bluuebunny/crossref_metadata_2025 huggingface dataset:
An evidence‐based medicine fellowship in a children’s teaching hospital
Authors: Coulthard Mark G , Callaghan Leisha A
Published: March 2003

Abstract This paper reports the introduction of an evidence‐based medicine fellowship in a children’s teaching hospital. The results are presented of a self‐reported ‘evidence‐based medicine’ questionnaire, the clinical questions requested through the information retrieval service are outlined and the results of an information retrieval service user questionnaire are reported. It was confirmed that clinicians have frequent clinical questions that mostly remain unanswered. The responses to four questions with ‘good quality’ evidence‐based answers were reviewed and suggest that at least one‐quarter of doctors were not aware of the current best available evidence. There was a high level of satisfaction with the information retrieval service; 19% of users indicated that the information changed their clinical practice and 73% indicated that the information confirmed their clinical practice. The introduction of an evidence‐based medicine fellowship is one method of disseminating the practice of evidence‐based medicine in a tertiary children’s hospital.
Four general principles for the management and conservation of wetlands in large lakes: The role of water levels, nutrients, competitive hierarchies and centrifugal organization
Authors: Keddy Paul , Fraser Lauchlan H.
Published: March 2003

The most important factor in shoreline wetlands is variation in water depth. Superimposed upon this are gradients of soil fertility, ranging from sandy, open shorelines to sheltered, fertile bays. The use of both transplant and pot experiments shows that competitive hierarchies rapidly arise in wetland vegetation and that species are sorted along exposure and depth gradients according to their relative competitive abilities. These patterns can be summarized in the centrifugal organization model, in which competitive dominants occupy preferred core habitats and where different species and vegetation types are then arrayed outward along different constraint gradients (Wisheu & Keddy 1992). Knowledge of these general patterns provides an essential tool for managing lakes and reservoirs in order to maintain and enhance biological diversity.
Lake Champlain Basin Program: Working together today for tomorrow
Authors: Stickney Michaela , Hickey Colleen , Hoerr Roland
Published: March 2003

Lake Champlain is the sixth largest freshwater lake in the USA. Lake Champlain’s watershed is shared by Vermont and New York in the USA, and Quebec in Canada. The lake’s remarkable drainage area to surface area ratio is 19:1. More than 600 000 people live in the Lake Champlain basin and millions visit each year. The lake’s relatively healthy natural resources sustain a thriving economy. The three most challenging environmental issues facing the Lake Champlain basin are reducing phosphorus pollution, preventing toxic contaminants from entering the lake and managing invasive aquatic species that are not native that threaten native flora and fauna. To effectively address these issues, the Lake Champlain Basin Program (LCBP) believes that all decisions about the lake must be based on accurate, ongoing scientific research and that citizen involvement and inter‐jurisdictional cooperation is vital. The programme has worked hard to identify all citizens and organizations that have a stake in Lake Champlain and draw them into a cooperative, sustainable management process. A 1990 Act of Congress (Public Law 101‐596) established a coordinated framework to study and understand the diverse systems of Lake Champlain and its basin in order to develop a comprehensive management plan to protect and restore lake and watershed resources. A 31‐member multi‐stakeholder board was established to develop the plan, a process that took 5 years and included numerous public meetings. Today, a Steering Committee oversees the implementation of the plan and the activities of the LCBP.
Clinicopathological multiplicity of dementia with Lewy bodies
Authors: Iseki Eizo , Marui Wami , Kosaka Kenji , Kato Masanori , Yamamoto Takayuki , Uéda Kenji
Published: March 2003

‘Dementia with Lewy bodies (DLB)’ is a generic clinicopathological concept characterized by progressive dementia and Lewy bodies (LB). We examined 23 autopsied DLB cases clinicopathologically and immunohistochemically. These cases were classified into the neocortical type (10 cases), the limbic type (seven cases), the cerebral type (one case) and the brainstem type (none) according to our pathological criteria, which were based on the regional incidence of LB and the degree of neuronal loss in the substantia nigra. Each subtype of DLB was further divided into the common form and the pure form on the basis of the degree of Alzheimer pathology. The remaining five cases were not classified by our pathological criteria, and were designated ‘the senile dementia of Alzheimer type (SDAT) or Alzheimer's disease (AD) type of DLB with neocortical or limbic LB’. We examined how each subtype was correlated with various clinical features, such as the age of disease onset, the clinical duration, the degree of dementia, and the presence or absence of parkinsonism, fluctuating cognition and visual hallucination. The results of this study indicate that DLB can be clinicopathologically divided into a number of subtypes, that each subtype is preferentially correlated with some clinical feature, and that the neocortical type, common form, is the major type of DLB.
Meningioangiomatosis with a predominant fibrocalcifying component
Authors: Izycka‐Swieszewska Ewa , Rzepko Robert , Kopczynski Stefan , Franc Zbigniew , Szurowska Edyta , Borowska‐Lehman Jolanta
Published: March 2003

A case of meningioangiomatosis, resected from the parietal lobe in a 31‐year‐old female is presented. Macroscopically, the lesion was composed of five calcified nodules embedded within hardened elastic tissue. Histologically, cortical and subcortical calcified masses were found surrounded by a palisade of spindle and/or oval cells. In adjacent nervous tissue many pathological microvessels were observed and some were ensheathed by a perivascular proliferation of spindle cells. Moreover, gliosis with Rosenthal fibers and prominent connective tissue elements were observed. Immunohistochemical analysis based on monoclonal antibodies was performed. The spindle cells both within the palisades and the perivascular proliferations were vimentin and usually epithelial membrane antigenpositive. The possible pathogenesis of meningioangiomatosis is discussed and the role of angiogenesis within this lesion emphasized.
Degeneration of Pick bodies visualized by methenamine‐silver staining and immunohistochemistry
Authors: Odawara Toshinari , Iseki Eizo , Furukawa Yoshiko , Suzuki Kyoko , Hino Hiroaki , Kosaka Kenji
Published: March 2003

The degeneration process of Pick's bodies (PB) was investigated using methenamine‐silver (MS) staining and immunohistochemistry. Methenamine‐silver staining sensitively detected extracellular PB as well as intracellular PB in the granular cell layer of the dentate gyrus. Extracellular PB appeared as granular masses with ill‐defined boundaries in the neuropil. For MS electron microscopy, the extracellular PB were composed of randomly oriented fibrillary components measuring 9–12 nm in diameter with astroglial processes and degenerated organelles. Tau immunoreactivity of extracellular PB was reduced or abolished. These findings indicate that MS staining is a convenient method for detecting extracellular PB. In addition, it was shown that microglial involvement was associated with PB‐bearing neurons at the late stage of the degeneration process and that extracellular PB remained in the neuropil with astroglial reaction.
Neuropathological investigation of cerebral white matter lesions caused by closed head injury
Authors: Onaya Mitsumoto
Published: March 2003

In order to ascertain whether there is widespread axonal disruption of cerebral white matter in the so‐called ‘diffuse axonal injury’ (DAI), a type of closed head injury, proposed by Adams et al. the author investigated his own cases clinicopathologically. Twenty‐six male autopsied cases of head injury, aged between 19 and 84, 15 of which had sustained road traffic accidents, were examined; the others were due to falling from heights and so on. The study group all belonged to non‐missile head injuries and included 12 cases of diffuse brain injury, as well as 14 cases of focal brain injury, according to the classification of Gennarelli et al. The survival time ranged from 2 h to 21 years. Formalin‐fixed brains were cut coronally so as to make paraffin‐embedded hemispheric sections. Then these sections were stained conventionally (HE, Bodian, Kluver‐Barrera and Holzer) and immunohistochemically (GFAP) to assess axonal decrease, myelin pallor and gliosis by the use of light microscopy. In the 13 chronic cases that died more than 1 month after the accidents, the intensities of gliosis, myelin pallor and axonal decrease tended to correlate with each other. In the 13 acute cases who died less than 1 month after their accident, the degree of axonal decrease in white matter seemed to correlate with the severity of myelin pallor. Regardless of types of trauma, however, axonal retraction balls, the so‐called hallmark of DAI, were found only with myelin pallor suggesting the presence of brain swelling after the injury. Therefore these findings indicate that it may be difficult to accept the notion of DAI, that is, the presence of axonal retraction balls without brain swelling. In addition, diffuse vascular injury (2 cases) as well as rarefaction of subcortical white matter (6 cases) were presented and their pathogenesis individually discussed based on a literature review.
Changes in expression of p38 mitogen‐activated protein kinase in the dorsal motor nucleus of the vagus nerve and hypoglossal nucleus after axotomy in adult rats
Authors: Shimokawara Tatsuo , Yamada Eiji , Masui Katsuya , Mishima Kenji , Enomoto Yasunori , Inoue Kazuya , Sakaki Toshisuke , Ichijima Kunio
Published: March 2003

Mitogen‐activated protein (MAP) kinase cascades are activated in response to various extracellular stimuli. P38 MAP kinase is one of the MAP kinase family and is activated by proinflammatory cytokines and environmental stresses. Activating transcription factor‐2 (ATF‐2) is one of the targets for p38 MAP kinase. To obtain information on the role of the p38 MAP kinase in the neurons and glial cells after axotomy, we investigated changes of expression of p38 MAP kinase, MAP kinase kinase (MKK) 3, MKK4, MKK6 and ATF‐2 in the dorsal motor nucleus of the vagus nerve and the hypoglossal nucleus following axotomy in rats using in situ hybridization and immunohistochemical techniques. Expression of p38 MAP kinase mRNA was observed in the neurons in control rats and showed no remarkable changes after axotomy in both nuclei. On the other hand, expression of p38 MAP kinase mRNA was observed in the perineuronal microglias after axotomy. The expression of p38 MAP kinase, activated p38 MAP kinase, MKK3 and ATF‐2 were immunohistochemically observed in neurons of control rats in both nuclei. After axotomy, the expression of p38 MAP kinase, active and inactive, and ATF‐2 in neurons were reduced in both nuclei, while expression of mRNA of p38 MAP kinase showed no reduction in neurons. These findings indicate that p38 MAP kinase is functionally regulated not by synthesis but by phosphorylation and regulates the activation of ATF‐2 in neurons, and this cascade plays some role in retrograde neuronal reactions. Moreover, perineuronal microglial cells showed strong expression of p38 MAP kinase, active and inactive, after axotomy in both nuclei. These findings suggest that p38 MAP kinase is related to microglial cell reactions after axotomy.
Dosage requirement of erythropoietin can be reduced with more frequent administration
Authors: Wang Angela Yee Moon , Yu Alex Wai Yin , Lai Kar Neng , Lui Sui Fai
Published: March 2003

SUMMARY:

In short‐term studies, once weekly and twice weekly dosing regimens of erythropoietin (EPO) have both been shown to be effective in correcting anaemia in dialysis patients. However, the optimal dosing frequency has yet to be determined. The long‐term effects of EPO given by more frequent divided doses in 10 stable haemodialysis patients were studied. The patients achieved a stable haemoglobin level for at least 3 months prior to the study. The frequency of administration was altered from 4000 units once weekly to 2000 units twice weekly in seven patients, from 4000 units once every 10 days to 2000 units twice weekly alternating with 2000 units once weekly in two patients, and from 4000 units fortnightly to 2000 units once weekly in one patient. After the conversion, EPO dosage was adjusted in order to maintain the haemoglobin at the preconversion level. At the end of 28 weeks, the mean haemoglobin level remained unchanged. However, the mean dosage requirement of EPO reduced from 3400 units per week to 2500 units per week (P = 0.019). This represents a significant 26% reduction in dosage and cost. It was concluded that subcutaneous administration of frequent small doses of EPO is a more cost‐effective way of correcting anaemia in haemodialysis patients.
Dendritic cells, tolerance and transplantation
Authors: Coates Toby , Krishnan Ravi , Russ Graeme R.
Published: March 2003

SUMMARY:

Dendritic cells (CD) are professional antigen‐presenting cells of the immune system that play a central role in the initiation of the alloimmune response. Recently these cells have been found to also play a role in the maintenance of peripheral tolerance to antigens. Dendritic cells initiate alloimmunity by migrating from the graft to lymphoid sites within the host where they activate alloantigen‐specific T cells. They are therefore an ideal target for new biological therapies aiming to divert the response away from immunity and towards tolerance. Genetic modification of DC with immunosuppressive cytokines has already proven successful in modifying the alloimmune responsein vitroand in prolonging allograft survival in small animal transplantation studies. Manipulation of the DC subsets that maintain peripheral tolerance and targeting the mechanisms that control DC immunogenicity with somatic gene therapy is a promising and novel means of inducing immunosuppression for transplantation.
Gene polymorphism in IgA nephropathy
Authors: Tang Sydney , Lai Kar Neng
Published: March 2003

SUMMARY: IgA nephropathy (IgAN) is the most common primary glomerulonephritis in the world. Since its original description in 1968, a large body of clinical, epidemiological and immunological studies of its pathogenesis has emerged. However, the basic molecular mechanisms of abnormal mesangial IgA deposition have remained obscure. In recent years, much clinical and experimental evidence has indicated the presence of genetic factors in the development and progression of IgAN. The search for susceptibility loci has centred on the major histocompatibility complex (MHC) using disease association in family and population studies. In addition, genes outside the realm of the MHC have been reported. The evidence for genetic factors in the onset and progression of IgAN is reviewed in this paper. The major loci influencing disease susceptibility include HLA‐DR4, ‐DQw7 and ‐DQβ, C4 null and T‐cell receptor Cα genes, whereas those affecting the natural course of IgAN include HLA‐DQβ, angiotensin‐converting enzyme D/D, T‐cell receptor Cβ and endothelial cell nitric oxide synthase 4a alleles.
Apoptotic cells in six patients with IgA nephropathy in repeat biopsies
Authors: Tashiro Kyoichi , Kodera Sanki , Shou Ichiyu , Kurusu Atsushi , Hishiki Toshimasa , Funabiki Kazuhiko , Horikoshi Satoshi , Shirato Isao , Tomino Yasuhiko
Published: March 2003

SUMMARY: Programmed cell death is a selective process of physiological cell deletion and is known as apoptosis. The purpose of the present study was to determine the relationship between the existence of apoptotic cells in glomeruli and the clinical or histopathological findings obtained in repeat renal biopsies of patients with IgA nephropathy. Repeat renal biopsy specimens were obtained from six patients with IgA nephropathy. The nick end labelling method (TUNEL) was used for the detection of apoptotic cells. Clinical laboratory data, i.e. urinary protein excretion, creatinine clearance (Ccr), blood urea nitrogen (BUN) and serum creatinine, (s‐Cr) were obtained from these patients. At the first renal biopsy, apoptotic cells in the glomeruli were observed in three out of six patients using TUNEL. These patients were classified as the severe glomerular damage group. The other three patients without apoptotic cells were in the mild glomerular damage group. Mean levels of urinary protein excretion at the first renal biopsy in the patients with apoptotic cells were slightly higher than those in patients without apoptotic cells. Levels of Ccr in patients with apoptotic cells were lower than those in patients without apoptotic cells. There were no significant differences in the levels of BUN and s‐Cr in patients with or without apoptotic cells. Two patients with apoptotic cells in glomeruli at the first renal biopsy did not show apoptotic cells at the second renal biopsy. These two patients showed improvement not only in clinical laboratory findings but also in histological findings at the second biopsy. Only one patient with apoptotic cells at the first and second biopsies exhibited deterioration at the second biopsy. All three patients without apoptotic cells at the first renal biopsy also showed deterioration of the clinical laboratory and histopathological findings. It is postulated that various factors other than apoptosis might induce progression of renal injuries in such patients. It appears that the clinical laboratory data, i.e. proteinuria, renal function and histopathological findings, might be influenced by apoptosis in patients with IgA nephropathy. It is postulated that apoptosis may induce reduction of excess proliferative glomerular mesangial cells and/or infiltrating cells and tissue repair.
Cyclosporine‐associated post‐partum haemolytic uraemic syndrome in a renal transplant patient: lack of response to plasmapheresis but remission after intravenous immunoglobulin G
Authors: Bastani Bahar , Mistry Bhargav M , Jamal1 Jawaid A , Contis2 Joseph
Published: March 2003

SUMMARY: We present the case of a young woman who developed severe post‐partum (cyclosporine‐associated) haemolytic uraemic syndrome (HUS) 6 years after a living related donor kidney transplant. Her pregnancy had become complicated with preeclampsia (hypertension and nephrotic syndrome) and progressive renal insufficiency extending for 1 month after delivery, and there was evidence of cyclosporine vasculopathy on a kidney biopsy. Despite six daily treatments with plasmapheresis and fresh‐frozen plasma replacement, her HUS progressively deteriorated, culminating in severe pulmonary haemorrhage. At this point, treatment with i.v. infusion of immunoglobulin G was initiated, which resulted in resolution of HUS. Moreover, at the time of diagnosis of HUS the patient was taken off cyclosporine and maintained on mycophenolate mofetil and prednisone.
Maintaining clearance in peritoneal dialysis
Authors: Johnson David W
Published: March 2003

Numerous studies have now established that there is a strong association between small solute clearance and improved outcomes in peritoneal dialysis (PD) patients. Preservation of both renal and peritoneal clearances is therefore of paramount importance, although very few trials have satisfactorily addressed this critical issue. Observational studies have suggested that the groups most at risk of loss of residual renal function are women, non‐whites, diabetic patients, patients with congestive cardiac failure, patients who experience frequent episodes of peritonitis and, possibly, patients treated with automated PD (APD). There have been no controlled trials of renoprotective therapies in PD patients, but reasonable strategies for preventing renal functional decline include avoidance of nephrotoxins and infection, maintenance of adequate blood pressure, abstinence from smoking and possibly administration of angiotensin‐converting enzyme inhibitors and/or calcium channel blockers. In contrast, peritoneal small solute removal can be maximized by augmenting fill volume, increasing exchange frequency and using either long‐dwell continuous ambulatory PD (CAPD) or short‐dwell (APD) therapies to suit individual patients’ transport characteristics. Tidal PD may additionally increase solute clearance, although studies have reported conflicting findings. Preservation of membrane function may be achieved by minimizing episodes of peritonitis and avoiding hypertonic glucose exchanges. Newer peritoneal dialysates, such as icodextrin, amino acids, bicarbonate‐buffered solutions and aldehyde‐poor fluids, are more biocompatible in experimental models of PD, but their long‐term clinical safety and efficacy have not yet been established by clinical trials. Moreover, no trials have demonstrated an independent effect of peritoneal clearance on patient outcomes. Further studies determining the relative value of renal and peritoneal clearances are therefore urgently required in order to optimize dialytic adequacy for PD patients.
Pharmacokinetic studies of cyclosporine in Oriental kidney transplantation patients
Authors: Kungsamrith Thitima , Eiam‐Ong Somchai , Tungsanga Kriang , Chusil Sauwaluck , Ayudhya Duangchit Panomvana Na
Published: March 2003

SUMMARY: Pharmacokinetic studies were performed in 10 stable kidney transplantation patients who received microemulsion formulation (Neoral®) of cyclosporine A (CsA) twice daily. No agents having pharmacokinetic effects on CsA had been used in these patients. The values of various basic pharmacokinetic parameters were similar to those reported in Western literature. The complete area under the blood concentration–time curve (AUC) of CsA for the duration of 12 h (12‐h AUC) was determined using the linear trapezoidal rule from seven concentrations at 0, 1, 2, 4, 6, 8, and 12 h after CsA administration. The mean values of 12‐h AUC were 4603.63 ± 344.61 ng h/mL. CsA concentrations at 2 h after dosing (not the trough levels) showed the best correlation with the complete AUC (r2 = 0.9322). The abbreviated AUC of CsA was calculated either by stepwise multiple linear regression analysis or by the linear trapezoidal rule from a few sampling time points. Using stepwise multiple linear regression analysis, which was used in calculating abbreviated AUC in all previous studies, the model equation that had the highest correlation and the lowest prediction error with the complete AUC was derived by using CsA concentrations at 2 and 8 h after dosing (12‐h AUC = 4.262C2 + 8.390C8− 669.417; r2 = 0.9808, absolute prediction error = 3.97 ± 0.96). Two model equations derived using the linear trapezoidal rule provided the best correlation with the complete AUC: (1) The two time points selected model equation 12‐h AUC = 4C2 + 5C8; r2 = 0.9780, absolute prediction error = 6.41 ± 1.22). (2) The three time points selected model equation 12‐h AUC = 4C0 + 3C2 + 5C6; r2 = 0.9475, absolute prediction error = 5.00 ± 1.41). When different pharmacokinetic data sets were applied to the model equations derived using regression analysis, the values of coefficients and the constant of the regression equation had changed from the initial equation. Thus, new model equations will emerge every time the new data are applied. In contrast, the values of coefficients in the model equation calculated using trapezoidal rule were unaltered when tested by the new pharmacokinetic data set. Thus, the abbreviated AUC derived using the linear trapezoidal rule would be simpler than and superior to that obtained using stepwise multiple linear regression analysis in prediction of the complete AUC.
Angiotensin‐converting enzyme inhibition attenuates renal platelet‐derived growth factor gene expression and cell proliferation in subtotal nephrectomy
Authors: Jandeleit‐Dahm Karin , Wu Leonard L. , Johnson Richard J. , Cox Alison J. , Kelly Darren J. , Cooper Mark E. , Gilbert Richard E.
Published: March 2003

Cell proliferation, matrix accumulation and cell infiltration are characteristic features of progressive glomerulosclerosis and tubulointerstitial fibrosis. Platelet‐derived growth factor (PDGF), a cytokine which has proliferative, prosclerotic and chemokine properties, has been shown to be upregulated in the rat remnant kidney model. Inhibition of the renin–angiotensin system by angiotensin‐converting enzyme (ACE) inhibitors has a beneficial effect on renal function and morphology, but the effect of ACE inhibition on PDGF gene expression and PDGF‐mediated cellular proliferation in subtotal nephrectomy has not been studied in detail. Twelve rats were subtotally nephrectomized (STNx) and received either the ACE inhibitor perindopril or a placebo for 12 weeks. Five sham‐operated rats served as controls. Subtotal nephrectomy was associated with hypertension, proteinuria, elevated plasma creatinine and increased kidney weight. After 12 weeks, PDGF B‐chain mRNA was significantly upregulated in the glomeruli and tubulointerstitium of subtotally nephrectomized rats. ACE inhibition attenuated PDGF mRNA expression in association with a reduction in tubular and glomerular proliferation, as assessed by staining for proliferating cell nuclear antigen. In the context of the known in vitro and in vivo effects of PDGF, it is postulated that the renoprotective action of ACE inhibitors may be partially related to PDGF‐mediated antiproliferative mechanisms.
Nitric oxide synthesis and nitric oxide synthase expression in the kidney of rats treated by FK506
Authors: WANG LiMing , KUBODERA Satoshi , ARAKI Isao , UENO Akira , TAKEDA Masayuki
Published: March 2003

SUMMARY: FK506‐induced nephrotoxicity is characterized by a disturbance in renal haemody‐namics that is attributed to an imbalance between the various modulators of renal vascular tone. It has not been well defined whether nitric oxide (NO), as an important vasoactive factor, is involved in FK506‐induced nephrotoxicity. This study was designed to evaluate the involvement of nitric oxide in FK506‐induced nephrotoxicity by investigating NO synthesis and NO synthase (NOS) expression in the kidney of rats treated with FK506. Male Wistar rats weighing 240–260 g, aged 11 weeks, were administered with FK506 (3.2mg/kg per day i.m.) for 4 weeks. Renal function and urinary NOx was measured using biochemical methods at the end of both 2 and 4 weeks of treatment. Expression of NOS protein and NOS mRNA in the kidney was also investigated using Western blot analysis and reverse transcription/polymerase chain reaction, respectively. FK506 administration induced nephrotoxicity, which was indicated by renal dysfunction (elevated blood urea nitrogen and creatinine, and reduced creatinine clearance, P < 0.05 vs control). FK506‐induced nephrotoxicity was accompanied by higher urinary NOx excretion at the end of 2 weeks' treatment. In parallel with an increase in NO synthesis, increased eNOS protein and mRNA expression were also found in the renal medulla and renal cortex at week 2. the expression remained at higher levels in the renal medulla and returned to normal levels in the renal cortex at week 4. FK506 treatment induced nephrotoxicity in rats, which was accompanied by a temporal increase in NO synthesis in the kidney. Increased eNOS protein and mRNA expression were also found in the kidney of treated rats, which may be responsible for the enhanced NO synthesis.
Pyridinoline cross‐linked carboxy‐terminal telopeptide of type I collagen in uremic hyperparathyroidism
Authors: HATADA Takuya , IKEDA Hidehiro , FUJIWARA Yoshinori , YOH Kousei , YAMAMURA Takehira
Published: March 2003

SUMMARY: We compared the serum level of the pyridinoline cross‐linked carboxy‐terminal telopeptide of type I collagen (I‐CTP) with clinical parameters of bone formation and skeletal symptoms to investigate whether I‐CTP can predict the degree of renal osteodystrophy. Serum I‐CTP was measured in 41 patients with secondary hyperparathyroidism who underwent total parathyroidectomy and autoimplantation (PTx). Measurement was done by using radioimmunoassay. Blood samples were collected before surgery and at 1, 3, 6, 9, 12, 15, and 18 months afterwards for the measurement of bone formation parameters. Serum I‐CTP levels were significantly higher in patients with Jensen grade 3–5 renal osteodystrophy than in patients with grade 0–2 renal osteodystrophy. the I‐CTP levels were also significantly higher in patients with bone or joint pain compared with patients without pain. There was a significant negative correlation between the serum I‐CTP level and the lumbar vertebral (L2‐4) bone mineral density. Serum I‐CTP was significantly correlated with the serum levels of alkaline phosphatase, calcium, and phosphate, as well as the serum calcium x phosphate product, and the intact parathyroid hormone level. These findings suggest that serum I‐CTP could be used as a marker for evaluating osteodystrophy in uremic hyperparathyroidism.
Prevalence of cancers in Korean recipients of renal transplants
Authors: KIM Hee Jin , LEE Tab Won , IHM Chun Gyoo , KIM Myung Jae
Published: March 2003

SUMMARY:Cancer is a complication in immunosuppressed transplant recipients, and is widely recognized. of the 10 029 Korean recipients of renal transplants in 1975–1999, cancer developed in 193 (1.9%). the total number of cancers was 197, with four patients developing two cancers. Only the patients with cancers were reviewed according to their age, sex, type of immunosuppression, interval between transplantation and the diagnosis of cancer, and the method of treatment and survival. In 108 males and 85 females (mean age 40.7 years), cancer developed approximately 64.9 months after renal transplantation. Eighteen patients received conventional immunosuppression‐azathioprine with prednisone, and another 175 patients received cyclosporin‐containing immunosuppression therapy. Twenty‐two patients had skin cancers, 21 patients had Kaposi's sarcoma, 17 patients had post‐transplantation lymphoproliferative disorder, two patients had myelodysplastic syndrome, and 132 patients had solid cancers, respectively. One hundred and nine patients underwent surgical treatment; 88 patients with advanced disease received radiotherapy, chemotherapy or symptomatic therapy. One hundred and twenty‐one (62.7%) patients are alive, with no evidence of disease 42.2 months (on average) following the diagnosis of cancer. Another 11 patients were lost to follow up. Forty‐nine patients died of progressive malignant disease, and 12 died of other causes. the average survival of dead patients with cancers was approximately 9 months (the mean survival period of dead patients caused by progressive malignant disease was 7.7 months). the time of diagnosis of cancers ranged from 2 to 240 months after kidney transplantation. We conclude that in immunosuppressed renal transplant recipients, the possibility of the development of cancer always should be considered. and we recommend follow up of appropriate intervals for signs of cancer over a long period.
Current incidence, treatment patterns and outcome of end‐stage renal disease among indigenous groups in Australia and New Zealand
Authors: MCDONALD STEPHEN P , RUSS GRAEME R
Published: March 2003

SUMMARY: The changes in rates of treated end‐stage renal disease (ESRD) among indigenous populations have profound consequences for those individuals affected and for health‐care providers. By using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we examined the current incidence, treatment and outcomes of ESRD among indigenous groups in Australia and New Zealand. All patients who began renal replacement therapy (RRT) in Australia or New Zealand between October 1991 and September 2000 were included. Rates of ESRD, RRT modalities, renal transplantation and mortality were the outcomes examined. End‐stage renal disease rates among indigenous groups in Australia and New Zealand exceeded non‐indigenous rates up to eightfold. The median age of indigenous ESRD patients was younger (51 vs 60 years, P < 0.0001), and there was an excess of comorbidities, particularly diabetes. For Australian Aboriginal and Torres Strait Islanders, and New Zealand Maori patients, mortality rates across all modalities of RRT were 70% higher than non‐indigenous rates. Indigenous people were less likely to receive a renal transplant prior to dialysis treatment, less likely to be accepted onto the cadaveric transplant waiting list, and less likely to receive a well‐matched transplant. The poorer outcomes among Australian Aboriginal and Torres Strait Islanders, and New Zealand Maori patients did not appear to be explained by the different comorbid conditions or age. Whether the outcomes reflect unmeasured differences in disease burden or treatment differences is not known. Tackling this problem will involve a spectrum of people and approaches, from tertiary care providers and RRT to local staff and preventative programs.
Profiling the IgA nephropathy renal transcriptome: analysis by complementary DNA array hybridization
Authors: Yano Naohiro , Fadden‐Paiva Kimberly J , Endoh Masayuki , Sakai Hideto , Kurokawa Kiyoshi , Dworkin Lance D , Rifai Abdalla
Published: March 2003

SUMMARY:
A comprehensive profile of genes expressed at the mRNA level (transcriptome) in human renal tissue is important for elucidating the pathogenesis and treatment of IgA nephropathy (IgAN). The recent development of complementary DNA (cDNA) array hybridization allows the parallel monitoring of thousands of genes expressed in renal tissue. High‐density cDNA containing 18 326 paired unique human cDNA gene probes were used to quantitatively analyse the expression of genes in renal biopsies of IgAN and controls. Computational analysis was used to cluster genes according to similarity in pattern of gene expression. Through relational database analysis, we determined 1901 genes that were commonly expressed in four selected IgAN renal biopsies and four controls. Further analysis of the expressed genes by self‐organizing maps and hierarchical clustering revealed a genomic profile unique to severely affected IgAN patients. These findings represent a comprehensive preliminary molecular index of genes transcribed in IgAN. More importantly, this molecular approach may accelerate the discovery of pathogenic mechanisms underlying the most common form of glomerulonephritis worldwide.
Recurrence of IgA nephropathy in renal transplants
Authors: Woodroffe Andrew , Clarkson Anthony
Published: March 2003

SUMMARY:The present article provides an update from the literature on the clinical significance of recurrent IgA disease in renal transplant patients, and it identifies possible reasons for the differences between the data that have been published. The clinical features of recurrent IgA nephropathy are described here, along with suggestions for the management of these patients.
Embracing technology: an exploration of the effects of writing nursing
Authors: Purkis Mary Ellen
Published: March 2003

Contemporary societal factors influencing the delivery of healthcare in Canada include loud and persistent demands for accountability around the use of public funds. Interests in fiscal accountability are not only held by managers and politicians. Practitioners too hold interests in this domain, particularly where ‘interest’ means having a reserved seat at the table where discussions regarding resource allocation will take place. In this light, practitioners are also interested in enrolling forms of technology that enable them to make visible their ‘unique contribution’ to the care delivery enterprise. Latour’s writings on ‘technology’ as durability offer methods for describing socio‐technical processes that contribute to the appearance of domination. Challenging the prevailing view that order results from powerful domination, Latour argues that domination is an effect of contingent processes. A case study is presented where multiple interests in developing a form of nursing that is visibly ‘autonomous’ and ‘cost‐effective’ are brought together with technological forms that promise such visibility. Costs associated with purchasing visibility are critically examined.
The required role of the psychiatric‐ mental health nurse in primary health‐ care: an augmented Delphi study
Authors: Walker Louise , Barker Phil , Pearson Pauline
Published: March 2003

The required role of the psychiatric‐mental health nurse in primary health‐care: an augmented Delphi study

An augmented Delphi study was employed to elicit the perceptions of CPNs, GPs, social workers, managers of psychiatric nursing services and health service purchasers in England, on the role required of a psychiatric (mental health) nurse in primary health care. In the final stage of the study, users of mental health service were enlisted in a verification study of the emergent findings. A broad consensus emerged that a gap existed in mental health services in primary care. This was perceived as placing a large burden on GPs, which might be reduced by the appropriate development of community psychiatric‐mental health nursing. The study suggested the possibilities for development of a ‘mental health nurse consultant’ role, which might augment the current CPN role, within which the nurse might offer not only direct patient care, but also support to members of the primary care team.
Understanding between care providers and patients with stroke and aphasia: a phenomenological hermeneutic inquiry
Authors: Sundin Karin , Jansson Lilian , Norberg Astrid
Published: March 2003

Understanding between care providers and patients with stroke and aphasia: a phenomenological hermeneutic inquiry

The present study illuminates the understanding in communication between formal care providers and patients with stroke and aphasia. Five care providers and three such patients participated in the study. Video recordings were made during conversations about pictures (n = 15), and the care providers were also interviewed (n = 15) after the video‐recorded conversations. A phenomenological hermeneutic method of interpretation of the interview text was used. The findings showed that a range of conditions for ‘understanding and being understood’ in the communication on the part of the care providers exists. These different conditions are:lackingboth knowledge and understanding;havingknowledge but not necessarily accompanied by understanding; andbeingin understanding. Within the condition ‘being in understanding’, the care providers create a feeling of at‐homeness in a relaxed atmosphere and thus have the opportunity to be in ‘understanding and being understood’ together with the patient. The condition ‘being in understanding’ appears in connection with the care providers’ creating of a ‘calm liturgy of caring’ by mediating humility and calm vitality affects to the patients, and further, when needed, being present on the level of mystery, i.e. caring communion.
Dissociogenic stress: A transcultural concept
Authors: OKANO KEN‐ICHIRO
Published: March 2003

Traumatic stress takes different forms in different sociocultural contexts. It is more reasonable to include covert and apparently nontraumatic stress as a factor contributing to dissociative disorders, rather than to limit our attention to overt and stereotyped forms of trauma, such as childhood sexual and physical abuse. Despite their different manifestations, covert stress and overt stress may cause dissociative pathology under certain conditions. This condition could be the suppression of projection and externalization of negative mental contents under a given stress. The author would like to call this form of stress `dissociogenic stress.' Whether or not an individual develops a dissociative disorder as a result of dissociogenic stress also depends on the individual's constitutionally based dissociative and hypnotic tendency.
The Noh mask test for analysis of recognition of facial expression
Authors: Minoshita Seiko , Satoh Shinji , Morita Nobuaki , Tagawa Akihito , Kikuchi Tadashi
Published: March 2003

A preliminary study on the Noh mask test for analysis of recognition of facial expression was performed. The present study was conducted on 15 normal subjects (mean age: 32 years, SD 9.7 years) as the first step to test for the differences between psychiatric patients and normal subjects. Stimuli were created by photographs of 15 Noh masks at different vertical angles. Subjects were given 12 tasks (12 emotion items), and each task consisted of 15 trials (15 Noh mask images). In each trial, the subject viewed a colour monitor, and was shown an emotion item, followed by a Noh mask image. The subject pressed either the yes or no key to indicate whether the Noh mask image expressed the emotion item. The subject’s response and reaction time to each Noh mask image showed no deviation, although the subject’s response and reaction time to each emotion item showed some deviation. As the vertical angle of the Noh mask changed, normal subjects recognized all emotion items except the ‘uncanny’ expression. Factor analysis of the 15 Noh mask images produced three factors, and the analysis of 12 emotion items produced five factors. Thus, the Noh mask test was simplified to nine images and nine items. Further developments of the Noh mask test may include the evaluation of the dysfunction of perception on delicate facial expression in psychiatric patients.
Analyses of mothers’ sleep logs in postpartum periods
Authors: Horiuchi Shigeko , Nishihara Kyoko
Published: March 2003

In order to investigate mothers’ sleep–wake patterns from five to 12 weeks in the postpartum period, we analyzed continuous sleep logs. Data for 341 days from seven mothers were analyzed for each postpartum week. There were significant differences in total sleep time and wake time at night. Wake time at night gradually decreased from the fifth to the twelfth week. These results from continuous sleep logs support the results of our previous polysomnographic findings based on intermittent measurements. A transition from interrupted sleep to non‐interrupted sleep was observed from the ninth to twelfth week of postpartum. The mothers’ sleep–wake patterns are discussed focusing on their relationships to the infants’ sleep–wake patterns and feeding rhythm.
Comorbidity of depression among physically ill patients and its effect on the length of hospital stay
Authors: Hosaka Takashi , Aoki Takayuki , Watanabe Toshiyuki , Okuyama Toru , Kurosawa Hisashi
Published: March 2003

This study was carried out to demonstrate the prevalence of depression among physically ill patients and to investigate its effects on the length of hospital stay. Out of 65 inpatients (44 male, 21 female; 51 with benign and 14 with malignant diseases), 14 (21.5%) met the criteria for major depression in the DSM‐IV. The average length of hospital stay was compared according to the comorbidity with major depression. Among the patients with benign diseases, those with major depression stayed longer (P < 0.05) at the hospital than those without it (82.2 vs 36.0 days). Likewise, among the cancer patients, those with major depression stayed longer than those without it (83.8 vs 51.4 days), although this was not significantly different. The duration of hospitalization needs to be shortened because of the reduction in national medical costs, the economics of hospital administration and the quality of life of patients and their families. Further research is needed to demonstrate the role of consultation–liaison psychiatry in the shortening of hospitalization.
Factors responsible for the prolongation of school refusal
Authors: Okuyama Mizuho , Okada Motohiro , Kuribayashi Michito , Kaneko Sunao
Published: March 2003

Two hundred and one school refusers (≤18 years old), excluding schizophrenia, were treated at the Department of Neuropsychiatry, Hirosaki University Hospital between April 1975 and March 1995. Of 56 cases of school refusal, 31 did not improve for more than 2 years (group P), and 25 cases had improved in the degree of school refusal and social impairment (group B). The remaining cases were excluded from the analysis for several reasons. There was no significant difference between groups B and P in age at the first psychiatric evaluation as well as the age of onset of school refusal. The duration from school absence to the first evaluation of group P was significantly longer than that of group B. The duration of school refusal significantly and positively correlated with the duration from school absence to the first evaluation. Introversion and nervousness prolonged the duration of school refusal. The non‐presence of volition for school attendance, and a low frequency of school attendance during the 1 month prior to the first evaluation influenced the prolongation of school refusal. The ‘duration from school absence to the first evaluation’, the ‘patient’s character’, the ‘non‐presence of volition for school attendance’ and the ‘frequency of school attendance’ influenced the prolongation of school refusal. The introduction of treatment within 10 months of the onset of school refusal is an important factor in preventing the prolongation of the school refusal.
Changes in limbic dopamine metabolism following quinolinic acid lesions of the left entorhinal cortex in rats
Authors: Kurachi Masayoshi , Sumiyoshi Tomiki , Shibata Ryoko , Sun Yue‐Ji , Uehara Takshi , Tanii Yasuyuki , Suzuki Michio
Published: March 2003

To examine the effects of lesions of the entorhinal cortex on limbic dopamine (DA) metabolism, DA and its metabolites were assayed in five brain regions (the medial prefrontal cortex, anterior cingulate cortex, caudate‐putamen, accumbens nucleus, and lateral amygdala), 14 and 28 days after quinolinic acid or sham lesions of the left entorhinal cortex in rats. Concentrations of 3,4‐dihydroxyphenylacetic acid (DOPAC) on day 14 in the medial prefrontal cortex, accumbens nucleus, and lateral amygdala of the entorhinal cortex lesioned animals were significantly decreased compared with the controls, but they returned to control levels on day 28. The concentration of DA in the lateral amygdala and spontaneous locomotion to a novel environment were significantly increased on day 28 after the lesion. These results suggest that entorhinal cortex lesions alter mesolimbic dopamine metabolism, particularly in the amygdala.
Adolescent hyperactivity and general psychopathology
Authors: Chang Hsueh‐Ling , Chuang Hung‐Yi
Published: March 2003

The aim of this study was to explore the relationship between activity and psychopathology in adolescents. A total of 289 high school students completed the Symptom Check List‐90‐R (SCL‐90‐R) and Wender Utah Rating Scale (WURS) in December 1998. The WURS was used to measure the students’ activity level and the SCL‐90‐R was used as a measure of general psychopathology. Forty‐one students (14.18%) scored higher than 46, the cut‐off point for differentiation of attention deficit hyperactivity disorder (ADHD) from the general population according to Ward’s report, in the WURS (WURS(+)). The WURS(+) students scored significantly higher than the WURS(–) students in all the subscales of SCL‐90‐R. The prevalence rate of adolescent WURS(+) in this study is 14.18%. This result shows that ADHD adolescents have overlapping symptoms with depression.