bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient participation in psychiatric services: a literature review and proposal for a research strategy
Authors: Glenister David
Published: February 2006

There is a trend in nursing policy and practice towards patients participating actively in their treatments and the services they use. Nursing theorists often attempt to describe the phenomena of patient participation from a psychological perspective while neglecting sociological issues, such as power, ideology and moral status. This paper commences by examining policy and ethical issues in relation to patient participation. Studies examining immediate patient participation, for example active participation in treatments, and distant patient participation, namely participation in psychiatric service planning, are then reviewed. Various settings of psychiatric services are examined, including the initial interview, primary health care, hospitalization and clinical innovation, in order to uncover common themes. These studies often fail to pay attention to the patient's experience of participation, even when clinically innovative schemes are being described, and also fail to develop hypotheses and theories about participation. The importance of a sociological perspective in future studies is indicated. The author concludes that psychiatric patients want a more active role in treatments and service planning, and that psychiatric clinicians, including nurses, find more active patient participation threatening. Nevertheless, there is evidence of more rewarding alliances being formed between patients and nurses in some settings. The nurse's role in democratizing psychiatric services, thus permitting greater patient participation, while fulfilling statutory obligations is a considerable challenge to nursing practice in the future. This paper concludes by discussing some current limitations of nursing research and the value of some ideas taken from critical theory, in particular reflection, dialogue and praxis, as a practical basis for social action and nursing research.
The effects of family work training on mental health nurses' attitude to and knowledge of schizophrenia: a replication
Authors: Gamble Catherine , Midence Kenny , Leff Julian
Published: February 2006

The association between expressed emotion and the outcome of schizophrenia is well established, and the efficacy of family work for schizophrenia has been demonstrated. Mental health nurses are an expanding group in mental health service provision but their training does not include family work. Although there is some evidence that training mental health nurses in schizophrenia family work increases their knowledge of, and changes their attitudes towards schizophrenia, very little research has been conducted in this area. This paper replicates a previous study, and investigates whether mental health nurses can change their attitude and beliefs, and increase their knowledge about schizophrenia. Knowledge increased and attitudes changed during the initial period (3 months), and the gains were maintained throughout the %month course. However, in order to incorporate the skills learnt into their routine practice, mental health nurses will continue to need ongoing recognition, support, and enthusiasm from colleagues and managers.
Nursing interventions with families: a demand or an invitation to change?
Authors: Robinson Carole A.
Published: February 2006

While nurses are becoming more adept at the assessment of families, intervention with families is an area that requires increased attention. This paper provides a critical analysis of existing nursing literature pertaining to interventions with families who are managing a member's chronic health condition. Three orientations to nursing interventions with families (traditional, transitional and non‐traditional) are proposed, based on underlying perspectives regarding objectivity and linear versus systemic thinking. These orientations are further distinguished in relation to beliefs that are reflected in the intervention literature.
The adaptation of an experimental sampling procedure for application in naturalistic psychiatric nursing research settings
Authors: Rushforth David
Published: February 2006

External constraints on random sampling remains a constant challenge to nurse researchers seeking control over patient recruitment when investigating the outcome of nursing treatments. Traditional non‐random sampling strategies employed in naturalistic clinical settings are prone to extraneous variables that frequently compromise the internal validity of the research design and confidence in the results. This paper explores the value of the Buglass scale and minimization in the context of a quasi‐experimental research study to examine the management of deliberate self‐ham by community psychiatric nurses. Discussion centres on their scope for control of extraneous variables without sacrificing the naturalistic setting within which community psychiatric nurses operate. A worked example illustrates the sampling procedure for minimizing differences between subjects assigned to a treatment and comparison group.
Preparing children and families psychologically for day surgery: an evaluation
Authors: Ellerton Mary‐Lou , Merriam Craig
Published: February 2006

The increasing use of ambulatory care settings for children's surgery places more responsibility on parents for psychological preparation of children for surgery and for their post‐operative care. This paper describes the evaluation of a pre‐admission programme to prepare children between the ages of 3 and 15 years and their families psychologically for day surgery. Seventy‐five families comprised the study sample, 23 in the programme group and 53 in the non‐intervention group. The programme focused on familiarizing families with the physical and procedural components of day surgery through a videotape of a family in a naturally occurring day surgery situation, a tour, and hospital play. Fewer children and parents in the programme group reported high anxiety levels awaiting surgery. Children and parents with previous surgical experience reported higher levels of pre‐surgical anxiety than inexperienced families. Families reported the physicians and day surgery nurse as their primary sources of information and rated the day surgery nurse highest in their satisfaction with information received. Implications for practice, particularly for meeting the needs of young children and out‐of‐town families, are discussed.
Pain in elderly patients: a neglected phenomenon?
Authors: José Closs S.
Published: February 2006

The assessment and control of pain in elderly patients present unique problems. Old people are likely to experience more pain, both chronic and acute, than their younger counterparts. Demographic changes mean that larger numbers of older patients will require effective and efficient control of pain in order to optimize their quality of life. Relatively little research has focused on this potentially huge problem. This paper discusses issues specific to pain in elderly people, and suggests that wide ranging and careful assessments are needed. Benefits can be achieved not only from the appropriate use of analgesic drugs, but also physical and psychological therapies.
Reasons for uses of physical restraint and alternatives to them in geriatric nursing: a questionnaire study among nursing staff
Authors: Liukkonen Arja , Laitinen Pirjo
Published: February 2006

This study is part of a major research project that is concerned with disruptive behaviour among elderly patients and the use of physical restraint in geriatric nursing. The purpose of this study was to describe the use of physical restraint and alternatives as reported by professional nurses. The data were collected by a structured questionnaire. Nursing staff (n=287) from a geriatric unit of a health centre, a nursing home, and the medical and psychiatric clinics of a university hospital in one city in central Finland, volunteered for the study. The clear majority (85%) of the nurses stated that physical restraint had been used on the ward during the week preceding the questionnaire. Reasons cited most often for restraint use were reduced physical and cognitive capacity of demented patients. The most common alternative was to try to understand the reasons for the elderly patient's disruptive behaviour. A major challenge for future research and for field experiments is to provide new alternatives to the use of physical restraint in geriatric nursing.
Self‐efficacy in caregivers of cognitively impaired elderly people: a concept analysis
Authors: Mowat Janyth , Spence Laschinger Heather K.
Published: February 2006

Research with caregivers of cognitively impaired individuals has provided evidence which suggests that most caregivers experience at least some degree of burden. However, it has been postulated that it is the caregiver's subjective interpretation of the situation that is the primary factor responsible for mediating the degree of burden experienced. Caregivers who cope well with this type of stress may possess a high level of self‐efficacy. The purpose of this paper is to analyse the concept of self‐efficacy and its relationship to health care using Walker & Avant's concept analysis methodology. Uses of the concept of self‐efficacy, as well as its defining attributes, antecedents, consequences and empirical referents, are discussed. Also, model, borderline, related, contrary and invented cases are constructed to illustrate the concept further. The relevance of the concept to nursing practice and areas requiring future investigation are noted.
A theory of holistic comfort for nursing
Authors: Kolcaba Katharine Y.
Published: February 2006

Although the construct of comfort has been analysed, diagrammed in a two‐dimensional content map, and operationalized as a holistic outcome, it has not been conceptualized within the context of a broader theory for the discipline of nursing. The theoretical work presented here utilizes an intra‐actional perspective to develop a theory of comfort as a positive outcome of nursing case. A model of human press is the framework within which comfort is related to (a) interventions that enhance the state of comfort and (b) desirable subsequent outcomes of nursing care. The paper concludes with a discussion about the theory of comfort as a significant one for the discipline of nursing.
A comparison of hospital‐ and community‐based mental health nurses: perceptions of their work environment and psychological health
Authors: Fielding John , Weaver Susan M.
Published: February 2006

This study compares hospital‐ (n=67) and community‐based (n=55) mental health nurses in relation to their perceptions of the work environment and also their psychological health. Measures include: the General Health Questionnaire, the Maslach Burnout Inventory and the Work Environment Scale. The data, obtained from self‐returned questionnaires, show that community nurses rated their work environments higher for the dimensions of Involvement, Supervisor Support, Autonomy, Innovation and Work Pressure. Hospital nurses saw their environments as being higher in (managerial) Control. There were no differences between the groups for the dimensions of Peer Cohesion, Task Orientation, Clarity or (physical) Comfort. Furthermore, there were no overall differences between the two groups in relation to psychological health, although the pattern of factors associated with emotional well‐being differed. Finally, analyses of the Community data revealed that those nurses with ‘flexitime’ arrangements evaluated their work environments less positively and showed higher levels of psychological strain than did those working ‘fixed‐time’ schedules. The findings suggest that the hospital and community environments make different demands on nursing staff, and that this should be considered when organizing nursing services if stress is to be avoided.
Metaphor in illness and nursing: a two‐edged sword. A discussion of the social use of metaphor in everyday language, and implications of nursing and nursing education
Authors: Czechmeister Catherine A.
Published: February 2006

Study of the use of language, and in particular metaphor, is a valuable approach to an understanding of the experiential, lived world of the patient. There is an emerging focus on the need for nursing care to be informed by an appreciation of the experience of the phenomena of illness and patient hood. Related nursing epistemological issues are discussed as background. The anatomy and social use of metaphor in language in general are described. The metaphors surrounding cancer are examined to illustrate the two main functions of metaphor; the instrumental and the expressive. Illness metaphors may have negative consequences, imbibing myth, fear and stigma. However, the author concludes that awareness of the expressive function of metaphor provides a valuable focus for listening to and understanding the experience of the patient. Finally, some of the implications of both functions of metaphor in nurse education are outlined.
Nursing faculty practice: benefits vs costs
Authors: Budden Lea
Published: February 2006

The transfer of nurse education from the hospital setting to the university sector has increased the dichotomy between theory and practice. Nurse academics have been exploring methods of maintaining clinical competence and credibility through organizational structures such as faculty practice. Faculty practice is a formal arrangement which exists between a clinical setting and a university which allows nurse academics to consult and deliver client care resulting in research and scholarly outcomes. The most important advantage of faculty practice is its potential to contribute to nursing knowledge and validate theories through the use of reflective practice and professional Journalling by nurse academics which can help demystify and analyse the intricate elements of nursing. Other advantages of faculty practice are described as improving student's learning and client care through the application of an advanced knowledge base and facilitation by a faculty member. It also facilitates communication with clinical staff and assists in the professional development of nurse academics. The major barriers which need to be addressed to facilitate faculty practice are the allocation of time in the nurse academic's workload which incorporates consultation and faculty administrative support and the recognition of promotion and tenure process of universities.
An investigation into food preferences and the neural basis of food‐related incentive motivation in Prader–Willi syndrome
Authors: Hinton E. C. , Holland A. J. , Gellatly M. S. N. , Soni S. , Owen A. M.
Published: February 2006

Background  Research into the excessive eating behaviour associated with Prader–Willi syndrome (PWS) to date has focused on homeostatic and behavioural investigations. The aim of this study was to examine the role of the reward system in such eating behaviour, in terms of both the pattern of food preferences and the neural substrates of incentive in the amygdala and orbitofrontal cortex (OFC).

Method  Participants with PWS (n = 18) were given a food preference interview to examine food preferences and to inform the food‐related incentive task to be conducted during the neuroimaging. Thirteen individuals with PWS took part in the positron emission tomography (PET) study, the design of which was based on a previous study of non‐obese, non‐PWS controls. For the task, participants were asked to consider photographs of food and to choose the food they would most like to eat in two conditions, one of high and one of low incentive foods, tailored to each participant’s preferences. For comparison of the food preference data, 12 non‐PWS individuals were given one part of the interview.

Results  Individuals with PWS expressed relative liking of different foods and showed preferences that were consistent over time, particularly for sweet foods. The participants with PWS did give the foods in the high incentive condition a significantly higher incentive value than the foods in the low incentive condition. However, activation of the amygdala and medial OFC was not associated with the prospect of highly valued foods as predicted in those with PWS.

Conclusions  It would appear that incentive motivation alone plays a less powerful role in individuals with PWS than in those without the syndrome. This is likely to be due to the overriding intrinsic drive to eat because of a lack of satiety in those with PWS, and the impact of this on activity in the incentive processing regions of the brain. Activity in such reward areas may not then function to guide behaviour selectively towards the consumption of high preference foods.
A hundred years of cascading – started by Paul Morawitz (1879–1936), a pioneer of haemostasis and of transfusion
Authors: Boulton F.
Published: February 2006

summary.  Morawitz is mainly remembered for clarifying the role of prothrombin in clotting, but his mature years saw him guide advances in transfusion therapy. He was among the first to describe haemolytic transfusion reactions and to advocate using blood anticoagulated by citrate. He was a talented organiser – founding the Leipzig Donor Centre during increasingly difficult economic and political times. An excellent general physician, his interest in clotting led to clinical work in thrombosis and angina, and the use of quinidine for cardiac dysfunction. Ironically he died of acute myocardial infarction two years after his first attack of angina and coronary thrombosis.
Assessment of the economic value of the INTERCEPT blood system in Belgium
Authors: Moeremans K. , Warie H. , Annemans L.
Published: February 2006

summary.  Emerging pathogens continue to threaten blood safety, requiring novel safety approaches. INTERCEPT Blood System for platelets (IBSP) inactivates pathogens, aiming at eliminating the risk of transmitting current and emerging pathogens. The objective was to evaluate the incremental cost‐effectiveness ratio (ICER) for IBSP in Belgium.

A decision model comparing a ‘world with IBSP’ to a ‘world without IBSP’ calculates lifetime costs and ‘quality adjusted life years’ (QALYs) following platelet transfusion in different indications. Disease‐specific life expectancy and consequences of transfusion‐transmitted infections were obtained from literature. Transfusion safety and costs were obtained from official sources. Hepatitis C virus‐like emerging pathogen was simulated.

A wide range of ICERs was observed, highly sensitive to the risk of emerging pathogen trans‐ mission, underlying disease and age. In the most conservative approach, ICER ranged from 3,459,201€/QALY in absence of emerging pathogen to 195,364€/QALY. The mean threshold of emerging infection risk for IBSP dominance (saving money and producing health gains) ranged from 1/1,079 to 1/2,858 transfusions.

Considering the high value authorities appear to place on preventing accidental injury, and ICER of recent implementations in transfusion medicine (NAT: up to €2·3 million per lifeyear), IBSP can be considered cost‐effective, taking into account the potential risk of emerging pathogens.
A multistate cluster of red blood cell transfusion reactions associated with use of a leucocyte reduction filter
Authors: Alvarado‐Ramy F. , Kuehnert M. J. , Alonso‐Echanove J. , Sledge L. , Haley N. R. , Epstein J. , Vostal J. , Pearson M.
Published: February 2006

summary.  In 2000, the American Red Cross (ARC) received reports of unusual transfusion reactions of unknown aetiology among patients receiving leucocyte‐reduced (LR) red blood cell (RBC) units in multiple distribution regions.

We evaluated potential risk factors of reactions among patients who received LR‐RBC transfusions. A case–patient was defined as any patient with onset of back pain while receiving an LR‐RBC transfusion from 1 January to 25 May 2000. Controls were chosen randomly and selected in a 1:3 case : control ratio from healthcare facilities in which case–patients were transfused. Product‐specific risk factors of reactions were further determined through nested case–control study, procedural review of blood collection facility and quality‐control‐testing record review of product processing. Reaction incidence rates were determined through ARC blood product distribution data by region of blood collection and processing.

There were 29 reactions detected in patients who received transfusions in 13 healthcare facilities in five states. Eighteen case–patients and 78 controls were included in the case–control study. In univariate analysis, case–patients were more likely than controls to have a haematologic malignancy, to have received the transfusion as an outpatient, to have received an RBC transfusion within the previous 3 months, to have received medication used to prevent reactions or to diminish their intensity upon transfusion (i.e. premedication) or to have received LR‐RBC units prepared with the HemaSure r\LS System™ (HS) rather than two other filters used. In multivariate analysis limited to recipients of HS‐filtered RBC units, transfusion premedication [adjusted odds ratio (AOR) = 7; 95% confidence interval (CI) 1·4–37; P = 0·02] and transfusion as an outpatient (AOR = 5; 95% CI 1·1–20; P = 0·03) were independently associated with reactions. The rate of reported transfusion reactions was 2·0 reactions per 10 000 RBC units distributed.

A multistate cluster of transfusion reactions was significantly associated with leucocyte filtration of RBC units prepared with a specific product, the HS filter. The reactions also were independently associated with premedication and transfusion as an outpatient; these may be surrogates for an increased risk of reaction or for greater likelihood of detection. The mechanism for these reactions has not been elucidated. This cluster of reactions underscores the importance of surveillance efforts to detect adverse events after transfusion, particularly when new methods to modify blood products are introduced.
The Onset of Song Learning and Song Tutor Selection in Fledgling Zebra Finches
Authors: Roper Annabelle , Zann Richard
Published: February 2006

We investigated song development in the pre‐independent zebra finch (aged 15–35 d), a period when neural pathways for song learning and production are forming and social influences outside the family are limited. Expt 1 investigated the onset and the minimum duration of tutoring needed for song learning in fledglings. We found most begin to learn song from 25 d of age and need about 10 d contact with the father tutor to make accurate copies. This onset corresponds with major developments in the formation of the neural circuitry implicated in song acquisition. Subsong also begins on day 25 suggesting that the sensory and motor phases of song learning fully overlap in the zebra finch. Our findings support the hypothesis that the song circuitry is fully functional by 35 d of age and the sensitive phase for zebra finches extends therefore from about days 25–65. However, only the first 10 d of this period are necessary to learn a tutor's song with fair accuracy. Expt 2 investigated the role of the paternal bond, spatial proximity and mating status in a fledgling's choice of song tutor where the father was the sole parent. Young chose the father over single unrelated males (expt 2a) or unrelated males in company with their female partners (expt 2b). Given the close spatial proximity of both potential tutors to the fledglings it is probably the filial bond, established via paternal care that is the cause of this preference. Zebra finches sing the same song phrase in two contrasting contexts: female‐directed song during pre‐copulatory courtship and undirected song where no female or display is involved. In expt 3 we tested the song learning preference of pre‐independent young for two categories of non‐paternal tutors: those singing predominantly female‐directed song and those singing exclusively undirected song. There was a small, but significant, preference for fledgling zebra finches to copy songs from males that sang female‐directed song. This preference is consistent with the hypothesis that young males not only learn the acoustic features of their tutor's song but also the visual and dynamic movements that constitute the courtship display.
Maternal Condition Affects the Offspring Testosterone Concentration in Early Nestling Period: An Experimental Test on Tawny Owls
Authors: Sasvári Lajos , Hegyi Zoltán , Péczely Péter
Published: February 2006

This study addressed the question of whether maternal condition during egg laying or the rearing environment has a greater effect on offspring testosterone levels. We tested this in field experiments on a population of tawny owls Strix aluco in Duna‐Ipoly National Park, Hungary. In the experiments with females of poor condition, when broods were supplied with extra food none of the nestlings died, whereas in control broods, which were not supplied with extra food, some nestlings did die. Large differences in testosterone levels were correlated positively with hatching order both in experimental and control broods. However, it was only in control broods that the later‐hatched nestlings with low testosterone concentrations, died. In the experiments with females of good condition, the males were removed and females and their broods were supplied with restricted amounts of food. In these broods starving nestlings, whose growth had stopped, were considered as having died and were removed from the nest and hand‐reared. In control broods all nestlings fledged, and both in experimental and control broods testosterone concentrations were more even between siblings. Both types of trials confirmed a maternal influence on offspring testosterone concentration: large between‐sibling differences in concentrations in the broods of females of poor condition, where some nestlings died, could not be reduced with increased food supply, and the more even concentrations in the broods of females in good condition, where all nestlings survived, could also not be increased by restricting the food supply.
Role of Helicobacter pylori virulence factor and genotypes in non‐ulcer dyspepsia¶
Authors: TAN HUCK JOO , RIZAL ABDUL MANAF , ROSMADI MOHAMED‐YUSOFF , GOH KHEAN‐LEE
Published: February 2006

Background and Aim:  The role of Helicobacter pylori (HP) in non‐ulcer dyspepsia is debatable. Eradicating HP will help a small group of non‐ulcer dyspeptic patients. However, it is unclear which subgroup of patients will benefit from eradication therapy. The aim of the present study was to compare the cagA and cagE status, as well as vacA genotypes, of HP in non‐ulcer dyspeptic patients who responded successfully to eradication therapy compared with those patients who did not.

Methods:  Consecutive patients with moderate to severe (Likert 2 or 3) non‐ulcer dyspepsia with HP were recruited prospectively. Gastric biopsies were taken, DNA extracted and polymerase chain reaction performed to determine the cagA and cagE status and vacA alleles. Eradication therapy was offered until HP was eradicated successfully. The HP status was checked 1 month after eradication therapy using the [13C]‐urea breath test. All patients were assessed by one interviewer using Gastrointestinal Symptom Rating Scale (GSRS), a four‐point Likert scale, and SF‐36 for quality of life over 12 months. Treatment success was defined as minimal or no symptoms (Likert 1 or 0). The cagA, cagE and vacA status was blinded to the investigators until completion of the study.

Results:  Seventy‐three patients (36 males, 37 females) were recruited to the study. The mean ± SD patient age was 53.38 ± 12.09 years. When the 36 patients who improved (group A) were compared with the 37 (group B) who did not, no significant difference was found in the cagE positive rate (55.6 vs 43.2%, respectively; P = 0.638), cagA positive rate (83.1 vs 73.0%, respectively; P = 0.247), vacA m1 versus m2 subtype (84.0 vs 55.6%, respectively; P = 0.472) or vacA s1a versus s1c (39.4 vs 57.1%, respectively; P = 0.166). There was also no significant difference noted in the SF‐36 scores between the two groups after the conclusion of eradication therapy.

Conclusions:  Stratification of HP genotypes and virulence factor has no significant impact on the treatment success of non‐ulcer dyspepsia.
γδ T cells increase with gastric mucosal interleukin (IL)‐7, IL‐1β, and Helicobacter pylori urease specific immunoglobulin levels via CCR2 upregulation in Helicobacter pylori gastritis
Authors: FUTAGAMI SEIJI , HIRATSUKA TETSURO , SUZUKI KENJI , KUSUNOKI MASANORI , WADA KEN , MIYAKE KAZUMASA , OHASHI KAZUSHI , SHIMIZU MASUMI , TAKAHASHI HIDEMI , GUDIS KATYA , KATO SHUNJI , TSUKUI TAKU , SAKAMOTO CHOITSU
Published: February 2006

Background and Aims:  The purpose of this study was to investigate possible factors that could impact on γδ T cell accumulation in the gastric mucosa.

Method:  Subjects were 22 Helicobacter pylori (H. pylori)‐free and 75 H. pylori‐infected mucosa biopsies classified into grades I∼III gastritis as per our previous study. The number of γδ‐ and 45 RO‐positive T cells were determined by immunostaining. Gastric mucosal anti‐H. pylori urease specific antibodies and interleukin (IL)‐1β, IL‐2, 4, 7, 10 and IL‐12 levels were assayed by enzyme‐linked immunosorbent assay (ELISA). CC chemokine receptor 2 (CCR2) expression levels, migration, and cytokine production in γδ T cells stimulated by H. pylori urease were also evaluated.

Results:  The γδ T cell count was significantly higher in grade III gastritis which exhibits strong immunoglobulin (Ig)A and IgG responses to H. pylori urease with lymphoid follicles than in other groups. γδ T cell count was significantly correlated with IL‐1β and interleukin‐7 (IL‐7) levels in the gastric mucosa. H. pylori urease immunoreactivity was detected in lamina propria of grade III gastritis, along with many γδ T cells. After H. pylori eradication therapy, the γδ T cell count in grade III gastritis significantly decreased. H. pylori urease stimulated significant increases in CCR2 expression levels, although to a lesser degree than those induced by IL‐7 stimulation in both peripheral and mucosal γδ T cells. Interferon (IFN)‐γ and IL‐10 production was also stimulated by H. pylori urease in peripheral γδ T cells.

Conclusions:  Gastric mucosal increases in IL‐7 and IL‐1β closely corresponded to the accumulation of γδ T cells in gastric mucosa. An association was also seen between γδ T cell accumulation and H. pylori urease‐specific Ig levels.
Antiproliferative effects of 5‐fluorouracil and interferon‐alpha in combination on a hepatocellular carcinoma cell line in vitro and in vivo
Authors: KOJIRO SAKIKO , YANO HIROHISA , OGASAWARA SACHIKO , MOMOSAKI SEIYA , TAKEMOTO YUMI , NISHIDA NAOYO , KOJIRO MASAMICHI
Published: February 2006

Background and Aim:  We investigated the antiproliferative effects of interferon‐alpha (IFN‐α) and 5‐fluorouracil (5‐FU) in combination on a hepatocellular carcinoma (HCC) cell line.

Method:  In the in vitro study, IFN‐α and/or 5‐FU was added to the culture of the poorly differentiated‐type HCC cell line, HAK‐1B, and their antiproliferative effects and additional or synergic effects in combination treatment were examined. In the in vivo study, HAK‐1B cells were transplanted into nude mice and the changes in tumor volume and weight, apoptosis, BrdU and cyclin A positive cells, and artery‐like blood vessels were investigated. Expressions of angiogenesis factors and IFN‐α receptor (IFNAR‐2) were examined in the developed tumors.

Results:  In vitro growth of HAK‐1B cells was suppressed dose‐dependently to 5‐FU, but the addition of IFN‐α did not induce additional or synergic effects. In vivo growth in terms of tumor diameter and weight was suppressed at most in the IFN‐α + 5‐FU (combination) group, that is, the tumor volume became 29.3% and the tumor weight became 54.7% of the control. In the combination group, numbers of BrdU‐positive S‐phase cells and cyclin A positive cells increased together with the increase in apoptotic cells, but there was no significant relation between the tumor shrinkage effects and angiogenesis factors or artery‐like blood vessels. In the combination group, INFAR‐2 decreased significantly in comparison to the other groups.

Conclusion:  The synergic growth‐suppression effects in the current in vivo study using the combination treatment are attributable to the enhanced induction of S‐phase arrest and of apoptosis.
Polymorphism of CD14 gene but not the mutation of TLR4 gene is associated with colorectal cancer in Chinese patients
Authors: GUO QIUSHA , ZHU JIANBO , XIA BING
Published: February 2006

Objectives:  Toll‐like receptor 4 and CD14 are components of the lipopolysaccharide receptor complex. Our study aimed to investigate an association between TLR4 Asp299Gly and CD14‐260 polymorphisms in Chinese patients with colorectal cancer.

Method:  By a method of polymerase chain reaction–based restriction fragment length polymorphism (PCR‐RFLP), we genotyped TLR4 Asp299Gly and CD14‐260 polymorphisms in 110 unrelated patients with colorectal cancer and 160 healthy controls from the Chinese Han population.

Results:  We found significant differences in CD14 genotypes between healthy controls and patients with colorectal cancer. The frequency of the C/C genotype in healthy controls (15.6%) was significantly lower than in the group of colorectal cancer patients (32%). The frequency of the C/T genotype in healthy controls (48.1%) was significantly higher than that in the group of colorectal cancer patients (31%). No TLR4 Asp299Gly mutation was detected in any patients or healthy controls in the Chinese Han population.

Conclusions:  These findings indicated that the polymorphism of CD14 but not TLR4 Asp299Gly mutation was associated with Chinese patients with colorectal cancer, and the CD14 gene may contribute to the predisposition to colorectal cancer. Screening for the CD14 C‐260T genotype is likely to be a useful tool for risk assessment or prognostication for colorectal cancer in the Chinese Han population.
Biliary excretion of sulfated bile acids and organic anions in zone 1‐ and zone 3‐injured rats
Authors: SASAMOTO TAKAHIRO , SANO NAOYO , TAKIKAWA HAJIME
Published: February 2006

Background and Aims:  There are several reports on the biliary excretion of bile acids and organic anions in zone 1‐ and zone 3‐injured rat liver, but the results are controversial. In order to dissolve the discrepancy between previous works about the role of hepatic zonation on the hepatic handling of the substrates of multidrug resistance protein 2, the biliary excretion of sulfated bile acids, pravastatin and phenolphthalein glucuronide was studied in zone 1‐ and zone 3‐injured rats.

Methods:  Zone 1 and zone 3 injury were caused by allyl alcohol and bromobenzene, respectively. Bile acid sulfates, pravastatin and phenolphthalein glucuronide were administered i.v. to bile duct‐cannulated rats, and their biliary excretion was studied.

Results:  The biliary excretion of a tracer dose of taurolithocholate‐3‐sulfate and its excretory maximum were unchanged in zone 1 injury, but were diminished in zone 3 injury, whereas the biliary excretion of taurochenodeoxycholate‐3‐sulfate was unchanged in zone 1 and zone 3 injury. The biliary excretion of pravastatin and phenolphthalein glucuronide was markedly decreased only in zone 3 injury, whereas the excretory maximum of phenolphthalein glucuronide was decreased in both zone 1 and zone 3 injury.

Conclusions:  These findings indicate that zone 3 is important for the biliary excretion of substrates of multidrug resistance protein 2.
Rodent nutritional model of steatohepatitis: Effects of endotoxin (lipopolysaccharide) and tumor necrosis factor alpha deficiency
Authors: KIRSCH RICHARD , CLARKSON VIVIAN , VERDONK ROBERT C , MARAIS ADRIAN D , SHEPHARD ENID G , RYFFEL BERNARD , DE LA M HALL PAULINE
Published: February 2006

Background and Aims:  Intestinal endotoxin (lipopolysaccharide) is thought to contribute to liver injury in both alcoholic and nonalcoholic steatohepatitis (NASH). Tumor necrosis factor alpha (TNFα) is an important mediator of this process and is considered central to the inflammatory response in NASH. This study aimed to investigate the effects of lipopolysaccharide on liver injury in the methionine choline deficient (MCD) nutritional model of NASH, and to determine if TNFα is required for the development of steatohepatitis in this model.

Method:  Male C57/BL6 mice received a MCD diet for 4 weeks, whilst a control group received an identical diet supplemented with 0.2% choline bitartrate and 0.3% methionine. At 4 weeks, mice received either an intraperitoneal injection of lipopolysaccharide (0.5 µg/g body mass) or sterile saline, and were killed 24 h thereafter. In a separate study, TNFα knockout and wild type C57BL/6 mice received either MCD or control diets for 4 weeks. Serum transaminase levels, liver histology (steatosis, inflammation and apoptosis), hepatic triglyceride concentration and hepatic lipid peroxidation products (conjugated dienes, lipid hydroperoxides and thiobarbituric reactive substances, free and total) were evaluated.

Results:  Intraperitoneal administration of lipopolysaccharide augmented serum alanine aminotransferase (ALT) levels (P < 0.02), hepatic inflammation (P < 0.025), apoptosis (P < 0.01) and free thiobarbituric acid reactive substances (P < 0.025) in MCD mice. TNFα knockout mice fed the MCD diet developed steatohepatitis with histological and biochemical changes similar to those seen in wild type counterparts.

Conclusions:  Lipopolysaccharide augments liver injury in MCD mice, and TNFα is not required for the development of steatohepatitis in MCD mice.
Long‐term prognosis of nonalcoholic fatty liver disease: Is pharmacological therapy actually necessary?
Authors: CINAR KUBILAY , COBAN SAHIN , IDILMAN RAMAZAN , TUZUN ALI , SARIOGLU MUSTAFA , BEKTAS MEHMET , ERDEN ESRA , BOZKAYA HAKAN , OZDEN ALI
Published: February 2006

Background and Aim:  Nonalcoholic fatty liver disease (NAFLD) comprises a wide spectrum of liver injury, ranging from steatosis and steatohepatitis to cirrhosis. Reasons for the different natural course in individuals with NAFLD are still unclear. The aim of this study was to describe the natural course of disease in individuals with NAFLD who did not receive pharmacological therapy.

Methods:  A total of 27 individuals with NAFLD (male/female ratio: 10/17, mean age 49.7 years) were prospectively enrolled. Management after diagnosis consisted of establishment of an appropriate diet and exercise (walking and jogging) program, treatment of associated metabolic conditions such as diabetes and dyslipidemia, and discontinuation of potentially hepatotoxic drugs if the patient was taking these. Liver tests were performed at diagnosis and at 3‐month intervals during the follow‐up period. Mean follow‐up period was 43.3 months (range 36–49 months).

Results:  From baseline to the end of the follow‐up period, although there was no significant difference observed in terms of the mean body mass index, serum aminotransferase levels significantly improved (48.8 ± 29.9 U/L to 31.6 ± 16.0 U/L for aspartate aminotransferase [AST] and 66.3 ± 38.3 U/L to 39.6 ± 22.9 U/L for alanine aminotransferase [ALT]; P < 0.05). No significant differences in platelet counts, serum albumin level or prothrombin time were observed (P > 0.05). No patient developed signs of advanced liver disease during the follow‐up period.

Conclusion:  A treatment strategy comprising diet, exercise and management of associated metabolic conditions is associated with improvement in aminotransferases among patients with NAFLD. Further investigation is needed to examine the long‐term efficacy of this approach on liver histology and clinical outcomes.
Effect of exercise and dietary modification on serum aminotransferase levels in patients with nonalcoholic steatohepatitis
Authors: BABA CHALAMALASETTY SREENIVASA , ALEXANDER GEORGE , KALYANI BIKKASANI , PANDEY RAKESH , RASTOGI SUJATA , PANDEY AMARESH , CHOUDHURI GOURDAS
Published: February 2006

Background: Nonalcoholic steatohepatitis (NASH) is commonly associated with overweight and insulin resistance. Aerobic exercise is known to reduce insulin resistance. We studied the effect of regular aerobic exercise on serum aminotransferase levels in patients with NASH.

Methods: Sixty‐five (mean age 38.7 ± 9.5 years; 46 [78%] males) out of 94 patients diagnosed with NASH participated in the study. Each patient was advised regular aerobic exercise for 30 min duration per day, and trained to achieve a heart rate of 60–70% of his/her maximal heart rate for at least 5 days a week. In addition, those with a high body mass index (BMI) were advised a moderately energy‐restricted diet. Patients were followed up monthly for at least 3 months by BMI, waist‐hip ratio (WHR), waist circumference (WC), aspartate aminotransferase (AST) and alanine aminotransferase (ALT).

Results: Forty‐three (72.8%) patients had a high BMI. Central obesity (WHR ≥0.90 cm in men and ≥0.85 cm in women) was present in 58 (98.3%) patients and metabolic syndrome in 12 (20.3%) patients. In the 44 patients who complied regularly with the exercise program, serum ALT normalized in 20 (45%;P < 0.05), and mean AST and ALT values declined from 70.5 and 104.0–41.5 (P < 0.001) and 63.2 (P < 0.001), respectively. Overweight patients lost a mean 3.1 kg (range 0–13 kg) weight and showed a decline in BMI (28.7vs27.5;P < 0.001) and WC (99.4 cmvs96.1 cm;P = 0.001). Serum ALT did not normalize in any of the 15 patients who failed to comply with the exercise program; their pre‐ and post‐AST (82.8 and 81.2, respectively) and ALT (98.0 and 96.1, respectively) levels, BMI (27.5 and 27.6, respectively) and WHR (0.99 cm and 0.99 cm, respectively) did not show any significant change at 3 months, and also for an extended mean follow‐up period of 5.3 months.

Conclusion: Moderate intensity aerobic exercise helps in normalizing ALT levels in patients with NASH.
Effects of Helicobacter pylori eradication therapy on gastric emptying measured using the 13C‐octanoic acid breath test and the acetaminophen method
Authors: Kachi Masaaki , Shirasaka Daisuke , Aoyama Nobuo , Ebara Shigeyuki , Miki Ikuya , Morita Yoshinori , Tamura Takao , Kasuga Masato
Published: February 2006

Background:  The relationship between Helicobacter pylori eradication and gastric emptying has been reported; however, the effect of eradication therapy on gastric emptying is still unclear. This study evaluated the relationship between three gastric emptying techniques, the scintigraphic technique, the 13C‐octanoic acid breath test, and the acetaminophen method, measured simultaneously, and the effect of H. pylori eradication therapy on gastric emptying and abdominal symptoms in patients with functional dyspepsia who were H. pylori positive.

Methods:  Fifty‐three consecutive patients with positive H. pylori infection were enrolled in this study. In the first 14 patients, gastric emptying was measured using the three gastric emptying techniques. In 42 patients cured of H. pylori infection, the 13C‐octanoic acid breath test and the acetaminophen method were performed before and 3 months after eradication.

Results:  Significant correlations were found between the scintigraphic technique, the 13C‐octanoic acid breath test, and the acetaminophen method. Gastric emptying determined by the 13C‐octanoic acid breath test and the acetaminophen method was not changed after eradication, on average. In 14 (33.3%) patients a decrease in symptom score after eradication was observed. In four (9.5%) patients, accelerated gastric emptying after eradication may have led to a reduction in the abdominal symptoms.

Conclusions:  The 13C‐octanoic acid breath test and the acetaminophen method are appropriate for investigating gastric emptying. A causal relationship between improvement of symptoms and accelerated gastric emptying was not found, and the efficacy of H. pylori eradication therapy in patients with functional dyspepsia was minimally exhibited.
Incidence, impact on the family and cost of gastroenteritis among 4 to 6‐year‐old children in South Australia
Authors: Heyworth Jane S , Jardine Andrew , Glonek Gary , Maynard Edward J
Published: February 2006

Background:  Gastroenteritis is an important cause of morbidity in both adults and children worldwide. Although the burden of morbidity and mortality is highest in developing countries, gastroenteritis is still a significant cause of morbidity in Australia, particularly in young children. The aims of the present study were to determine the incidence of gastroenteritis among 4–6‐year‐old children in South Australia, to describe the impact on daily activities of the child and caregiver and estimate the cost of gastroenteritis in this population.

Methods:  A diary study of drinking water consumption and gastrointestinal and respiratory symptoms was undertaken among 965 rural children in South Australia over a 6‐week period during February–May 1999. Data on the response to gastrointestinal episodes were collected by telephone surveys midway and at the end of the 6‐week period. Costing was based on the methods of Hellard et al.

Results:  The incidence of community gastroenteritis among 4–6‐year‐old children was 5.53 episodes per child‐year (95% confidence interval: 4.87–5.80). The costs associated with childhood gastroenteritis were estimated to be between $AU16 858 360 and $AU22 477 814 per annum.

Conclusions:  The incidence of community gastroenteritis among the 4–6‐year‐olds in the South Australian population is high and it costs the community a significant amount of money in terms of direct medical costs and time lost by parents and carers looking after their ill children.
Clinical study of 31 patients with primary gastric mucosa‐associated lymphoid tissue lymphoma
Authors: Hu Chuangying , Yi Cuiqiong , Dai Xiaobo
Published: February 2006

Background:  The purpose of the present paper was to investigate the clinical, endoscopic and histological features of 31 patients with gastric mucosa‐associated lymphoid tissue (MALT) lymphoma to enable correct, early stage diagnosis.

Methods:  A retrospective study was undertaken of 31 patients with gastric MALT lymphoma. The cases were examined immunohistologically with anti‐CD20CY and CD45RO antibodies for further diagnosis. Helicobacter pylori infection was also detected with modified Giemsa staining.

Results:  Patients with MALT lymphoma were aged between 22 and 73 years (mean, 45.0 years), and the male : female ratio was 11:20. The patients presented with non‐specific symptoms, but chronic epigastric pain was the common symptom in a large proportion of the cases. The gastric smaller curvature was involved in 83.9% of cases (26/31) and in 13/31 cases (41.9%) it was confined the antrum. Under endoscopy, large and deep ulcers were similar to cancers in the majority of patients. Only 29.0% of patients were diagnosed by endoscopy on first examination. CD20CY were expressed in all cases and CD45RO expressed in only one case among 10 cases of indefinite diagnosis. Helicobacter pylori infection was found in 87.1% of patients.

Conclusions:  These findings suggest that primary gastric MALT lymphoma has unique clinical, endoscopic and histological features. The diagnosis for primary gastric MALT lymphoma was delayed not only due to the non‐specific symptoms but also due to lack of attention to its features. Endoscopy and submucosal multiple biopsy were the principal diagnostic tools in patients with gastric MALT lymphoma. CD20CY and CD45RO immunological staining are recommended, especially for patients with indefinite diagnosis of gastric MALT lymphoma.