (HCV) infection an AST : ALT ≥ 1 has 100% specificity and positive predictive value in distinguishing cirrhotic from non‐cirrhotic patients. Such statistical certainty attached to a simple biochemical test merits further evaluation. The present study, therefore, assessed the AST : ALT in patients with chronic HCV infection to determine the validity of the ratio in predicting cirrhosis and to correlate the ratio with the histological grade of necroinflammatory activity and fibrosis.

Methods
: A retrospective analysis of 153 patients with chronic HCV infection was conducted. Serum biochemistry had been obtained within a mean of 4 weeks of liver biopsy. The histology was scored in terms of activity and fibrosis as described by Scheuer and correlated with AST : ALT.

Results
: In 30 patients with cirrhosis, the mean AST : ALT (0.99 ± 0.06) was higher than in 123 patients without cirrhosis (0.60 ± 0.02; P < 0.001). A ratio ≥ 1 had 95.9% specificity and 73.7% positive predictive value in distinguishing cirrhotic from non‐cirrhotic patients, with a 46.7% sensitivity and 88.1% negative predictive value. The ratio also parallelled the Scheuer score with respect to fibrosis but not with respect to inflammation.

Conclusion
: Although relatively insensitive, an AST : ALT ≥ 1 is highly specific but not diagnostic for the presence of cirrhosis in patients with chronic HCV infection. The ratio reflects the grade of fibrosis in these patients.