bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased expression of vascular endothelial growth factor in small hepatocellular carcinoma
Authors: Iavarone M. , Lampertico P. , Iannuzzi F. , Manenti E. , Donato M. F. , Arosio E. , Bertolini F. , Primignani M. , Sangiovanni A. , Colombo M.
Published: August 2006

Summary.  Vascular endothelial growth factor (VEGF) is involved in both development and progression of several epithelial tumours, but its role in hepatocellular carcinoma (HCC) is unclear. Assessment of liver and blood levels of VEGF may provide further insights on angiogenesis in HCC. Tissue mRNA of VEGF‐165, VEGF‐189 and their receptor KDR was assessed by a semi‐quantitative retro‐transcriptase polymerase chain reaction, and expressed as target transcript/beta‐actin ratio, in 29 patients with HCC, 26 with cirrhosis and 15 with chronic hepatitis. VEGF‐165 was also measured by ELISA in plasma samples obtained from both hepatic and femoral veins in additional 58 patients, including 15 with HCC. The liver expression of mRNA of VEGF‐165, VEGF‐189 and KDR was higher in HCC than in chronic liver diseases (1.54 ± 0.89 vs 0.62 ± 0.47, P < 0.0001; 1.09 ± 0.65 vs 0.64 ± 0.54, P = 0.003; 1.30 ± 1.09 vs 0.69 ± 0.72, P = 0.014). VEGF‐165 was higher in HCC tissue than in extra‐tumoural tissues (1.44 ± 0.31 vs 1.03 ± 0.21, P = 0.0009) and in the cirrhotic tissue of HCC patients than in HCC‐free cirrhosis (1.03 ± 0.23 vs 0.45 ± 0.45, P = 0.0002). Tissue VEGF‐189 mRNA inversely correlated with tumour size and degree of tumour cell proliferation. The hepatic and femoral vein levels of VEGF‐165 protein were significantly higher in HCC patients than in cirrhotic patients (66.7 ± 57.1 vs 24.2 ± 16.4 pg/mL, P = 0.0001 and 37.1 ± 42.2 vs 13.5 ± 9.6 pg/mL, P = 0.001). There was a gradient of VEGF‐165 between hepatic and femoral veins in both HCC and cirrhosis. In conclusion, VEGF appears to be involved in the development of HCC and it could be a predictor of HCC development in patients with cirrhosis.
The impact of inherited prothrombotic risk factors on individuals chronically infected with hepatitis C virus from a single source
Authors: Goulding C. , O'Brien C. , Egan H. , Hegarty J. E. , McDonald G. , O'Farrelly C. , White B. , Kelleher D. , Norris S.
Published: August 2006

Summary.  Intrahepatic thrombotic events have been postulated to play a key role in the pathogenesis of hepatic fibrosis. Genetic and acquired thrombotic risk factors may therefore contribute to the varying rates of fibrosis progression observed in patients with chronic hepatitis C virus (HCV) infection. The aim of this study was to assess the impact of inherited mutations in factor V and factor II (prothrombin) on hepatic fibrosis progression rates in individuals infected with HCV. Two hundred and ten Irish women infected with HCV genotype 1b, contracted from a single source (HCV‐contaminated anti‐D immunoglobulin) were genotyped for the factor V Leiden G1691A and prothrombin G20210A polymorphisms, and compared with Irish Caucasoid controls. Index and subsequent liver biopsies were scored (Ishak scoring system) by a single pathologist. Statistical analysis was performed using SPSS. Factor V Leiden and prothrombin G20210A heterozygosity were determined in 3.7% and 1.85%, respectively, of the study population. There was no association between these polymorphisms and fibrotic score on the index biopsy, or degree of change in fibrotic score on subsequent biopsies. The mean fibrotic score for factor V wild type was 1.06 vs 0.71 for the heterozygotes (P = 0.89). The mean change in fibrotic scores between subsequent biopsies was 0.72 for factor V wild type vs 0.50 for heterozygotes (P = 0.68). Similarly, there was no significant difference in fibrotic score for those with the prothrombin G20210A polymorphism (P = 0.936). Alanine aminotransferase levels for factor V wild type were significantly lower than those for the heterozygotes, 45.9 vs 57 (P = 0.032). Factor V Leiden and prothrombin G20210A heterozygosity rates were infrequently detected in this HCV cohort and were similar to rates seen in a Caucasian Irish control population. In this cohort, neither factor V Leiden nor prothrombin G20210A polymorphisms had a significant impact on fibrotic scores or degree of change between subsequent biopsies. These data do not support a key role for thrombotic risk factors in fibrogenesis in HCV‐infected patients.
Thioredoxin reductase is required for growth and regulates entry into culmination of Dictyostelium discoideum
Authors: Jeong Sun‐Young , Choi Chang‐Hoon , Kim Ji‐Sun , Park Seong‐Jun , Kang Sa‐Ouk
Published: August 2006

The thioredoxin system, consisting of thioredoxin, thioredoxin reductase and NADPH, has been well established to be critical for the redox regulation of protein function and signalling. To investigate the role of thioredoxin reductase (Trr) in Dictyostelium discoideum, we generated mutant cells that underexpress or overexpress Trr. Trr‐underexpressing cells exhibited severe defects in axenic growth and development. Trr‐overexpressing (TrrOE) cells formed very tiny plaques on a bacterial lawn and had a lower rate of bacterial uptake. When developed in the dark, TrrOE cells exhibited a slugger phenotype, defined by a prolonged migrating slug stage. Like other slugger mutants, they were hypersensitive to ammonia, which has been known to inhibit culmination by raising the pH of intracellular acidic compartments. Interestingly, TrrOE cells showed defective acidification of intracellular compartments and decreased activity of vacuolar H+‐ATPase which functions in the acidification of intracellular compartments. Moreover, biochemical studies revealed that the thioredoxin system can directly reduce the catalytic subunit of vacuolar H+‐ATPase whose activity is regulated by reversible disulphide bond formation. Taken together, these results suggest that Dictyostelium Trr may be essential for growth and play a role in regulation of phagocytosis and culmination, possibly through the modulation of vacuolar H+‐ATPase activity.
Expression of CD34 as a novel marker for glioneuronal lesions associated with chronic intractable epilepsy
Authors: Deb P. , Sharma M. C. , Tripathi M. , Sarat Chandra P. , Gupta A. , Sarkar C.
Published: August 2006

The spectrum of glioneuronal lesions underlying intractable epilepsies includes malformative pathologies like focal cortical dysplasia (FCD); and neoplastic lesions like gangliogliomas (GG) and dysembryoplastic neuroepithelial tumours (DNT). These may occur either singly or as dual lesions, having simultaneous presence of both elements. Currently, the relationship between the malformative and neoplastic glioneuronal lesions is poorly understood. Recently, CD34, a stem cell marker transiently expressed during early neurulation, has been identified in these tumours. This study was undertaken to (i) evaluate the role of CD34 as a diagnostic marker for glioneuronal lesions of epilepsy, namely, GG, DNT and FCD, and (ii) attempt to define the relationship among these lesions, using CD34 as a marker.

Tissues resected from 47 patients with intractable epilepsy due to glioneuronal lesions (GG, FCD, DNT) were studied. These were evaluated for CD34 expression, using immunohistochemistry.

Dysplastic or atypically differentiated neural precursors which could not be identified on routine haematoxylin and eosin (H&E) staining were highlighted by CD34 immunostaining. The pattern of immunostaining was diffuse in GGs, unlike FCDs, wherein cells were present singly or in small clusters. However, cases of DNT and control tissue were largely CD34‐immunonegative.

Based on these findings, we propose a possible common origin of GG and FCD, from a bipotent precursor that undergoes abnormal glioneuronal development, while DNTs possibly have a different origin. The CD34‐immunoreactive cells represent dysplastic or undifferentiated neural precursors, which may signify a valuable marker for the diagnostic evaluation of neoplastic and/or malformative pathologies in patients with intractable epilepsy.
Degeneration of ingestion‐related brainstem nuclei in spinocerebellar ataxia type 2, 3, 6 and 7
Authors: Rüb U. , Brunt E. R. , Petrasch‐Parwez E. , Schöls L. , Theegarten D. , Auburger G. , Seidel K. , Schultz C. , Gierga K. , Paulson H. , Van Broeckhoven C. , Deller T. , De Vos R. A. I.
Published: August 2006

Dysphagia, which can lead to nutritional deficiencies, weight loss and dehydration, represents a risk factor for aspiration pneumonia. Although clinical studies have reported the occurrence of dysphagia in patients with spinocerebellar ataxia type 2 (SCA2), type 3 (SCA3), type 6 (SCA6) and type 7 (SCA7), there are neither detailed clinical records concerning the kind of ingestive malfunctions which contribute to dysphagia nor systematic pathoanatomical studies of brainstem regions involved in the ingestive process. In the present study we performed a systematic post mortem study on thick serial tissue sections through the ingestion‐related brainstem nuclei of 12 dysphagic patients who suffered from clinically diagnosed and genetically confirmed spinocerebellar ataxias assigned to the CAG‐repeat or polyglutamine diseases (two SCA2, seven SCA3, one SCA6 and two SCA7 patients) and evaluated their medical records. Upon pathoanatomical examination in all of the SCA2, SCA3, SCA6 and SCA7 patients, a widespread neurodegeneration of the brainstem nuclei involved in the ingestive process was found. The clinical records revealed that all of the SCA patients were diagnosed with progressive dysphagia and showed dysfunctions detrimental to the preparatory phase of the ingestive process, as well as the lingual, pharyngeal and oesophageal phases of swallowing. The vast majority of the SCA patients suffered from aspiration pneumonia, which was the most frequent cause of death in our sample. The findings of the present study suggest (i) that dysphagia in SCA2, SCA3, SCA6 and SCA7 patients may be associated with widespread neurodegeneration of ingestion‐related brainstem nuclei; (ii) that dysphagic SCA2, SCA3, SCA6 and SCA7 patients may suffer from dysfunctions detrimental to all phases of the ingestive process; and (iii) that rehabilitative swallow therapy which takes specific functional consequences of the underlying brainstem lesions into account might be helpful in preventing aspiration pneumonia, weight loss and dehydration in SCA2, SCA3, SCA6 and SCA7 patients.
The 5′ stem‐loop and its role in mRNA stability in maize S cytoplasmic male sterility
Authors: Xiao Hailin , Zhang Fangdong , Zheng Yonglian
Published: August 2006

The co‐transcribed orf355‐orf77 region of the mitochondrial genome is associated with S cytoplasmic male sterility (CMS‐S) in maize; the amounts of its 1.6‐ and 2.8‐kb transcripts were previously shown to be greatly reduced in fertility‐restored microspores relative to the amounts in sterile plants. To investigate the mechanism underlying this reduction, detailed analysis of the 5′ and 3′ termini of these transcripts was conducted. Using 3′ RACE analysis, the polyadenylation sites of the 1.6‐ and 2.8‐kb transcripts were mapped adjacent to a 3′ stem‐loop, which may play an important role in stabilizing their 3′ ends. No difference was found between the polyadenylation sites in sterile and fertility‐restored microspores that could account for the differences in orf355‐orf77 transcript levels. The 5′ terminus of the 1.6‐kb transcript was further studied by primer extension; the result revealed that there was a deletion of nine nucleotides only in fertility‐restored microspores, and that this deletion eliminated a 5′ stem‐loop sequence. We propose that the elimination of the 5′ stem‐loop in the fertility‐restored microspores could be the cause of the degradation of the 1.6‐kb transcript. Because the 2.8‐kb transcript can be cleaved to generate the 1.6‐kb transcript, the amount of the 2.8‐kb transcript is also reduced in fertility‐restored microspores.
Homoeologous gene silencing in hexaploid wheat
Authors: Bottley A. , Xia G. M. , Koebner R. M. D.
Published: August 2006

The vast majority of angiosperms are (or were once) polyploid, and as hexaploid bread wheat has undergone two ploidy events separated by approximately 0.5 million years, it represents an elegant model to study gene silencing over time in polyploids. Using an SSCP platform, we have analysed patterns of transcriptional silencing (frequency, genome identity and organ specificity) within 236 single‐copy genes, each mapping to one locus on one of the three homoeologous chromosomes within groups 1, 2, 3 and 7 of wheat. In about 27% of unigenes expressed in leaf, and about 26% of those in root, one (rarely two) members of a gene set (homoeoalleles) were not present in the cDNA template. Organ‐specific regulation is commonplace, with many homoeoalleles transcribed in leaf but not root (and vice versa). There was little indication of extensive bias towards selective silencing of a particular genome copy. Expression of some of the silenced homoeoalleles was restored in certain aneuploid lines and varieties, and these displayed a significant degree of genetic variation for the silencing of a given homoeoallele. We propose that a substantial proportion of this phenomenon is effected by an epigenetic mechanism, and suggest that this form of genetic variation may be a significant player in the determination of phenotypic diversity in breeding populations.
Ethylene‐induced stomatal closure in Arabidopsis occurs via AtrbohF‐mediated hydrogen peroxide synthesis
Authors: Desikan Radhika , Last Kathryn , Harrett‐Williams Rhian , Tagliavia Cecilia , Harter Klaus , Hooley Richard , Hancock John T. , Neill Steven J.
Published: August 2006

Ethylene is a plant hormone that regulates many aspects of growth and development. Despite the well‐known association between ethylene and stress signalling, its effects on stomatal movements are largely unexplored. Here, genetic and physiological data are provided that position ethylene into the Arabidopsis guard cell signalling network, and demonstrate a functional link between ethylene and hydrogen peroxide (H2O2). In wild‐type leaves, ethylene induces stomatal closure that is dependent on H2O2 production in guard cells, generated by the nicotinamide adenine dinucleotide phosphate hydrogen (NADPH) oxidase AtrbohF. Ethylene‐induced closure is inhibited by the ethylene antagonists 1‐MCP and silver. The ethylene receptor mutants etr1–1 and etr1–3 are insensitive to ethylene in terms of stomatal closure and H2O2 production. Stomata of the ethylene signalling ein2–1 and arr2 mutants do not close in response to either ethylene or H2O2 but do generate H2O2 following ethylene challenge. Thus, the data indicate that ethylene and H2O2 signalling in guard cells are mediated by ETR1 via EIN2 and ARR2‐dependent pathway(s), and identify AtrbohF as a key mediator of stomatal responses to ethylene.
Identification of an allene oxide synthase (CYP74C) that leads to formation of α‐ketols from 9‐hydroperoxides of linoleic and linolenic acid in below‐ground organs of potato
Authors: Stumpe Michael , Göbel Cornelia , Demchenko Kirill , Hoffmann Manuela , Klösgen Ralf B. , Pawlowski Katharina , Feussner Ivo
Published: August 2006

Allene oxide synthase (AOS) enzymes are members of the cytochrome P450 enzyme family, sub‐family CYP74. Here we describe the isolation of three cDNAs encoding AOS from potato (StAOS1–3). Based on sequence comparisons, they represent members of either the CYP74A (StAOS1 and 2) or the CYP74C (StAOS3) sub‐families. StAOS3 is distinguished from the other two AOS isoforms in potato by its high substrate specificity for 9‐hydroperoxides of linoleic and linolenic acid, compared with 13‐hydroperoxides, which are only poor substrates. The highest activity was shown with (9S,10E,12Z)‐9‐hydroperoxy‐10,12‐octadecadienoic acid (9‐HPODE) as a substrate. This hydroperoxide was metabolized in vitro to α‐ and γ‐ketols as well as to the cyclopentenone compound 10‐oxo‐11‐phytoenoic acid. They represent hydrolysis products of the initial StAOS3 product 9,10‐epoxyoctadecadienoic acid, an unstable allene oxide. By RNA gel hybridization blot analysis, StAOS3 was shown to be expressed in sprouting eyes, stolons, tubers and roots, but not in leaves. StAOS3 protein was found in all organs tested, but mainly in stems, stolons, sprouting eyes and tubers. As in vivo reaction products, the α‐ketols derived from 9‐hydroperoxides of linoleic and linolenic acid were only found in roots, tubers and sprouting eyes. Immunolocalization showed that StAOS3 was associated with amyloplasts and leucoplasts.
A role for caleosin in degradation of oil‐body storage lipid during seed germination
Authors: Poxleitner Marianne , Rogers Sally W. , Lacey Samuels A. , Browse John , Rogers John C.
Published: August 2006

Caleosin is a Ca2+‐binding oil‐body surface protein. To assess its role in the degradation of oil‐bodies, two independent insertion mutants lacking caleosin were studied. Both mutants demonstrated significant delay of breakdown of the 20:1 storage lipid at 48 and 60 h of germination. Additionally, although germination rates for seeds were not affected by the mutations, mutant seedlings grew more slowly than wild type when measured at 48 h of germination, a defect that was corrected with continued growth for 72 and 96 h in the light. After 48 h of germination, wild‐type central vacuoles had smooth contours and demonstrated internalization of oil bodies and of membrane containing α‐ and δ‐tonoplast intrinsic proteins (TIPs), markers for protein storage vacuoles. In contrast, mutant central vacuoles had distorted limiting membranes displaying domains with clumps of the two TIPs, and they contained fewer oil bodies. Thus, during germination caleosin plays a role in the degradation of storage lipid in oil bodies. Its role involves both the normal modification of storage vacuole membrane and the interaction of oil bodies with vacuoles. The results indicate that interaction of oil bodies with vacuoles is one mechanism that contributes to the degradation of storage lipid.
Circadian control of isoprene emissions from oil palm (Elaeis guineensis)
Authors: Wilkinson Michael J. , Owen Susan M. , Possell Malcolm , Hartwell James , Gould Peter , Hall Anthony , Vickers Claudia , Nicholas Hewitt C.
Published: August 2006

The emission of isoprene from the biosphere to the atmosphere has a profound effect on the Earth's atmospheric system. Until now, it has been assumed that the primary short‐term controls on isoprene emission are photosynthetically active radiation and temperature. Here we show that isoprene emissions from a tropical tree (oil palm, Elaeis guineensis) are under strong circadian control, and that the circadian clock is potentially able to gate light‐induced isoprene emissions. These rhythms are robustly temperature compensated with isoprene emissions still under circadian control at 38°C. This is well beyond the acknowledged temperature range of all previously described circadian phenomena in plants. Furthermore, rhythmic expression of LHY/CCA1, a genetic component of the central clock in Arabidopsis thaliana, is still maintained at these elevated temperatures in oil palm. Maintenance of the CCA1/LHY‐TOC1 molecular oscillator at these temperatures in oil palm allows for the possibility that this system is involved in the control of isoprene emission rhythms. This study contradicts the accepted theory that isoprene emissions are primarily light‐induced.
Factors determining client satisfaction with hospital‐based perinatal care in Sri Lanka
Authors: Senarath Upul , Fernando Dulitha N. , Rodrigo Ishani
Published: August 2006

Objectives  To describe mothers’ satisfaction with perinatal care received during hospitalization for delivery, and to identify sociodemographic and health‐care‐related factors associated with satisfaction.

Method  A cross‐sectional study of 446 mother–newborn pairs from five hospitals in Puttalam district, Sri Lanka, was carried out by stratified randomization. Client satisfaction was measured using a 16‐item survey instrument with high internal consistency (Cronbach's α = 0.81), through exit interview.

Results  The proportion of mothers who were fully satisfied varied from 10.8% to 31.4% for interpersonal aspects, and from 10.1% to 28.9% for technical aspects of care. The satisfaction rates were lower with physical environment (6.1–10.1%) and higher with outcome of care (41.0–48.0%). Multivariate analyses indicated that mothers were more satisfied with the services available from lower level hospitals. Multiparae were more satisfied than primiparae. Determinants of satisfaction included providing immediate mother–newborn contact, information after examination and counselling on family planning. Higher satisfaction with the physical environment was associated with being Moor or Tamil as opposed to Sinhalese and with lower family income.

Conclusions  The factors associated with client satisfaction identified in this study may be helpful in improving quality of care. Hospital staff should ensure that these are addressed and develop interpersonal relationships, especially with the first‐time mothers and in higher level hospitals. Maternity units of lower level institutions should be upgraded with essential facilities.
Sweet's syndrome in a woman with chronic dermatophytic infection
Authors: Martínez Walter , Del Pozo Jesús , Peña Carmen , Yebra‐Pimentel María Teresa , Almagro Manuel , Rodríguez‐Lozano Jesús , Fonseca Eduardo
Published: August 2006

Sweet's syndrome is considered a variable manifestation of hypersensitivity to several antigens. Many etiological factors, including drugs, infectious, inflammatory, neoplastic and miscellaneous disorders, have been reported to be associated with this syndrome. We report the case of a patient who subsequently developed inflammatory dermatophytosis and Sweet's syndrome; an association not previously described.
Early‐stage mycosis fungoides, parapsoriasis en plaque, and pregnancy
Authors: Amitay‐Layish Iris , David Michael , Kafri Batia , Barzilai Aviv , Feinmesser Meora , Hodak Emmilia
Published: August 2006

Background  Non‐Hodgkin's lymphoma (NHL) coincident with pregnancy is rare, and the literature regarding mycosis fungoides (MF), the most common primary cutaneous NHL, and pregnancy is strikingly sparse. The effect of pregnancy on MF, or on parapsoriasis en plaque (PPP), and the effect of these diseases on pregnancy, are still unknown.

Objective  To study the effect of pregnancy on MF and PPP and the impact of these diseases on pregnancy.

Methods  The files of the MF and PPP patients seen during the past 12 years in our department were reviewed to search for patients who had been pregnant during the course of their disease.

Results  Nine women who met the study criteria were identified, seven with early‐stage MF and two with PPP. A total of 12 pregnancies was recorded: nine in patients with MF and three in patients with PPP. In none of the patients was there any indication that pregnancy changed the course of MF or PPP. Of the 12 pregnancies, 11 were normal; one was naturally aborted. Two of the patients were treated with topical steroids during pregnancy. One patient was treated with narrow‐band ultraviolet‐B combined with topical steroids. The rest preferred to avoid any therapy.

Conclusions  Pregnancy appeared to have no impact on the course of early MF or PPP, and no adverse effect was noted on pregnancy. Further studies are needed to clarify the interplay between pregnancy and MF or PPP.
Monoclonal gammopathies and malignancies in patients with chronic urticaria
Authors: Karakelides Martha , Monson Kristi L. , Volcheck Gerald W. , Weiler Catherine R.
Published: August 2006

Background Monoclonal gammopathy of undetermined significance (MGUS) has been described in association with chronic urticaria (CU) in patients with Schnitzler syndrome. Chronic urticaria may be a manifestation of hematologic malignancies.

MethodsThis study was conducted to evaluate the frequency and characteristics of MGUS or malignancy in patients with CU. The Mayo Clinic electronic database was reviewed to identify patients with the diagnosis of CU.

Results Of the 1639 patients presenting with CU between 1994 and 2001, 797 (49%) underwent laboratory evaluation for the presence of a coexisting monoclonal protein. Forty‐seven CU patients had MGUS, 142 had a malignancy, and 24 had both. Fifteen percent of CU patients with MGUS had a hematologic malignancy compared with 0.9% of CU patients without MGUS (P < 0.001). Patients presenting with a new diagnosis of CU at an older age (> 56 years) were more likely to have associated underlying MGUS. The occurrence of MGUS in this group was higher than the reported incidence of MGUS in the general population.

Conclusions Patients with CU younger than 43 years were unlikely to have associated MGUS or malignancy. A higher percentage of patients with CU and MGUS had an associated diagnosis of hematologic malignancy.
What choices should we be able to make about designer babies? A Citizens’ Jury of young people in South Wales
Authors: Iredale Rachel , Longley Marcus , Thomas Christian , Shaw Anita
Published: August 2006

Background  Young people will increasingly have the option of using new technologies for reproductive decision making but their voices are rarely heard in debates about acceptable public policy in this area. Capturing the views of young people about potentially esoteric topics, such as genetics, is difficult and methodologically challenging.

Design  A Citizens’ Jury is a deliberative process that presents a question to a group of ordinary people, allows them to examine evidence given by expert witnesses and personal testimonies and arrive at a verdict. This Citizens’ Jury explored designer babies in relation to inherited conditions, saviour siblings and sex selection with young people.

Participants  Fourteen young people aged 16–19 in Wales.

Results  Acceptance of designer baby technology was purpose‐specific; it was perceived by participants to be acceptable for preventing inherited conditions and to create a child to save a sibling, but was not recommended for sex selection. Jurors stated that permission should not depend on parents’ age, although some measure of suitability should be assessed. Preventing potential parents from going abroad was considered impractical. These young people felt the Human Fertilisation and Embryology Authority should have members under 20 and that the term ‘designer baby’ was not useful.

Conclusions  Perspectives on the acceptability of this technology were nuanced, and based on implicit value judgements about the extent of individual benefit derived. Young people have valuable and interesting contributions to make to the debate about genetics and reproductive decision making and a variety of innovative methods must be used to secure their involvement in decision‐making processes.
Predicting preferences: a neglected aspect of shared decision‐making
Authors: Sevdalis Nick , Harvey Nigel
Published: August 2006

In recent years, shared decision‐making between patients and doctors regarding choice of treatment has become an issue of priority. Although patients’ preferences lie at the core of the literature on shared decision‐making, there has not been any attempt so far to link the concept of shared decision‐making with the extensive behavioural literature on people's self‐predictions of their future preferences. The aim of the present review is to provide this link. First, we summarize behavioural research that suggests that people mispredict their future preferences and feelings. Secondly, we provide the main psychological accounts for people's mispredictions. Thirdly, we suggest three main empirical questions for inclusion in a programme aimed at enriching our understanding of shared decision‐making and improving the procedures used for putting it into practice.
Decision aids for familial breast cancer: exploring women's views using focus groups
Authors: Rapport Frances , Iredale Rachel , Jones Wendy , Sivell Stephanie , Edwards Adrian , Gray Jonathon , Elwyn Glyn
Published: August 2006

Background There is increasing need for accessible information about familial breast cancer for those facing complex decisions around genetic testing, screening and treatment. Information currently includes leaflets and computerized decision aids, offering interactive interfaces to clarify complex choices.

Objective Exploration of users’ views and reactions to three decision aids for genetic testing for breast cancer using focus groups.

Setting A regional cancer genetics service in the UK.

Participants Women over 18 years of age who had been referred to Cancer Genetics Service for Wales (CGSW) and had received a risk assessment for familial breast cancer.

Methods Qualitative study involving one pilot and six extended focus groups with 39 women at high, moderate and population risk. Two CD‐ROMs and one paper‐based aid evaluated for: clarity of presentation, ease of handling, emotive response, increased knowledge and greater informed choice.

Results Women reported variable preferences for different types of decision aids and mixed emotions, indicating the sensitivity of raising issues in decision support tools, lack of consensus over the most appropriate aid and no systematic differences between risk groups. Women remarked that aids increased their knowledge, particularly about breast cancer genes and risk and wanted a decision aid designed within the context of the NHS, in both paper‐based and CD‐ROM formats from an authoritative source. Mixed views about presentation styles suggest decision aids would be most effective with a user‐selected range of formats.

Conclusions Decision aid development should be informed by users and should meet the needs of those concerned about their risk of breast cancer in the UK. Without such aids, patients will continue to search for information from a variety of sources of varying quality.
Ten‐year surveillance of fungal contamination of food within a protected haematological unit
Authors: Brenier‐Pinchart M. P. , Faure O. , Garban F. , Fricker‐Hidalgo H. , Mallaret M. R. , Trens A. , Lebeau B. , Pelloux H. , Grillot R.
Published: August 2006

Since 1992, we have established a protocol of food management (restrictive diet, food distribution protocol and fungal surveillance) for allogeneic stem‐cell transplant (SCT) recipients hospitalised in protected ward. This study analyses the results of 10‐year surveillance of fungal contamination of this diet. Among the 456 types of foods tested filamentous fungi were isolated in 37 of them (8.1%). Aspergillus fumigatus was isolated in one type of food only, while the majority of the food was contaminated to a lower extent.
A case of mycetoma successfully treated with itraconazole and co‐trimoxazole
Authors: Gündüz Kamer , Örgüç Şebnem , Demireli Peyker , Inanır Işıl , Sürücüoglu Süheyla , Ovalı Gülgün Yılmaz
Published: August 2006

A 29‐year‐old woman with swelling, multiple nodules and discharging sinuses of her right foot is presented. A single nodule on the sole was excised 15 years ago and since then she has had recurrent attacks of swelling and discharging sinuses that improved partially with antibiotics. Magnetic resonance images (MRI) revealed an ill‐defined mass predominantly with low signal intensity on T2W images. Within the granulomata, multiple unenhancing foci, with low T1W and T2W signal most likely representing the fungal balls or grains were detected. Histopathological examination revealed large clusters of microorganisms resembling fungal hyphae and bacteria, which were surrounded by mixed inflammatory infiltrate cells and stained positively by PAS and Gomori's methenamine silver stain. As minimal regression was seen on MRI with 4 months’ itraconazole (200 mg day−1) treatment, co‐trimoxazole (160 TMP/800 SMX b.i.d.) was added to treatment. Complete remission was established by MRI examination after 10 months with this combination therapy.
Delayed ABLC prophylaxis after allogeneic stem‐cell transplantation
Authors: Jansen Jan , Akard Luke P. , Wack Matthew F. , Thompson James M. , Dugan Michael J. , Leslie Jill K. , Mattison Reid
Published: August 2006

Invasive fungal infections (IFI) are frequent causes of mortality after allogeneic stem‐cell transplantation (SCT). A very important risk factor for IFI is the use of steroids. We used a risk‐based chemoprevention in an open‐labelled pilot study. All patients received oral fluconazole or itraconazole (200–400 mg day−1) during their neutropenic episode. Starting on day +30, patients receiving prednisone ≥30 mg day−1 were switched to twice weekly Amphotericin‐B‐lipid‐complex (ABLC) in a dose of 4 mg kg−1. Patients receiving lower steroid doses continued on the fluconazole/itraconazole prophylaxis. Between 1999 and 2002, 100 patients were enrolled and followed for IFI for 1 year. Seven patients were started on therapeutic daily ABLC treatment before day +30 because of documented or suspected IFI; four had definite or probable aspergillosis, and two had candidaemia. Thirty patients did not need prophylactic ABLC; only one developed candidaemia. Sixty‐three patients received ABLC prophylaxis for a median of 52 days (range: 1–289). Seven of these patients developed IFI; one definite and two probable cases of aspergillosis, one case of probable Trichosporon beigelii infection, and three cases of candidaemia. The twice weekly ABLC was well tolerated. This risk‐based chemoprevention appears to be effective and might diminish the role of steroids as risk factor for IFI after allogeneic SCT. The relatively high incidence of early IFI suggests that additional prophylaxis for IFI may be indicated for poor‐risk patients prior to day +30.
Pityriacitrin – a potent UV filter produced by Malassezia furfur and its effect on human skin microflora
Authors: Machowinski Angelika , Krämer Hans‐Joachim , Hort Wiebke , Mayser Peter
Published: August 2006

In Malassezia furfur, tryptophan as the main nitrogen source induces production of the potent ultraviolet‐absorbing indole compound pityriacitrin. An in vitro study about the effects of pityriacitrin on other human skin microorganisms is presented, with special focus on Candida albicans and staphylococci in which its toxicity and UV‐protective capacity were investigated. Candida albicans was irradiated with UVB light either in the presence or in the absence of pityriacitrin (11 mmol) and the growth rate was determined. A UVB dose of 1 J cm−2 caused death of the fungi without pityriacitrin, whereas those in the presence of pityriacitrin showed almost unaffected growth. A diffusion test in staphylococci revealed no antibiotic effects of pityriacitrin. For testing of an ultraviolet‐protective effect, staphylococci were either inoculated and irradiated in a plate model for visual assessment of growth or inoculated and irradiated in square quartz cylinders for quantitative measurement of cell density, each time in the absence or presence of pityriacitrin. Cell density of the bacterial suspensions exhibited nearly no influence of pityriacitrin on growth rates, while again a UV‐protective effect was observed. In summary, pityriacitrin has an ultraviolet‐protective effect on Candida albicans and staphylococci with no toxicity in the range tested.
Mutations in ISDR of NS5A gene influence interferon efficacy in Chinese patients with chronic hepatitis C virus genotype 1b infection
Authors: Shen Chuanlai , Hu Ting , Shen Ling , Gao Lei , Xie Wei , Zhang Jianqiong
Published: August 2006

Background and Aim:  The interferon sensitivity determining region (ISDR) in the non‐structural 5A protein (NS5A) gene of hepatitis C virus genotype 1b (HCV‐1b) has been demonstrated in Japanese patients; however, contradictory data have been reported from other parts of the world, particularly from Europe and the USA. This study investigated whether mutations in the ISDR of NS5A gene influence interferon efficacy in Chinese patients with chronic HCV‐1b infection

Methods:  Forty‐five Chinese patients with chronic HCV infection were enrolled in a retrospective study. Of these patients, 20 with HCV‐1b infection completed an interferon monotherapy course and 6‐month follow‐up. The pretreatment mutations in the nucleic acid sequence of NS5A 2209–2248 (ISDR) of HCV‐1b were identified by sequencing RT‐PCR products followed by comparison with the prototype sequence (HCV‐J). Correlation with the clinical efficacy of interferon alpha therapy was then analyzed retrospectively.

Results:  The statistical analysis indicated a significant correlation between the mutations in ISDR of HCV‐1b and sustained virological response to interferon alpha treatment (P < 0.05), and an association of the mutations in ISDR with the pretreatment serum alanine aminotransferase levels (P < 0.01) in Chinese patients with chronic HCV‐1b infection.

Conclusions:  The results support the concept that the response of HCV‐1b infected patients towards interferon therapy is influenced by the mutations within the ISDR of NS5A gene.
Effects of octreotide in acute hemorrhagic necrotizing pancreatitis in rats
Authors: Wenger Frank Axel , Kilian Maik , Heukamp Ina , Foitzik Thomas , Jacobi Christoph Andreas , Guski Hans , Schimke Ingolf , Müller Joachim Michael
Published: August 2006

Background and Aim:  Octreotide is considered to reduce exocrine pancreatic secretion in acute hemorrhagic necrotizing pancreatitis decreasing pancreatic autodigestion. The aim of this study was to determine whether octreotide also has antioxidative effects in acute pancreatitis. Additionally time and dose of application were of interest.

Method:  Ninety male Sprague‐Dawley rats were randomized into six groups (n = 15). Group 1 underwent a laparotomy, and animals in groups 2–6 received intraductal glycodeoxycholic acid followed by intravenous cerulein. Groups 3 and 4 were injected with 0.5 mg octreotide, while groups 5 and 6 received continuous intravenous infusion of 0.05 mg octreotide/h for 10 h. Treatment was initiated 6 hours after induction of pancreatitis (IP) in groups 3 and 5, and 14 h after IP in groups 4 and 6. At 24 h after IP all animals were killed and each pancreas was analyzed histopathologically. In addition, levels of pancreatic lipid peroxidation protective enzymes glutathione‐peroxidase (GSH‐Px) and superoxide dismutase (SOD) as well as lipid peroxidation via thiobarbituric acid reactive substances (TBARS) were determined.

Results:  Early bolus application of octreotide reduced severity of histopathological changes in acute pancreatitis and decreased lipid peroxidation in pancreatic tissue samples; however, late bolus application and continuous intravenous infusion did not influence pancreatitis or lipid peroxidation.

Conclusion:  Octreotide seems to have a dose‐ and time‐dependent effect on histopathology and lipid peroxidation in a model of pancreatitis in rats.
Abdominoperineal resection or anterior resection for rectal cancer: patient preferences before and after treatment
Authors: Zolciak A. , Bujko K. , Kepka L. , Oledzki J. , Rutkowski A. , Nowacki M. P.
Published: August 2006

Objective  Literature data do not provide any evidence as to whether oncological outcome and quality of life after anterior resection (AR) are superior to those observed after abdominoperineal resection (APR) for low‐lying rectal cancer. In view of this, patient preferences should play an important role in the process of decision making. The aim of this study was to investigate these preferences.

Patients and methods  A series of consecutive patients with rectal cancer (60 prior to surgery, 65 after APR and 124 after AR) who attended our outpatient clinic were asked to express their preference as to the type of surgery. The second part of the study was performed 4 years later; 30 patients evaluated before surgery, free of disease, were again asked to express their preference as to the type of treatment.

Results  Patient preferences as to performing APR, AR or as to leaving the decision to the surgeon were as follows: (i) the group prior to surgery – 5%, 30% and 65%, respectively, (ii) group after APR – 46%, 22% and 32%, respectively, and (iii) group after AR – 4%, 69% and 28%, respectively. Patients after AR pointed to the type of surgery that they had undergone more frequently than patients after APR (69%vs 46%, respectively, P < 0.001). Sixty per cent of patients evaluated twice had altered their initial preferences, usually choosing the type of surgery that they had undergone.

Conclusions  Our results suggest that the sequelae of AR are generally perceived as more acceptable than those of APR. Nevertheless, approximately half of the patients after APR prefer the type of surgery that they have undergone, which suggests the positive reappraisal of APR, once experienced.
Factors predicting early recurrence after transanal endoscopic microsurgery excision for rectal adenoma
Authors: McCloud J. M. , Waymont N. , Pahwa N. , Varghese P. , Richards C. , Jameson J. S. , Scott A. N. D.
Published: August 2006

Introduction  Transanal endoscopic microsurgery (TEM) is an accepted way of excising rectal adenomas with low morbidity and mortality, avoiding major resectional surgery. However, there are no agreed criteria for surveillance following TEM. The purpose of this study was to identify criteria to guide surveillance programmes, thus reducing the surveillance burden for those patients at low risk of recurrence.

Patients and methods  Patients who had undergone TEM for rectal adenomas were identified, and a retrospective review of patient, pathological and histological parameters was performed.

Results  Seventy‐five (40 male) patients were identified; median age 70 years (39–85). There were seven tubular, 33 tubulo‐villous and 35 villous adenomas. All were considered completely excised by the operating surgeon. Forty‐seven (62.7%) were reported as being completely excised histologically. There was no significant association between recurrence at 6 months and sex, age, type or position of adenoma, height above the anal verge, or degree of dysplasia. Recurrence rates at six months were 0% for the completely excised adenomas and 21.4% for the incompletely excised ones; this was statistically significant (Pearson χ2, P < 0.001). In all there were 12 recurrences, 10 in the incompletely excised group at a median follow up of 31 (6–80) months (P < 0.001).

In addition, a significant association for large adenomas to recur was noted at median follow up (Armitage Trend test, P = 0.019).

Conclusions  Histological assessment of completeness of excision of rectal adenoma and size of adenoma are important predictors of early recurrence and have potential to guide follow‐up strategies after TEM.
Simple clinical examination predicts complexity of perianal fistula
Authors: Becker A. , Koltun L. , Sayfan J.
Published: August 2006

Objective  To investigate the diagnostic value of the distance between external opening of perianal fistula and anal verge and to evaluate its relation to the type of fistula. Preoperative identification of complex fistulae is important for proper planning of treatment.

Patients and methods  One hundred and fifteen consecutive patients operated for perianal fistula were studied prospectively. The distance between the external opening and the anal verge was measured. Location of the external opening, demographic and medical history data were correlated with characteristics of the fistulae. Data analysis was performed using the SPSS statistical package. The association between categorical variables was examined using the χ2‐test or Fisher's exact test for small sample. Comparison of continuous variables between two groups was analysed by t‐test.

Results  The mean distance between external opening and anal verge in simple fistulae was 2.8 cm (range 1.5–4.3, SD 0.689) and in complex fistulae it was 4.4 cm (range 3.5–6.0, SD 0.526). This difference was statistically significant –P < 0.0001. Age and previous operations (particularly attempted definitive operations) were also significantly related to the complexity of the fistula. Data concerning location and direction of the fistulous tracts confirm the validity of Goodsall's rule.

Conclusion  Simple preoperative clinical examination may reliably predict the complexity of a perianal fistula. Identification of these patients permits to select the cases that should have specific sophisticated preoperative work‐up. The first definitive operation is most important to assure a successful outcome, thus such preoperative triage may also permit selective referral to a specialized colorectal team.
Family and personal history in colorectal cancer patients: what are we missing?
Authors: Alberto V. O. , Harocopos C. J. , Patel A. A. , Clark S. K.
Published: August 2006

Objective  Family and personal history of colorectal cancer and associated tumours are crucial in identifying families with hereditary nonpolyposis colorectal cancer (HNPCC). The aim of this study was to determine the adequacy of these aspects of history‐taking in the management of colorectal cancer patients.

Patients and methods  Colorectal cancer patients attending outpatient follow‐up were interviewed to obtain a detailed family and personal history of cancers. The medical notes were then reviewed to identify whether these had been documented previously.

Results  One hundred and one patients took part. In seven, no family history had been recorded; none of these actually had a significant pedigree. In 88, the family history was not significant, a finding correctly documented in the records. Three had a high‐risk family history and another three had a personal history of other possible HNPCC‐related cancers. In each of these patients, the relevant findings had been documented, but no further action had been taken.

Conclusions  Family history was taken in the majority of patients, but in the only three with a pedigree indicative of HNPCC, its significance was not appreciated. The potential relevance of multiple HNPCC‐related cancers in the same individual was also overlooked. Improved education and referral pathways are needed to ensure that families with HNPCC have access to appropriate surveillance and genetic testing.
Hyperthermic intraperitoneal chemotherapy and cytoreductive surgery for peritoneal carcinomatosis of colorectal origin: a novel treatment strategy with promising results in selected patients
Authors: Moran B. J. , Meade B. , Murphy E.
Published: August 2006

Peritoneal carcinomatosis is a major cause of treatment failure in colorectal cancer with few options for treatment. Recent reports, including a single randomized trial, suggest that localized peritoneal carcinomatosis, in the absence of other metastases, could be considered regional metastatic disease analogous to liver metastases, and thus amenable to locoregional therapy. Optimal treatment involves complete tumour removal by complex surgical techniques, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment strategy has significant morbidity and mortality risks and careful selection is essential to avoid futile procedures. The best results are achieved in patients with limited disease who have complete macroscopic tumour removal, when the primary and peritoneal metastases are removed synchronously, and when the primary tumour is a cancer of the appendix. Improvements in cross‐sectional imaging and increasing utilization of laparoscopy in colorectal cancer surgery may help in detecting suitable cases for these techniques. Selected patients with localized disease have been shown to have good outcomes with prolonged survival and perhaps a possibility of cure.