bluuebunny/crossref_metadata_2025 huggingface dataset:
Interleukin 1 induces renal CD44 expression in vivo and in vitro: role of the transcription factor Egr‐1
Authors: TAKAZOE Kazunori , FOTI Rita , HURST Lynette A , LAN Hui Y , ATKINS Robert C , NIKOLIC‐PATERSON David J
Published: March 2003

SUMMARY: Tubular expression of the cell‐surface adhesion molecule CD44 is upregulated in both human and experimental glomerulonephritis, and this is associated with interstitial leucocytic infiltration. However, we know little of the mechanisms by which renal CD44 expression is upregulated in disease. This study focuses on the potential role of the proinflammatory cytokine interleukin 1 (IL‐1) and the IL‐1‐inducible transcription factor early growth response factor‐1 (Egr‐1) on tubular CD44 expression in vivo and in vitro. Immunostaining identified constitutive CD44 expression by occasional glomerular cells and a small number of cortical tubules in normal rat kidney. Glomerular and tubular CD44 expression was markedly upregulated in rat crescentic anti‐glomerular basement membrane glomerulonephritis. Blocking IL‐1 activity by administration of the IL‐1 receptor antagonist significantly reduced glomerular and tubular CD44 expression in this disease model. In vitro studies found that the NRK52E rat tubular epithelial cell line constitutively expresses CD44 mRNA and protein. Stimulation with 10U/mL IL‐1 caused upregulation in both CD44 mRNA and protein expression. A role for the transcription factor Egr‐1 in this process was suggested by a time course study in which IL‐1 stimulation of NRK52E cells caused a rapid and transient increase in Egr‐1 mRNA, peaking at 30–60 min, which preceded the increase in CD44 mRNA that was evident at 3–6h. A direct link between Egr‐1 and CD44 expression was provided by the ability of an Egr‐1 antisense oligonu‐cleotide, but not sense or scrambled control oligonucleotides, to inhibit IL‐1‐induced upregulation of CD44 protein in NRK52E cells. These data demonstrate that IL‐1 is an important stimulus for upregulation of tubular CD44 expression in vivo and in vitro. Furthermore, in vitro studies have shown that IL‐1‐induced upregulation of CD44 expression operates, at least in part, via the transcription factor Egr‐1.
Does regular use of non‐steroidal anti‐inflammatory drugs increase the risk of renal disease?
Authors: KOHLHAGEN Johanna , KATRIB Amel , STAFFORD Leanne , BROWN Mark A , EDMONDS John
Published: March 2003

SUMMARY: Some studies have suggested a disturbing incidence of chronic renal failure (CRF) and renal papillary necrosis (RPN) following regular non‐steroidal anti‐inflammatory drug (NSAID) use. This study was undertaken to assess the prevalence of renal insufficiency in rheumatology patients taking regular NSAIDs and a control group of age‐matched subjects who had other chronic illnesses but were not taking regular NSAIDs. Sixty‐nine patients with rheumatological disorders and significant NSAID use but no known renal abnormalities were compared with 69 age‐matched subjects with non‐renal chronic disease who were not taking NSAIDs. Each patient completed a questionnaire regarding NSAIDs and analgesic use, and then had their blood pressure measured along with urinalysis, urine microscopy, serum electrolytes and creatinine and calculated creatinine clearance using the Cockroft‐Gault formula. If clinically indicated, patients had further renal imaging to detect structural renal damage. By definition of the study design, rheumatology patients took significantly more NSAIDs than control subjects (P < 0.0001). Twelve patients (19%) in the rheumatology group had renal impairment compared with 10 (17%) in the control group (P= 0.67). Seven patients (10%) in the rheumatology group had microscopic haematuria with or without proteinuria, which was not statistically different to that in the control group (3%, P= 0.09), but isolated microscopic haematuria was detected more commonly in the rheumatology group (11 vs2%, P= 0.03). No patient in either group had clinically apparent RPN, which appeared to be an uncommon complication of chronic NSAID use in rheumatology patients. Chronic renal insufficiency is present in approximately one in five rheumatology patients taking long‐term NSAIDs, but this prevalence is no greater than in patients with other chronic illnesses who do not take long‐term NSAIDs.
Ca2+Mg3+‐ATPase activity in erythrocyte membranes in hypercalciuric nephrolithiasic patients
Authors: HEGUILÉN Ricardo M , GIMENEZ Maria I , IMPERIALI Nora , BERNASCONI Amelia R , ALGRANATI S Luis , FARÍAS Eduardo DOS RAMOS
Published: March 2003

SUMMARY: Ca2+Mg2+ATPase is an enzyme involved in calcium transport across biological membranes. In order to determine its possible role in the pathogenesis of calcium nephrolithiasis, we assessed Ca2+Mg2+‐ATPase activity in erythrocyte membranes from 18 hypercalciuric (HC) nephrolithiasic patients (nine with absorptive hypercalciuria (AHC), nine with renal hypercalciuria (RHC)) and eight normocalciuric healthy controls (C). Participants took no medication for at least 3 months before the study and remained on a diet containing approximately 25 mmol of calcium per day for 14 days. Pump activity was measured in calmodulin‐free red blood cell membranes and expressed in umol of phosphate released per mg of membrane protein per h. There were statistically significant differences in pump activity between groups (1.43±0.07; 1.93±0.1; 1.65±0.06; C, AHC, RHC, respectively, P < 0.005 (three groups) and P < 0.02 AHC versus RHC. Enzyme activity was positively correlated with 24‐h urinary calcium excretion (r = 0.64, P < 0.01) in HC patients; no such relationship was found in C. In conclusion, erythrocyte membrane Ca2+Mg2+ATPase activity is increased in HC. Differences in enzyme activity between AHC and RHC may reflect different degrees of a single generalized epithelial calcium transport disturbance.
Haemophagocytic syndrome associated with Epstein‐Barr virus infection and promoted by tuberculosis reactivation in a patient undergoing chronic haemodialysis
Authors: YE Chunlin , MIZOGUCHI Yoshikazu , TOMITA Makoto , SHINZATO Masanori , KURODA Makoto , SHAMOTO Mikihiro , KASAHARA Masao , MATSUYAMA Mutsushi , MATSUURA Akihiro
Published: March 2003

SUMMARY: A 73‐year‐old man who had been undergoing chronic haemodialysis (CHD) for 3 years developed haemophagocytic syndrome (HPS) that might have been triggered by Epstein‐Barr virus (EBV) infection. the patient finally died of miliary tuberculosis (TB) reactivation that promoted the progression of HPS. Immunological abnormalities in patients undergoing CHD may be notable. the early diagnosis of TB reactivation may be important for reducing the mortality in cases of HPS, as a high incidence of TB is encountered in patients undergoing CHD. In contrast, the simultaneous occurrence of an EBER‐positive hybridization signal with T cell‐specific immunolabelling of CD45RO cells was well detected in the spleen and lymph nodes, and interferon gamma was elevated in the serum. These findings coincide with the reported preferential expansion of T cells rather than B cells in EBV infection, and support the hypothesis that systemic hypercytokinaemia caused by the proliferation of EBV‐infected T cells may play a crucial role in the development of HPS.
High‐flux dialysers*
Authors: KERR Peter G
Published: March 2003

SUMMARY: This brief review attempts to define high‐flux dialysis and differentiate it from low‐flux and high‐efficiency dialysis. High‐flux dialysis membranes offer improved clearance of larger‐molecular‐weight solutes, particularly β‐2 microglobulin. Patients exhibit improved cardiovascular stability and long‐term use of these membranes may delay the onset of dialysis‐related amyloidosis. Although high‐flux membranes have improved biocompatibility compared with most low‐flux membranes, this has not been demonstrated to provide morbidity or mortality benefits. Backfiltration of solutes and toxins from the dialysate to the blood is a potential but probably overstated complication of high‐flux dialysis. Most high‐flux membranes are actually efficient barriers to the passage of endotoxins. Cost is the major barrier to more widespread use of high‐flux dialysis.
Long‐term anti‐glomerular basement membrane disease in the rat: a model of chronic giomerulonephritis with nephrosis, hypertension and progressive renal failure
Authors: FU Ping , ROBERTSON Tara , HILL Prudence , TESCH Greg , NIKOLIC‐PATERSON David J , ATKINS Robert Charles , CHADBAN Steven J
Published: March 2003

SUMMARY: Current experimental models of glomerulonephritis focus on the acute phases of renal injury. Models replicating the features of human glomerulonephritis, including hypertension, protein‐uria, hyperlipidaemia, renal fibrosis and renal failure, are lacking. the aim of this experiment was to define a rat model of glomerulonephritis that replicates the features of progressive glomerulonephritis in humans. Passive accelerated antiglomerular basement membrane disease was induced in inbred Sprague‐Dawley rats. Age‐matched control rats received pre‐immunisation, but were given saline rather than nephrotoxic serum. Groups of diseased rats (n=4–6) were killed at 4, 6 and 7 weeks, and tissues were extracted for histological assessment. Diseased rats developed renal failure over 7 weeks (91% reduction in creatinine clearance vs controls at week 7, P< 0.001). Proteinuria reached a plateau from week 2 to week 7 (269.1 ± 107.9 mg/24h vs 1.00 ± 0.18 mg/mL for controls at week 7, P< 0.001). Diseased rats became hyperlipidaemic (108% increase in cholesterol vs control, P<0.05) and hypertensive (38% increase in systolic blood pressure vs controls, P<0.001). Histology revealed progressive renal fibrosis and scarring, with fibrocellular crescent formation (93% of glomeruli by week 7), glomerulosclerosis and tubulointerstitial damage. α‐Smooth muscle actin expression and interstitial matrix (collagen III) deposition increased progressively. Urinary transforming growth factor‐β excretion was increased by over eightfold versus controls. This model of passive accelerated antiglomerular basement membrane disease simulates many clinical and pathological features of chronic giomerulonephritis in humans, and may provide a good model to test new therapies.
Acyclovir‐induced acute renal failure
Authors: KUO Mei‐Chuan , CHANG Jer‐Ming , LIN Shih‐Pi , LEE Jia‐Jung , CHEN Hung‐Chun , LAI Yung‐Hsiung
Published: March 2003

SUMMARY: Acyclovir is an effective antiviral agent in the treatment of herpes simplex and varicella‐zoster viral infections. the best known side‐effects of this drug are significant nephrotoxicity and neurotoxicity. We report on a diabetic patient with acute retinal necrosis who developed non‐oliguric acute renal failure during the administration of high doses of intravenous acyclovir (500 mg/m2 intravenous infusion every 8h). No obvious uremic symptoms or signs were noted. No obvious haematuria, proteinuria or crystalluria were noted in the urine. After discontinuing the acyclovir administration, renal function partially recovered. In this paper, we also review the mechanism of acyclovir‐induced acute renal failure, and the precipitating factor of acyclovir‐induced acute renal failure. Finally, we must once again emphasize the importance of hydration and routine check ups for renal function in preventing acyclovir‐induced acute renal failure.
Increased expression of HB‐EGF and its receptor erbB4/HER4 in accelerated anti‐GBM disease
Authors: LEVIDIOTIS Vicki , KHONG Tee Fern , KATERELOS Marina , FRASER Scott , POWER David Anthony
Published: March 2003

SUMMARY: In the kidney, heparin‐binding epidermal growth factor‐like growth factor (HB‐EGF) and its receptors, epidermal growth factor‐receptor (EGF‐R) and human epidermal receptor 4 (erbB4/HER4), may be important in the response of cells to tissue injury. to further define the role of HB‐EGF, we have determined its distribution in the accelerated anti‐GBM model of kidney disease. Within the glomerulus, immunohistochemical staining showed increased HB‐EGF expression in podocytes and infiltrating macrophages. This was associated with strong de novo expression of erbB4/HER4 on podocytes. These data suggest that increased expression of HB‐EGF and erbB4/HER4 is a response to inflammation in the glomerulus in accelerated anti‐GBM disease. to determine the potential role of HB‐EGF in anti‐GBM disease, a blocking monoclonal antibody against HB‐EGF (DE10) was administered by intravenous injection. There was, however, no significant difference in the extent of 24 h urinary protein, renal function, or histological appearances. the effects of blocking HB‐EGF, therefore, may be masked by the redundancy in the EGF growth factor family.
Increase of matrix metalloproteinase‐2 in dialysate of rat sclerosing encapsulating peritonitis model
Authors: HIRAHARA Ichiro , UMEYAMA Kazuhiro , SHOFUDA Ken‐Ichi , KUSANO Eiji , MASUNAGA Yoshinori , HONMA Sumiko , ASANO Yasushi
Published: March 2003

SUMMARY: Sclerosing peritonitis (SP) and sclerosing encapsulating peritonitis (SEP) are serious complications of continuous ambulatory peritoneal dialysis (CAPD). the mortality rate of SP/SEP is extremely high. It is important to clarify the mechanism of progression of SP/SEP, and to prevent this complication. We prepared an animal model of SEP by intraperitoneal administration of chlorhexidine gluconate (CHX) using male Sprague‐Dawley rats. Dialysate drained from these animals was analysed by gelatin zymography. In this animal model of SEP, fibrous peritoneal thickening accompanied by cellular infiltration and peritoneal adhesion, were observed. Four of six rats presented with a so‐called abdominal cocoon. an increase of peritoneal absorption of glucose was also confirmed. Zymographic analysis revealed that the matrix metalloproteinase‐2 (MMP‐2) level was high in the dialysate from the animal model, although MMP‐9 was hardly detected. From these results, the MMP‐2 level in drained dialysate was considered to increase in SP/SEP. Matrix metalloproteinase‐2 might be associated with the progression of SP/SEP.
Clinicopathological correlation of intrarenal cytokines and chemokines in IgA nephropathy
Authors: LIM CHUN SOO , YOON HYUNG JIN , KIM YON SU , AHN CURIE , HAN JIN SUK , KIM SUHNGGWON , LEE JUNG SANG , LEE HYUN SOON , CHAE DONG‐WAN
Published: March 2003

SUMMARY: The pathogenetic mechanisms of IgA nephropathy are diverse and are not yet clearly elucidated. We believe pro‐inflammatory cytokines, Th1/Th2, and chemokines would be involved in the pathogenetic pathways and would affect the functional and histological consequences of IgA nephropathy. By using semiquantitative reverse transcriptase–polymerase chain reactions (RT‐PCR), we measured the level of intrarenal gene expression of various cytokines and chemokines in 61 renal core biopsy specimens confirmed as IgA nephropathy. And, by using immunohistochemistry (IHC), the degree of expression and the location of various cytokines and chemokines in renal tissues in 29 of the above patients were attempted to be determined. In RT‐PCR, the γ‐interferon (IFN‐γ)/interleukin‐10 (IL‐10) ratio was higher in patients with renal dysfunction than in those with normal renal function. The levels of pro‐inflammatory cytokine gene transcripts (tumor necrosis factor‐α (TNF‐α), IL‐1β) were high in patients with significant proteinuria. In patients with severe glomerular sclerosis, the ratio of IFN‐γ/IL‐10 gene transcripts was high. The level of IL‐10 gene transcript was related to the severity of tubular atrophy and interstitial fibrosis. The extent of intrarenal arteriolar lesions correlated with the expression of the IL‐8 gene transcript. The degree of IgA deposition in glomeruli was related to the expression of IL‐15 and IL‐6. In IHC, TNF‐α, IFN‐γ and IL‐2 were immunostained dominantly in the mesangial region, but not in the tubulointerstitial region. In contrast, positive reactions for IL‐10 were observed primarily in tubules. Significant reactions for IL‐8 were noted in the periarteriolar and arteriolar areas. The results of RT‐PCR and IHC showed positive relationships, but these were not statistically significant. This study suggests that pro‐inflammatory, Th1/Th2 cytokines and chemokines are involved in the specific processes of inflammation and immunological injury in IgA nephropathy.
Inflammatory cytokines in glomerulonephritis
Authors: Atkins RC
Published: March 2003

SUMMARY: The importance of various inflammatory cytokines in mediating renal disease is now recognized, and the potential for the use of cytokine blockade as a therapeutic intervention is under active investigation. Studies in rat anti‐glomerular basement membrane (GBM) disease model showed that antagonism of the proinflammatory cytokine IL‐1 inhibited induction of glomerulonephritis, and prevented progression of established disease. A second cytokine Tumour Necrosis Factor‐alpha (TNF‐α) had similar proinflammatory effects to IL‐1 in this model. Blocking the actions of both cytokines together, however, had no added benefit. Another cytokine Macrophage Migration Inhibitory Factor (MIF) has been shown to override the anti‐inflammatory effects of corticosteriods. Renal MIF is markedly up‐regulated in rat anti‐GBM disease and blocking studies have demonstrated MIF plays a pathological role in mediating renal injury in this model. The importance of MIF in glomerulonephritis has been demonstrated by the fact that MIF is produced locally within the kidney, that it reflects the severity of the cellular immune response, and can be measured in the urine. Macrophage Migration Inhibitory Factor is up‐regulated in human glomerular disease and correlates with loss of renal function and is thus a potential target for therapy for human glomerulonephritis. Thus, the inflammatory cytokines, IL1, TNF‐α and MIF each play a role in the immune/inflammatory process in glomerulonephritis. Blocking their action reduces disease and cytokine blocking agents have therapeutic potential.
Oxygen mediated gene regulation
Authors: Pugh CW , Maxwell PH , Ratcliffe PJ
Published: March 2003

SUMMARY: Studies of hypoxia‐inducible cis‐acting sequences from the erythropoietin gene have led to the recognition of a widespread transcriptional response to hypoxia based on the activation of a DNA‐binding complex, hypoxia‐inducible factor‐1 (HIF). Genes with functions in cellular energy metabolism, iron metabolism, catecholamine metabolism, vasomotor control and angiogenesis have subsequently been shown to be responsive to HIF, indicating a role in the coordination of oxygen supply and cellular metabolism. Hypoxia‐inducible factor‐1 is a heterodimer of two basic helix–loop–helix proteins of the PAS family, HIF‐1 alpha and HIF‐1 beta, although different isoforms of each subunit are now known to exist. When oxygen tension is lowered, HIF‐alpha subunits dimerize with HIF‐beta and activate gene transcription. Hypoxia‐inducible factor‐1‐mediated gene transcription is regulated predominantly by oxygen‐dependent destruction of HIF‐alpha via the ubiquitin‐proteasome pathway. This destruction is mediated by a ubiquitin E3 ligase complex, in which the von Hippel‐Lindau (VHL) protein (pVHL) recognizes and binds oxygen‐dependent destruction domain(s) in HIF‐alpha subunits. In VHL disease, the destruction of HIF‐alpha is blocked, at least partly explaining the phenotype. The recognition of HIF‐alpha by pVHL in normoxia has recently been shown to be conditional on enzymatic post‐translational hydroxylation of critical prolyl residues. It is hoped that a detailed understanding of these gene regulatory mechanisms may lead to therapeutically useful interventions in the future, for example by up‐regulating HIF activity in ischaemic disease or down‐regulating it in cancer.
Timing of nephrology referral: a study of its effects on the likelihood of transplantation and impact on mortality
Authors: Cass A , Snelling P , Cunningham J , Wang Z , Hoy W
Published: March 2003

SUMMARY: Delayed referral of patients with end‐stage renal disease (ESRD) to a nephrologist is associated with considerable early morbidity and increased mortality. The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) has collected data regarding the timing of referral to a nephrologist for all patients beginning renal replacement therapy (RRT) since 1 April 1995. We examined survival and likelihood of transplantation for patients who started RRT between 1 April 1995 and 31 December 1998, with follow‐up until 31 March 2000 (up to 5 years follow‐up). Of 4886 patients starting RRT, 1277 (26.1%) were in the late referral (LR) group and 3609 (73.9%) were not (NLR). In a multivariate analysis, predictors of LR were age 0–44 years and the presence of two or more comorbidities. Ninety days after referral, 60% of patients in the LR group were on haemodialysis compared with 55% of patients in the NLR group; 40% of patients in each group were receiving peritoneal dialysis at this time. Patients in the LR group were significantly less likely to receive a transplant in the first year after referral and throughout the duration of the study compared with the NLR group. Mortality rates were 19 and 13 persons per 100 patient years in the LR and NLR groups, respectively. In conclusion, delayed referral to a nephrologist was associated with increased mortality which continued for up to 5 years, even after adjustment for known predictors of mortality including age, sex, comorbidities and primary renal disease.
Differentiating paroxysmal nocturnal haemoglobinuria and pre‐eclampsia in pregnancy
Authors: Brown MA , Mcmahon L
Published: March 2003

SUMMARY: During her first pregnancy, a 26‐year‐old‐woman developed symptoms of severe pre‐eclampsia at 23 weeks gestation. Fetal death in utero was confirmed shortly after presentation. A similar event at 13 weeks gestation in her second pregnancy prompted further investigation. She was found to have a rare form of haemolytic anaemia, paroxysmal nocturnal haemoglobinuria (PNH). Supportive management with prednisolone and anticoagulation enabled the gestation to continue and she was delivered successfully at 34 weeks.
Therapeutic aspects of IgA nephropathy: an overview
Authors: Schena Francesco P , Strippoli Giovanni FM , Manno Carlo
Published: March 2003

SUMMARY:
IgA nephropathy (IgAN) is the cause of end‐stage renal failure in 15–20% of patients within 10 years from the apparent onset of the disease and in 30–40% of individuals within 20 years. The degree of renal lesions, serum creatinine, severe proteinuria and microhematuria are independent prognostic indicators. No specific therapy has been definitely established, although several approaches have been experimented. The most important aspects of each randomized controlled trial (RCT) available in the literature were analysed regarding the treatment of IgAN with corticosteroids, cytotoxic agents and fish oil. Their quality was evaluated according to the Consolidated Standards of Reporting Trials (CONSORT) statement, an analysis was performed of heterogeneity between trials and finally these results were used to obtain a meta‐analysis adjusted for the duration of follow up. Regarding the quality assessment of the considered trials, the analysis showed that the majority of RCT lack key information, particularly in their methods and results sections. Because a wide heterogeneity existed among RCT, the meta‐analysis was performed with both fixed and random methods to obtain the most reliable results. The present study showed that only corticosteroid treatment may be beneficial for the outcome of renal function, while this is only partially true for fish‐oil treatment and not true for cytotoxic agents. These statements are in concordance with previously published meta‐analyses. Furthermore, when the results of meta‐analysis on the effect of treatment for corticosteroids, cytotoxic agents and fish oil were adjusted for the duration of follow up, it was found that their effects decreased and became null as follow up increased. In conclusion, further RCT are necessary, including more homogeneous groups of IgAN patients and therapeutic regimens with a long‐term follow up. It is necessary to state that the results of meta‐analysis must be used with care and not as a surrogate for sound decision‐making. They should not be considered as absolute, and this is particularly true in fields such as nephrology in which the number of patients enrolled in individual studies is very small and the duration of follow up is very short.
Live donor renal transplantation in patients with end‐stage renal failure due to IgA nephropathy: clinicopathological assessment
Authors: Kim Yu Seun , Jeong Hyeon Joo , Kwon Kye Won , Lee Ho Yung , Han Dae Suk , Park Kiil
Published: March 2003

SUMMARY:The long‐term outcome was evaluated, in terms of recurrence and graft survival, after live donor renal transplantation in 90 grafts in 89 patients with biopsy‐proven IgA nephropathy (IgAN) as a primary diagnosis of end‐stage renal disease. Additionally, histological assessment including glomerular morphometry was performed in 19 grafts having recurrent IgAN. The 10‐year graft survival for IgAN patients was 66%, which was comparable with that of 84% for 107 reference recipients having other kinds of glomerulonephritis (GN) or 69% for 90 other recipients having non‐GN renal failure (P = 0.27). In 43 grafts, 54 event graft biopsies were performed, and mesangial IgA deposits were documented in 19 grafts. In eight grafts, lesions were accompanied by chronic rejection (CR). Ten‐year cumulative recurrence was 44%. In total, 10 grafts were lost: this was due to CR (n = 3) or acute rejection (n = 1) in 24 recurrence‐free recipients; CR (n = 2) or recurrence (n = 2) in 19 patients with recurrence; and patient death (n = 2) in 46 patients who did not have graft biopsy. No difference in 10‐year graft survival between the patients with and without recurrence (63%vs74%;P = 0.98), or the proportion of related donors was found (68%vs83%;P = 0.25). In the grafts with recurrence, renal histological damage was relatively mild and had no uniform pattern. The percentage of global and segmental sclerosis were 11.9% and 3.7%, respectively. Non‐sclerotic glomeruli were ischaemic or hypertrophied. Mesangium showed lysis or focal and mild expansion by matrix and cellular increase. Glomerular morphometry was performed in seven patients, in whom glomerular hypertrophy was found as demonstrated by increases of Bowman's and glomerular tuft areas (1.4 and 1.3 times the control, respectively) and concomitant decrease of total glomerular and mesangial cells per glomerular cross‐section (71.2% and 84.9% of the control, respectively). In conclusion, recurrence increased to 44% with longer follow up, but this did not limit the graft outcome. Recurrence was not affected by the types of live donor. Glomerular hypertrophy in the recurrent IgAN group suggests hyperfiltration.
Meaning of retrograde phenotypic change of mesangial cells in IgA nephropathy
Authors: Shigematsu Hidekazu , Kaneko Yoko , Zhang Lianshan , Nakazawa Koh
Published: March 2003

SUMMARY:
Mesangial cells show phenotypic changes such as that of glomerular differentiation at the fetal stage in various nephropathies, including IgA nephropathy. Such a process seems necessary for reparative or regenerative reactions in post‐inflammatory or post‐injury glomerular tissues, particularly for the rearrangement of glomerular capillary networks. Glomerular sclerosis may be the end result of failure or maldevelopment of this phenotypic glomerular transformation.
A psycho for every generation
Authors: Welch Mark , Racine Twilla
Published: March 2003

For almost 40 years, thanks to Alfred Hitchcock’s seminal film, the word Psycho has conjured up some of the strongest and most enduring, not to say frightening and even misleading images of mental illness in contemporary western culture. It has become a byword for terrifying homicidal impulses, the unpredictability of a deranged mind, and has created, in Norman Bates, an archetype for the Other. However, we must now accept that time has passed. There is now another Psycho with which we have to deal, so close in shot selection and script as to pass for identical. Gus van Sant has produced a Psycho for the 1990s — or so we might consider. This paper will examine the way in which the two films, one produced in 1960 and the second in 1988, deal with the notions of mental illness, madness and the construction of the Other. It will pay particular attention to the central character of Norman Bates, how and why he is so terrifying to us, how his madness is explained and demonstrated and what a deconstructed analysis of that portrayal may signal. It will consider the notion that, just as we have come to accept that every generation may produce its own interpretation of roles from the classical stage repertoire, such as Hamlet, every generation can and will interpret Psycho to mirror its own concerns.
Postdisciplinarity in mental health‐care: an Australian viewpoint
Authors: Holmes Colin A.
Published: March 2003

Postdisciplinarity in mental health‐care: an Australian viewpoint

This paper outlines some of the powerful forces progressively undermining the conceptual and practical foundations upon which the major disciplines have been established, and dissolving the boundaries which have traditionally distinguished them from each other, particularly those disciplines involved in the healthcare enterprise. It discusses some of the implications of these processes for mental health nursing, and champions a new cadre of ‘postdisciplinary’ staff, comprising a graduate generic mental healthcare worker and a postgraduate clinical specialist. It is argued that such a specialist — a ‘Generic Mental Health Worker’— should be welcomed by all those who want to see improved quality of care in mental health services rather than defend a failing system.
High technology and nursing: ethical dilemmas nurses and physicians face on high‐technology units in Norway
Authors: Bunch Eli Haugen
Published: March 2003

High technology and nursing: ethical dilemmas nurses and physicians face on high‐technology units in Norway

Results from two studies of ethical dilemmas nurses and doctors experience on two high‐technology units are compared and discussed. The qualitative comparative methodology of grounded theory was used to generate theoretical frameworks grounded in the empirical realities of the units. The ethical dilemmas they faced were related to: treating the one vs. the common good; end of life questions; and resource allocations with inadequate staffing. Similarities were related to intensity and urgency of nursing care and patient treatment, clear nursing ideologies based on treating humans within a framework of hope, embracing technology and scarce resources. Differences between the two study units were patient diagnosis, hierarchical structure on one unit while one had a vertical structure and decision‐making processes, and finally how nursing knowledge and autonomy were used. The two studies demonstrated that clinical, ethical and administrative interactions and decisions are highly compounded, stressful and intertwined.
Exploring nursing expertise: nurses talk nursing
Authors: Hardy Sally , Garbett Robert , Titchen Angie , Manley Kim
Published: March 2003

Exploring nursing expertise: nurses talk nursing

It has become increasingly important for practitioners to articulate their expertise in modern healthcare settings that demand high levels of accountability and evidence‐based practice. The material presented within this article has been interpreted drawing from discourse analysis1to help explore the discourses that shape and influence understandings of nursing practice. What we present are extracts from four of the 35 participant nurses who applied to take part in the Royal College of Nursing Institute's Expertise in Practice (pilot) Project (EPP). The material presented is used to provide a starting point for exploring how nurses talk about and construct expertise in nursing practice. The four nurse participants’ clinical practice areas cover palliative care, mental health, intensive care and fertility care. The material reveals high levels of intensity in the nurse–patient relationship, ‘maverick’ nursing practices and ongoing reflexivity. All of these aspects appear to capitalize on expertise as a ‘catalyst’ that alters treatment pathways and maximizes patient‐centred outcomes. Exploring a discourse of nursing expertise exposes the tacit situated nature of professional practice that is heterogeneous and most difficult to articulate and explain. It is proposed that expertise tends to be understood from traditional and dominant discourses of medicine, management and technology. Explaining expertise in practice exposes non‐conventional practice that in itself can be isolating and challenging to the status quo of contemporary health‐care.
Further characterization of the 5′‐flanking promoter region of the human β1‐adrenergic receptor gene
Authors: OKAWA YOSHINORI , ADACHI ATSUSHI , INO MIYUKI , NAGUMO SATOKO , MATSUI HIROAKI
Published: March 2003

Further characterization of the 5′‐flanking promoter region of the human β1‐adrenergic receptor (AR) gene was attempted. The transcription initiation sites, determined by the primer extension and the rapid amplification of the 5′‐cDNA end, are multiple in a spanning about 30 nucleotides (−289 to −261 relative to the translation start site). There exist inverted CCAAT boxes, multiple binding sites for transcription factor Sp1 and AP‐2 nearby transcription initiation sites, however, this region lacks a typical TATA box. In order to localize the regulatory region for the basal transcription of the human β1‐AR gene, a variety of 5′‐flanking sequence/chloramphenicol acetyltransferase reporter gene fusion constructs was prepared and transiently expressed in HeLa cells. Functional analyses reveal negatively (−3813 to −2925 and −1772 to −796) as well as positively (−2925 to −1772) regulatory regions, in addition to the region (−796 to −87) being necessary for the basic expression of the human β1‐AR gene.
HLA DR2 and DQ1 frequency among narcoleptic patients in Hong Kong Chinese
Authors: WING YUN‐KWOK , CHEN CHAR‐NIE , HO CROVER K.W.
Published: March 2003

Narcolepsy is a life‐long crippling sleep disorder with significant physical and psychosocial impairments. Although its exact etiology and neuropathology is not clear, a strong association with specific human leucocyte antigen (HLA) subtype, particularly DR2 (DRw15) and DQw1 (DQw6), has been demonstrated across different ethnic groups including Caucasians and Japanese. The presence of 100% association with HLA DR2 in a series of Hong Kong Chinese narcoleptic patients has previously been reported. The report can now be extended, and as far as could be ascertained in the available subjects, all were HLA DQw1 (DQw6)‐positive. This is concordant with the experiences of Japanese narcoleptic patients who are 100% HLA DR2‐ and DQw1‐positive. However, the definitive account of the population prevalence of narcolepsy in Chinese could be determined only by a well‐conducted epidemiological study with laboratory confirmation.
The nature and longitudinal course of psychological trauma
Authors: McFARLANE ALEXANDER C.
Published: March 2003

In comprehending the nature of posttraumatic reactions, time is a critical dimension in understanding the nature and severity of reactions. The relationship between the acute reaction to the traumatic event and posttraumatic stress disorder (PTSD) is an issue that is frequently referred to, and many assumptions are presumed. In particular, it is often presumed that those who develop PTSD behave in maladaptive ways at the time of the trauma. Increasingly it appears that there are relatively few differences in the immediate proximity of traumatic events between those who go on to develop PTSD, as opposed to those who do not develop any disorder or develop conditions such as posttraumatic depression. It appears that the disorder emerges in the days and weeks that follow the event, suggesting some abnormality of dampening of reactivity. While PTSD is a valuable construct in describing the long‐term outcomes of trauma, it is important to recognize that there are a range of other psychiatric disorders such as depression, substance abuse and anxiety which can emerge in the aftermath of these experiences. The longer term follow‐up of traumatized populations also increasingly demonstrates the impact on their health and health‐seeking behaviors. The long‐term course of PTSD can best be understood by considering the interaction between a range of biological, psychological and social variables that influence the individual's propensity and predisposition. The nature of the biological stress response at the time of the trauma may be a critical factor that influences the long‐term outcome. As well, the patterns of substance abuse can also modify the longitudinal phenomenology of this disorder. The emergence of findings from longitudinal studies is increasingly indicating that the nature of PTSD at different points in its life history may need to be distinguished. It is possible that treatment interventions that are effective at one point may not be so in the more chronic forms. The progressive psychobiological changes in this condition require greater clarification.
Pharmacotherapy for posttraumatic stress disorder: A status report
Authors: FRIEDMAN MATTHEW J.
Published: March 2003

Pharmacotherapy for posttraumatic stress disorder (PTSD) appears to be a promising approach because many neurobiological systems appear to be altered in PTSD patients. This review encompasses the current published literature on clinical trials with antiadrenergic agents (propranolol, clonidine, guanfacine), selective serotonin reuptake inhibitors (SSRI), other serotonergic agents, monoamine oxidase inhibitors (MAOI), tricyclic antidepressants (TCA), benzodiazepines, anticonvulsants, narcotic antagonists and antipsychotic agents. It is suggested that although more randomized clinical trials are needed with the drugs cited in the present review, that an important future direction would be with drugs that directly modify the complex psychobiology of the human stress response, in general, and PTSD‐related abnormalities, in particular.
Reliability of childhood mental disorder: Diagnoses by Japanese psychologists
Authors: Hasui Chieko , Sugiura Tomoko , Tanaka Eriko , Sakamoto Shinji , Sugawara Masumi , Kitamura Toshinori , Aoki Yuko
Published: March 2003

The recent entry of psychologists into psychiatric practices and schools in Japan calls for diagnostic skills, because psychiatrists are less available in such settings. We examined the reliability of the diagnoses of 10 DSM‐IV childhood mental disorders by 11 Japanese psychologists, using 20 case vignettes. Most categories had good reliability (κ), except for attention deficit hyperactivity disorder. Japanese clinical psychologists may be able to use DSM‐IV reliably as a tool for diagnosis of childhood psychiatric disorders, if sufficient training is provided.
Effects of morning bright light on sleep in healthy elderly women
Authors: Kobayashi Riko , Kohsaka Masako , Fukuda Noriko , Sakakibara Satoshi , Honma Hiroshi , Koyama Tsukasa
Published: March 2003

Subjective sleep feeling and polysomnography were measured in 10 elderly women to investigate the effects of 8000 lux morning bright light (BL) exposure. The profile of sleep feeling in the BL condition was better than in the control condition. The proportion of awakening time in the first one‐third of night sleep decreased, and the amount of awakening time in the last one‐third increased in BL condition. Daytime napping reduced in BL condition. These findings suggested the effectiveness of exposure to bright light on the improvement of sleep quality and daytime vigilance of healthy elderly women.
Colony‐stimulating factors in rapid eye movement sleep and non‐rapid eye movement sleep regulation
Authors: Kimura Mayumi , Kodama Tohru , Honda Yoshiko , Zhang Shi‐Qing , Inoué Shojiro
Published: March 2003

Although several cytokines are known to be somnogenic, no study has been conducted to examine whether colony‐stimulating factors (CSF) affect sleep. Therefore, we studied the effects of granulocyte‐macrophage CSF (GM‐CSF) and macrophage CSF (M‐CSF) on sleep in rats and their possible mechanism of action. At the dose of 10 pmol, GM‐CSF or M‐CSF significantly increased both non‐rapid eye movement and rapid eye movement (REM) sleep or REM sleep only when infused intracerebroventricularly during the dark period. When injected locally in the hypothalamus, GM‐CSF and M‐CSF increased nitric oxide (NO) production. Thus, NOergic neural signals in the hypothalamus may take part in the somnogenic action of CSF.
Treatment of obstructive sleep apnea syndrome with a Kampo‐formula, San’o‐shashin‐to: A case report
Authors: Hisanaga Akito , Saitoh Osamu , Fukuda Hidemichi , Kurokawa Kenzo , Okabe Akihito , Tachibana Hiroyuki , Hagino Hirofumi , Mita Tatsuo , Yamashita Ikiko , Tsutsumi Manabu , Kurachi Masayoshi , Itoh Takashi
Published: March 2003

The following describes a 76‐year‐old male with obstructive sleep apnea syndrome successfully treated with a Kampo‐formula, San’o‐shashin‐to (Formula medicamentorum tres ad dispellendi cordis). Polysomnography, performed before and after administration of San’o‐shashin‐to, revealed that the apnea index decreased from 11.1 events/hour to 4.1 events/hour, and that the apnea plus hypopnea index decreased from 18.4 events/hour to 10.7 events/hour. The patient was normo‐weight (body mass index: 20.4 kg/m2), and events of sleep apnea and hypopnea were mostly noted during a non‐rapid eye movement sleep. It is possible that San’o‐shashin‐to has some alleviating effects on the upper airway resistence during sleep.
Polysomnographic and urodynamic changes in a case of obstructive sleep apnea syndrome with enuresis
Authors: Arai Hideki , Furuta Hisakazu , Kosaka Kazuto , Kaneda Reizo , Koshino Yoshifumi , Sano Joh , Yokoyama Osamu
Published: March 2003

A 53‐year‐old female patient with obstructive sleep apnea syndrome was reported. She had complained of enuresis as well as a 15‐year history of snoring, but she had no complaint of sleep and awake disturbance. Polysomnographic study showed repeated obstructive apnea and hypopnea with an apnea/hypopnea index of 52.6, and severe oxygen desaturation during sleep. On cystometography during sleep, the changing amplitude of the spike wave corresponds to the changes of respiratory efforts against a closed upper airway. The patient was treated successfully with imipramine and acetazolamide for the obstructive sleep apnea and enuresis. Apnea/ hypopnea index, nocturnal oxygen desaturation, and sleep architecture were improved, and enuresis completely disappeared. Cystometrography during sleep showed that the average amplitude of the spike wave tended to be low. Percentage urinary volume during sleep compared with 24 h volume was significantly reduced. We considered that the enuresis was mainly related to increased intra‐abdominal pressure produced by respiratory efforts and enhanced nocturnal urine production.
Physiognomic perception, vitality affect and delusional perception in autism
Authors: Kobayashi Ryuji
Published: March 2003

The relationship between autism and schizophrenia has been denied from the symptomatological and epidemiological standpoints. However, the mechanism whereby psychotic symptoms appear in association with autism has not been investigated at any length. Therefore, an investigation was conducted on how the unique modes of perception in autism are related to the psychotic symptoms observed. Through the therapy of one case of adolescent autism, the author points out the existence of physiognomic perception and vitality affect as characteristic modes of perception in autism. It was inferred that should autistics be placed under circumstances forcing them to withdraw from open communalism, their unique interpretation of the environmental world could give rise to psychopathological phenomena which would be considered delusional perception.
Attentional processing of emotional information in obsessive–compulsive disorder
Authors: Unoki Keiko , Kasuga Takashi , Matsushima Eisuke , Ohta Katsuya
Published: March 2003

In order to investigate attentional processing of emotional information in obsessive–compulsive disorder (OCD), 14 patients with OCD and 28 normal control (NC) subjects were asked to name the background colors of anxiety‐relevant, compulsion‐relevant, positive and neutral words (an emotional Stroop color‐naming test). The stimulus words were presented subliminally, and supraliminally. The time of subliminal presentation for each subject was determined in advance by the lexical decision task. In the subliminal condition, the delay for anxiety‐ and compulsion‐relevant words, when compared with neutral words, was greater in OCD patients, while no difference was found in NC subjects. In the supraliminal condition, no delay was found for both OCD patients and NC subjects. In other words, OCD patients were more sensitive to threat information when it could not be identified with consciousness. Moreover, the present study compared checking OCD with cleaning OCD in the attentional processing of emotional information. As a result, it was found that checking OCD patients responded more slowly in naming the background color of subliminal emotional words than cleaning OCD patients. The results indicate that OCD patients, especially with checking compulsion, may have a deficit in automatic processing of threat information.
Effects of propofol anesthesia on cognitive recovery of patients undergoing electroconvulsive therapy
Authors: Sakamoto Atsuhiro , Hoshino Takeshi , Suzuki Norihito , Suzuki Hiroko , Kimura Mahito , Ogawa Ryo
Published: March 2003

The effects of different doses of propofol on post‐electroconvulsive therapy (ECT) cognitive recovery were evaluated together with the effects on seizure duration and hemodynamic changes during ECT in 15 depressive patients. Propofol attenuated the increase in arterial blood pressure and heart rate in a dose‐dependent manner compared with thiamylal. Propofol showed a clinically significant anticonvulsant effect during ECT in a dose‐dependent manner. There were no significant differences among the four different induction groups in the mean recovery time from anesthesia, however, a low dose of propofol suppressed the early recovery of cognitive function. For early cognitive recovery after ECT, a deep anesthetic level is necessary when the traditional ECT apparatus is used which produces sine curve wave stimuli.
Mood disorders and influenza epidemics in Japan
Authors: Mino Yoshio , Oshima Iwao , Okagami Kazuo
Published: March 2003

The finding that influenza epidemics are associated with an increased risk of adult mood disorder has been controversial. In this study, data were collected from governmental statistics, the Patient Survey in Japan, in 1996. Index years were defined as 1957/58, 1962, and 1965, and comparison years were defined as 2 years before and 2 years after the index year. The subjects were 361 patients with mood disorders who were born in the index years of influenza epidemics. In order to isolate patients exposed to an influenza epidemic during their second prenatal trimester, the months of birth 5 months after the influenza epidemics were defined as risk exposure months. The proportions of patients born during the exposure period in the index years were compared with those of patients born in the corresponding months in the comparison years. The same procedures were conducted for the periods 2 and 8 months after the epidemics. For female in‐patients only, the proportion of patients born in the A2 influenza‐exposure months in 1965 with second‐trimester exposure was smaller than that of patients born in the corresponding months in the comparison years; the same phenomenon was observed for third‐trimester exposure in 1957–58. However, no differences were observed in other comparisons. These findings suggest that prenatal exposure to influenza might decrease the risk for adult mood disorders in females. However, whether there is a causal relationship is still unproven.