bluuebunny/crossref_metadata_2025 huggingface dataset:
Respect as the main lay care activity among the Bena in Ilembula village in Tanzania
Authors: Juntunen Anitta , Nikkonen Merja , Janhonen Sirpa
Published: March 2003

The aim of this ethnographic study was to explore the cultural care practised among the Bena in the Ilembula villages in Tanzania. The purpose was to describe the cultural norms of the social and familiar relationship practices among the Bena for improving and maintaining health in terms of lay care. The data were collected through interviews, participant observation and personal working diaries in the Ilembula villages. Sixty‐one villagers were interviewed. The findings show that respect has two main functions: it confirms unity and ensures well‐being. Unity is important, and any violation against it is expected to be followed by a punishment, usually in the form of health deterioration. The main respective activities ensuring unity are observed in communication patterns, obedience, sharing the hardships of life and innocence. Rituals focus on the living‐dead ancestors and serve both to confirm unity and to ensure well‐being. Adult individuals guarantee their own and their descendants’ well‐being by taking care of their parents’ basic needs and taking care of them when they are ill. The parents ensure their children's well‐being by teaching them the Bena cultural beliefs and taboos. Respect is based on the world view of the Bena, which pivots on harmonious unity between individuals, supernatural forces and the kinship system.
Development of a group model of clinical supervision to meet the needs of a community mental health nursing team
Authors: Walsh Ken , Nicholson Jennifer , Keough Colleen , Pridham Robert , Kramer Myra , Jeffrey Jennifer
Published: March 2003

Clinical supervision is an important tool in the development of quality nursing care. It involves a process of reflection upon practice, the aim of which is to improve clinical practices and hence improve patient outcomes. The term ‘clinical supervision’ is itself problematic in that it implies an hierarchical, rather than a nurse‐centred and reflective, process. In addition there are a variety of models of supervision which range from the purely managerial to the clinical. This gives rise to confusion and in some cases suspicion, in clinicians. This paper reports on the development, implementation and evaluation of a group model of clinical supervision developed by a small team of mental health nurses in a community mental health setting. This team recognised the need for a formal clinical supervision model but was unsure as to the model which best suited their practice situation and needs. Through collaboration with a university department of nursing, this group developed its own model of group clinical supervision. This paper reports on the development of the model and its evaluation. The model was developed with a small team of community nurses and hence may not be applicable to other teams and other settings. However, the methods described may be useful as a guide to other nurses who wish to plan, implement and evaluate a model of clinical supervision in their workplace.
Paleoseismic events and the 1596 Keicho‐Fushimi large earthquake produced by a slip on the Gosukebashi fault at the eastern Rokko Mountains, Japan
Authors: Lin Aiming , Maruyama Tadashi , Miyata Takao
Published: March 2003

Field surveys and trench excavation investigations revealed that there were at least four large seismic events produced by slips on the Gosukebashi fault in the Holocene in the southeastern Rokko Mountains of Japan. The characteristics of deformed topographies and three‐dimensionally excavated exposures show that this fault is a right‐lateral strike–slip fault having an average slip rate of 1.0 mm/year, with a reverse displacement component. The principle indicators of past faulting events are: (i) termination of secondary faults; (ii) sedimentary deposits related to faulting; and (iii) injection veins of fault gouge related to seismic faulting in the fractured zone. Radiocarbon dates indicate that the events occurred pre‐1660 BC, 1660 BC–220 AD, from ∼ 30–220 to 600 AD and 15th century AD. The youngest event is probably associated with the large 1596 AD Keicho‐Fushimi earthquake which occurred in the area around Kyoto and Kobe Cities. The second younger event is probably correlated with the 416 AD Yamato earthquake, which is the oldest historic earthquake in Japanese historic records. The results of trench surveys show that the horizontal displacement produced by an individual event is ∼ 1.5 m, and the recurrence of seismic event intervals is ∼ 1200 years in the Gosukebashi fault.
Late Jurassic (Tithonian) radiolarians from a clastic unit of the Khabarovsk complex (Russian Far East): Significance for subduction accretion timing and terrane correlation
Authors: Zyabrev Sergei , Matsuoka Atsushi
Published: March 2003

A well‐preserved radiolarian fauna from a clastic unit of the Khabarovsk accretionary complex (southern part of the Badzhal accretionary wedge terrane in the Russian Far East) is assigned to the basal part of the Pseudodictyomitra carpatica zone. The age of the fauna is most likely late Tithonian. This is the first reliable dating of the clastic unit and makes it possible to constrain the timing of subduction accretion in the Badzhal terrane. The Khabarovsk complex is correlated chronologically with the Bikin and Samarka terranes (Russian Far East), Mino, Southern Chichibu and North Kitakami terranes (Japan), and Nadanhada terrane (northeast China).
Strike–slip origin of Cretaceous Mazhan Basin, Tan‐Lu Fault Zone, Shandong, east China
Authors: Hong Jingpeng , Miyata Takao
Published: March 2003

The Mazhan Basin, Shandong Province, China, is located between the main faults, F3 and F4, of the Tan‐Lu Fault Zone. It is an elongated basin more than 60 km in length and 8 km in width and contains a series of typical continental sediments (the Upper Cretaceous Wangshi Group). This series was divided into three sedimentary facies associations: conglomerate facies association; sandstone facies association of alluvial fan to lake margin environment; and siltstone facies association of lacustrine origins. Their zonal distribution pattern may represent a contemporaneous heterotopic facies due to a lateral facies change from margins to axis of the basin. Their stratigraphic sequence becomes younger northward along the boundary faults. This suggests that the depocenter of the fan–lake system tends to migrate northward along F3. From the asymmetric features (i.e. basin shape, lithofacies distribution, facies change) the Mazhan Basin can be explained by progressive subsidence at the Tangwu releasing bend of F3 with sinistral strike–slip movement. Judging from the fission track (FT) ages from the Wangshi Group, it was concluded that a sinistral strike–slip movement along the main fault, F3 of the Tan‐Lu Fault in Shandong, has lasted until the Late Cretaceous. Its displacement is estimated to be larger than the migrated distance, 60 km, of the depocenter of the Mazhan Basin.
Cenozoic history of the Bering Sea and its northwestern margin
Authors: Chekhovich Vadim , Kovalenko Dmitry , Ledneva Galina
Published: March 2003

Tectonic reconstructions based on the geodynamic analysis of geologic, paleomagnetic, structural and kinematic data of Cenozoic age from the western Bering Sea region are proposed in the present paper. The most active tectonic and magmatic processes took place in the Komandorsky segment of the Bering Sea, exemplified by the Late Cretaceous–Early Eocene Olutorsky Arc and Eocene–Oligocene Govena–Karaginsky Arc, which was built on the structures of the Olutorsky Arc. A model of the complex collision of these two arcs with the paleocontinental margin, which considers rotations of the geological blocks from the various structural zones of the western margin of the Bering Sea in the horizontal plane (paleomagnetic data), was proposed by the authors. According to this model the collision of the flanks of the Olutorsky and Govena–Karaginsky arcs took place in the Eocene, before the collision of the central parts in the Miocene.
Sea‐floor fissures, biological communities and sediment fatty acids of the Northern Okushiri Ridge, Japan Sea: Implications for possible methane seepage
Authors: Naganuma Takeshi , Julius Meisel C. , Wada Hideki , Kato Yukihiro , Takeuchi Akira , Fujikura Katsunori , Naka Jiro , Fujioka Kantaro
Published: March 2003

A biological community was discovered in the Northern Okushiri Ridge, northeastern Japan Sea. The community was closely associated with sea‐floor fissures, and presumed to be supported by methanotrophic and/or thiotrophic bacterial production. Sediments inside of and in the vicinity of the fissures were collected, and the short‐chain (C9–20) sediment fatty acids were analyzed for amounts and compositions. The fatty acid compositions were compared with those from a known methane seep and a submarine volcano in the Sagami Bay, central Japan, and from a whale skeleton at the Torishima Seamount, northwestern Pacific Ocean. As a result, a close relationship between the sediments from the Northern Okushiri Ridge, the known methane‐seep, and the whale skeleton was found. This finding represents the first discovery of methane seepage and associated biological communities in the Japan Sea. This also supports the hypothesis that the eastern margin of the northern Japan Sea is at the early stage of new subduction.
Mantle diapir‐induced arc volcanism: The Ueno Basalts, Nomugi‐Toge and Hida volcanic suites, central Japan
Authors: Kimura Jun‐Ichi , Yoshida Takeyoshi
Published: March 2003

Stratigraphic and geochronological data show that the late Cenozoic Ueno Basalts and related Nomugi‐Toge and Hida volcanic suites of the Norikura Volcanic Chain, Japan, were active for ~ 1 million years. Temporal and spatial variations of the volcanic activity and chemistry of the volcanic products suggest that it was induced by a common mantle diapir. The Ueno Basalts are small monogenetic volcanoes scattered over an area 50 km in diameter, and comprise a small volcanic province. The Ueno Basalts are almost all subalkalic basalt to basaltic andesite, erupted through the late Pliocene to the earliest Pleistocene (2.7–1.5 Ma). Andesite to dacite of the Nomugi‐Toge volcanic rocks were concurrently active in the back arc side, and two eruption stages (2.6–2.2 and 2.1–1.7 Ma) are recognizable. Two voluminous dacite and rhyolite ignimbrites, the Hida Volcanic Rocks, were erupted deeper in the back‐arc region, at ca 1.75 and 1.7 Ma. Both the Nomugi‐Toge and Hida suites are also subalkalic, except for the last ignimbrite. In the Ueno Basalts, alkali olivine basalt was erupted in the earliest stage, and was followed by subalkalic basalt, showing that the magma segregation depth ascended with time. This coincided with uplift of the volcanic province and with quasi‐concentric expansion of the eruption centers, suggesting that an upwelling mantle diapir was the cause of the volcanism. The Nomugi‐Toge andesite–dacite lavas and the Hida dacite and rhyolite ignimbrites are considered to have originated from the same mantle diapir, because of their close proximity to the Ueno Basalts and their near‐contemporaneous activity. Mantle diapirs have a significant role in the origin of subalkalic volcanic rocks in the island arcs.
Thermal structure and paleo‐heat flow in the Shimanto accretionary prism, Southwest Japan
Authors: Sakaguchi Arito
Published: March 2003

Abstract Thermal structural analysis and paleo‐heat flow estimation provide clues to understanding the thermal evolution of the accretionary complex. The thermal structure and heat flow in the Jurassic Chichibu and Cretaceous to Tertiary Shimanto accretionary complex, Southwest Japan, have been investigated by vitrinite reflectance measurement and fluid inclusion analysis. As a result, the local and multistage metamorphisms were recognized as follows. First, the Tertiary complex around the Miocene Ashizuri granite underwent exposure to extra‐high temperatures. Second, the Okitsu Melange underwent exposure to higher temperatures than the surrounding strata and was formed concurrently with the Kula‐Pacific ridge subduction beneath the Japanese Islands in the Eocene. Finally, the thermal structure of most of the Cretaceous and southern Jurassic complexes is independent of the geologic structure, indicating that these areas suffered thermal overprint. Regional radiometric dating studies show that most of the Cretaceous Shimanto complex was heated in the Eocene; the thermal overprint might have occurred as a result of ridge subduction. The heat flow during peak heating was estimated to be 95–120 mW/m2 except for the Cretaceous Okitsu melange and the Cretaceous Nonokawa formation, north of the Okitsu Melange; a much higher value of heat flow of ~200 mW/m2 was estimated in the Okitsu Melange. An estimation of heat flow failed for the non‐okawa formation because thermal equilibrium between the fluid and rocks has not yet been reached. It is probable that the southern strata underwent a higher heat flow. Such a trenchward increase in heat flow resembles the present situation of the Nankai Trough, although the heat flow in the Eocene was much higher.
Continental basalts in the accretionary complexes of the South‐west Japan Arc: Constraints from geochemical and Sr and Nd isotopic data of metadiabase
Authors: Kagami Hiroo , Yuhara Masaki , Iizumi Shigeru , Tainosho Yoshiaki , Owada Masaaki , Ikeda Yasuo , Okano Osamu , Ochi Shuji , Hayama Yoshikazu , Nureki Terukazu
Published: March 2003

Abstract The Ryoke Belt is one of the important terranes in the South‐west Japan Arc (SJA). It consists mainly of late Cretaceous granitoid rocks, meta‐sedimentary rocks (Jurassic accretionary complexes) and mafic rocks (gabbros, metadiabases; late Permian–early Jurassic). Initial ɛSr (+ 25– + 59) and ɛNd (− 2.1–−5.9) values of the metadiabases cannot be explained by crustal contamination but reflect the values of the source material. These values coincide with those of island arc basalt (IAB), active continental margin basalt (ACMB) and continental flood basalt (CFB). Spiderdiagrams and trace element chemistries of the metadiabases have CFB‐signature, rather than those of either IAB or ACMB. The Sr–Nd isotope data, trace element and rare earth element chemistries of the metadiabases indicate that they result from partial melting of continental‐type lithospheric mantle. Mafic granulite xenoliths in middle Miocene volcanic rocks distributed throughout the Ryoke Belt were probably derived from relatively deep crust. Their geochemical and Sr–Nd isotopic characteristics are similar to the metadiabases. This suggests that rocks, equivalent geochemically to the metadiabases, must be widely distributed at relatively deep crustal levels beneath a part of the Ryoke Belt. The geochemical and isotopic features of the metadiabases and mafic granulites from the Ryoke Belt are quite different from those of mafic rocks from other terranes in the SJA. These results imply that the Ryoke mafic rocks (metadiabase, mafic granulite) were not transported from other terranes by crustal movement but formed in situ. Sr–Nd isotopic features of late Cretaceous granitoid rocks occurring in the western part of the Japanese Islands are coincident with those of the Ryoke mafic rocks. Such an isotopic relation between these two rocks suggests that a continental‐type lithosphere is widely represented beneath the western part of the Japanese Islands.
Talc‐phengite‐albite assemblage in piemontite‐quartz schist of the Sanbagawa metamorphic belt, central Shikoku, Japan
Authors: Izadyar J. , Hirajima T. , Nakamura D.
Published: March 2003

Abstract The talc (Tlc) + phengite (Phn) + albite (Ab) assemblage is newly confirmed in MnOtotal‐rich (1.65 wt% in average) piemontite‐quartz schists from the intermediate‐ and high‐grade part of the Sanbagawa belt, central Shikoku, Japan. Talc is in direct contact with Phn, Ab and chlorite (Chl) with sharp boundaries, suggesting that these four phases mutually coexist. Other primary constituents of the Tlc‐bearing piemontite‐quartz schist are spessartine, braunite, hematite (Ht), crossite/barroisite and dolomite. Phlogopite (Phl) rarely occurs as a later stage mineral developing along the rim of Phn. The studied piemontite‐quartz schist has mg# (= Mg/(Mg + Fe2+)) ~ 1.0, because of its high oxidation state. Schreinemakers’ analysis in the KNMASH system and the mineral assemblage in the Sanbagawa belt propose a possible petrogenetic grid, in which the Tlc–Phn assemblage is stable in a P‐T field surrounded by the following reactions: lower‐pressure limit by Chl + Phl + quartz (Qtz) = Phn + Tlc + H2O as proposed by previous workers; higher‐pressure limit by glaucophane + Qtz = Tlc + Ab + H2O; and higher‐temperature limit by Tlc + Phn + Ab = Phl + paragonite + Qtz + H2O. Thermodynamic calculation based on the database of
Holland & Powell (1998), however, suggests that the Tlc–Phn stability field defined by these reactions is unrealistically limited around 580–600 °C at 11.6–12.0 (± 0.7) kbar. Schreinemakers’ analysis in the KNMA‐Fe3+‐SH system and the observed mineral assemblage predict that Chl + crossite = Tlc + Ab + Ht + H2O is a preferable Tlc‐forming reaction in the intermediate‐grade part of the Sanbagawa belt and that excess Ab + hematite narrows the stability field of the Tlc–Phn assemblage.
Thermobaric structure of the Kokchetav ultrahigh‐pressure–high‐pressure massif deduced from a north–south transect in the Kulet and Saldat–Kol regions, northern Kazakhstan
Authors: Ota Tsutomu , Terabayashi Masaru , Parkinson Christopher D. , Masago Hideki
Published: March 2003

AbstractTo investigate the regional thermobaric structure of the diamondiferous Kokchetav ultrahigh‐pressure and high‐pressure (UHP–HP) massif and adjacent units, eclogite and other metabasites in the Kulet and Saldat–Kol regions, northern Kazakhstan, were examined. The UHP–HP massif is subdivided into four units, bounded by subhorizontal faults. Unit I is situated at the lowest level of the massif and consists of garnet–amphibolite and acidic gneiss with minor pelitic schist and orthogneiss. Unit II, which structurally overlies Unit I, is composed mainly of pelitic schist and gneiss, and whiteschist locally with abundant eclogite blocks. The primary minerals observed in Kulet and Saldat–Kol eclogites are omphacite, sodic augite, garnet, quartz, rutile and minor barroisite, hornblende, zoisite, clinozoisite and phengite. Rare kyanite occurs as inclusions in garnet. Coesite inclusions occur in garnet porphyroblasts in whiteschist from Kulet, which are closely associated with eclogite masses. Unit III consists of alternating orthogneiss and amphibolite with local eclogite masses. The structurally highest unit, Unit IV, is composed of quartzitic schist with minor pelitic, calcareous, and basic schist intercalations. Mineral assemblages and compositions, and occurrences of polymorphs of SiO2(quartz or coesite) in metabasites and associated rocks in the Kulet and Saldat–Kol regions indicate that the metamorphic grades correspond to epidote–amphibolite, through high‐pressure amphibolite and quartz–eclogite, to coesite–eclogite facies conditions. Based on estimations by several geothermobarometers, eclogite from Unit II yielded the highest peak pressure and temperature conditions in the UHP–HP massif, with metamorphic pressure and temperature decreasing towards the upper and lower structural units. The observed thermobaric structure is subhorizontal. The UHP–HP massif is overlain by a weakly metamorphosed unit to the north and is underlain by the low‐pressure Daulet Suite to the south; boundaries are subhorizontal faults. There is a distinct pressure gap across these boundaries. These suggest that the highest grade unit, Unit II, has been selectively extruded from the greatest depths within the UHP–HP unit during the exhumation process, and that all of the UHP–HP unit has been tectonically intruded and juxtaposed into the adjacent lower grade units at shallower depths of about 10 km.
Fault‐related folds and an imbricate thrust system on the northwestern margin of the northern Fossa Magna region, central Japan
Authors: Okamura Yukinobu
Published: March 2003

Abstract  The Nishikubiki Mountains, which are located on the northwestern margin of the northern Fossa Magna region, central Japan, and the area offshore to the north of the mountains are underlain by folded and faulted Neogene and Quaternary sequences. The folds are composed of open, symmetric anticlines or tight, asymmetric anticlines trending north 20–70° east. On the basis of the geometry of the anticlines and growth strata, the symmetric and asymmetric anticlines are interpreted as fault‐bend folds and fault‐propagation folds, respectively. The formation of the anticlines is attributed to the growth of an imbricate thrust system composed of three thrust sheets that developed, from southeast to northwest, mainly in the late Pliocene, early Pleistocene, and middle Pleistocene–Holocene. The horizontal component of the northwestern‐most sheet was estimated to be approximately 1.2 km on the basis of the width of the growth triangle, and the thickness of the sheet at its southeast margin was estimated to be 8.5 km on the basis of area balancing along one of the seismic profiles. The thrust is inferred to extend to a depth of more than 10 km toward the southwest. The three thrust sheets are probably connected by a detachment zone along the boundary between the upper and lower crusts. The anticlines are bounded by the Itoigawa–Shizuoka Tectonic Line (ISTL) to the west and by lateral ramps or tip lines to the northeast. The ISTL possibly continues northward offshore into the Toyama Trough. The structural model proposed in this paper suggests that similar thrust systems are wide spread in the northern Fossa Magna region and that active deformation zones have migrated and switched during the past 2–3 million years along the fold belt.
Etiopathogenesis of acute hepatic failure: Eastern versus Western countries
Authors: ACHARYA SK , BATRA Y , HAZARI S , CHOUDHURY V , PANDA SK , DATTAGUPTA S
Published: March 2003

Abstract Etiopathogenesis of acute hepatic failure (AHF) in Eastern and Western countries is distinct. In the East hepatitis viruses cause AHF in more than 95% of such cases, while causes of AHF in the West are quite heterogenous. Hepatitis E virus is the major etiological agent of AHF in countries like India where the virus is hyperendemic. Occult HBV infection may also be causing AHF in a sizable proportion of cases in areas where chronic HBV infection frequency is high. Paracetamol causes AHF in about 70% cases in the UK and about 20% cases in USA, whereas in France and Denmark, non‐steroidal anti‐inflammatory drugs are more frequently associated with AHF. Hepatitis B virus causes AHF in about one‐third of cases in the latter two countries.

© 2002 Blackwell Publishing Asia Pty Ltd
Pathogenesis of ascites and predictors of resistance to therapy
Authors: DE FRANCHIS ROBERTO , SALERNO FRANCESCO
Published: March 2003

Abstract  Ascites is one of the most frequent complications of cirrhosis. Its appearance is considered as the marker of the transition from the compensated to the decompensated stage of the disease. Appearance of ascites also has prognostic significance, as it causes a sharp drop in the expected survival rate. Portal hypertension is a sine qua‐non for the development of ascites. Although no precise portal pressure threshold has been defined for the development of ascites, the latter rarely develops with portal pressures below 12 mmHg. In addition, in patients treated with interventions that markedly decrease portal pressure, such as surgical porta‐caval shunts or transjugular intrahepatic portalsystemic shunts, a disappearance or a marked reduction of ascites can be observed. The currently most accepted theory of ascites formation is the so‐called ‘forward’ theory. According to this theory, the development of ascites is related to the presence of severe sinusoidal portal hypertension, which causes marked splanchnic arterial vasodilation and a forward increase in the splanchnic production of lymph. Splanchnic arterial vasodilation also causes a significant reduction of the effective blood volume, leading to activation of sodium and water‐retaining mechanisms. The retained sodium and water, however, while increasing total plasma volume, are unable to compensate for the reduced effective blood volume, initiating a vicious cycle. In the advanced stages of cirrhosis, the extreme underfilling of the arterial circulation leads to a maximal stimulation of the vasoconstrictor mechanisms which override the protective effect of renal vasodilator factors and cause renal vasoconstriction, further aggravating ascites and leading to functional renal insufficiency. Renal insufficiency is also one of the main causes of resistance to diuretic therapy. While several studies have investigated the predictors of survival in cirrhotic patients with ascites, this has not been done for the occurrence of resistance to therapy. However, as the mechanisms of refractoriness are associated with advanced disease and short survival, the models developed for predicting survival should be employed also to verify if they can exert such additional prediction.

© 2002 Blackwell Publishing Asia Pty Ltd
Rhabdomyolysis and acute pancreatitis
Authors: Pezzilli Raffaele , Billi Paola , Cappelletti Onda , Barakat Bahjat , Miglio Federico
Published: March 2003

Aims: To establish the incidence of rhabdomyolysis in patients with acute pancreatitis and to determine the effectiveness of myoglobin in assessing the severity of the disease.

Methods: Sixty‐one patients having acute pancreatitis (33 males, 28 females, mean age 66 years, range 16–97 years) were studied; diagnosis of acute pancreatitis was based on the typical abdominal pain associated with elevated concentrations of serum lipase and further confirmed by imaging techniques. Rhabdomyolysis was defined as a level of serum myoglobin which is two or more times greater than the upper normal test limit. All patients had normal renal function at the time of the study, none had clinical and/or electrocardiographic signs of acute myocardial infarction and none were drug addicts. Forty‐five patients had mild acute pancreatitis and 16 had the severe form of the disease. Serum myoglobin was determined using a nephelometric technique.

Results: Patients with mild pancreatitis had serum concentrations of myoglobin (median and range; 35.7, 24–713 μg/L) similar to those with severe pancreatitis (26.8, 24–710 μg/L). Twelve of the 61 patients with acute pancreatitis (20%) had serum myoglobin concentrations above the upper normal limit: eight of the 45 patients with mild pancreatitis (17.7%) and four of the 16 patients with severe pancreatitis (25.0%). Four of the 61 patients with acute pancreatitis (7%) had serum myoglobin levels more than twice the upper normal limit: two with mild disease and two with the severe form of pancreatitis.

Conclusions: Rhabdomyolysis may occur asymptomatically in patients with acute pancreatitis, especially in those with the severe form of the disease. Serum myoglobin determination is not useful in establishing the severity of acute pancreatitis.
Calcitriol for bone disease in patients with cirrhosis of the liver
Authors: Shiomi Susumu , Masaki Kyoko , Habu Daiki , Takeda Tadashi , Nishiguchi Shuhei , Kuroki Tetsuo , Tanaka Takashi , Ochi Hironobu
Published: March 2003

Background
: Osteoporosis is associated with cirrhosis of the liver, but the effects of therapy for osteoporosis associated with cirrhosis are still controversial.

Methods
: We evaluated the effects of calcitriol (1α,25‐dihydroxyvitamin D3) on bone mineral density (BMD) in 76 patients (26 men and 50 women) with cirrhosis who were assigned randomly to receive calcitriol (0.5 mg twice per day) or not. The BMD of the lumbar vertebrae was measured by dual‐energy X‐ray absorptiometry at least twice, 12–57 months apart.

Results
: For men, the mean annual change in BMD was 1.1% in the treated group and –0.4% in the control group. The median (25th and 75th percentiles) annual change in BMD was 0.6 (–0.1, 2.1%) in the treated group and –1.4 (–1.9, 1.6%) in the control group. The difference in the median annual change between the two groups was significant (P = 0.013). For women, the mean annual change in BMD was –0.5% in the treated group and –2.3% in the control group. The median (25th and 75th percentiles) annual change in BMD was –0.5 (–1.8, 1.3%) in the treated group and –1.5 (–3.8, –0.7%) in the control group. This difference was significant (P = 0.011).

Conclusions
: Our results suggest that calcitriol can prevent bone loss and, therefore, may be useful for the treatment of bone disease in patients with cirrhosis of the liver.

© 1999 Blackwell Science Asia Pty Ltd
C ASE R	EPORT: Colonic duplication: A rare cause of obstruction
Authors: Jimenez Susan G , Oliver Mark R , Stokes Keith B , Morreau Phillip N , Chow Chung Wo
Published: March 2003

Complete duplication of the entire large bowel with partial ileal involvement is very rare and diagnosis can often be difficult as illustrated by this case report. We also review the other clinical associations of this rare condition and briefly discuss the embryology of duplications of the gastrointestinal tract.
Diffuse submucosal cysts of the stomach: Report of two cases in association with development of multiple gastric cancers during endoscopic follow up
Authors: Inaba Tomoki , Mizuno Motowo , Kawai Kozou , Okada Hiroyuki , Tsuji Takao
Published: March 2003

Background
: Diffuse submucosal cysts of the stomach have been suggested as a predisposing condition for the development of gastric cancer, especially multiple cancers. We report here two cases of diffuse submucosal cysts of the stomach associated with multiple gastric cancers which were detected during endoscopic follow‐up.

Methods and Results
: The first patient was a 75‐year‐old man and the second patient was a 72‐year‐old man. In the first case, we performed an endoscopic examination every year and detected an advanced cancer and two early cancers on the fifth year of the follow up. Because one of these cancers was advanced, we examined the second patient endoscopically every six months. In this patient, we detected two early cancers after 1.5 years follow up.

Conclusions
: We suggest that patients with this disorder should be examined regularly by endoscopy for the detection of gastric cancer, preferably every six months.

© 1999 Blackwell Science Asia Pty Ltd
CASE REPORT: Portal vein thrombosis associated with hereditary protein C deficiency: A report of two cases
Authors: Yang Ying‐Ying , Chan Che‐Chang , Wang Sun‐Sang , Chiu Chang‐Fang , Hsu Hui‐Chi , Chiang Jen‐Huey , Tasy Shyh‐Haw , Chang Full‐Young , Lee Shou‐Dong
Published: March 2003

Protein C deficiency is one of the causes of curable or preventable portal vein thrombosis. We report two patients of portal vein thrombosis associated with hereditary protein C deficiency. The first patient presented with continuous right upper quadrant pain and high fever. The abdominal sonography revealed normal liver parenchyma but portal vein and superior mesenteric vein thrombosis. Based on a 55% (normal 70–140%) plasma protein C level, he was diagnosed as having protein C deficiency. A trace of his family history showed that his elder brother also had protein C deficiency with a 50% plasma C level. Both patients received anticoagulant therapy. The younger brother showed good response. Unfortunately, the elder one suffered from recurrent episodes of variceal bleeding and received a life‐saving splenectomy and devascularization. We herein remind clinicians that early screening and therapy are helpful in preventing late complications of protein C deficiency with portal vein thrombosis.

© 1999 Blackwell Science Asia Pty Ltd
Natural history of acute hepatitis C
Authors: Tanaka Eiji , Kiyosawa Kendo
Published: March 2003

To study the short‐ and long‐term outcomes of acute hepatitis C, three groups of patients were enrolled. Of 26 patients with acute hepatitis C, 18 (69%) maintained HCV viraemia and 8 had cleared virus naturally at 12 months after the onset. Normalization of ALT was seen in all 8 patients with acute resolving hepatitis, but in only 1 (5%) of the 18 patients with chronic HCV infection (P < 0.001). Changes in liver histology were analysed in 43 patients with acute hepatitis C who underwent repeated liver biopsy. The mean score of the fibrotic stage was 0.9 within 1 year of the onset, and it increased gradually up to 3.5 at 30 years from the onset (0.1 grade/year). The fibrotic stage increased more rapidly in patients aged more than 50 years. In 115 patients, the mean duration between blood transfusion and the diagnosis of HCC increased significantly (P < 0.001) in accordance with increasing age at blood transfusion; 35 ± 5.3 years in patients aged less than 30 years, 30 ± 4.9 years in those aged between 30 and 40 years, and 25 ± 6.8 years in those aged more than 40 years. In conclusion, approximately 70% of patients with acute hepatitis C develop chronic hepatitis. Once patients develop chronic hepatitic fibrosis of the liver, it progresses over several decades, faster in older patients.
Regulatory mechanism of acid secretion in the damaged stomach: Role of endogenous nitric oxide
Authors: Takeuchi Koji , Araki Hideo , Kawauchi Shoji , Kunikata Tomonori , Mizoguchi Hiroyuki , Tashima Kimihito
Published: March 2003

The present article overviews the regulatory mechanism of acid secretion in the stomach after damage with taurocholate (TC), one of the bile acids. Mucosal exposure of a rat stomach to 20 mmol/L TC for 30 min caused a decrease of acid secretion with a concomitant increase in nitric oxide (NO) and prostaglandin (PG) E2 (PGE2) as well as Ca2+ in the luminal contents. Prior administration of NG‐nitro‐
L‐arginine methyl ester (
L‐NAME), as well as indomethacin, significantly attenuated the reduction of acid secretion by TC and acid secretion was even increased in the presence of
L‐NAME. The acid stimulatory effect of
L‐NAME in the damaged stomach was not mimicked by aminoguanidine and was antagonized by co‐administration of
L‐arginine but not
D‐arginine. Increased NO release in the damaged stomach was suppressed by pretreatment with
L‐NAME or co‐application of EGTA and the latter also inhibited the increase in luminal Ca2+. The enhanced acid secretory response in the presence of
L‐NAME was also inhibited by cimetidine, FPL‐52694 (a mast cell stabilizer) or sensory deafferentation. Mucosal exposure to TC caused an increase in luminal histamine output, together with a decrease in the number of mucosal mast cells in the stomach. These changes were prevented by FPL‐52694 and sensory deafferentation and were also partly suppressed by indomethacin. In addition, the acid stimulatory action of
L‐NAME in the damaged stomach was significantly mitigated when indomethacin was administered together with
L‐NAME. We conclude that: (i) damage in the stomach may activate acid a stimulatory pathway in addition to a PG‐, NO‐ and Ca2+‐dependent inhibitory mechanism, but the latter effect overcomes the former, resulting in a decrease in acid secretion; (ii) acid stimulation in the damaged stomach is mediated by histamine released from the mucosal mast cell, a process interacting with capsaicin‐sensitive sensory nerves; (iii) the increase in luminal Ca2+ plays a role in increasing NO production and, hence, in regulating acid secretion; and (iv) PG may have a dual role in the regulation of acid secretion in the damaged stomach: an inhibitory effect at the parietal cell and an excitatory effect, probably through enhancing the release of mucosal histamine.
Decreased trabecular bone mineral density in newly diagnosed inflammatory bowel disease patients in Korea
Authors: Lee Sang‐Ho , Kim Hyo‐Jong , Yang Suk‐Kyun , Kim Won‐Ho , Joo Yeong‐Shil , Dong Seok‐Ho , Kim Byung‐Ho , Lee Jung‐Il , Chang Young‐Woon , Chang Rin
Published: March 2003

Background
: Decreased bone mineral density (BMD) is common in Western patients with inflammatory bowel disease (IBD). However, BMD has never been studied in Asia where the demographic and socio‐economic status are different from the West. The aim of this study was to investigate the prevalence and mechanisms of osteopenia in newly diagnosed Korean patients with IBD.

Methods
: We studied 14 patients with Crohn’s disease (CD) and 25 patients with ulcerative colitis (UC), all of whom had never been treated with corticosteroids. Bone mineral density was measured in the lumbar spine and the femoral neck by dual energy X‐ray absorptiometry. Biochemical parameters including serum osteocalcin, parathyroid hormone, plasma inactive and active vitamin D, and urinary deoxypyridinoline were measured.

Results
: The BMD Z score at the lumbar spine was lower both in CD and in UC patients, but there was no significant difference between the two groups. There was no significant difference in nutritional status or biochemical parameters of bone metabolism between patients with a normal BMD and those with a decreased BMD.

Conclusions
: Low BMD at the lumbar spine is common in newly diagnosed Korean patients with IBD, a result which is similar to Western studies. The mechanism for low bone mass remains undetermined; however, nutritional status and hormonal parameters of bone metabolism, and ethnic differences are not likely to be an important factor in the pathogenesis of this bone loss.
Parathyroid hormone‐related peptide producing cholangiocellular carcinoma with a marked psammoma formation
Authors: Yamada Shinwa , Sanefuji Hayato , Morimoto Hiroaki , Harada Yuji , Mine Shinichiro , Morimoto Isao , Eto Sumiya
Published: March 2003

Humoral hypercalcemia caused by parathyroid hormone‐related peptide (PTHrP), associated with cholangiocellular carcinoma (CCC), has rarely been documented. There have been no reports of CCC associated with extensive calcification of the tumor with psammoma body formation. A 66‐year‐old man was admitted with a large calcified tumor in the liver detected on an abdominal X‐ray. An ultrasound‐guided fine needle biopsy specimen of the liver tumor showed evidence of adenocarcinoma. He had hypercalcemia with an elevated PTHrP level. The patient died because of disseminated intravascular coagulation and progressive hepatic failure. A postmortem examination revealed a large poorly differentiated CCC in the liver. Immunohistochemical examination showed the presence of PTHrP‐positive tumor cells. The calcified lesion consisted of a number of accumulated psammoma bodies. We present a case of PTHrP producing CCC with a marked psammoma formation.
Folate deficiency diminishes the occurrence of aberrant crypt foci in the rat colon but does not alter global DNA methylation status
Authors: Le Leu Richard K , Young Graeme P , McIntosh Graeme H
Published: March 2003

Abstract Background and Aims: It has been suggested that a diminished folate status may enhance colorectal carcinogenesis by causing DNA hypomethylation. The aims of the present study were to assess the impact of different levels of folate depletion on azoxymethane (AOM)‐induced aberrant crypt foci (ACF) formation and DNA hypomethylation in the colon of male Sprague–Dawley rats.

Methods: Rats, aged 4 weeks, were divided into four groups and were fed semipurified diets either containing adequate folate (control), devoid of folate (FD) or FD + 1% succinylsulfathiazole before AOM treatment (FD1) or during the last 4 weeks of the study (FD2). At 8 weeks of age, all animals received subcutaneous injections of AOM once weekly for 3 weeks at a dose rate of 15 mg/kg bodyweight. Animals were necropsied 6 weeks after the last AOM injection and the ACF were visualized under light microscopy in formalin‐fixed, methylene blue‐stained colons.

Results: Blood folate concentrations were significantly depleted (P < 0.001) in the treatment groups consuming folate deplete diets, with the FD2 treatment group having significantly lower folate levels compared with all other groups. Higher plasma homocysteine concentrations (P < 0.001) were observed in the groups that exhibited diminished blood folate levels. There were no significant differences in global DNA methylation in the liver or colonic mucosa between the four groups, despite some groups exhibiting marked folate depletion. Animals with the most severe folate deficiency (FD2) had a lower final bodyweight and had significantly fewer ACF in their colon (P < 0.05) compared with control animals. Total (mean ± SEM) ACF counts were as follows: control 286 ± 24; FD 290 ± 25; FD1 218 ± 32; and FD2 205 ± 27.

Conclusions: In this model, folate deficiency diminished the occurrence of ACF but did not alter global DNA methylation status in the colon.
Detection of Listeria monocytogenes by polymerase chain reaction in intestinal mucosal biopsies from patients with inflammatory bowel disease and controls
Authors: Chen Wangxue , Li Dong , Paulus Barbara , Wilson Ian , Chadwick Vinton S
Published: March 2003

Abstract Background and Aims: Components of the intestinal microflora are believed to play an important role in the pathogenesis of inflammatory bowel disease (IBD) in genetically susceptible hosts acting either as a non‐specific antigenic stimulus or as a specific pathogen. Listeria monocytogenes has been suggested as an organism with the potential to cause IBD. The objective of the present study was to investigate the prevalence of L. monocytogenes DNA in intestinal biopsies from patients with IBD and from non‐IBD controls by using nested polymerase chain reaction (PCR).

Methods: The DNA was extracted from 274 colonoscopic biopsies, which were obtained from 23 patients with Crohn's disease (CD), 28 with ulcerative colitis (UC) and 39 non‐IBD control patients. Nested PCR amplification was used to detect the presence of the L. monocytogenes listeriolysin O (hly) gene. The sequences of positive PCR products were determined and compared with databases.

Results: The sensitivity of our nested PCR was 10 fg L. monocytogenes DNA. Overall, L. monocytogenes DNA was detected in 13.0% patients with CD, 17.9% patients with UC and 25.6% non‐IBD control patients or in 29 of 274 (10.6%) endoscopic biopsies. Among them, L. monocytogenes DNA was detected in four of 67 (6%) biopsies from patients with CD, five of 94 (5.3%) biopsies from patients with UC and 20 of 113 biopsies (17.7%) from non‐IBD control patients. Sequence analysis of positive PCR products demonstrated more than 95% similarity to the hly gene sequence of L. monocytogenes, confirming the authenticity of our PCR products.

Conclusion: Listeria monocytogenes DNA was detected in the intestine of both patients with IBD and in non‐IBD control patients, probably reflecting the widespread presence of this organism in the environment. The low yield of positive biopsies in our IBD patients (5–6%) and the fact that the detection rate of L. monocytogenes DNA was similar in endoscopic biopsies from IBD patients and non‐IBD controls does not support a direct role for L. monocytogenes in the pathogenesis of IBD, at least in New Zealand patients.
Comparison of the expression of ABH/Lewis‐related antigens in polypoid and non‐polypoid growth types of colorectal carcinoma
Authors: Nakagoe Tohru , Fukushima Kiyoyasu , Nanashima Atsushi , Sawai Terumitsu , Tsuji Takashi , Jibiki Masa‐Aki , Yamaguchi Hiroyuki , Yasutake Toru , Ayabe Hiroyoshi , Matuo Tatsuki , Tagawa Yutaka
Published: March 2003

Background and Aims: Colorectal tumors can be classified based on their growth pattern into the polypoid growth‐type (PG‐type) and non‐polypoid growth‐type (NPG‐type). To ascertain whether there is any relationship between the expression of particular blood group‐related antigens (A, B, H, Lewis (Le) a, sialyl Lea, Lex, sialyl Lex) in a colorectal tumor, and a tumor having polypoid or non‐polypoid growth, we examined 78 PG‐type and NPG‐type colorectal cancers.

Methods: Fourteen PG‐type and 64 NPG‐type colorectal carcinomas were subjected to immunohistochemical analyses by using monoclonal antibodies against A, B, H, Lea, sialyl Lea, Lex and sialyl Lex.

Results: The patients with NPG‐type carcinomas had a significantly younger age of onset, significantly smaller maximal tumor diameter, significantly higher rate of lymph node metastasis and significantly worse prognosis than those with PG‐type carcinomas. Among the 32 tumors of patients with blood type A or AB, isoantigen A was expressed in a significantly larger percentage of NPG‐type carcinomas than PG‐type carcinomas (95.8 vs 62.5%, respectively; P = 0.014). Among all 78 tumors, sialyl Lex antigen was expressed in a significantly larger percentage of NPG‐type than PG‐type carcinomas (90.6 vs 64.3%, respectively; P = 0.010). Multivariate analysis using the logistic regression model revealed that isoantigen A and sialyl Lex expression were independent predictive risk factors for the development of NPG‐type colorectal carcinoma.

Conclusions: These data suggest that the expression of isoantigen A and sialyl Lex in a colorectal carcinoma partially determines whether the tumor will have polypoid or non‐polypoid growth.
Role of endothelin in endotoxin‐induced hepatic microvascular dysfunction in rats fed chronically with ethanol
Authors: Horie Yoshinori , Kato Shinzo , Ohki Eiji , Tamai Hironao , Ishii Hiromasa
Published: March 2003

Background: We examined the role of endothelin in endotoxin‐induced hepatic microcirculatory disturbance in pair‐fed rats given a liquid diet containing ethanol or isocaloric control.

Methods and Results: One lobe of the liver was observed with the use of an intravital microscope. Erythrocytes (RBCs) labeled with fluorescein isothiocyanate (FITC) were injected, and the flow velocity of the FITC‐RBCs in the sinusoids was measured with an off‐line velocimeter. The flow velocity decreased 30 min after 1 mg/kg of lipopolysaccharide (LPS) was administered to the controls, and portal pressure (PP) was increased at 60 min. In ethanol‐fed rats, however, both the flow velocity and PP increased in the early phase (at 10 min), and in the late phase, flow velocity decreased and PP increased more than in the controls. The LPS‐induced decrease in flow velocity was blunted, when BQ‐123, an antagonist of endothelin receptor subtype A, was infused into ethanol‐fed rats, and BQ‐123 also attenuated the change in PP. The plasma endothelin levels in both systemic and portal blood of the ethanol‐fed rats were higher than in the controls.

Conclusions: These results suggest that endothelin plays a role in the LPS‐induced hepatic microcirculatory disturbance, especially in alcohol‐fed animals.
Expression of interleukin‐6, leukemia inhibitory factor and their receptors by colonic epithelium and pericryptal fibroblasts
Authors: Rockman Steven P , Demmler Kirsten , Roczo Nandor , Cosgriff Angela , Phillips Wayne A , Thomas Robert J S , Whitehead Robert H
Published: March 2003

Background and Aim: The cellular configuration of the human colon suggests a predetermined organization that creates specific microenvironments. The role of pericryptal fibroblasts in this microenvironment has been the subject of considerable speculation. This study examined the expression of growth factors and their receptors by colonic crypt epithelium and pericryptal fibroblasts.

Methods and Results: Pericryptal fibroblast cells were isolated and cultured from decrypted human colonic mucosa. The pericryptal fibroblast cells expressed messenger RNA (mRNA) for interleukin‐6 (IL‐6), leukemia inhibitory factor (LIF), LIF receptor α, and the common coreceptor glycoprotein 130 (GP130), but not the IL‐6 receptor α. Interleukin‐6 protein expression was confirmed by the analysis of conditioned medium and immunohistochemistry. In comparison, normal colonic epithelial cells express mRNA for LIF but not IL‐6 as well as the receptors for GP‐130, IL‐6 receptor α but not LIF receptor α. As cultures of normal human colonic epithelial cells were not available, the conditioned medium was assayed from established colon carcinoma cell lines and demonstrated a secretion of LIF but not IL‐6 protein.

Conclusion: The expression of reciprocal cytokine and receptor expression suggest that there is a paracrine relationship between pericryptal fibroblasts and colonic epithelium.