bluuebunny/crossref_metadata_2025 huggingface dataset:
Constitutive deficiency in DNA mismatch repair
Authors: Felton KEA , Gilchrist DM , Andrew SE
Published: May 2007

Mutations in the DNA mismatch repair (MMR) genes are associated with the inheritance of hereditary non‐polyposis colorectal cancer, also known as Lynch syndrome, a cancer syndrome with an average age at onset of 44. Individuals presenting with colorectal cancer are diagnosed with Lynch I, whereas individuals who present with extra‐colonic tumors (such as endometrial, stomach, etc.) are identified as patients with Lynch syndrome II. Recently, 30 families have been reported with inheritance of biallelic mutations in the MMR genes. Here we summarize the phenotype of individuals with inheritance of homozygous or compound heterozygous mutations in the MMR genes that result in a complete lack of protein or greatly compromised protein function. In contrast to individuals with Lynch syndrome I and II, individuals with no MMR function present with childhood onset of hematological and brain malignancies, whereas residual MMR function can also result in gastrointestinal cancers and an age of onset in the second to fourth decade. Individuals with biallelic MMR mutations often present with café‐au‐lait spots, regardless of the level of MMR function remaining. Thus, the inheritance of two MMR gene mutations is a separate entity from Lynch I or II or the subtypes Turcot and Muir–Torre.
The influence of living donor liver transplantation on families with or without siblings
Authors: Yoshino Mayumi , Yoshino Hiroyuki , Kusano Atsuko , Mizuta Koichi , Kawarasaki Hideo
Published: May 2007

Abstract:  With child living donor liver transplantation (LDLT), two people from one family, a child patient and one parent and one parent are forced to be hospitalized, so the family faces very servere problems. This is especially severe in cases when pediatric patients have siblings. Our research investigated the influence of LDLT upon families with siblings as compared to those without, especially the impact of surgery and hospitalization on family relationships. Families with siblings had more stress about child care and they tended to be more anxious about child development. The siblings had a lot of stress and mental problems. Therefore, the families of LDLT are seen to need special supports, especially those who had siblings.
Percutaneous recanalization of an occluded hepatico‐jejunostomy, using Colapinto needle, in a two‐yr‐old patient after partial liver transplantation
Authors: Miraglia Roberto , Luca Angelo , Maruzzelli Luigi , Caruso Settimo , Henderson Kristine , Riva Silvia , Spada Marco , Gridelli Bruno
Published: May 2007

Abstract:  We report one case of percutaneous recanalization of an hepatico‐jejunostomy, using Colapinto needle, in a two‐yr‐old patient after partial liver transplantation and occlusive anastomotic biliary stricture non‐crossable with conventional interventional radiology techniques. The procedure was successfully performed and followed by biliary trans‐anastomotic catheter placement. Later, the patient underwent multiple session of conventional percutaneous balloon dilatation of the anastomosis as a good flow of contrast from bile ducts to bowel loops was achieved. The patient is now without percutaneous biliary catheter since 10 months in good general conditions and with good liver function tests.
Determinants of urinary calcium and uric acid excretion in children after renal transplantation
Authors: Peterson J. M. , Butani L.
Published: May 2007

Abstract: HC and HU predispose healthy children to develop hematuria and nephrolithiasis. The natural history of HC and HU has not been studied in renal transplant recipients who may be at greater risk of complications. Our study investigated the prevalence of HC and HU after Tx and determined independent predictors of urinary calcium and uric acid excretion. Twenty‐five pediatric transplant patients were studied between one and 12 months after Tx. Demographic data and measurements of the random Uca/cr and uric acid excretion were collected. Multivariable regression analyses were used. The median age of the patients was 10.6 yr. The prevalence of HC and HU was 20% each at one month. At 12 months, 20% had HC and 13% had HU. There were no predictors for HC; for HU, the only predictor was systolic hypertension (p = 0.03). Our data demonstrate a high prevalence of HU and HC in pediatric renal Tx recipients. The long‐term clinical implication of these metabolic abnormalities remains to be elucidated in prospective trials.
Assessment of risk factors for cardiovasuclar disease in pediatric renal transplant patients
Authors: Silverstein Douglas M. , Mitchell Miranda , LeBlanc Pamela , Boudreaux J. Philip
Published: May 2007

Abstract: Pediatric renal TP recipients are at risk for CVD. We performed a cross‐sectional study of the prevalence of RF for CVD in 45 long‐term pediatric renal TP patients. The time since TP was 42 months. The GFR was 87.8 ± 3.4 mL/min/1.73m2; 25/45 (56%) had Stage 2–4 CKD. A total of 33% had elevated SBP and 24% had high DBP; 57% had elevated SBP or DBP. A total of 20% had elevated serum CHOL levels, while 45% had high serum TG levels. A total of 42% had high HCY levels and 50% had low HCT levels. The vast majority (66.7%) had at least two RF for CVD. A total of 18.2% had abnormal post‐TP echocardiography results. There was a negative correlation between GFR and SBP, DBP, serum CHOL, HCY, and BMI. There was a positive correlation between GFR and HCT. Serum CHOL was significantly lower and SBP and DBP trended lower in patients on a SF immunosuppression regimen. Similarly, SBP and DBP trended higher and CHOL was significantly higher in patients receiving SRL vs. mycophenolate mofetil. We conclude that the majority of pediatric renal TP patients exhibit multiple CVD RF.
Avoiding steroids in pediatric renal transplantation: Long‐term experience from a single centre
Authors: Pedersen Erik Bo , El‐Faramawi Mohamad , Foged Nils , Larsen Karl‐Egon , Jespersen Bente
Published: May 2007

Abstract:  We report our experience in pediatric renal transplantation avoiding steroids whenever possible. Immunosuppression consisted of an initial induction with antithymocyte globulin followed by maintenance therapy with a calcineurin inhibitor and MMF. Steroids were only given to selected patients because of the primary disease, recurrence, rejection, or PTLD. Thirty‐four transplants grafted into 32 recipients between 1995 and 2005 were followed for a median of 3.5 yr (range 1–9.8). All patients survived. Graft rejection occurred in 10 cases during the first year post‐transplantation and graft survival at one, five, and seven yr was 97, 88 and 88%, respectively. Steroids were given to half of the patients (n = 16); in nine cases due to rejection. Only four patients (13%) were continuously on steroids. Calculated GFR at one to five yr post‐transplant were 73, 74, 68, 64, and 70 mL/min/1.73 m2. Unfortunately PTLD occurred in three patients, but all survived with functioning grafts. Accordingly, our findings indicate that steroid avoidance in pediatric renal transplantation is possible with good results with respect to acute graft rejection as well as long‐term graft survival.
Early transplantation of unrelated cord blood in a two‐month‐old infant with Wiskott–Aldrich syndrome
Authors: Jaing Tang‐Her , Tsai Bih‐Yu , Chen Shih‐Hsiang , Lee Wei‐I , Chang Kuei‐Wen , Chu Shih‐Ming
Published: May 2007

Abstract:  This report exemplified a success of unrelated CBT in a two‐month‐old boy with Wiskott–Aldrich Syndrome. Umbilical cord blood was chosen as the stem‐cell source because of its immediate availability and reduced tendency to cause GVHD. The conditioning regimen was cyclophosphamide, busulfan, and antithymocyte globulin. GVHD prophylaxis consisted of cyclosporin and methylprednisolone. The patient received an HLA 1‐locus‐mismatched cord blood unit, and the total number of infused nucleated cells was 11.14 × 107/kg. Neutrophil engraftment was achieved on day +11, and a platelet count greater than 50 × 109/L was achieved on day +71. He is currently alive and doing well at nine months post‐transplant and free of any bleeding episodes. This case suggests that unrelated donor CBT may be safe and technically feasible, even in early infancy, when an appropriately matched related or unrelated donor is unavailable.
Invasive diagnostic procedures for pulmonary infiltrates in pediatric hematopoietic stem cell transplant recipients
Authors: Armenian Saro H. , Hoffman Jill A. , Butturini Anna M. , Kapoor Neena , Mascarenhas Leo
Published: May 2007

Abstract:  To evaluate the role of BAL, CTB, and OLB in the management of pulmonary infiltrates in pediatric HSCT recipients, we conducted a retrospective review of clinical records of pediatric HSCT recipients. Data were analyzed using Chi‐square for dichotomous and anova for continuous variables. Logistic regression was used to adjust confounding variables for diagnostic yield. Forty patients underwent 44 separate procedures. Infections were the prevailing cause of infiltrates with a positive diagnostic yield (96%). CTB and OLB were performed more often in patients with focal infiltrates compared with BAL (100%, 71% vs. 22%; p < 0.01). Adverse events were not significantly different across the three procedures. OLB more often yielded information that led to change in medical management (71% vs. 0%, 34%; p < 0.05) compared with CTB and BAL. Patients who had a positive diagnostic yield had no apparent survival advantage when compared with those in whom a procedure yielded no information. Logistic regression demonstrated that focal infiltrate was the only independently predictive variable for identifying a cause of pulmonary infiltrate. In conclusion, all three invasive diagnostic procedures were safe. Having a focal infiltrate was independently and significantly associated with having a positive diagnostic yield.
Liver transplantation in pediatric patients: Twenty years of experience at the University of Wisconsin
Authors: D’Alessandro A. M. , Knechtle S. J. , Chin L. Thomas , Fernandez L. A. , Yagci G. , Leverson G. , Kalayoglu M.
Published: May 2007

Abstract:  Developments in surgical technique, immunosuppression, organ procurement and preservation, and patient selection criteria have resulted in improved long‐term patient and graft survival after pediatric liver transplantation. In this study, we examined the results of 196 liver transplants performed in 155 pediatric patients at University of Wisconsin Children’s Hospital. Patients were divided into two groups according to age at the time of liver transplant. Infants under 12 months of age comprised Group 1 (n = 74) and children from one to 18 yr comprised Group 2 (n = 122). Outcomes for whole, reduced‐size, and split liver transplantation were compared in infants and children. Biliary atresia was the most common indication in both groups. Patients underwent 128 whole size, 50 reduced size, and 18 split liver transplants. Forty‐one retransplantations were performed in 14 infants (18.9%) and in 27 children (22.1%). One hundred eleven patients (56.6%) had one or more rejection episode [37 infants (50.0%) and 74 children (60.6%)]. Thirty‐nine patients (19.8%) developed CMV infections, 42 (21.4%) developed EBV infections, and 14 developed PTLD (six infants and eight children). Thirty‐six patients (18.3%) developed HAT. Seven patients (4.5%) developed malignancy (one infant and six children). Out of 155 patients, 33 (21.3%) died during the study period. The most common etiology of mortality included central nervous system pathology (n = 7; 4.5%), sepsis (n = 6; 3.8%), and cardiac causes (n = 6; 3.8%). One‐, five‐, and 10‐yr actuarial patient survival was 86, 79, and 74% in infants and 90, 83 and 80% in children. Graft survival at one, five, and 10 yr was 77, 73 and 71% in infants and 88, 81 and 78% in children, respectively. Despite its technical challenges, the outcomes of liver transplantation in pediatric patients with end‐stage liver disease are excellent and result in significant long‐term patient and graft survival.
Leaf senescence and N uptake parameters as selection traits for nitrogen efficiency of oilseed rape cultivars
Authors: Schulte auf’m Erley Gunda , Wijaya Ketut‐Anom , Ulas Abdullah , Becker Heiko , Wiesler Franz , Horst Walter J.
Published: May 2007

The cultivation of N‐efficient oilseed rape cultivars could contribute to a reduction of the large N balance surpluses of this crop. To facilitate the breeding process of N‐efficient cultivars, the identification of secondary plant traits correlating with N efficiency is necessary. The objectives of this study were to investigate leaf senescence and N uptake parameters of oilseed rape cultivars and doubled haploid (DH) lines with contrasting N efficiency in a short‐term nutrient solution experiment and to relate these results to their performance in field experiments. In the nutrient solution experiment, genotypes differed in leaf senescence of fully expanded leaves and maximum N uptake rate per unit root length under low N supply. A high maximum N uptake rate seemed to have contributed to delayed leaf senescence by enhancing N accumulation in leaves. Also in the field experiments, genotypes differed in leaf senescence after flowering at limiting N supply. Additionally, the most N‐efficient DH line was able to adapt leaf photosynthetic capacity to the low‐light conditions in the canopy during flowering. N efficiency (grain yield at limiting N supply) was positively correlated with delayed leaf senescence both in nutrient solution and field experiments. It is concluded that important leaf and root traits of N‐efficient cultivars are expressed in short‐term nutrient solution experiments, which may facilitate the selection of N‐efficient cultivars.
Traumatic life events in bipolar disorder: impact on BDNF levels and psychopathology
Authors: Kauer‐Sant'Anna Marcia , Tramontina Juliana , Andreazza Ana Cristina , Cereser Keila , Costa Sabrina da , Santin Aida , Yatham Lakshmi N , Kapczinski Flavio
Published: May 2007

Background:  There is evidence that vulnerability to depression and anxiety disorders is markedly increased by traumatic life events. While childhood abuse has been reported to be associated with poorer outcomes in bipolar disorder, little is known about the neurobiological basis underlying this association. The aim of this study was to ascertain whether bipolar patients who were exposed to a traumatic event or events (TE) have lower brain‐derived neurotrophic factor (BDNF) levels and more severe psychopathology as indicated by increased comorbidity and other clinical features when compared to those who were not exposed to TE.

Methods:  One‐hundred and sixty‐three consecutively recruited bipolar outpatients were assessed by Structured Clinical Interview for DSM‐IV (SCID) and standard protocol in order to evaluation psychopathology and clinical features. The reported TE was assessed using DSM‐IV stem criteria for trauma (as defined by A1 and A2 criteria for trauma for post‐traumatic stress disorder). Subjects were divided into 2 groups according to presence or absence of lifetime TE. The levels of BDNF, comorbidity and other clinical features were compared between groups.

Results:  After adjusting for confounders, results indicated that bipolar patients with a history of TE have alcohol abuse/dependence (p < 0.001), anxiety comorbidity, and lower levels of serum BDNF (p < 0.01) compared to those without a history of TE. There was no difference between the 2 groups in age of onset, presence of psychosis, other substance abuse and dependence, rapid cycling or suicide attempts.

Conclusions:  Our findings suggest that TE are associated with significantly increased prevalence of alcohol and anxiety comorbidity as well as lower BDNF levels in bipolar patients. It is possible that a decrease in BDNF levels may account for increased comorbidity, but further prospective studies are required to confirm this.
Impaired verbal memory and otherwise spared cognition in remitted bipolar patients on monotherapy with lithium or valproate
Authors: Senturk Vesile , Goker Ceren , Bilgic Ayhan , Olmez Senay , Tugcu Handan , Oncu Bedriye , Cem Atbasoglu E
Published: May 2007

Objectives:  Patients with bipolar disorder have been reported to have neurocognitive deficits; however, it is not known whether the cognitive dysfunctions are state‐dependent or a stable trait. Lithium and valproate, 2 of the most widely used mood stabilizers in the treatment of bipolar disorder, have also been associated with cognitive impairment. However, the degree and pattern of neurocognitive impairment in euthymic bipolar patients on either monotherapy with lithium or valproate have not been compared before in depth.

Methods:  We compared 17 euthymic outpatients with bipolar disorder (BD) on lithium monotherapy to 11 euthymic outpatients with BD on valproate monotherapy and 29 comparison subjects using tests measuring immediate verbal memory and executive functions in addition to 3 subtests of the Wechsler Adult Intelligence Scale Revised. The groups were similar in terms of level of education, duration and severity of illness, and gender distribution. Patients on lithium monotherapy were older than patients on valproate and healthy controls. Mood symptoms as assessed by standardized scales were mild to non‐existent in both patient groups.

Results:  Immediate verbal memory was impaired in both patient groups compared to controls, where the main effect of age was not significant. No significant differences could be found on the other cognitive measures.

Conclusions:  Both lithium and valproate may be associated with immediate verbal memory impairment, sparing other cognitive functions. Presence of a similar verbal memory deficit in the lithium and valproate groups suggests that this deficit might be intrinsic to BD or that the 2 medications influence immediate verbal memory similarly. Larger samples of remitted bipolar patients on monotherapy should be studied for more precise conclusions.
In vitro activities of four antifungal drugs against Trichophyton rubrum isolates exhibiting resistance to fluconazole
Authors: Santos D. A. , Hamdan J. S.
Published: May 2007

Thirty‐two clinical isolates of Trichophyton rubrum exhibiting resistance to fluconazole [minimum inhibitory concentrations (MICs) ≥ 64 μg ml−1] were selected to test the antifungal activity of ketoconazole, itraconazole, griseofulvin and terbinafine. We followed the guidelines of the National Committee for Clinical Laboratory Standards for testing filamentous fungi. The strains Candida parapsilosis (ATCC 22019), Candida krusei (ATCC 6258), T. rubrum (ATCC 40051) and Trichophyton mentagrophytes (ATCC 40004) were included for quality control. The microdilution plates were incubated at 28 °C and were read visually after 7 days of incubation and endpoint determination readings were performed visually. The MIC ranges for the four antifungals were: 0.0625–2 μg ml−1 for ketoconazole, 0.25–2.0 μg ml−1 for griseofulvin, ≤0.031–1.0 μg ml−1 for itraconazole and ≤0.031 μg ml−1 for terbinafine (for all tested isolates). Terbinafine was the most potent drug against T. rubrum, in vitro, followed by itraconazole, ketoconazole and griseofulvin. Much work is still needed to correlate the MICs of these drugs with clinical outcomes to develop interpretative breakpoints for T. rubrum and other dermatophytes.
A 7‐year survey of dermatophytoses in Crete, Greece
Authors: Maraki Sofia , Nioti Eleni , Mantadakis Elpis , Tselentis Yannis
Published: May 2007

Dermatophytoses are of worldwide distribution. Epidemiological studies concerning dermatophyte infections have been performed in many countries and differences in the incidence and the aetiological agents have been reported in different geographical locations. This study was undertaken to investigate the prevailing species of dermatophytes in the island of Crete, Greece, and their pattern of infection during a 7‐year period (1997–2003). A total of 5544 samples obtained from 3751 patients with clinically suspected dermatomycoses were examined mycologically in the laboratory of Clinical Microbiology at the University Hospital of Crete, Greece. Skin, hair and nail specimens were subjected to direct microscopy and culture. Dermatophytes were isolated from 520 patients (13.9%). Trichophyton rubrum was the most frequently isolated dermatophyte accounting for 48% of the infections, followed by Microsporum canis (17.9%), Trichophyton mentagrophytes var. interdigitale (14.2%) and Epidermophyton floccosum (6%). Tinea unguium, tinea pedis, tinea corporis, tinea capitis, tinea cruris, tinea manuum and tinea facei were the clinical types of dermatophytoses in decreasing order of frequency. Trichophyton rubrum is the predominant dermatophyte in our area. As the epidemiology of dermatophytoses is changing over time it is important to review periodically the incidence of dermatophytes and their distribution.
Majocchi's granuloma of the scrotum
Authors: Cho Hee‐Ryung , Lee Mu‐Hyoung , Haw Choong‐Rim
Published: May 2007

Majocchi's granuloma is a well known but uncommon folliculitic and perifolliculitic dermatophyte infection of the dermal and subcutaneous tissue by fungal organism, usually limited to the superficial dermis. We report a rare case of superficial perifollicular form of Majocchi's granuloma, caused by Trichophyton rubrum on the scrotal skin of a healthy man. Histological examination of the biopsied nodule revealed perifolliculitis with fungal elements and the periodic acid schiff staining was positive to fungal elements. His lesion cleared completely with the use of a topical antifungal agent.
Rapid phenotypic assessment of bird cherry‐oat aphid resistance in winter wheat
Authors: Dunn B. L. , Carver B. F. , Baker C. A. , Porter D. R.
Published: May 2007

Rhopalosiphum padi L. causes significant damage to winter wheat (Triticum aestivum L.), even without obvious aboveground symptoms of injury. Our objectives were to develop a juvenile‐plant bioassay for bird cherry‐oat aphid (BCOA) resistance that allows rapid phenotypic differentiation. Central features of the bioassay include root and shoot weight measurements of 3‐week‐old seedlings produced in seed germination pouches, a 14‐day aphid exposure period, and a non‐infested control treatment to establish a baseline for expected biomass per genotype. Cultivars used in bioassay development were ‘Illinois Rustproof’ and ‘Skala’, which showed smaller BCOA‐induced reductions in biomass than the more susceptible genotypes, ‘Patrick’ and ‘Scout 66’. Mean reductions in root biomass were 48% for ‘Patrick’ and ‘Scout 66’, compared with 29% for ‘Illinois Rustproof’ and ‘Skala’. This rapid and repeatable bioassay is extendable to large wheat collections and inbred line populations.
Delayed decrease in differential renal function after successful pyeloplasty in children with unilateral antenatally detected hydronephrosis
Authors: Matsumoto Fumi , Shimada Kenji , Kawagoe Mari , Matsui Futoshi , Nagahara Akira
Published: May 2007

Aim:  The aim of this study was to evaluate functional outcome of congenital hydronephrotic kidney.

Methods:  The records of consecutive children who underwent pyeloplasty for unilateral prenatally detected ureteropelvic junction obstruction were reviewed. Renal function was assessed renographically before and after surgery. Mean follow‐up period was 100 months.

Results:  Sufficient pre‐ and postoperative data were available for 60 children. Differential renal function (DRF) improved in 14 (23%) and decreased in nine (15%) of 60 patients in the early postoperative period. DRF improved in seven (18%) and decreased in 13 (34%) of 38 patients at the end of follow‐up. Five of 14 patients with increased DRF at early postoperative scan returned to the preoperative level at the end of follow‐up. No patients with decreased DRF at early postoperative scan showed any recovery in DRF and progressive decrease was seen in four of nine children.

Conclusions:  The DRF was not stable in some patients after successful pyeloplasty. In some patients impairment of renal function came to be apparent with time. Improvement of DRF may be a transient phenomenon seen in the early postoperative period. To avoid overestimation of functional recovery, long‐term follow‐up with delayed renographic evaluation is recommended.
Is a complete urological evaluation necessary in all newborns with asymptomatic renal ectopia?
Authors: Arena Francesco , Arena Salvatore , Paolata Antonina , Campenni Alfredo , Zuccarello Biagio , Romeo Giuseppe
Published: May 2007

Aim:  To evaluate if a complete urological screening is justified by potential urological anomalies in newborns or infants with asymptomatic renal ectopia (RE).

Methods:  The database records of 60 consecutive neonatal cases of RE diagnosed at the authors' hospital from 1990 to 2004 were retrospectively reviewed.

Results:  At diagnosis, mean patient age was 1.6 months. In 58 of 60 patients, the suspected diagnosis of RE was made during prenatal or postnatal screening ultrasonography, including two newborns with anorectal malformation. There were 24 patients with crossed RE (C‐RE) and 36 patients with simple RE (S‐RE). A solitary RE was present in two patients. The most frequent associated urological abnormality was vesico‐ureteral reflux (37.5% of C‐RE and 16.6% of S‐RE). Hydronephrosis was detected in seven RE and five contralateral kidneys. An obstructive megaureter was present in one patient with C‐RE. In 40% of S‐RE and 92.9% of C‐RE, the 99mTc DMSA documented reduction of function of RE. The longitudinal diameter of the ectopic kidney was significantly smaller than the contralateral one. Other non‐renal diseases were present in 15% of patients, of which the most frequent was cryptorchidism (6.6%).

Conclusions:  A complete urological evaluation is necessary in newborns with C‐RE for the high incidence of associated urological anomalies, of which VUR is the most frequent. A complete urological evaluation is also reasonable in patients with S‐RE who have a pelvic dilatation. No diagnosis or treatment of the associated urological diseases, in consideration of congenital decreased function of the ectopic kidney, might predispose these children to improvement of renal function impairment.
Association analysis of glutathione‐S‐transferase P1 (GSTP1) polymorphism with urothelial cancer susceptibility and myelosuppression after M‐VAC chemotherapy
Authors: Yokomizo Akira , Yamamoto Ken , Kinukawa Naoko , Tsunoda Toshiyuki , Koga Hirofumi , Naito Seiji
Published: May 2007

Aim:  Glutathione‐S‐transferase P1 (GSTP1) detoxifies a wide range of endogenous and exogenous carcinogens and anticancer agents such as cisplatin and doxorubicin. The aim of this study was to examine the association between GSTP1 polymorphism and both urothelial cancer susceptibility and adverse events of M‐VAC (methotrexate, vinblastine, doxorubicin and cisplatin) chemotherapy in Japanese urothelial cancer patients.

Methods:  This cohort consisted of 179 urothelial cancer patients and 225 healthy controls matched for age and sex. GSTP1 Ile105Val polymorphism was identified by direct sequencing methods. Furthermore, the association of GSTP1 polymorphism and adverse events of M‐VAC chemotherapy was investigated.

Results:  A similar frequency of GSTP1 Ile105Val allele was observed in the urothelial cancer patients and in the control group. However, when the 46 patients who underwent systemic M‐VAC chemotherapy were investigated, significantly more severe toxicity in leukocytopenia (P = 0.044, odds ratio +∞, 95% confidence interval 0.9203– +∞) and a prolonged duration of G‐CSF administration (P = 0.013, odds ratio 8.625, 95% confidence interval 1.390–89.98) were observed in patients with the Val allele in comparison to those with the Ile allele.

Conclusions:  The GSTP1 Ile105Val polymorphism was not found to be significantly associated with urothelial cancer susceptibility but it may be associated with myelosuppressive adverse events in M‐VAC chemotherapy. The 105Val might therefore be a useful marker for predicting myelosuppression in M‐VAC chemotherapy.
Oncological outcome of laparoscopic prostatectomy
Authors: Hara Isao , Kawabata Gaku , Tanaka Kazushi , Kanomata Naoki , Miyake Hideaki , Takenaka Atsushi , Fujisawa Masato
Published: May 2007

Aim:  Oncological outcomes including surgical margin status and biological progression‐free survival (bPFS) were analyzed in patients who underwent laparoscopic prostatectomy (LRP) only.

Methods:  A total of 136 patients who underwent LRP only without lymph node metastasis or perioperative supportive therapy between April 2000 and October 2005 were analyzed. All patients received ≥6 months postoperative follow‐up. Biological progression was defined as elevation of prostate‐specific antigen by >0.2 ng/mL.

Results:  The positive margin (ew+) rate was 36.8% and the 3‐year bPFS was 72.6% for all patients. Positive margin rates in pT2a–b, pT2c, pT3a and pT3b were 10.0%, 27.5%, 77.3% and 53.8%, respectively. Three‐year bPFS rates in pT2, pT3a and pT3b were 91.8%, 66.8% and 44.9%, respectively. Although the positive margin rate at posterior and anterior sites decreased as more patients were recruited, no significant improvements were observed at apex and base sites. Three‐year bPFS rates in pT2 ew–, pT2 ew+, pT3 ew– and pT3 ew+ were 95.8%, 85.7%, 81% and 48.5%, respectively, indicating that positive margins exert a greater impact in pT3 disease than in pT2 disease.

Conclusions:  Although 3‐year bPFS results were almost identical to previous reports of LRP and retropubic radical prostatectomy, the positive margin rate in pT3a disease was particularly high, probably due to immature surgical skill. Although positive margins at posterior and anterior sites decreased with the leaning curve, improvements are needed to reduce positive margin rates at the apex. Positive margins exert greater impact in pT3 disease than in pT2 disease.
Upper urinary tract recurrence following radical cystectomy for bladder cancer
Authors: Furukawa Junya , Miyake Hideaki , Hara Isao , Takenaka Atsushi , Fujisawa Masato
Published: May 2007

Aim:  The objective of this study was to analyze the clinicopathological features of upper urinary tract recurrence following radical cystectomy for bladder cancer.

Methods:  Between 1995 and 2003, 583 patients underwent radical cystectomy and urinary diversion for bladder cancer at the authors' institution and the related hospitals. A retrospective review of patient records was carried out to evaluate characteristics of patients who underwent upper urinary tract recurrence after radical cystectomy.

Results:  During the observation period (median, 41.5 months), 12 (2.1%) of the 583 patients had upper urinary tract recurrence. Of the 12 patients with upper urinary tract recurrence, there were multiple tumors in eight at the initial diagnosis of bladder cancer, and eight received transurethral resections two or more times before radical cystectomy. The median time to diagnosis of an upper urinary tract cancer after radical cystectomy was 29.5 months. When upper urinary tract recurrence was detected, five patients had metastatic diseases simultaneously, and two had bilateral upper urinary tract cancers. The cancer‐specific survival in patients with upper urinary tract recurrence was significantly poorer than that in those without upper urinary tract recurrence. In addition, eight of the 12 patients (66.7%) died of disease progression within 3 years after the diagnosis of upper urinary tract cancer.

Conclusions:  These findings suggest that despite the low incidence of upper urinary tract recurrence following radical cystectomy, the prognosis of such patients was markedly poorer compared with that of those without upper urinary tract recurrence. Accordingly, intensive therapies should be considered when upper urinary tract recurrence is detected after radical cystectomy.
Crown dieback events as key processes creating cavity habitat for magellanic woodpeckers
Authors: OJEDA VALERIA S. , SUAREZ M. LAURA , KITZBERGER THOMAS
Published: May 2007

Abstract  Woodpeckers are considered keystone species for webs of cavity nesters and habitat and resource specialists that strongly depend on availability of trees suitable for cavity excavation. Most studies carried out in northern hemisphere temperate coniferous forests emphasize the importance of old growth stages of forests or large dead trees as habitat for cavity builders. We present a study of Nothofagus pumilio tree selection by the magellanic woodpecker (Campephilus magellanicus) that incorporates dendroecological data on long‐term growth trends of trees that provides new insights into the processes that create suitable habitat for cavity excavating species. We analysed 351 cavity and neighbouring control trees in terms of age and radial growth patterns, as well as external tree characteristics. In addition, from a subsample of these trees we developed tree‐ring chronologies for each group using standard methods in order to analyse potential differences in radial growth patterns between cavity and non‐cavity trees. Multivariate models that account for differences between paired cavities versus control trees indicated that growth decline and the degree of crown dieback were the primary variables explaining magellanic woodpecker tree selection for cavity building. In contrast to previous work, neither diameter (above a certain threshold) nor age, were important determinants of selection. Furthermore, trees that became present cavity are those that had synchronously declined in radial growth during the 1943–44 and 1956–57 droughts and the 1985–86 massive caterpillar defoliation. Insect outbreaks and extreme climatic events may episodically reduce vigour, induce partial crown mortality, trigger increased fungal attack and heart rot formation at different tree heights on the bole in a group of trees and thus increase availability of soft substrate and their likelihood of cavity excavation by the magellanic woodpecker. These results underscore the importance of drought/biotically‐induced canopy dieback events in creating habitat for woodpeckers and their dependent cavity users.
Fast response of freshwater consumers to a new trophic resource: Predation on the recently introduced Asian bivalve Limnoperna fortunei in the lower Paraná river, South America
Authors: SYLVESTER FRANCISCO , BOLTOVSKOY DEMETRIO , CATALDO DANIEL H.
Published: May 2007

Abstract  Comparison of Limnoperna fortunei numbers and biomass in screened (5, 15 and 40 mm) and unscreened cages deployed for 18 months in the lower Paraná delta indicates that predators harvest 26–79% (numbers), or 20–85% (biomass) of the mussel population. Predation impact decreases with mussel size. On average, 6 kg of whole live mussel × m−2 × year−1 (0.36 g of dry mussel tissue × m−2 × day−1) were eliminated from the unscreened cages. Cages with 15 and 40 mm screens lost between 1 and 2 kg × m−2 × year−1. Aquatic mammals, birds, and especially fish, are probably the main consumers of large mussels. Small L. fortunei are most probably eaten by fish and also by several invertebrates, including crustaceans, leeches and gastropods. It is suggested that L. fortunei intercepts a significant fraction of the organic carbon that the Paraná‐Uruguay rivers flush into the ocean, locally boosting numbers of benthophagous animals, deposit feeders and, indirectly, higher level predators. Our results indicate that only 15 years after its first introduction in South America this invasive species is very actively consumed by local predators, but predatory suppression of the mussel seems very unlikely. Comparisons with the effects reported for the zebra mussel (Dreissena polymorpha) in Europe and North America suggest that L. fortunei is consumed more actively and that its negative impact on the local fauna is more restricted. These differences are attributed to the fact that while D. polymorpha feeds chiefly on plankton, a limited resource, L. fortunei feeds on detrital particulate organic matter, whose supply in these large South American rivers largely exceeds consumption.
No evidence for simultaneous pollen and resource limitation in Aciphylla squarrosa: A long‐lived, masting herb
Authors: BROOKES ROWAN H. , JESSON LINLEY K.
Published: May 2007

Abstract  For successful reproduction animal pollinated plants must provide resources for both pollinator attraction and offspring production, and theory suggests that resources and pollen delivery limit reproduction simultaneously. We conducted a series of experiments involving supplemental pollination, flower removal, fertilizer addition and foliage removal to investigate the interaction of resources and pollen on fruit‐set of Aciphylla squarrosa, a long‐lived, dioecious, masting herb in Wellington, New Zealand. Reducing floral display decreased open‐pollinated fruit‐set, suggesting that display size is a reflection of an optimal investment between attraction and fecundity. In combination with supplemental pollination, resource reduction and fertilization addition did not alter fruit‐set, suggesting that changes in resource availability did not limit reproduction in the current year. In addition, supplemental pollination of non‐manipulated treatments did not increase fruit‐set, demonstrating that plants were not naturally pollen limited. While we found that simultaneous pollen and resource limitation did not occur within a season, this is possibly mitigated by life history patterns including mast flowering and a storage taproot. Multiple year studies are required to further examine simultaneous resource and pollen limitation.
The short‐term effects of edges created by forestry operations on the bird community of the jarrah forest, south‐western Australia
Authors: CRAIG MICHAEL D.
Published: May 2007

Abstract  Forestry operations in jarrah forests of south‐western Australia use two types of selective logging, gaps which remove 85–95% of basal area and shelterwoods which remove 40–60% of basal area. These operations create considerable lengths of forestry edge (edges between logged and unlogged forest) each year, but their impact on the avifauna of the jarrah forest is unknown. Changes in bird density were examined along edges created by forestry operations in jarrah forests using a BACI design experiment. Bird densities were estimated on 1‐ha plots that were surveyed three times per season, in three seasons both before and after logging. There was no evidence of edge effects at the community level; overall bird density and species richness did not changes along forestry edges. Scarlet robin (Petroica multicolor) abundance increased significantly along both gap and shelterwood edges, relative to controls. Apart from a probably spurious increase in density along gap edges by red‐winged fairy‐wrens (Malurus elegans), no other species showed a significant change in density along edges. There was also no difference in responses to gap and shelterwood edges, despite gaps removing more basal area than shelterwoods, suggesting that response to forestry edges in the jarrah forest may be threshold dependent, rather than increasing with increasing intensity of logging operations. Comparisons with other studies examining density changes along forestry edges in south‐western Australia suggest that density changes observed in this study are short‐term in nature. The limited density change in avifauna along forestry edges is probably because selective logging practices were examined instead of clear‐felling. Studies in the literature indicate that this pattern is likely to be true for many forest ecosystems.
Land management affects grass biomass in the Eucalyptus tetrodonta savannas of monsoonal Australia
Authors: BOWMAN DAVID M. J. S. , FRANKLIN DONALD C. , PRICE OWEN F. , BROOK BARRY W.
Published: May 2007

Abstract  We surveyed herbaceous biomass across the range of Eucalyptus tetrodonta savannas in north‐western Australia. Sample sites (n = 211) were stratified within four broad geographical regions characterized by different mixes of land management regimes. Grasses dominated (87% mean) the herbaceous biomass. After controlling for climatic and edaphic gradients, herbaceous biomass was highest in the Greater Darwin region (2.2 t ha−1) which is managed predominantly by Europeans, and least under semi‐traditional Aboriginal management in Arnhem Land region (1.1 t ha−1). In the drier Gulf of Carpentaria and Kimberley regions, where a mix of Aboriginal, conservation and pastoral land uses occurs, fuel loads were higher than in Arnhem Land region but still considerably lower than around Darwin. Sarga was recorded in all regions except the Gulf of Carpentaria and had the highest biomass in Darwin (0.88 t ha−1) and lowest biomass in the Kimberley (0.54 t ha−1). The proportion of herbaceous biomass made up of perennial grasses was least in Darwin (17%) and greatest in the Gulf (77%) regions. We suggest that climate, soils and land management account for differences between the drier pastoral regions of the Gulf of Carpentaria and the Kimberley and the wet Greater Darwin region relative to the Arnhem Land region. The high frequency, and larger spatial scale, of fires in the Greater Darwin region relative to the Arnhem Land region underpins the contrasting trends in total herbaceous biomass and abundance of flammable annual grasses.
PERIOPERATIVE HIGH‐DOSE OXYGEN THERAPY IN VASCULAR SURGERY
Authors: Puckridge Phillip J. , Saleem Hafees A. , Vasudevan Thodur M. , Holdaway Christopher M. , Ferrar David W.
Published: May 2007

Background:  Patients undergoing infrainguinal bypass surgery have reduced baseline tissue oxygen tension and high rates of wound infections. The hypoxaemia worsens during surgery, potentially reducing the ability to combat bacterial lodgement. We investigated whether high‐dose perioperative oxygen administration to patients undergoing infrainguinal arterial surgery results in increased tissue oxygenation.

Methods:  Ten consecutive patients undergoing infrainguinal arterial surgery had transcutaneous partial pressure of oxygen (TcpO2) measured preoperatively, intraoperatively after arterial clamps applied, postoperatively and at discharge. Measurements were taken with inspired oxygen concentration (FiO2) of 30% then 80%. Arterial blood gases were measured at the same times.

Results:  Tissue oxygenation showed no difference intraoperatively while arterial clamps were in place, but significantly higher tissue oxygenation was seen with use of high‐dose oxygen (FiO2 80%) postoperatively (P < 0.05). Carbon dioxide levels in tissue increased while arterial clamps were in place (P < 0.01) and pH fell intraoperatively and following reperfusion (P < 0.05).

Conclusion:  The administration of high‐dose oxygen to vascular surgical patients undergoing lower‐limb arterial surgery results in increased tissue oxygen concentrations when perfusion is not reduced by the presence of arterial clamps. These results suggest the administration of high‐dose oxygen intraoperatively may be beneficial in reducing wound infections, but further research is required.
THE LENGTH OF SUPERFICIAL TEMPORAL ARTERY BIOPSIES
Authors: Sharma Neil S. , Ooi Ju‐Lee , McGarity Bruce H. , Vollmer‐Conna Uté , McCluskey Peter
Published: May 2007

Background:  To compare temporal artery biopsy specimen lengths from a tertiary care and a community hospital in New South Wales to recommended clinical guidelines in suspected giant cell arteritis.

Design:  A retrospective observational study of all patients who underwent temporal artery biopsy at Bathurst Base Hospital (BBH) and Royal Prince Alfred Hospital (RPAH) over a 5‐year period.

Methods:  Patients who underwent temporal artery biopsy during the 5‐year period were identified using computerized hospital databases. A retrospective chart review was carried out on all cases. Data were collected regarding patient age, patient sex, length of biopsy specimen, histopathological results and surgical team carrying out the biopsy.

Results:  During the 5‐year period, 157 temporal artery biopsies were carried out at both hospitals, with 38/157(24%) at BBH and 119/157 (76%) at RPAH. There was no significant difference in biopsy length at the two hospitals. The mean specimen length at BBH was 12.1 mm compared with 11.7 mm at RPAH (t = 0.35; P = 0.73). At RPAH, there was no significant difference in specimen length between the surgical specialties carrying out the biopsy (anovaF = 1.37; P = 0.26). Specimens of length 20 mm or greater were 2.8 times more likely to show features of giant cell arteritis than those less than 20 mm.

Conclusion:  The mean length of temporal artery biopsy specimens at both hospitals was substantially shorter than recommended guidelines of a minimum 20 mm. We recommend all surgeons carrying out temporal artery biopsies ensure a specimen of sufficient length is obtained.
LAPAROSCOPIC BILE DUCT EXPLORATION: RESULTS OF 160 CONSECUTIVE CASES WITH 2‐YEAR FOLLOW UP
Authors: Taylor Craig J. , Kong Justin , Ghusn Michael , White Stephen , Crampton Nick , Layani Laurent
Published: May 2007

Background:  Despite numerous reports showing the advantages of laparoscopic common bile duct exploration (LCBDE), many general surgeons, particularly those working outside of nonspecialist units, continue to rely heavily on endoscopic retrograde cholangiography with sphincterotomy (ERCP) to manage bile duct stones (BDS). This article investigates the performance of LCBDE when adopted as the preferred first‐line management of both suspected and incidental BDS by general surgeons in a regional setting.

Methods:  A retrospective review was conducted of all patients in whom LCBDE was attempted by a regional general surgical unit. The unit policy was to preferentially treat all incidental and suspected BDS (except in ascending cholangitis or severe pancreatitis) by LCBDE, with ERCP used only if unsuccessful. In addition to chart review, formal prospective follow up by telephone interview was carried out.

Results:  A total of 160 consecutive patients with BDS (mean age 66.9 years, 65% suspected and 35% incidental) underwent attempted LCBDE between January 2000 and July 2005. Successful clearance was achieved in 84.3% according to chart review. However, four additional cases of retained choledocholithiasis shown by late telephone interview (median interval 2.5 years) yielded a more accurate clearance rate of 81.8%. Major morbidity occurred in 13.8%, including biliary leak in 7.5% and one late biliary stricture (0.6%). Median length of hospital stay was 4.8 days. In‐hospital mortality was 0.6%.

Conclusion:  Laparoscopic common bile duct exploration remains an effective, efficient and safe first‐line treatment of BDS even when carried out in regional nonspecialist units. In spite of the wide availability of ERCP, general surgeons should be encouraged to continue performing LCBDE in order to optimise patient care and maintain important surgical skills.
CANCER STEM CELLS: A REVIEW
Authors: Spillane John B. , Henderson Michael A.
Published: May 2007

Research has been increasing in recent years into the application of stem cell biology to clinical medicine, particularly its role in the evolution and metastasis of tumours. Stem cells may be the target cell for malignant transformation, and tumour formation could be considered a disorder of stem cell self‐renewal pathways. Cancer stem cells have been identified in acute myeloid leukaemia and in breast and central nervous system tumours. Cancer stem cells may have a specific role in tumour metastasis, and their understanding may provide insights into the development of predictive and prognostic markers and specific therapeutic interventions.