bluuebunny/crossref_metadata_2025 huggingface dataset:
The social production of hepatitis C risk among injecting drug users: a qualitative synthesis
Authors: Rhodes Tim , Treloar Carla
Published: September 2008

Background  Intervention impact on reductions in hepatitis C virus (HCV) incidence among injecting drug users (IDUs) are modest. There is a need to explore how drug injectors' interpret HCV risk.

Aims  To review English‐language qualitative empirical studies of HCV risk among IDUs.

Methods  Qualitative synthesis using a meta‐ethnographic approach. Searching of eight electronic databases and reference lists identified manually papers in peer‐reviewed journals since 2000. Only studies investigating IDU perspectives on HCV risk were included. Themes across studies were identified systematically and compared, leading to a synthesis of second‐ and third‐order constructs.

Findings  We included 31 papers, representing 24 studies among over 1000 IDUs. Seven themes were generated: risk ubiquity; relative viral risk; knowledge uncertainty; hygiene and the body; trust and intimacy; risk environment; and the individualization of risk responsibility. Evidence supports a perception of HCV as a risk accepted rather than avoided. HCV was perceived largely as socially accommodated and expected, and in relative terms to human immunodeficiency virus (HIV) as the ‘master status’ of viral dangers. Symbolic knowledge systems, rather than biomedical risk calculus, and especially narratives of hygiene and trust, played a primary role in shaping interpretations of HCV risk. Critical factors in the risk environment included policing, homelessness and gendered risk.

Conclusions  Appealing to risk calculus alone is insufficient. Interventions should build upon the salience of hygiene and trust narratives in HCV risk rationality, and foster community changes towards the perceived preventability of HCV. Structural interventions in harm reduction should target policing, homelessness and gendered risk.
Blood pressure reduction during treatment for alcohol dependence: results from the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study
Authors: Stewart Scott H. , Latham Patricia K. , Miller Peter M. , Randall Patrick , Anton Raymond F.
Published: September 2008

Aims  Heavy drinking is associated with hypertension. This study evaluated blood pressure changes occurring during treatment for alcohol dependence.

Participants  Subjects included 1383 people participating in the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study, a large multi‐center treatment study for alcohol dependence.

Measurements  Methods appropriate for repeated‐measures data were used to assess the relationship of percentage of drinking days (PDD) to systolic and diastolic blood pressure over a 16‐week treatment period. Modification of these associations by demographic and other variables was assessed.

Findings  Blood pressure reduction was evident only in people who were above the median blood pressure at baseline. In this group, systolic blood pressure decreased by an average of 12 mmHg and diastolic blood pressure decreased by an average of 8 mmHg. Blood pressure reduction occurred during the first month of treatment. This effect was similar regardless of age, sex, body mass index, reported history of hypertension and use of anti‐hypertensive medications. An observed association between blood pressure and PDD in Caucasians was not evident in African Americans due largely to their lower pre‐treatment blood pressure.

Conclusions  Reduction in alcohol consumption has a potent anti‐hypertensive effect in alcoholics with higher blood pressure. For hypertensive, alcohol‐dependent people, treatment for alcoholism should be considered a major component of anti‐hypertensive therapy.
Density of alcohol outlets and teenage drinking: living in an alcogenic environment is associated with higher consumption in a metropolitan setting
Authors: Huckle Taisia , Huakau John , Sweetsur Paul , Huisman Otto , Casswell Sally
Published: September 2008

Aim  This study examines the relationship between physical, socio‐economic and social environments and alcohol consumption and drunkenness among a general population sample of drinkers aged 12–17 years.

Design, setting, participants and measures  The study was conducted in Auckland, New Zealand. The design comprised two components: (i) environmental measures including alcohol outlet density, locality‐based measure of willingness to sell alcohol (derived from purchase surveys of outlets) and a locality‐based neighbourhood deprivation measure calculated routinely in New Zealand (known as NZDEP); and (ii) the second component was a random telephone survey to collect individual‐level information from respondents aged 12–17 years including ethnicity, frequency of alcohol supplied socially (by parents, friends and others), young person's income; frequency of exposure to alcohol advertising; recall of brands of alcohol and self‐reported purchase from alcohol outlets. A multi‐level model was fitted to predict typical‐occasion quantity, frequency of drinking and drunkenness in drinkers aged 12–17 years.

Findings  Typical‐occasion quantity was predicted by: frequency of social supply (by parents, friends and others); ethnicity and outlet density; and self‐reported purchasing approached significance. NZDEP was correlated highly with outlet density so could not be analysed in the same model. In a separate model, NZDEP was associated with quantity consumed on a typical drinking occasion. Annual frequency was predicted by: frequency of social supply of alcohol, self‐reported purchasing from alcohol outlets and ethnicity. Feeling drunk was predicted by frequency of social supply of alcohol, self‐reported purchasing from alcohol outlets and ethnicity; outlet density approached significance. Age and gender also had effects in the models, but retailers' willingness to sell to underage patrons had no effects on consumption, nor did the advertising measures. The young person's income was influential on typical‐occasion quantity once deprivation was taken into account.

Conclusion  Alcohol outlet density was associated with quantities consumed among teenage drinkers in this study, as was neighbourhood deprivation. Supply by family, friends and others also predicted quantities consumed among underage drinkers and both social supply and self‐reported purchase were associated with frequency of drinking and drunkenness. The ethnic status of young people also had an effect on consumption.
Smokers' use of nicotine replacement therapy for reasons other than stopping smoking: findings from the ITC Four Country Survey
Authors: Hammond David , Reid Jessica L. , Driezen Pete , Cummings K. Michael , Borland Ron , Fong Geoffrey T. , McNeill Ann
Published: September 2008

Aims  To measure the prevalence and correlates of nicotine replacement therapy (NRT) use for reasons other than quitting smoking among smokers in four countries.

Design and setting  Population‐based, cross‐sectional telephone survey with nationally representative samples of adult smokers in Canada, the United States, the United Kingdom and Australia, conducted in 2005.

Participants  A total of 6532 adult daily smokers in Canada (n = 1660), the United States (n = 1664), the United Kingdom (n = 1617) and Australia (n = 1591).

Measurements  Survey questions included demographics, smoking behaviour, use of NRT and reasons for NRT use, as well as access and availability of NRT.

Findings  Approximately 17% of smokers surveyed had used NRT in the past year. Among NRT users, approximately one‐third used NRT for a reason other than quitting smoking, including temporary abstinence or reducing the number of cigarettes smoked. The prevalence of non‐standard NRT use was remarkably consistent across countries. Using NRT for reasons other than quitting was associated with higher education level, heavier smoking, having no quit intentions, having no past‐year quit attempts, the type of NRT product used and accessing NRT without a prescription.

Conclusions  The use of NRT for purposes other than quitting smoking is fairly common and may help to explain the difficulty in detecting significant quitting benefits associated with NRT use in population studies. Tobacco control policies, including the accessibility of NRT, may have important implications for patterns of NRT use.
Updated survival analyses after prolonged follow‐up of the phase 2, multicenter CREST study of bortezomib in relapsed or refractory multiple myeloma
Authors: Jagannath Sundar , Barlogie Bart , Berenson James R. , Siegel David S. , Irwin David , Richardson Paul G. , Niesvizky Ruben , Alexanian Raymond , Limentani Steven A. , Alsina Melissa , Esseltine Dixie‐Lee , Anderson Kenneth C.
Published: September 2008

The Clinical Response and Efficacy Study of Bortezomib in the Treatment of Relapsing Multiple Myeloma (CREST) demonstrated substantial activity with two dose levels of bortezomib (1·0 and 1·3 mg/m2), alone or with dexamethasone, in relapsed or refractory multiple myeloma. We present updated survival analyses after prolonged follow‐up (median >5 years). One‐ and 5‐year survival rates were 82% and 32%, respectively, in the 1·0 mg/m2 group (n = 28), and 81% and 45%, respectively, in the 1·3 mg/m2 group (n = 26). Notable survival, response, and time‐to‐progression data suggest that a bortezomib starting dose of 1·3 mg/m2 is preferred. If bortezomib dose reduction is required, the 1·0 mg/m2 dose still offers patients a substantial survival benefit.
Food habits and marine survival of juvenile Chinook and coho salmon from marine waters of Southeast Alaska
Authors: WEITKAMP LAURIE A. , STURDEVANT MOLLY V.
Published: September 2008

Little is known about the food habits of juvenile Chinook (Oncorhynchus tshawytscha) and coho (Oncorhynchus kisutch) salmon in marine environments of Alaska, or whether their diets may have contributed to extremely high marine survival rates for coho salmon from Southeast Alaska and much more modest survival rates for Southeast Alaskan Chinook salmon. To address these issues, we documented the spatial and temporal variability of diets of both species collected from marine waters of Southeast Alaska during summers of 1997–2000. Food habits were similar: major prey items of both species included fishes, crab larvae, hyperiid amphipods, insects, and euphausiids. Multivariate analyses of diet composition indicated that the most distinct groups were formed at the smallest spatial and temporal scales (the haul), although groups also formed at larger scales, such as by month or habitat type. Our expectations for how food habits would influence survival were only partially supported. As predicted, Southeast Alaskan coho salmon had more prey in their stomachs overall [1.8% of body weight (BW)] and proportionally far fewer empty stomachs (0.7%) than either Alaskan Chinook (1.4% BW, 5.1% empty) or coho salmon from other regions. However, contrary to our expectations, coho salmon diets contained surprisingly few fish (49% by weight). Apparently, Alaskan coho salmon achieved extremely high marine survival rates despite a diet consisting largely of small, less energetically‐efficient crustacean prey. Our results suggest that diet quantity (how much is eaten) rather than diet quality (what is eaten) is important to marine survival.
Microgeographic life history variation in an alpine caddisfly: plasticity in response to seasonal time constraints
Authors: SHAMA LISA N. S. , ROBINSON CHRISTOPHER T.
Published: September 2008

1. Temporally constrained environments, such as habitats with short growth seasons or short hydroperiods, cause potentially strong selection on life histories. Depending on the predictability of these events and the extent of spatial and temporal heterogeneity, local populations could become adapted either via a fixed phenotype or via life history plasticity in response to these environmental cues.

2. We used a common garden experiment to investigate microgeographic variation in life history responses to combined changes in photoperiod (ambient/late) and hydroperiod (constant/drying) time constraint cues in an alpine caddisfly (Trichoptera). We compared six populations (three permanent/three temporary streams) originating from a small, alpine floodplain and which spanned an expected gradient in growth period duration (GPD) with distance from glaciers.

3. We made two main predictions in relation to locally varying selection pressures: (i) populations nearest glaciers (shorter GPD and strongest time constraints) should have the fastest development rates and (ii) populations from permanent streams should be less able to respond to drying hydroperiods than populations from temporary streams.

4. All populations and both sexes accelerated development in response to late season photoperiod cues. However, only permanent stream populations showed an increase in development time with increasing GPD, suggesting that other factors were influencing populations in temporary streams.

5. Permanent stream populations showed countergradient variation (genetic and environmental influences were in opposition) in development time, and under‐compensation of growth rates resulted in a converse Bergmann cline in body size (smaller body size along gradients of declining season length). The extent of plasticity in response to hydroperiod, and the combined effects of both time constraints, differed between populations and sexes, but were not consistent among populations.

6. Taken together, our results suggest adaptive plasticity in response to season length. The lack of a predictable pattern in response to hydroperiod may be due to gene flow or weak selection. We conclude that spatially structured populations can strongly differ in phenotypic plasticity even at microgeographic scales.
Conservative physiotherapeutic management of chronic haematomata and haemophilic pseudotumours: case study and comparison to historical management
Authors: D’YOUNG A. I.
Published: September 2008

Summary.  A conservative, non‐operative physiotherapeutic regime for the management of chronic haematomata and pseudotumours in patients suffering from haemophilia is described in this article. Two cases are described where physiotherapy treatment is applied to large masses at the shoulder and femur respectively, where therapy commenced within the first 6 months following onset. These are presented relative to a case that was managed over a much longer period without early physiotherapy input, and the relative outcomes are examined. While both the early physiotherapy‐managed cases showed a complete resolution at follow‐up examination, the more established chronic pseudotumour required surgical excision, with significant residual muscle contractility, length and strength issues noted on clinical and magnetic resonance imaging reviews. No adverse symptoms or haemostatic issues were reported in response to this less invasive treatment regime by either patient in the two conservative physiotherapy cases.
Access to immunology through the Gene Ontology
Authors: Lovering Ruth C. , Camon Evelyn B. , Blake Judith A. , Diehl Alexander D.
Published: September 2008

The Gene Ontology (GO) is widely recognized as the premier tool for the organization and functional annotation of molecular aspects of cellular systems. However, for many immunologists the use of GO is a very foreign concept. Indeed, as a controlled vocabulary, GO can almost be considered a new language, and it can be difficult to appreciate the use and value of this approach for understanding the immune system. This review reflects on the application of GO to the field of immunology and explains the process of GO annotation. Finally, this review hopes to inspire immunologists to invest time and energy in improving both the content of the GO and the quality of GO annotations associated with genes of immunological interest.
The transition to parenthood: what does it mean for fathers?
Authors: Deave Toity , Johnson Debbie
Published: September 2008

Title.  The transition to parenthood: what does it mean for fathers?

Aim.  This paper is a report of a study to explore the needs of first‐time fathers in relation to the care, support and education provided by healthcare professionals during the antenatal period, particularly in relation to preparing them for the transition to fatherhood.

Background.  Pregnancy and transition to parenthood are major developmental periods within families throughout the world. Previous research suggests that fathers in many different countries feel unprepared for parenthood.

Methods.  Purposive sampling was used to recruit 20 partners of primiparous women from two healthcare provider organizations in South‐West England between December 2005 and July 2006. Recruitment took place at about 28 weeks gestation. Semi‐structured interviews were undertaken at home in the last trimester of pregnancy and 3–4 months postpartum. Content analysis of the interview data was undertaken.

Findings.  Several common themes emerged from both the ante‐ and postnatal data, including lack of support mechanisms, involvement in antenatal provision and the need for more information given in the antenatal period on parenting, baby care and relationships.

Conclusions.  Adequately preparing new fathers for parenthood in advance of the birth of their baby is important, and healthcare professionals can contribute to this by involving and supporting new fathers. Further study is needed to explore the role of fathers in antenatal education and the types of interventions that are effective in improving their early experiences of parenthood. The study needs to be repeated with fathers from black and ethnic minority groups.
The experience of heavy menstrual bleeding: a systematic review and meta‐ethnography of qualitative studies
Authors: Garside Ruth , Britten Nicky , Stein Ken
Published: September 2008

Title.  The experience of heavy menstrual bleeding: a systematic review and meta‐ethnography of qualitative studies.

Aim.  This paper is a report of a systematic review and meta‐ethnography of the experience of heavy menstrual bleeding.

Background.  Heavy menstrual bleeding is common. Not all women seeking help have heavy menstrual bleeding as measured objectively and, conversely, some who do have this problem do not seek help.

Data sources.  Seven electronic databases were searched in 2004 and updated in 2008, and supplemented with hand‐searching.

Method.  We identified four papers describing qualitative research among women with heavy menstrual bleeding. Key themes and concepts were extracted and synthesised using meta‐ethnography, the key process of which is translation, identifying similar or contradictory findings in primary research. In the updated search three papers were identified.

Findings.  Three papers were largely descriptive. These provided support for the fourth paper’s conceptual framework of a lay model of heavy menstrual bleeding which shows little overlap with the traditional clinical definition. Details of physical, practical and emotional elements of this model were identified. A matrix of uncertainties were identified suggesting reasons why women may or may not seek medical help for heavy menstrual bleeding. Women and healthcare professionals may conspire to privilege blood loss over other symptoms and the disease model of heavy menstrual bleeding is little help to either. Two papers from the updated search were also largely descriptive. The third interpreted key elements of the lay model as relating to the need for concealment demanded by ‘menstrual etiquette’.

Conclusion.  A lay model of heavy menstrual bleeding is proposed, detailing key physical, social and emotional impacts that women find problematic.
Increased levels of nerve growth factor in the airways of patients with sarcoidosis
Authors: Dagnell C. , Grunewald J. , Idali F. , Wikén M. , Kemi C. , Sköld C. M. , Planck A. , Newman L. S. , Eklund A. , Olgart Höglund C.
Published: September 2008

Objectives.  Nerve growth factor (NGF) is a potent neuronal growth factor with inflammatory properties that recently has been proposed to be of importance in airway pathology. A role for NGF in the inflammatory granulomatous lung disease sarcoidosis is not well elucidated. The aims of this study were to investigate the secreted levels of NGF in bronchoalveolar lavage fluid (BALF) from sarcoidosis patients compared with patients with resolved disease, patients with another granulomatous disease – chronic beryllium disease (CBD) – and healthy subjects and also to investigate the relationship between NGF levels and markers of inflammation.

Methods and results.  NGF levels in BALF from 56 patients with active sarcoidosis (22 with Löfgren’s syndrome), nine subjects with resolved sarcoidosis, six patients with CBD, and 31 healthy subjects were compared. A 10‐fold elevation of NGF levels was found in patients with active sarcoidosis compared with subjects with clinically resolved sarcoidosis, patients with CBD and healthy subjects. In sarcoidosis patients, positive correlations between concentrations of NGF and lymphocytes, eosinophils and interferon‐γ, interleukin (IL)‐4, IL‐10, IL‐12 were found.

Conclusions.  We demonstrate that secreted levels of NGF are markedly enhanced in the airways in active pulmonary sarcoidosis. Furthermore, a relationship between NGF and pulmonary inflammation in sarcoidosis is supported.
Treatment with apo B peptide vaccines inhibits atherosclerosis in human apo B‐100 transgenic mice without inducing an increase in peptide‐specific antibodies
Authors: Fredrikson G. N. , Björkbacka H. , Söderberg I. , Ljungcrantz I. , Nilsson J.
Published: September 2008

Objectives.  Autoantibodies to apolipoprotein (apo) B‐100 peptides are present in human plasma and have been shown to be associated with decreased cardiovascular risk. The present study aimed to determine if apo B‐100 peptide vaccines are atheroprotective in mice expressing human apo B‐100 and if the effectiveness of the vaccines is influenced by the level of pre‐existing peptide‐specific autoantibodies.

Design.  LDL receptor−/−/human apo B‐100 transgenic mice were immunized with native human apo B‐100 peptides p45 or p210 at 6, 9 and 11 weeks and the extent of atherosclerosis determined by en face Oil Red O staining of the aorta at 25 weeks. Autoantibody levels were determined by enzyme‐linked immunosorbent assay, and RNA expression in the spleen was assessed by real time PCR.

Results.  Control mice had high levels of autoantibodies against p210 but only low levels against p45. Immunization with native p45 and p210 reduced atherosclerosis by 66% (P < 0.02) and 59% (P = 0.06), respectively. The atheroprotective effect of apo B peptide immunization occurred in the absence of an increase in peptide‐specific IgG, but was associated with an increase in IgM recognizing native and copper‐oxidized LDL.

Conclusions.  Immunization with apo B peptide‐based vaccines inhibits atherosclerosis in mice expressing human apo B‐100 suggesting that they can interact with their target as expressed in humans. The protective effect is independent of the pre‐existing level of apo B peptide autoantibodies and can occur without activating an increase in peptide‐specific antibodies suggesting that atheroprotection can be mediated by cellular immune responses.
Reduced leucocyte cholesteryl ester transfer protein expression in acute coronary syndromes
Authors: Ye D. , Kraaijeveld A. O. , Grauss R. W. , Willems S. M. , Van Vark‐van der Zee L. C. , De Jager S. C. A. , Jauhiainen M. , Kuivenhoven J. A. , Dallinga‐Thie G. M. , Atsma D. E. , Hogendoorn P. C. W. , Biessen E. A. L. , Van Berkel T. J. C. , Jukema J. W. , Van Eck M.
Published: September 2008

Objective.  Cholesterol ester transfer protein (CETP) plays an important role in HDL cholesterol metabolism. Leucocytes, including monocyte‐derived macrophages in the arterial wall synthesize and secrete CETP, but its role in atherosclerosis is unclear. The aim of the current study was to investigate the effect of acute coronary syndromes (ACS) on leucocyte CETP expression.

Research design.  Peripheral blood mononuclear cells (PBMCs) were freshly isolated from hospitalized ACS patients displaying Braunwald class IIIB unstable angina pectoris (UAP) on admission (t = 0) and at 180 days post inclusion (t = 180) for analysis of CETP expression. In addition, to prove the potential correlation between leucocyte CETP and ACS the effect of acute myocardial infarction on leucocyte CETP expression was studied in CETP transgenic mice.

Results.  Upon admission, UAP patients displayed ∼3–6 fold (P < 0.01) lower CETP mRNA and nearly absent CETP protein expression in PBMCs, as compared to healthy age‐/sex‐matched controls. Interestingly, CETP mRNA and protein levels were significantly elevated in PBMCs isolated from UAP patients (both stabilized and refractory) at t = 180 as compared to t = 0 (P < 0.01), which was correlated with a reduced inflammatory status after medical treatment. In agreement with the data obtained in UAP patients, markedly down‐regulated leucocyte CETP mRNA expression was observed after coronary artery ligation in CETP transgenic mice, which also correlated with increased serum amyloid A levels.

Conclusions.  We are the first to report that episodes of UAP in humans and myocardial infarction in CETP transgenic mice are associated with reduced leucocyte CETP expression. We propose that the impairment in leucocyte CETP production is associated with an enhanced inflammatory status, which could be clinically relevant for the pathogenesis of ACS.
Molecular and clinical pharmacology of intranasal corticosteroids: clinical and therapeutic implications
Authors: Derendorf H. , Meltzer E. O.
Published: September 2008

Intranasal corticosteroids (INSs) are effective treatments for allergic rhinitis, rhinosinusitis, and nasal polyposis. In recent years, increased understanding of corticosteroid and glucocorticoid receptor pharmacology has enabled the development of molecules designed specifically to achieve potent, localized activity with minimal risk of systemic exposure. Pharmacologic potency studies using affinity and other assessments have produced similar rank orders of potency, with the most potent being mometasone furoate, fluticasone propionate, and its modification, fluticasone furoate. The furoate and propionate ester side chains render these agents highly lipophilic, which may facilitate their absorption through nasal mucosa and uptake across phospholipid cell membranes. These compounds demonstrate negligible systemic absorption. Systemic absorption rates are higher among the older corticosteroids (flunisolide, beclomethasone dipropionate, triamcinolone acetonide, and budesonide), which have bioavailabilities in the range of 34–49%. Studies, including 1‐year studies with mometasone furoate, fluticasone propionate, and budesonide that evaluated potential systemic effects of INSs in children have generally found no adverse effects on hypothalamic–pituitary–adrenal axis function or growth. Clinical data suggest no significant differences in efficacy between the INSs. Theoretically, newer agents with lower systemic availability may be preferable, and may come closer to the pharmacokinetic/pharmacologic criteria for the ideal therapeutic choice.
Geographical distribution of atopic rhinitis in the European Community Respiratory Health Survey I*
Authors: Bousquet P.‐J. , Leynaert B. , Neukirch F. , Sunyer J. , Janson C. M. , Anto J. , Jarvis D. , Burney P.
Published: September 2008

Background:  No large studies in adults has examined geographical variation in the prevalence of nasal allergy/allergic rhinitis in adults or considered the proportion of reported nasal symptoms on exposure to allergen attributable to atopy. The aim of this report was to describe the geographic distribution of subjects with nasal symptoms who are sensitized as determined by skin prick tests, using data from the European Community Respiratory Health Survey I.

Methods:  Information on the presence of nasal allergy, nasal symptoms on exposure to allergen and atopy using skin prick tests was collected from 15 394 adults aged 20–44 years living in 35 centres in 15 countries. Age sex standardized prevalence of symptoms and the attributable fraction of IgE sensitization for nasal symptoms on exposure to allergen were determined.

Results:  The age‐sex standardized prevalence of nasal allergy ranged from 11.8% in Oviedo (Spain) to 46.0% in Melbourne (Australia). The prevalence of atopic nasal allergy ranged from 4.6% in Oviedo to 31.8% in Melbourne (analysis limited on 12 566 subjects). The median attributable fraction for atopy on nasal symptoms on exposure ranged between 12.8% and 65.9% (median 27.2%).

Conclusion:  In the general population there is a wide variation in the prevalence of nasal allergy in young adults. Many subjects complaining from nasal symptoms on exposure to allergen are not atopic.
Preliminary report of multimodal treatment with ifosfamide, 5‐fluorouracil, etoposide and cisplatin (IFEP chemotherapy) against metastatic adenocarcinoma of the urachus
Authors: Tatokoro Manabu , Kawakami Satoru , Yonese Junji , Fujii Yasuhisa , Okubo Yuhei , Yamamoto Shinya , Takeshita Hideki , Komai Yoshinobu , Ishikawa Yuichi , Fukui Iwao
Published: September 2008

Abstract:  We report the effectiveness of a combination chemotherapy consisting of ifosfamide, 5‐fluorouracil, etoposide and cisplatin (IFEP chemotherapy) against metastatic adenocarcinoma of the urachus. From April 1995 to November 2004, four patients with adenocarcinoma of the urachus who developed metastases after definitive surgery were treated with the IFEP chemotherapy followed by consolidative radiotherapy or salvage surgery in good responders. During the median follow‐up period of 26 months, three of the four patients responded to the regimen (75%). In one patient with pulmonary metastases, four cycles of the IFEP chemotherapy, followed by stereotactic consolidative radiotherapy resulted in a complete remission for more than 8 years. Two patients achieved partial remission after the IFEP chemotherapy. We have demonstrated the IFEP chemotherapy is one of the most effective chemotherapy regimens against metastatic adenocarcinoma of the urachus. A multimodal treatment strategy, even with curative intent, can be considered when a sufficient effect was obtained by the IFEP chemotherapy.
Japanese Urological Association guidelines on prostate‐specific antigen‐based screening for prostate cancer and the ongoing cluster cohort study in Japan
Authors: Ito Kazuto , Kakehi Yoshiyuki , Naito Seiji , Okuyama Akihiko ,   Japanese Urological Association
Published: September 2008

The exposure rate of screening for prostate cancer using prostate‐specific antigen (PSA) in Japan is still very low compared with that in the USA or Western Europe. The mortality rate of prostate cancer will increase in the future and in 2020 it will be 2.8 times higher than in 2000. Therefore, there is an urgent need to determine the best available countermeasures to decrease the rate of prostate cancer death.
Attitudes towards mental illness in Sweden: Adaptation and development of the Community Attitudes towards Mental Illness questionnaire
Authors: Högberg Torbjörn , Magnusson Annabella , Ewertzon Mats , Lützén Kim
Published: September 2008

ABSTRACT:  The main purpose for the expansion of supported community care for persons with serious mental illness in Sweden was to ensure the right for these persons to live as citizens in the community. However, earlier research shows that negative attitudes towards mental illness present an obstacle for social integration of persons with serious mental illness. The aim of this study, conducted in Sweden, was to evaluate an existing instrument's (Community Attitudes towards Mental Illness, CAMI), validity and reliability. An additional aim was to adapt and develop the questionnaire to Swedish circumstances. After translation and modification of the original CAMI, the Swedish version of the questionnaire (CAMI‐S) was distributed to all student nurses at three different universities in Sweden. The overall Cronbach's alpha coefficient was 0.90 of the original CAMI‐S. A corrected inter‐item total correlation excluded 20 items because they showed loading <0.43. The overall Cronbach's alpha coefficient on the 20 items (new CAMI‐S) that showed loading, >0.43, was 0.903. A factor analysis of these items revealed that the data could be extracted in three factors labelled as: open‐minded and pro‐integration, fear and avoidance and community mental health ideology. Finally, in order to reach reliable results in attitude research, it is important to measure the respondent's attitude towards the object in common as well as the respondent's attitude to interact with the object. Accordingly, it is important to add behavioural intention items to the ‘new CAMI‐S’. Statements exemplifying how something ‘ought to be’ in an impersonal way have a good degree of stability over time and place.
Never the twain? Reconciling national suicide prevention strategies with the practice, educational, and policy needs of mental health nurses (Part one)
Authors: Cutcliffe John R. , Stevenson Chris
Published: September 2008

ABSTRACT:  Suicide remains as a distinct global public health problem, and the reduction of rates continues to be a major concern of the governments of many countries; this has given rise to the creation of national suicide prevention strategies. As with any other mental health‐related policy document, it behoves mental health nurses to juxtapose these against the realities of their practice and educational needs. To this end, this two part paper draws on national suicide prevention strategy policy directions that appear to speak directly to the practice and/or educational needs of mental health nurses and critiques these. The direction indicating more training in risk assessment is perhaps questionable given that this is already by far the most developed area of the suicidology‐focused literature and that our increased knowledge has risk factors that have not so far produced widespread reductions in suicide rates. Furthermore, this additional attention, at least in part, reflects the clear move towards more coercion and control in international mental health policy. The direction indicating that practitioners should use evidence‐based interventions to prevent suicide is laudable although difficult to reconcile with practice realities given that there is currently a distinct lack of evidence‐based interventions for working with people who are suicidal. As a result, this paper offers some suggested amendments to the national suicide prevention strategies, and the second part of this paper focuses on three more policy directions.
Never the twain? Reconciling national suicide prevention strategies with the practice, educational, and policy needs of mental health nurses (Part two)
Authors: Cutcliffe John R. , Stevenson Chris
Published: September 2008

ABSTRACT:  Suicide remains as a distinct global public health problem and the reduction of rates continues to be a major concern of the governments of many countries. This two‐part paper focuses on national suicide prevention strategies; it highlights common policy directions that appear to speak directly to the practice and/or educational needs of mental health (MH) nurses and juxtaposes these against the realities of their practice and educational needs. Part one focused on two of these policy directions, whereas part two concentrates on the following policy directions: (iii) initiatives to reduce access to lethal means; (iv) improve surveillance systems; and (v) training for caregivers to improve delivery of effective treatments. The paper argues that while being mindful of the physical environment and its associated access to means, the national suicide prevention policy literature should consider reflecting that this should be an adjunct to the more central aspects of MH nursing care of people who are suicidal. Further, it is argued that the suicide policy literature should consider replacing ‘improving surveillance systems’ with ‘improving the ability and capacity of MH nurses to engage with people who are suicidal’. Lastly, the paper asserts that the suicide policy literature might consider refining the policy direction on additional training to indicate the need for additional post‐graduate (post‐basic) education and training in care of the person with suicidal tendencies, which includes dialectical behavioural therapy; the work emanating from the University of Toronto; and the skills, attitudes, and knowledge perhaps captured with the terms, engagement, co‐presencing, and inspiring hope.
The diversity and abundance of bacteria inhabiting seafloor lavas positively correlate with rock alteration
Authors: Santelli Cara M. , Edgcomb Virginia P. , Bach Wolfgang , Edwards Katrina J.
Published: September 2008

Young, basaltic ocean crust exposed near mid‐ocean ridge spreading centers present a spatially extensive environment that may be exploited by epi‐ and endolithic microbes in the deep sea. Geochemical energy released during basalt alteration reactions can theoretically support chemosynthesis, contributing to a trophic base for the ocean crust biome. To examine associations between endolithic microorganisms and basalt alteration processes, we compare the phylogenetic diversity, abundance and community structure of bacteria existing in several young, seafloor lavas from the East Pacific Rise at ∼9°N that are variably affected by oxidative seawater alteration. The results of 16S rRNA gene analyses and real‐time, quantitative polymerase chain reaction measurements show that the abundance of prokaryotic communities, dominated by the bacterial domain, positively correlates with the extent of rock alteration – the oldest, most altered basalt harbours the greatest microbial biomass. The bacterial community overlap, structure and species richness relative to alteration state is less explicit, but broadly corresponds to sample characteristics (type of alteration products and general alteration state). Phylogenetic analyses suggest that the basalt biome may contribute to the geochemical cycling of Fe, S, Mn, C and N in the deep sea.
Potential for phosphonoacetate utilization by marine bacteria in temperate coastal waters
Authors: Gilbert Jack A. , Thomas Simon , Cooley Natalie A. , Kulakova Anna , Field Dawn , Booth Tim , McGrath John W. , Quinn John P. , Joint Ian
Published: September 2008

Phosphonates are organic compounds that contain a C–P bond and are a poorly characterized component of the marine phosphorus cycle. They may represent a potential source of bioavailable phosphorus, particularly in oligotrophic conditions. This study has investigated the distribution of thephnAgene which encodes phosphonoacetate hydrolase, the enzyme that mineralizes phosphonoacetate. Using newly designed degenerate primers targeting thephnAgene we analysed the potential for phosphonoacetate utilization in DNA and cDNA libraries constructed from a phytoplankton bloom in the Western English Channel during July 2006. Total RNA was isolated and reverse transcribed and phosphonoacetate hydrolase (phnA) transcripts were PCR amplified from the cDNA with the degenerate primers, cloned and sequenced. Phylogenetic analysis demonstrated considerable diversity with 14 sequence types yielding five uniquephnAprotein groups. We also identified 28phnAhomologues in a 454‐pyrosequencing metagenomic and metatranscriptomic study from a coastal marine mesocosm, indicating that > 3% of marine bacteria in this study containedphnA.phnAhomologues were also present in a metagenomic fosmid library from this experiment. Finally, cultures of four isolates of potential coral pathogens belonging to theVibrionaceaecontained thephnAgene. In the laboratory, these isolates were able to grow with phosphonoacetate as sole P and C source. The fact that the capacity to utilize phosphonoacetate was evident in each of the three coastal environments suggests the potential for widespread utilization of this bioavailable P source.
Comparison of type I and II papillary renal cell carcinoma (RCC) and clear cell RCC
Authors: Waldert Matthias , Haitel Andrea , Marberger Michael , Katzenbeisser Daniela , Ozsoy Mehmet , Stadler Elisabeth , Remzi Mesut
Published: September 2008

OBJECTIVE

To compare the pathological features of clear cell renal cell carcinoma (ccRCC) with papillary RCC (pRCC) and further differentiate type I and II pRCC as independent prognosticators for survival.

PATIENTS AND METHODS

From September 1994 to February 2007 557 RCCs were treated and reviewed. All patients underwent radical nephrectomy or nephron‐sparing surgery. We reviewed patient data and correlated RCC subtypes to tumour size, pathological stage, nuclear grade, and 5‐year cancer‐specific survival (CSS). pRCC was re‐evaluated in to type I and II. The 2002 Tumour‐Node‐Metastasis and Fuhrman classifications were used.

RESULTS

In all, 391 (70%) patients had ccRCC, 96 (17%) had pRCC, 34 (6%) had chromophobe RCC, seven (1%) had ductus Bellini RCC and 29 (5%) had unclassified RCC. Upon re‐evaluation 34 patients had type I pRCC and 62 had type II. The pRCCs were significantly smaller than the ccRCCs, at a mean (sd) of 4.5 (2.5) cm vs 5 (2.9) cm (P = 0.013), and multifocal (25% vs 12%, P = 0.001). Whereas patients with ccRCC had significantly more primary metastases (12% vs 3%, P = 0.014). The mean (sd) follow‐up was 42.3 (41.4) months. The 5‐year CSS for M0 patients was 84% for ccRCC and 90% for pRCC (P = 0.573). At multivariate analyses predictors for 5‐year CSS were only tumour size (hazard ratio, HR 2.6, P < 0.001), pathological stage (HR 3.9, P < 0.001) and nuclear grade (HR 2.7, P < 0.001). The type I and II pRCCs had significantly different lymphovascular invasion (LVI) and 5‐year CSS rates (94% vs 74%, P = 0.03).

CONCLUSIONS

The ccRCCs were significantly larger at diagnosis than the pRCCs. The histological subtype (pRCC vs ccRCC) had no impact on the 5‐year CSS in multivariate analyses. The type I and II pRCCs had similar histopathological features except for a significant difference in LVI. However, the 5‐year CSS was significantly different in type I and II pRCC.
Iatrogenic recto‐urethral fistula: perineal repair and buccal mucosa interposition
Authors: Spahn Martin , Vergho Daniel , Riedmiller Hubertus
Published: September 2008

OBJECTIVE

To present a new and promising technique for repairing recto‐urethral fistulae (RUF) using a perineal approach and buccal mucosa graft interposition, as RUF are rare but severe complications of rectal or urinary tract surgery, radiation treatment, trauma or inflammation, and the repair of recurrent or persistent RUF is particularly difficult when previous surgical attempts have failed, resulting in high recurrence rates.

PATIENTS AND METHODS

Between 2004 and 2006, five men (aged 61–67 years) with iatrogenic RUF had the perineal fistula closed using a buccal mucosa graft interposition. The RUF had developed after laparoscopic or retropubic radical prostatectomy in four patients and after radical cystectomy and ileal neobladder in the fifth. Four of the patients had had at least one failed RUF repair before their referral to our institution.

RESULTS

Four of the five RUF were repaired successfully using the perineal approach and buccal mucosa graft interposition. Failure occurred in one patient who had developed a RUF after laparoscopic radical prostatectomy followed by two unsuccessful attempts at closure. The failure was most probably due to a previously undetected postoperative perineal haematoma with infection.

CONCLUSION

Our perineal approach for repairing RUF, combined with buccal mucosa graft interposition, is a simple technique fulfilling all the requirements for successful fistula closure, especially in repeat surgery.
Advanced‐stage renal cell carcinoma treated by radical nephrectomy and adjacent organ or structure resection
Authors: Karellas Michael E. , Jang Thomas L. , Kagiwada Megan A. , Kinnaman Michael D. , Jarnagin William R. , Russo Paul
Published: September 2008

OBJECTIVE

To examine the effect of radical nephrectomy (RN) with adjacent organ and structure resection on survival, as invasion of adjacent organs in patients with renal cell carcinoma (RCC) is rare.

PATIENTS AND METHODS

After institutional review board approval, we reviewed our database and statistically analysed of patients with pathological stage T3 or T4 RCC who had RN and resection of a contiguous organ or structure.

RESULTS

We identified 38 patients of 2464 (1.5%) who had RN with adjacent organ or structure resection. The median (interquartile range) size of the mass was 11 (8–14) cm, and the follow‐up 13 (5–33) months. Most patients (68%) were pT4 stage and had conventional clear cell carcinoma (95%). Fourteen patients (37%) had positive surgical margins. The liver (10) was the most commonly resected adjacent organ or structure. Only one patient remains alive with no evidence of disease at 5 years, while three are currently alive with disease. Overall, 34 of 38 patients (90%) ultimately died from disease at a median (range) of 11.7 (5.4–29.2) months after surgical resection. The surgical margin status was the only statistically significant factor for recurrence and death (P = 0.006).

CONCLUSIONS

The prognosis for patients with advanced RCC and adjacent organ or structure involvement is extremely poor and similar to that of patients with metastatic disease. These patients should be thoroughly counselled about the impact of surgical management and considered for entry into neoadjuvant or adjuvant clinical trials with new targeted systemic agents.
Does laser ablation prostatectomy lead to oncological compromise?
Authors: Biers Suzanne M. , Oliver Helen C. , King Alex J. , Adamson Andrew S.
Published: September 2008

OBJECTIVE

To assess the incidence and outcome of incidental prostate cancer detected at transurethral resection of the prostate (TURP), and to evaluate whether laser ablation prostatectomy would miss significant cancer by failing to provide tissue for histopathological analysis.

PATIENTS AND METHODS

Information on TURP‐detected prostate cancer was gathered from 1996 to 2006, from The South‐west Cancer Intelligence Service, hospital‐operating and coding records, histopathology databases and The British Association of Urological Surgeons Cancer Registry. We recorded the total number of prostate cancers diagnosed per year, number of TURPs performed, Gleason scores and patients outcomes.

RESULTS

TURP‐detected prostate cancer has declined since the relatively high rates (22%) recorded locally in 1996–97. Between 2001 and 2006, a mean (range) of 124 (111–135) prostate cancers were detected per year. Incidental cancers accounted for only 1.5–5.6% of all newly diagnosed prostate cancers per year. Incidental cancers had a mean (sem) Gleason score of 5.7 (0.3) compared to 8.0 (0.3) in known cancers (P < 0.01) undergoing TURP. Of newly diagnosed patients, 82% were allocated to active surveillance, whilst 18% were started on hormone therapy, with no prostate cancer‐related deaths over a mean (sem, range) follow‐up of 49.7 (2.4, 11–81) months.

CONCLUSIONS

TURP mainly samples transitional‐zone tissue where tumours are relatively uncommon, and have a good prognosis. Our series of incidental TURP‐detected cancers showed an incidence in keeping with published data, and favourable histological and clinical outcomes. We suggest the lack of tissue should not discourage the use of laser prostatectomy surgery.