bluuebunny/crossref_metadata_2025 huggingface dataset:
Using higher‐order crossings to distinguish liver regeneration indices in hepatectomized diabetic and non‐diabetic rats
Authors: LIATSOS CHRISTOS , HADJILEONTIADIS LEONTIOS J , THEOCHARIS STAMOS , PETRIDOU EVANGELIA , MARGELI ALEXANDRA , SKALTSAS SPYRIDON , MAVROGIANNIS CHRISTOS , MYKONIATIS MICHAEL
Published: December 2004

Background and Aims:  Diabetes mellitus is implicated in several liver diseases; hence, its potential affection to liver regenerative capacity is an open research question. So far, only sporadic studies have addressed this issue, mainly using basic statistical techniques. The current study evaluated the ability of a novel technique, namely higher‐order crossings (HOC), based on liver DNA biosynthesis and thymidine kinase (TK) enzymatic activity data, to discriminate liver regeneration processes between hepatectomized diabetic and non‐diabetic rats.

Methods:  We used 251 adult male rats, divided in two groups; diabetic by Alloxan injection and non‐diabetic control, subjected to 70% partial hepatectomy and killed at different time intervals post‐partial hepatectomy (PH) (0–240 h). The rate of tritiated thymidine (3HTdR) incorporation into hepatic DNA and the enzymatic activity of liver TK were estimated and, after proper interpolation, were analyzed using HOC sequences. Changes of the latter were captured and used as a means for linear discrimination between the two groups.

Results:  Ninth‐order HOC estimated for post‐PH (24, 28, 40, 44, 72 and 84 h) exhibited linear discrimination for the rate of 3HTdR incorporation, whereas second‐order HOC estimated for (44–72 h) post‐PH exhibited linear discrimination for the TK enzymatic activity data. Fuzzy logic‐based c‐means cluster analysis of HOC provided distinct areas of group categorization (100% accuracy) for diagnostic distinctions (P < 0.001). The data grouping pointed out by the HOC‐based analysis revealed an onset delay in the liver regeneration process when Alloxan diabetes was present (P < 0.05).

Conclusions:  Our results suggest that HOC have the potential to linearly discriminate between experimentally induced diabetic and non‐diabetic liver regeneration post‐PH processes, based on two liver regeneration indices, capturing the delay seen in the liver regeneration process due to Alloxan diabetes, fostering their use as an efficient classification tool. In this way, HOC could be used as an advanced, easily implemented and user‐friendly method to thoroughly analyze liver regeneration processes.
Relation of hepatolithiasis to helminthic infestation
Authors: HUANG MIN‐HO , CHEN CHIEN‐HUA , YEN CHUAN‐MIN , YANG JEE‐CHUN , YANG CHI‐CHIEH , YEH YUNG‐HSIANG , CHOU DER‐AUR , YUEH SEN‐KOU , YANG YU‐YEN , NIEN CHIU‐KUEI
Published: December 2004

Background and Aim:  The relation of helminthic infestation to hepatolithiasis is a subject of dispute. This case–control study was undertaken to evaluate the prevalence of helminthiasis in hepatolithiasis patients and to compare the clinicopathological features of hepatolithiasis between patients with and without helminthiasis.

Methods:  The prevalence of ascariasis or clonorchiasis was evaluated using ELISA in 131 patients with hepatolithiasis who were treated at Show‐Chwan Memorial Hospital and 121 subjects who constituted a control group. The patients’ detailed histories and medical charts were reviewed.

Results:  The prevalence of positive immunodiagnosis of ascariasis and clonorchiasis was higher in patients with hepatolithiasis than in control subjects (33.6%, 44/131 vs 17.4%, 21/121, odds ratio [OR] = 2.41, 95% confidence interval [CI] = 1.28–4.56, P = 0.005; and 6.9%, 9/131 v 0.8%, 1/121, OR = 8.85, 95% CI = 1.12–188.69, P = 0.02). Patients with helminthiasis rarely had concurrent gallbladder stones (26%, 12/47 vs 55%, 46/84, OR = 0.28, 95% CI = 0.12–0.66, P = 0.002). Prior to the diagnosis of hepatolithiasis in adulthood, most of the patients with helminthiasis tended to have a history of recurrent abdominal pain in their childhood and an asymptomatic ‘lucid interval’ during their teenage years (70.2%, 33/47 vs 39.3%, 33/84, OR = 3.64, 95% CI = 1.59–8.42, P = 0.0005). However, the prevalence of intrahepatic duct stricture (38.3%, 18/47 vs 40.5%, 34/84, OR = 0.91, 95% CI = 0.41–2.02, P > 0.05), secondary biliary cirrhosis (6.4%, 3/47 vs 3.6%, 3/84, OR = 1.84, 95% CI = 0.28–12.03, P > 0.05), cholangiocarcinoma (2.1%, 1/47 vs 0%, 0/84, OR = ∼, P > 0.05), and stone recurrence (54.8%, 24/42 vs 50.0%, 38/76, OR = 1.33, 95% CI = 0.58–3.06, P > 0.05) did not significantly increase.

Conclusions:  Helminthiasis is a possible risk factor for hepatolithiasis, although it is unlikely to increase the incidence of complications, including bile duct stricture, secondary biliary cirrhosis, and cholangiocarcinoma. Patients with helminthiasis tend to have a history of an asymptomatic ‘lucid interval’ between the periods of recurrent abdominal pain in their childhood and the diagnosis of hepatolithiasis in their adulthood.
Significance of hepatitis B virus DNA clearance and early prediction of hepatocellular carcinogenesis in patients with cirrhosis undergoing interferon therapy: Long‐term follow up of a pilot study
Authors: IKEDA KENJI , KOBAYASHI MASAHIRO , SAITOH SATOSHI , SOMEYA TAKASHI , HOSAKA TETSUYA , AKUTA NORIO , SUZUKI YOSHIYUKI , SUZUKI FUMITAKA , TSUBOTA AKIHITO , ARASE YASUJI , KUMADA HIROMITSU
Published: December 2004

Background and Aim:  Because the anti‐carcinogenic effect and mechanism of interferon (IFN) in patients with hepatitis B virus (HBV)‐related cirrhosis have not been elucidated, quantitative analysis of HBV‐DNA concentration was carried out sequentially.

Method:  Of 60 consecutive patients with cirrhosis who began IFN therapy between 1986 and 1990, 57 patients were completely observed for the appearance of hepatocellular carcinoma (HCC). All patients underwent intermittent administration of IFN for a median period of 18 months. HBV‐DNA was quantified using transcription mediated amplification and hybridization protection assay. A HBV‐DNA count <3.7 log‐genome equivalent (LGE)/mL (equivalent to 103.7 or 5000 copies/mL) was considered to be a negative value.

Results:  Of 25 patients who had HBV‐DNA loss after IFN therapy, nine lost HBV‐DNA during the therapy and 16 lost HBV‐DNA after cessation of the therapy. The other nine patients showed a transient loss of HBV‐DNA, and the remaining 23 retained persistently positive HBV‐DNA during and after therapy. Although HCC developed in two (8.0%) of the 25 patients with HBV‐DNA loss, carcinogenesis was found in 11 (34.4%) of 32 patients without HBV‐DNA loss (Fisher's exact test, P = 0.026). In the two exceptional patients, HCC was detected at 1.2 and 3.6 years after loss of HBV‐DNA, respectively. When the HBV‐DNA concentration decreased by 2 LGE/mL (decrease to 1/100) at 6 months after initiation of interferon, HBV‐DNA became negative eventually in 15 (60.0%) of 25 patients.

Conclusion:  A significant decrease or loss of serum HBV‐DNA prevents development of HCC, and sequential analysis of HBV‐DNA could be very useful in both the prediction and the early detection of small HCC.
Patterns of K‐ras codon 12 and 13 mutations found in pancreatic adenocarcinoma of 30 Chinese patients by microdissection, PCR and direct sequencing
Authors: WEI SHUANZENG , LIANG ZHIYONG , GAO JIE , WU SHAFEI , ZHU HONG , LIU HONGRUI , LIU TONGHUA
Published: December 2004

Background and Aim:  To our knowledge there are few reports on the K‐ras mutation pattern of pancreatic adenocarcinoma from Chinese mainland patients. We examined surgically resected formalin‐fixed, paraffin‐embedded primary pancreatic adenocarcinoma tissue blocks for the presence of activating point mutations at codon 12 and 13 of the K‐ras gene.

Methods:  Mutations were detected through the use of microdissection, polymerase chain reaction (PCR) and direct sequencing. The results were confirmed by reverse sequencing.

Results:  The combination of microdissection, PCR and direct sequencing techniques resulted in a rapid and sensitive detection of K‐ras mutations at codon 12 and 13. Twenty‐five (83%) of the 30 pancreatic adenocarcinomas examined harbored K‐ras mutation. Among the 25 pancreatic adenocarcinomas, 24 showed K‐ras mutation at codon 12 (11 with GGT‐GTT, seven with GGT‐GAT, four with GGT‐CGT, and two with GGT‐TGT), and only one showed a GGC‐TGC mutation at codon 13. In this study most of K‐ras mutations at codon 12 were at the second base (72%, 18/25) with a transition/transversion ratio of 1 : 1.57 (7/11).

Conclusions:  The mutation profiles of K‐ras at codon 12 in our pancreatic adenocarcinoma samples were significantly different from those of European and Japanese samples.
Detection and characterization of small hepatocellular carcinoma
Authors: MATSUI OSAMU
Published: December 2004

Abstract  Early detection and characterization of small hepatocellular carcinoma (HCC) by imaging is possible with high confidence, and is important for the improvement of the prognosis of the patient with liver cirrhosis. In this lecture, screening of HCC and its characterization by imaging, with special reference to imaging features of human multi step hepato carcinogenesis will be discussed.
Spectrum of liver pathology in immune mediated liver diseases
Authors: BURT ALASTAIR D
Published: December 2004

Abstract  Immune mechanisms are involved in a wide range of parenchymal liver diseases and are of particular importance in conditions where the pathogenesis appears to be related to loss of tolerance to self antigens. In the liver there are two classical ‘autoimmune’ conditions: primary biliary cirrhosis and autoimmune hepatitis. It is increasingly apparent however that these may represent ends of a spectrum and overlap syndromes are well recognised. Furthermore there is evidence that primary sclerosing cholangitis may be a further example of autoimmune liver disease and overlpa conditions between this and autoimmune hepatitis are described. Histopathological assessment remains an important diagnostic tool in the investigation of autoimmune liver disease, particularly in the context of outlier and overlap conditions.
Effects of liver failure on inter‐organ trafficking of ammonia: implications for the treatment of hepatic encephalopathy
Authors: CHATAURET NICOLAS , BUTTERWORTH ROGER F
Published: December 2004

Abstract  Hepatic encephalopathy due to acute or chronic liver failure is invariably associated with hyperammonemia. High ammonia concentrations have deleterious effects on brain function by both direct and indirect mechanisms. There is increasing evidence to suggest that hyperammonemia in liver failure results from altered inter‐organ ammonia trafficking. Under normal conditions the gut produces ammonia from glutamine and urea. During liver failure, the contribution of the gut to hyperammonemia is predominantly the consequence of a diminished hepatic elimination rather than increased intestinal production. Normally, the liver removes ammonia by two distinct pathways, namely urea and glutamine synthesis catalyzed by enzymes that are, respectively, localized in the periportal and perivenous hepatocytes. The skeletal muscle relies solely on glutamine synthesis to remove ammonia. During liver failure, muscle glutamine production increases and the muscle becomes the major route for ammonia detoxification. The kidney is capable of both producing and removing ammonia. Under normal conditions, the kidney produces ammonia from glutamine which is mainly excreted into the renal vein, the remainder being excreted into the urine. However, in liver failure the excretion of the ammonia produced by the kidney is increased. Like skeletal muscle the brain relies solely on glutamine synthesis to remove ammonia. But unlike muscle, glutamine synthetase in the brain operates at nearly maximal capacity in normal conditions, and its activity is reduced during chronic liver failure. A better understanding of the alterations of inter‐organ ammonia trafficking could give rise to combined therapies aimed at reducing ammonia production and increasing ammonia removal by target organs.
Overlap syndromes from pediatrics to adulthood
Authors: BOGDANOS DIMITRIOS , VERGANI DIEGO , MIELI‐VERGANI GIORGINA
Published: December 2004

Abstract  Overlap syndromes are autoimmune conditions with mixed immunological, clinical and histological features. The most frequent overlaps are between primary biliary cirrhosis (PBC) and autoimmune hepatitis (AIH), and between AIH and sclerosing cholangitis (SC). True AIH/PBC overlap syndrome is rare and characterized by elevation of transaminases and immunoglobulin G (IgG), positive anti‐smooth muscle antibodies and a liver biopsy showing interface hepatitis as well as changes typical of PBC. These patients respond to immunosuppressive treatment that must be given promptly, to avoid progression to liver failure. The so‐called ‘autoimmune cholangitis’ defines a small group of patients with cholestatic and histological features of PBC but negative for anti‐mitochondrial antibody (AMA) and positive for PBC‐specific anti‐nuclear antibody (ANA). The positivity for ANA in these patients is a consequence of the AMA negativity, since AMA masks ANA on immunofluorescence. These patients’ clinical course and response to treatment resemble that of classical PBC. AIH/ASC overlap syndrome is characterised by elevated levels of IgG and circulating autoantibodies, including ANA, SMA and atypical perinuclear anti‐neutrophil cytoplasmic antibody, in association with cholangiographic changes typical of SC. This condition affects in particular children and young adults and may represent the early stage of adult primary SC. The parenchymal liver inflammation responds satisfactorily to immunosuppression, while the bile duct damage may progress despite treatment.
Antecedents of renal disease in Aborigines
Authors: THOMAS Mark
Published: December 2004

SUMMARY:  Rates of end‐stage renal disease in the Aboriginal community have been increasing over the past two decades, particularly in the northern and more remote areas of Australia, and especially in disadvantaged communities.

Proteinuria predicts the rate of loss of renal function and is common in young adults and virtually universal in those over 50 years old. Cumulative independent risk factors include low birthweight, recurrent skin infections, adult obesity, diabetes or its precursors, smoking, excessive alcohol intake and a family history of renal disease. A plausible theory is that intrauterine malnutrition permanently reduces total nephron numbers, which are then overworked in adulthood by the metabolic stresses of obesity (from excess alcohol and poor diet), blood pressure and infections, while starved of blood supply through smoking.

Although renal disease is often only detected when already established, there are great rewards for active medical intervention. Control of blood pressure (preferentially using angiotensin‐converting enzyme (ACE) inhibitors and angiotensin‐II receptor blockers (AIIRB) in combination) can often stop or even reverse kidney damage, despite ongoing poor diabetic control. Adequately funded kidney health programmes with active Aboriginal Health Worker involvement are enormously cost‐effective: tight blood pressure control at least halves the rate of disease progression, and every year of dialysis deferred for one patient could fund the appointment of two more health workers. Addressing the underlying social causes for this epidemic is critical.
Bring me home: Renal dialysis in the Kimberley
Authors: KNEIPP Erica , MURRAY Richard , WARR Kevin , FITZCLARENCE Cherelle , WEARNE Marie , MAGUIRE Graeme
Published: December 2004

SUMMARY:  The incidence of end‐stage renal failure (ESRF) in the Kimberley region at the top end of Western Australia far exceeds known national rates and trend analysis demonstrates a close parallel to what is occurring in the Northern Territory. Dialysis prevalence in the Kimberley has nearly tripled in the last decade and has increased at a much faster rate than the rest of Western Australia. Almost all of these people with ESRF are Aboriginal Australians living in remote communities.

In January 2004, the Western Australia Country Health Service and Kimberley Aboriginal Medical Services’ Council, under the auspices of the Kimberley Aboriginal Health Planning Forum, embarked upon a review of renal disease in the Kimberley funded by the Western Australia Department of Health. The main purpose of the review was to identify the scope of the problem and make projections upon which to base programme and service development over the next 10 years.

This paper outlines the findings of the Review of Renal Disease in the Kimberley and presents, for the first time, regional data analysis and comparisons. In addition, future projections on the impact of ESRF and recommendations for improving current service delivery are discussed. Given the challenges of remoteness and individuals’ desire to return home, this review recommends development of locally‐based expertise capable of providing training and support to patients and their families, reinvigoration of community‐based dialysis modalities, and the initiation of planning for a second satellite service in the Kimberley.
Supporting peritoneal dialysis in remote Australia
Authors: CARRUTHERS Dale , WARR Kevin
Published: December 2004

SUMMARY:  Peritoneal dialysis is usually considered a first‐choice treatment for end‐stage renal disease for patients living in remote areas. The advantages of peritoneal dialysis over haemodialysis are that peritoneal dialysis preserves the residual renal function for longer, provides patients with more independence and gives patients a greater opportunity to return home quickly. In Australia, Aboriginal people suffer end‐stage renal failure at disproportionately higher rates than the general population. Given that many Aboriginal people live in remote communities a task of peritoneal dialysis units is to ensure the successful setting up and maintenance of peritoneal dialysis programmes in the outback. This paper examines how peritoneal dialysis units located in the city are able to deliver peritoneal dialysis to patients located often hundreds of kilometres and at times thousands of kilometres away in very remote communities. In preparing this paper interviews were conducted with renal and remote community‐based health professionals in Western Australia and the Northern Territory, and with peritoneal dialysis patients in Western Australia. The success of remote peritoneal dialysis programmes relies on many elements, most importantly an integrated approach to care by all members of the peritoneal dialysis team. The peritoneal dialysis team included not just health professionals but also patients, their families, their communities and other support people such as those involved in the transport of peritoneal dialysis supplies to the outback. Careful communication, a willingness to participate, friendliness and delivering care and supplies with a smile are essential ingredients to a winning program. Without all of these ingredients dialysis in the bush may fail.
Home haemodialysis in remote Australia
Authors: VILLARBA Angelina , WARR Kevin
Published: December 2004

SUMMARY:  The Royal Perth Hospital provides access to dialysis treatment to Indigenous Australians living in remote areas of Western Australia who are suffering from end‐stage renal disease (ESRD). The Remote Area Dialysis Programme (RADP), established in 1989, relocated traditional hospital services to remote communities and introduced home or community‐based therapy. This unique state‐wide programme was developed in cooperation with tribal elders in Aboriginal communities, and regional medical, nursing and community health staff. Prior to RADP's establishment, these patients faced the choice of permanent relocation to Perth for dialysis treatment or death from renal failure. Development of the RADP allowed Indigenous patients with ESRD to receive dialysis treatment in their own home/community.

Requirements for home haemodialysis include establishing the suitability and capability of patients, the availability of carers and an appropriate home or community environment for dialysis machine installation. This has required novel strategies to address cultural and language impediments to home therapy. The remoteness of some isolated communities has been a technical challenge for the dialysis technicians due to the uncertainty of power supply, climatic extremes and inadequate supply or poor quality of water. A specific training program has been developed to adapt to the needs of Aboriginal patients. Patients undertaking home haemodialysis face many challenges and a number of initiatives will need to be implemented to ensure the ongoing success of the programme.
Forest landscape pattern in the KwaZulu–Natal midlands, South Africa: 50 years of change or stasis?
Authors: LAWES MICHAEL J. , MACFARLANE DOUGLAS M. , EELEY HARRIET A. C.
Published: December 2004

Abstract  Understanding patterns and processes of habitat change is essential for managing and conserving forest fragments in anthropogenically altered landscapes. Digitized aerial photographs from 1944 and 1996 were examined for changes to the indigenous forest landscape in the Karkloof‐Balgowan archipelago in KwaZulu–Natal, South Africa. Attributes relating to proximate land‐use, patch shape, isolation and position in the landscape were used to determine putative causes of forest change. The total change in forest area was −5.7% (forest covered 6739 ha in 1996). This is contrasted with previous reports for the period 1880–1940 that estimated change in total forest area of up to −80%. Attrition was the predominant process of forest transformation between 1944 and 1996. Despite little overall change in forest area, 786 mostly small (<0.5 ha) forest patches were lost from the landscape, leaving 1277 forest patches in 1996. An increase in patch isolation, but no change in patch cohesion accompanied the changes in forest area. Ignoring patches that were eliminated, 514 patches decreased in area. This was partly a function of patch size, but the conversion of natural grassland to commercial plantation forestry in the matrix also influenced forest decline. Their small size and irregular shape caused forest patches in the region to be vulnerable to edge effects. Core area declined in a negative exponential way with increasing edge width and the total area of edge habitat exceeded that of core habitat at an edge width of only 50 m. Nevertheless, total core area decreased by only 2% (65 ha) between 1944 and 1996 because most of the eliminated patches were small and contained no core area. The large Karkloof forest (1649 ha) is a conservation priority for forest interior species, but the ecological role and biodiversity value of small forest patches should not be overlooked.
Net woody vegetation increase confined to seasonally inundated lowlands in an Australian tropical savanna, Victoria River District, Northern Territory
Authors: SHARP BEN R. , BOWMAN DAVID M. J. S.
Published: December 2004

Abstract  Georeferenced digital aerial photographs were used to assess changes in overstorey vegetation cover since 1948 in the Victoria River District, Northern Territory, Australia, across a range of lowland tropical savanna habitats and with explicit consideration of known and variable site‐specific grazing and fire management histories. Vegetation surveys at corresponding locations on the ground identified five distinct woody vegetation communities defined primarily by water drainage and secondarily by soil characteristics. Air‐photo analyses revealed that, contrary to popular perceptions and in contrast to results from other habitats, there has been no generalized net increase in overstorey woody vegetation cover across the full range of lowland savanna habitats. Rather, different habitats exhibited distinctly different vegetation change mechanisms: low‐lying seasonally inundated ‘wet’ habitats have experienced woody vegetation increase since 1948, whereas well‐drained ‘dry’ habitats have experienced overstorey vegetation stability or loss. In almost every instance woody vegetation increase could be attributed to the invasion or proliferation of a single species, Melaleuca minutifolia F.Muell. The extent of M. minutifolia increase was unrelated to historical grazing/fire regime. Demographic analyses for this species revealed that recruitment was often episodic and that synchronized recruitment events occurred uniformly across the full range of historical management treatments, most likely as a consequence of favourable climatic conditions in years with an extended wet season. Heavy grazing facilitated juvenile survival and/or recruitment, most likely by reducing grassy fuel loads and eliminating landscape fire. We conclude that while there has been no generalized net increase in overstorey woody vegetation cover in lowland environments, savanna dynamics are complex, and multiple change mechanisms have occurred simultaneously in different habitats, some of which have been significantly transformed since 1948. Where net woody vegetation increase has occurred it is primarily a natural consequence of episodic M. minutifolia establishment in climatically favourable years, but the extent and magnitude of this effect is likely mediated by fire/grazing regime.
Successful pregnancy following conservative treatment of massive ascites associated with acute Chlamydia trachomatis peritonitis
Authors: SUZUKI TATSUYA , SHIBAHARA HIROAKI , KIKUCHI KUMIKO , HIRANO YUKI , TAKAMIZAWA SATORU , SUZUKI MITSUAKI
Published: December 2004

It is well known that Chlamydia trachomatis causes acute and chronic pelvic inflammatory disease including salpingitis. We describe a case of successful pregnancy following conservative treatment of massive ascites associated with acute Chlamydia trachomatis peritonitis. In this present case, we conservatively treated a woman with acute chlamydial salpingitis accompanied with marked ascites and an adnexal mass that simulated a malignant neoplasm. Elevated CA125 and CA19‐9 also suggested a malignancy at the time of diagnosis, however following treatment they decreased to below the cut‐off value, and were useful in identifying the efficacy of medical treatment. The patient subsequently became pregnant after infertility treatment and underwent a normal vaginal delivery. We conclude that the possibility of Chlamydia trachomatis peritonitis should be considered when a patient presents with ascites and an adnexal mass in sexually active women. (Reprod Med Biol 2004; 3: 217–221)
Comparison of sperm counts in two groups of men presenting for infertility investigations 20 years apart
Authors: CLARKE GARY N. , STEWART TANYA , BAKER H.W. GORDON
Published: December 2004

Aims:  To compare sperm counts for two groups of men who had presented for infertility investigations approximately 20 years apart.

Methods:  The study compared results for 309 men tested between 1977 and 1981 with those of 559 men tested between 1997 and 1998 using identical methodology. In order to approximate the normal population, only those men with counts above 5 million/mL were included in the final analysis. Bias, due to repeated testing after an initial abnormal result, was minimized by including only the patient's first test results. In addition, to allow for time‐dependent changes in the requirements for semen samples, results were included only if a complete sample was produced by masturbation after 3–5 days abstinence.

Results:  There was a small, but statistically significant drop in ejaculate volume (3.9–3.6 mL, P = 0.015) and a significant increase in the patient's mean age (32.18 vs 35.08, P < 0.001). Both groups had median abstinence of 3 days and no difference in sperm counts with a mean (median) count for the early group of 87.9 (75) versus 92.0 (76) for the recent group (P > 0.80). The significant drop in ejaculate volume was not reflected in a difference (P = 0.45) in total sperm numbers in the ejaculate with 320.7 (255) versus 313.1 (234).

Conclusion:  This study found no evidence of a decrease in sperm counts or total sperm output in men (excluding those with severe oligospermia) presenting for infertility investigations in Melbourne, Australia, over the last two decades of the twentieth century. (Reprod Med Biol 2004; 3: 211–216)
Prostate‐specific antigen relapse‐free survival in patients with localized prostate cancer treated by brachytherapy
Authors: Joseph Joji , Al‐Qaisieh Bashar , Ash Daniel , Bottomley David , Carey Brendan
Published: December 2004

Brachytherapy has become a very popular way of treating prostate cancer worldwide, and increasing attempts are being made by radiation oncologists to find the exact type of patient for whom this treatment is the most suitable. One of the largest series has come from Leeds, and the authors present the PSA relapse‐free survival in 667 patients with localised prostate cancer treated by brachytherapy in their department.

Authors from Canada report on the value of taking a repeat prostate biopsy after an initially negative one, but point out that the practice pattern of repeat biopsies is unknown. They decide what factors were important influences in deciding whether a patient would have a repeat biopsy, and particularly those factors which were helpful in predicting prostate cancer at the repeat biopsy.

OBJECTIVE

To report the clinical outcome after permanent implantation of125iodine seeds (brachytherapy) for early prostate cancer, after 8.2 years of follow‐up.

PATIENTS AND METHODS

Between March 1995 and December 2001, 667 men (mean age 63 years, range 42–77) were treated with brachytherapy at the one cancer centre; 346 (51.9%) had a short course of neoadjuvant hormone therapy. The prescribed minimum peripheral dose was 145 Gy. No patient received external beam radiation.

RESULTS

The median (range) follow‐up was 31  (18–98.2) months; 41 patients were lost to follow‐up. The actuarial biochemical relapse‐free survival was 74.9%; 100 patients had biochemical relapse (international definition). In all, 20 patients had clinical relapse, and 24 died (10 from prostate cancer). The prostate‐specific antigen (PSA) relapse‐free survival was 78.3%, 66.5% and 56.4% for patients with Gleason scores of <7, 7 and > 7, respectively, and was 81.4%, 69.8% and 36.3% for those with PSA levels of <10, 10–20 and > 20 ng/mL, respectively (bothP < 0.001). There was a strong cohort effect depending on year of implant, with progressive annual improvements in relapse‐free survival (P < 0.001). Hormone therapy, tumour stage, prostate volume before implantation, age and D90 dose had no significant effect on the outcome.

CONCLUSION

The overall relapse‐free survival for all patients was 75%; the initial PSA, Gleason score and risk group were significant factors predicting the outcome. Increasing clinical experience was associated with a better outcome but neoadjuvant hormone therapy had no effect.
Variation in patterns of practice in diagnosing screen‐detected prostate cancer
Authors: Nam Robert K. , Toi Ants , Trachtenberg John , Jewett Michael A.S. , Klotz Laurence , Fleshner Neil , Bagnell P. Scott , Sweet Joan , Sugar Linda , Narod Steven A.
Published: December 2004

OBJECTIVE

To determine the practice pattern of repeat prostate biopsies to detect prostate cancer, as there is growing evidence to support the recommendation that a repeat prostate biopsy should be taken after an initially negative prostate biopsy, the rate of cancer detection then being ≈ 30%.

PATIENTS AND METHODS

We examined the practice patterns of taking a repeat prostate biopsy after an initial negative biopsy and the predictors for cancer at repeat biopsy among 1536 patients who had an initial prostate biopsy because of an elevated prostate‐specific antigen (PSA) level (>4.0 ng/mL) or abnormal digital rectal examination.

RESULTS

Of the 1536 men, 712 (46.4%) had cancer detected on the first biopsy; of the remaining 824 with no cancer detected, 268 (32.5%) had a repeat biopsy within a year, and 68 of these (25.4%) had cancer detected. Of the cancers detected at repeat biopsy, 31% were high‐grade. Men with abnormal histology (prostatic intraepithelial neoplasia or atypia) had an odds ratio of 3.2 (P < 0.001) for having a repeat biopsy. For men with normal initial prostate histology, those with an initial PSA of 10.0–20.0 and >20.0 ng/mL had an odds ratio of 3.6 and 4.5 (both P < 0.001), respectively, for a repeat prostate biopsy, compared with patients with a PSA of <10.0 ng/mL. However, the PSA level was not predictive of prostate cancer at repeat biopsy, but age and prostate volume were.

CONCLUSIONS

A third of patients had a repeat biopsy after a negative biopsy. The most important factors influencing whether a patient was to have a repeat biopsy were initial biopsy histology and PSA level. However, the latter was not an important factor for predicting prostate cancer at repeat biopsy.
Organ‐sparing surgery for invasive penile cancer: early follow‐up data
Authors: Pietrzak Peter , Corbishley Cathy , Watkin Nicholas
Published: December 2004

OBJECTIVE

To present early outcome data from patients treated for invasive penile cancers with organ‐sparing surgery, as the treatment of such malignancies has traditionally either been amputative surgery or radical radiotherapy, both associated with significant physical and psychosexual morbidity.

PATIENTS AND METHODS

A consecutive series of patients referred over a 3‐year period for the treatment of penile malignancy were analysed prospectively. After clinical staging and grading, those patients requiring surgery were offered either a glans‐preserving or a glans‐removing procedure.

RESULTS

Of the 78 patients referred, 49 required surgery, with penile‐preserving procedures in 39 of them; 32 were newly diagnosed tumours and seven were recurrences after radiotherapy. The tumour grade and stage were G1 in 11, G2 in 17 and G3 in 10 (one had melanoma and was not graded); and Ta in two, T1 in 19, T2 in 17 and T3 in one. The mean follow‐up was 16 months, with nine patients followed for ≥ 2 years. Complications included two patients who required immediate revisional surgery for positive resection margins, and one with radio‐necrosis. One patient who had a glans‐preserving procedure developed a recurrence, whereas none of those who had the glans removed did so.

CONCLUSION

With careful patient selection and meticulous follow‐up, most patients with invasive penile carcinoma can be offered penile‐preserving surgery.
Erectile response with vardenafil in sildenafil nonresponders: a multicentre, double‐blind, 12‐week, flexible‐dose, placebo‐controlled erectile dysfunction clinical trial
Authors: Carson Culley C. , Hatzichristou Dimitrios G. , Carrier Serge , Lording Douglas , Lyngdorf Peter , Aliotta Philip , Auerbach Stephen , Murdock Myron , Wilkins H. Jeffrey , McBride Trish A. , Colopy Michael W.
Published: December 2004

Associate Editor

Michael G. Wyllie

Editorial Board

Ian Eardley, UK

Jean Fourcroy, USA

Sidney Glina, Brazil

Julia Heiman, USA

Chris McMahon, Australia

Bob Millar, UK

Alvaro Morales, Canada

Michael Perelman, USA

OBJECTIVE

To evaluate the efficacy of vardenafil in patients previously unresponsive to sildenafil.

PATIENTS AND METHODS

A multicentre, double‐blind, 12‐week, flexible‐dose, placebo‐controlled trial was conducted, involving 463 men aged ≥ 18 years with moderate‐to‐severe erectile dysfunction (ED) and who were unresponsive to sildenafil (by history). After a 4‐week treatment‐free run‐in, patients received placebo or vardenafil 10 mg with the option to maintain current dose or to titrate by one dose level (5, 10 or 20 mg) based on efficacy and tolerability at 4 and 8 weeks. Outcome measures were the erectile function (EF) domain score of the International Index of Erectile Function, two Sexual Encounter Profile diary questions (vaginal penetration and maintenance of erection until successful completion of intercourse), and the Global Assessment Question (GAQ).

RESULTS

There was significantly better EF with vardenafil than with placebo throughout the study. The least‐square mean EF domain scores increased from 9.3 at baseline to 17.6 at the ‘last’ observation carried forward (LOCF) analysis with vardenafil (P < 0.001). Overall least‐square mean per‐patient success rates more than doubled for penetration (30.3% to 62.3%) and quadrupled for successful intercourse (10.5% to 46.1%) with vardenafil. Improved erections (positive response to the GAQ) were reported by 61.8% of patients receiving vardenafil and 14.7% of those receiving placebo at LOCF (P < 0.001). Normal EF (domain score ≥ 26) was achieved by 30% of patients receiving vardenafil and 6% receiving placebo at LOCF (P < 0.001). Adverse events were infrequent and representative of the phosphodiesterase‐5 inhibitor profile.

CONCLUSION

Vardenafil is an effective and generally safe treatment for ED, even in men unresponsive to sildenafil (by history).
Retroperitoneoscopic subcapsular nephrectomy for infective nonfunctioning kidney with dense perinephric adhesions
Authors: Xu Zhang , Xin Ma , Hong‐Zhao Li , Zhong Chen , Li Long‐Cheng , Ye Zhang‐Qun
Published: December 2004

OBJECTIVE

To evaluate the feasibility and clinical efficacy of retroperitoneoscopic subcapsular nephrectomy for infective nonfunctioning kidneys with dense perinephric adhesions.

PATIENTS AND METHODS

Twelve patients underwent retroperitoneoscopic subcapsular nephrectomy; the operative duration, blood loss, intestinal functional recovery time, complications during surgery and efficacy were recorded. Dissociation and ligation of the renal pedicle was the most important step, at which the renal capsule was cut near the renal hilum using a harmonic scalpel, and the fatty tissue around the renal hilum dissected carefully. The renal pedicle was then ligated and divided using an endoscopic linear stapler‐cutter after the renal pedicle tissues had been separated to an adequate thickness.

RESULTS

All 12 operations were successful and none required conversion to open surgery. The mean (sd, range) operative duration was 82.9 (22.3, 45–120) min, the blood loss 51.4 (12.2, 30–75) mL and the intestinal functional recovery time 12–48 h. There were no complications during or after the surgery, and in the follow‐up of 1–15 months the short‐term results were satisfactory.

CONCLUSION

Retroperitoneoscopic subcapsular nephrectomy can be used safely to remove an infected and heavily adhesive nonfunctioning kidney, with minimal trauma and blood loss, and with faster recovery than after an open subcapsular nephrectomy.
Clinical and molecular characterization of the bladder exstrophy‐epispadias complex: analysis of 232 families
Authors: Boyadjiev Simeon A. , Dodson Jennifer L. , Radford Cristi L. , Ashrafi Gerald H. , Beaty Terri H. , Mathews Ranjiv I. , Broman Karl W. , Gearhart John P.
Published: December 2004

Authors from John Hopkins University School of Medicine in Baltimore present their study into the identifying genetic and non‐genetic factors contributing to the risk of bladder exstrophy‐epispadias complex. They found it to occur most commonly as an isolated sporadic birth defect, and found no evidence of a single‐gene effect or a common environmental factor.

OBJECTIVE

To identify genetic and nongenetic factors contributing to the risk of bladder exstrophy‐epispadias complex (BEEC).

PATIENTS AND METHODS

In all, 285 families with BEEC were invited to participate in the study, and 232 of them were recruited. Epidemiological information was obtained from 151 of the consenting families, with a detailed clinical genetic examination of 94 probands. In all, 440 DNA samples were collected from 163 families for molecular analysis.

RESULTS

Most of the cases were sporadic and had no family history of BEEC. Among patients, 95% were Caucasian, and males were more common in both the epispadias group (M/F, 2.2, 29 patients) and the classic bladder‐exstrophy group (M/F 1.8, 164), but in the cloacal exstrophy group the sex ratio was close to unity (1.1, 15). There was a statistically significant association with advanced parental age (P < 0.001). Birth weight, gestational age and maternal reproductive history did not appear to be significantly different from those in the general population. Information on exposures to tobacco, alcohol and drugs was collected but none appeared to act as a risk factor. Karyotype analysis on 37 cases detected two chromosomal abnormalities, i.e. 46XY t(8;9)(p11.2; q13) and 47XYY. Molecular analysis of the HLXB9 gene, which causes Currarino syndrome, did not detect mutations in the blood or bladder DNA of 10 patients with bladder or cloacal exstrophy.

CONCLUSIONS

BEEC most commonly occurs as an isolated sporadic birth defect with a recurrence risk of << 1%. There was no evidence of a single‐gene effect or common environmental factor in this study population. In addition to race and advanced parental age, birth order may be a risk factor for BEEC. We suggest somatic mutations in a gene(s) within the pathway regulating bladder development may be the cause of BEEC.
The long‐term outcome of the endoscopic subureteric implantation of polydimethylsiloxane for treating vesico‐ureteric reflux in children: a retrospective analysis of the first 195 consecutive patients in two European centres
Authors: Van Capelle Jan‐Willem , Haan Tjard de , Sayed Wayed El , Azmy Amir
Published: December 2004

OBJECTIVE

To determine the long‐term efficacy of endoscopically implanting polydimethylsiloxane (PDS, Macroplastique®, Uroplasty BV, Geleen, the Netherlands) for treating vesico‐ureteric reflux (VUR) in children.

PATIENTS AND METHODS

We retrospectively reviewed the records of 195 children treated with PDS over the past 10 years in two European centres (Netherlands and UK) and conducted follow‐up investigations where deemed necessary. In the Dutch centre patients were treated according to a prospective approved study protocol.

RESULTS

Of the 195 treated children, 155 had a successful outcome; in all, 311 refluxing renal units were treated, with an overall success rate of 82.3% in a mixed group of patients with unilateral or bilateral VUR and duplex systems.

CONCLUSION

The long‐term data from these two independent centres confirms the viability of PDS and the technique for treating VUR in children. We conclude that the material is safe and effective and can be used in VUR grades II–V. Treating patients with grade I VUR is recommended in those cases where there is no spontaneous resolution and ‘breakthrough’ infections.
Tree crop smallholders, capitalism, andadat: Studies in Riau Province1, Indonesia
Authors: Potter Lesley , Badcock Simon
Published: December 2004

Abstract: This paper examines the extent to which traditional techniques and practices remain current among a sub‐set of Indonesian tree crop smallholders. Village‐based studies of independent oil palm and rubber smallholders in Riau (Sumatra) indicate that bio‐diverse ‘jungle rubber’ and multi‐cropping techniques still exist, but primarily as components of farmers’ coping strategies under low commodity prices. A further strategy, seeking income from non‐agrarian sources, notably ‘illegal’ logging and land sales to migrants, partially fits Rigg's ‘deagrarianisation’ thesis, though his suggestion that the farm household has become a mere ‘shell’ is not substantiated. The lack of full legalisation of tenure constrains full capitalist development but does not impede land sales. Land seizures during the Suharto period reduced belief in the efficacy of customary (adat) law, though adat has retained importance in dispute resolution and as a cultural framework. New structures of village governance following decentralisation have so far had minimal impact in either empowering villagers or dispossessing elites.
Symbolic and social dimensions in the economic production of seaweed
Authors: Majid Cooke Fadzilah
Published: December 2004

Abstract:  Based on the thesis of ‘deagrarianisation’ of farming economies, work on sustainable rural livelihoods (SRL) has successfully captured the agency of rural producers as they diversify their livelihoods to minimise risk. SRL captures a complex interplay of local and global factors, as well as the synergies emanating from natural (environmental), economic and social capital that underpin diversification. The framework has been found useful for analyses of change in coastal, marine‐based livelihoods. However, agency at the local level implies equal power to accept and reject development interventions. The way groups diversify or use the options open to them depends as much on access to resources (the means), as on how that access is interpreted (the meaning), and the latter dimension is a creative (unpredictable) one. New introduced forms of economic activities, in this case seaweed farming, can be assigned meaning by participants that were unanticipated by change agents. Livelihood diversification through seaweed cultivation on Banggi island off Kudat, northern Sabah (East Malaysia) is not attained by economic factors alone but also by the meaning attached to the activity.
Foreign Multinationals and Local Firms in Vietnam's Economic Transition*
Authors: Ngoc Phan Minh , Ramstetter Eric D.
Published: December 2004

This paper compares the economic performance of foreign multinational corporations (MNC) and local firms in Vietnam, distinguishing between two distinct types of local firms: state‐owned enterprises (SOE) and non‐SOE. Between the mid‐1990s and 2000, foreign MNC in Vietnam's economy grew very rapidly, but their growth has been much slower thereafter. Consistent with the theoretical suggestion that MNC possess relatively large amounts of firm‐specific assets related to production technology, marketing networks and management know‐how, these comparisons suggest that foreign MNC were generally larger and had higher labor productivity, capital intensity, wage levels, investment propensities and trade propensities than non‐MNC. On the other hand, foreign MNC tended to have relatively low capital productivity and wage shares of value added, while results regarding profitability were mixed. In general, these differentials tended to be relatively small between foreign MNC and SOE, and SOE tended to be larger than foreign MNC in terms of employment. Correspondingly, comparisons of foreign MNC with non‐MNC generally revealed more consistent differences, largely because the local private sector is still very underdeveloped in Vietnam.
One Country, Two Prices? A Study of the Deflationary Effect of Price Convergence on Hong Kong*
Authors: Ha Jiming , Fan Kelvin
Published: December 2004

Consumer prices in Hong Kong at the time of writing have declined by 15 percent from the peak recorded in 1998. We investigate the deflationary impact on Hong Kong of price convergence with the Mainland China, using 1990–2001 annual data on commodity prices in the former and in major cities of the latter. We find evidence of price convergence between the two economies over the past decade. Furthermore, price convergence is estimated to have accounted for one‐fifth of the deflation in Hong Kong. The results suggest that a significant portion of the deflation in Hong Kong is attributable to a process of structural adjustment due to growing economic integration with the Mainland.
Simulation driven inferences for multiply imputed longitudinal datasets*
Authors: Demirtas Hakan
Published: December 2004

In this article, we demonstrate by simulations that rich imputation models for incomplete longitudinal datasets produce more calibrated estimates in terms of reduced bias and higher coverage rates without duly deflating the efficiency. We argue that the use of supplementary variables that are thought to be potential causes or correlates of missingness or outcomes in the imputation process may lead to better inferential results in comparison to simpler imputation models. The liberal use of these variables is recommended as opposed to the conservative strategy.