bluuebunny/crossref_metadata_2025 huggingface dataset:
Cataract surgery in high‐risk age‐related macular degeneration: a randomized controlled trial
Authors: Hooper Claire Y , Lamoureux Ecosse L , Lim Lyndell , Fraser‐Bell Samantha , Yeoh Jonathan , Harper Colin A , Keeffe Jill E , Guymer Robyn H
Published: June 2009

Abstract

Background:  To investigate if cataract surgery causes progression, from high‐risk early age‐related macular degeneration (AMD) to choroidal neovascularization (CNV), in the postoperative period.

Methods:  Randomized controlled trial. Patients, with visually significant cataract and fundus features of early AMD at high risk of progression to CNV, were randomized into two groups and were evaluated at baseline and 6 months. The study patients (n = 27) underwent immediate cataract surgery. The control group (n = 29) comprised patients who had cataract surgery deferred until after the 6‐month visit. Assessment included visual acuity, quality of life (QoL) and fundus fluorescein angiography (FFA).

Results:  Of 68 eligible eyes, 60 participated and 56 completed the study. Three referred eyes (3.2%) were ineligible on the basis of a pre‐existing, unsuspected occult CNV that was detected by baseline FFA. All three cases had end‐stage exudative AMD in the fellow eye. Of the study eyes in the immediate surgery arm (n = 27), one (3.7%) developed CNV compared with none (0/29) in the deferred arm (χ2; P = 1.0) at 6 months. In the operated group, there was a 2.8‐line improvement in logMAR visual acuity and 2.1‐fold average gain in QoL at 6 months.

Conclusions:  No increased short‐term risk of progression of AMD to CNV in high‐risk fundi following uncomplicated phacoemulsification surgery was found. A low threshold for performing preoperative imaging in patients with AMD, especially in those with exudative AMD in the fellow eye, to exclude undetected CNV is recommended. Provided there is no CNV, there are distinct benefits of cataract surgery in people with early AMD.
Spherical aberration after implantation of an aspheric versus a spherical intraocular lens in high myopia
Authors: Yu A‐Yong , Wang Qin‐Mei , Sun Jing , Xue An‐Quan , Zhu Shuang‐Qian , Wang Shu‐Lin , Li Jin‐Yang
Published: June 2009

Abstract

Purpose:  To compare visual performance and wavefront aberration in high myopia implanted with an aspheric intraocular lens (IOL) and a spherical IOL.

Methods:  In this prospective investigation, 31 highly myopic patients were randomized to receive two IOL types: aspheric IOL (Acri.Smart 36A, 22 eyes) and spherical IOL (Rayner Superflex 620H, 23 eyes). Complete ophthalmological examination including best‐corrected visual acuity (BCVA) and corneal aberration (Humphrey corneal topography) were performed preoperatively, 1 and 3 months postoperatively. Ocular aberration (WASCA wavefront analyser) was performed 1 and 3 months postoperatively. Contrast sensitivity under different lighting condition (CSV‐1000) was performed 3 months postoperatively.

Results:  The aspheric IOL group and the spherical IOL group did not differ in baseline characteristics, including corneal spherical aberration Z40 (for 5‐mm pupil diameter 0.13 ± 0.06 vs. 0.15 ± 0.08 µm, P = 0.317; for 6‐mm pupil diameter 0.30 ± 0.11 vs. 0.29 ± 0.13 µm, P = 0.764). Compared with the spherical IOL group, the aspheric IOL group showed statistically significant less induction of Z40 of total ocular aberration at a pupil size of 5 and 6 mm 3 months postoperatively (0.07 ± 0.06 vs. 0.12 ± 0.06 µm, P = 0.017; 0.17 ± 0.11 vs. 0.27 ± 0.12 µm, P = 0.010), but not for 4‐mm pupil (0.03 ± 0.04 vs. 0.02 ± 0.04 µm, P = 0.54). The BCVA and contrast sensitivity were not statistically different between the two groups postoperatively.

Conclusions:  The aspheric IOL induces significantly less spherical aberration than the spherical IOL after implantation in high myopia. Implantation of an aspheric IOL may reduce spherical aberration in high myopia, but clinically superior vision is not achieved.
Isolated extraocular muscle involvement as the ophthalmic manifestation of leukaemia
Authors: Kiratli Hayyam , Balci Kadriye E , Himmetoğlu Çiğdem , Üner Ayşegül
Published: June 2009

Abstract

Background:  Clinical and imaging features of patients with orbital leukaemia primarily involving extraocular muscles were evaluated.

Methods:  This retrospective case series includes patients with leukaemia whose only ophthalmic manifestation was extraocular muscle enlargement. Demographic data, clinical information on the systemic disease, prominent ocular signs and symptoms, computed tomography and magnetic resonance imaging characteristics, treatments applied and the outcomes were collected.

Results:  Five patients were diagnosed as leukaemic infiltration of extraocular muscle between 1995 and 2008. The age at presentation ranged between 3 and 61 years. Acute myeloid leukaemia was the diagnosis in two patients, and chronic lymphocytic leukaemia, chronic myeloid leukaemia and biphenotypic acute leukaemia were found in one patient each, respectively. One patient had bilateral involvement. The lateral rectus muscle was affected in four patients and the superior rectus muscle in one case. Restricted ocular motility was the most common finding. In one patient who had no prior history of leukaemia, an incisional biopsy established the diagnosis. All patients received multi‐agent chemotherapy. Four patients expired after a rapid decline of the systemic status within a mean period of 7 months.

Conclusions:  Leukaemic infiltration of extraocular muscles is a rare and late manifestation of the advanced disease associated with relapse and there seems to be a predilection for the lateral rectus muscle. Systemic prognosis remains dismal despite intensive chemotherapy.
Notable role of glaucoma club on patients' knowledge of glaucoma
Authors: Chen Xueli , Chen Yuhong , Sun Xinghuai
Published: June 2009

Abstract

Purpose:  To assess how general glaucoma patients understand their disease compared with patients from the Shanghai Glaucoma Club and various influencing factors as well. Shanghai Glaucoma Club was further evaluated to determine its efficacy on its members' understanding and knowledge of glaucoma.

Methods:  A total of 301 glaucoma patients in Shanghai Glaucoma Club and 314 general glaucoma patients were investigated by a questionnaire, composed of three parts and consisting of 20 questions. The first part asked questions about ‘level of cognition about glaucoma’, the second part was about ‘compliance of medication and follow‐up’, and the third part was about ‘life style and habit’. Answers were graded on each question and scores were summed up separately for each part and as a total. Differences of scores and influencing effects were analysed using multivariate linear regression (stepwise) between the two groups.

Results:  The average total scores of the general glaucoma patients and the glaucoma club members were 19.6 ± 5.4 and 23.8 ± 4.0 (t = −11.14 P < 0.01), respectively. After multivariate linear regression adjustment for the effects of age, diagnosis and educational level glaucoma club members still had 3.73 points edge over the general patients.(t = 8.14, P < 0.01). The club was shown to be the strongest positive factor influencing patients' cognition. Patients in Shanghai Glaucoma Club understood the nature and course of glaucoma significantly better than the general glaucoma patients (t = 10.97, P < 0.01) and also lived healthier lives (t = 7.55, P < 0.01). The level of background education was found to be a positive influencing factor although age was negatively correlated with total score. Primary glaucoma patients demonstrated better cognition of their diseases compared with secondary glaucoma patients, and those patients unaware of their type of glaucoma produced lower scores.

Conclusions:  This study demonstrated significant differences regarding the basic understanding of glaucoma between two groups: general glaucoma patients and members of the Shanghai Glaucoma Club. Club members presented with better cognition of glaucoma and self‐management compared with general glaucoma patients. Therefore, the Shanghai Glaucoma Club is an effective medium to improve patients' knowledge of disease and compliance for medication.
Frequency and clinical features of intraocular inflammation in Tokyo
Authors: Keino Hiroshi , Nakashima Chikae , Watanabe Takayo , Taki Wakako , Hayakawa Ruriko , Sugitani Atsuhiko , Okada Annabelle A
Published: June 2009

Abstract

Background:  To investigate frequencies and clinical features of intraocular inflammation (uveitis) in Tokyo, Japan.

Methods:  Records of 834 consecutive new referral patients (352 men, 482 women) examined at the Kyorin University Hospital from April 2000 to December 2007 were retrospectively reviewed.

Results:  Mean age at onset was 44.8 years for men and 47.0 years for women. By anatomical classification, 229 patients (27.4%) had anterior uveitis, 10 (1.2%) had intermediate uveitis, 183 (21.9%) had posterior uveitis and 412 (49.4%) had panuveitis. The most common diagnoses were Vogt‐Koyanagi‐Harada (VKH) disease (11.0%), sarcoidosis (6.9%), acute anterior uveitis (6.5%), Behçet's disease (5.8%) and tuberculosis (4.3%). In the third and fourth decades, the most common diseases were Behçet's disease for men and VKH for women, whereas over 60 years of age, the most common diseases were VKH for men and sarcoidosis for women. Systemic corticosteroids were used in 25.5% of patients, and other immunomodulatory agents were required in 8.7% of patients.

Conclusions:  The most frequent diagnoses were sarcoidosis, VKH disease, acute anterior uveitis, Behçet's disease and tuberculosis, with Behçet's disease being common in young men and sarcoidosis being common in elderly women. One‐fourth of patients received systemic corticosteroids and 8.7% of patients required other immunomodulatory agents.
Geographic variations of seasonality and coexistence in communities: The role of diversity and climate
Authors: CANAVERO ANDRÉS , ARIM MATÍAS , BRAZEIRO ALEJANDRO
Published: June 2009

One of the most conspicuous and widely analyzed patterns in ecology is the latitudinal gradient in species richness. Over the 200 years since its recognition, several hypotheses have accumulated in order to account for spatial variations in diversity. Geographic variations in seasonality have been repeatedly proposed as a determinant of community richness. However, the geographic structure of community seasonality has not yet been analyzed. In the present work we evaluated three hypotheses that account for variations in the temporal structuring of communities: first, environmental seasonality determines community seasonality; second, community richness determines its degree of structuring; and third, the presence of an increase in species segregation with latitude, reflected in a pattern of species negative co‐occurrence. The hypotheses were evaluated using path analysis on 29 amphibian communities from South America, connecting latitude, environmental conditions, diversity, seasonality, and coexistence structure – nestedness and negative co‐occurrence – within communities. Latitude positively affects community seasonality through an increase in temperature seasonality, but a weak negative direct effect suggests that other variables not considered in the model – such as the strength of biotic interactions – could also be involved. Both latitude and diversity (directly and indirectly) determine an increase in negative co‐occurrence and nestedness. This suggests that groups of species that are mutually nested in time are internally segregated. Further, the strength of this structure is determined by community diversity and latitude. Temporal structuring of a community is associated with latitude and diversity, pointing to the existence of a systematic change in community organization far beyond, but probably interrelated, with the recognized latitudinal trend in richness. The available information and analysis supported the three hypotheses evaluated.
Structure and species richness in wetland continua on sandy soils in subtropical and tropical Australia
Authors: SPECHT RAYMOND L.
Published: June 2009

Net photosynthetic fixation of wetland plant communities is confined to the period of the year when the surface soil is not waterlogged and is thus well aerated. In the open‐structured vegetation continuum across freshwater wetlands on sandy soils in subtropical and tropical Australia, the sum of the foliage projective covers (FPCs) of the overstorey and understorey strata remains constant, while that of the overstorey decreases to zero as seasonal waterlogging (and anaerobic conditions) in the surface root systems increases. Density and height of the overstorey trees – of only one or two species – and species richness (number of species per hectare) in the understorey decreases along this waterlogging gradient.Melaleucapaperbark trees, possessing surface roots with cortical aerenchyma, may form a closed‐forest at the edge of the wetland continuum wherever there is a continuous flow of aerated water. As global warming progresses, an increase in air temperature in the atmosphere flowing over and through the wetland continuum during the short period of annual foliage‐growth will affect the combined FPCs of overstorey and understorey strata, as well as the leaf‐specific weights of all leaves throughout the plant community. With a reduction in net photosynthetic fixation, species richness of the plant community will slowly decline.
Host infestation patterns of the massive liana Hydrangea serratifolia (Hydrangeaceae) in a Chilean temperate rainforest
Authors: JIMÉNEZ‐CASTILLO MYLTHON , LUSK CHRISTOPHER H.
Published: June 2009

As competition from lianas reduces fitness of host trees, lianas could influence community composition and structure if potential host species differ in susceptibility to infestation. We quantified infestation frequencies of Chilean temperate rainforest tree species by the massive liana Hydrangea serratifolia (H. et A.) F. Phil (Hydrangeaceae), which climbs using adhesive adventitious roots, and examined relationships with host light requirements and stem diameter. We recorded presence or absence of H. serratifolia in a random sample of 515 trees ≥10 cm diameter. Fifty‐four per cent of trees were infested by at least one individual of H. serratifolia. Although there was significant interspecific variation in infestation frequency, this variation was not systematically related to light requirements of host tree species. Probability of infestation increased with diameter for most host tree species, and old trees were found to be infested by a wide range of liana size classes, including some stems <2 cm diameter. This evidence supports the proposal that lianas which attach by adhesive roots can colonize host stems of any size.
The potential of seed‐eating birds to spread viable seeds of weeds and other undesirable plants
Authors: TWIGG LAURIE E. , LOWE TIM J. , TAYLOR CATHERINE M. , CALVER MIKE C. , MARTIN GARY R. , STEVENSON CLAIRE , HOW RIC
Published: June 2009

The potential for seed‐eating birds to spread viable seeds was investigated using captive‐feeding trials to determine seed preference, passage time through the gut, and viability of passed seeds for bronzewing pigeons (Phaps chalcoptera), peaceful doves (Geopelia striata), crested pigeons (Ocyphaps lophotes), Senegal doves (Streptopelia senegalensis), zebra finches (Taeniopygia guttata), black ducks (Anas superciliosa) and wood ducks (Chenonetta jubata). Test seeds were bladder clover (Trifolium spumosum), crimson clover (Trifolium incarnatum), gorse (Ulex europaeus), canola (Brassica napus) and red panicum (Setaria italica). Their consumption was compared with that of commercial seed mixes. Although all test seeds were recognizable foods, their consumption usually decreased in the presence of other foods, except for canola, where consumption rates were maintained. Hard‐seeded bladder clover was the only species where viable seeds were passed by obligate seedeaters. In contrast, viable seeds of canola and gorse were passed by seed‐eating omnivorous/herbivorous ducks, although the germination of passed seeds (42%) was reduced significantly compared with that of untreated control seed (67%). Field validation with wild, urban bronzewings and Australian magpies (Gymnorhina tibicen) offered canola and commercial seed yielded similar outcomes, with a range of viable seeds recovered from magpie soft pellets. Mean seed passage time in captive birds ranged from 0.5 to 4.3 h for all test seeds and commercial seed mixes, suggesting that these bird species may potentially disperse seed over moderate distances. Despite the low probability of individual birds spreading viable seed, the high number of birds feeding in the wild suggests that the potential for granivorous and seed‐eating omnivorous birds to disperse viable seeds cannot be discounted, particularly if exozoochorous dispersal is also considered.
Seed moisture content affects afterripening and smoke responsiveness in three sympatric Australian native species from fire‐prone environments
Authors: TURNER SHANE R. , MERRITT DAVID J. , RENTON MICHAEL S. , DIXON KINGSLEY W.
Published: June 2009

Germination of freshly collected seeds of three sympatric herbaceous species native to fire‐prone environments in south‐western Australia was significantly improved through the application of novel combinations of dry heat, gibberellic acid, smoke water and dry afterripening. For fresh seeds, combinations of dry heat, gibberellic acid and/or smoke water resulted in >80% germination in Austrostipa elegantissima (Poaceae) and Stylidium affine (Stylidaceae) seeds and >60% germination in Conostylis candicans (Haemodoraceae) seeds, compared with <10% germination of control seeds. For fresh seeds, two broad germination patterns were observed in response to smoke water: nil – low germination for both control and smoke water‐treated seeds (A. elegantissima and S. affine); and a significant smoke response (35%) compared with control seeds (1%) (C. candicans). During afterripening, high germination for A. elegantissima seeds was achieved following 3 months storage of seeds at equilibrium relative humidities of 23–75%, but seeds stored at 5–13% equilibrium relative humidities took 6–36 months to achieve similar levels of germination. Germination of C. candicans seeds also increased after 3 months storage, to >60% at each equilibrium relative humidity and further increases over time were slight. For S. affine seeds >60% germination was achieved only after 36 months storage at 50% equilibrium relative humidity. Seeds from all three species were smoke‐responsive at some point, but the interaction/effects of afterripening on the smoke response varied significantly between species. This study highlights an apparent effect of seed dormancy status on response to smoke and a surprisingly high level of ecological variation in pre‐germination requirements (cues) for these co‐occurring species that may relate to variation(s) in microsite selection forces operating on the soil seed bank of the different species.
CURRENT STATUS AND FUTURE PERSPECTIVE OF ENDOSCOPIC DIAGNOSIS AND TREATMENT FOR COLORECTAL NEOPLASIA – SITUATION IN TAIWAN
Authors: Chiu Han‐Mo , Lin Jaw‐Town , Wu Ming‐Shiang , Wang Hsiu‐Po
Published: June 2009

The incidence of colorectal cancer (CRC) is rising substantially in Taiwan. Hence, both effective screening and management of colorectal neoplasms, including precursor lesions and early cancers, have become critically important. Colorectal cancer is not only curable, but also can be managed endoscopically if detected at the stage of precursor lesions or early cancer. Optimal management of colorectal neoplasia relies largely on accurate evaluation of the characteristics of lesions, including malignant transformation, and the depth of invasion of the malignant lesions. In this context, observation using image enhancing endoscopy (IEE) to magnify the image during colonoscopy is of utmost importance. Polypectomy or endoscopic mucosal resection is now the standard procedure for the treatment of colorectal adenoma or early cancerous lesions in Taiwan. Endoscopic submucosal dissection (ESD) is performed at only a few institutions; its long‐term efficacy and cost‐effectiveness require further elucidation. More attention from the government, academic societies, and individual clinicians is necessary.
ENDOSCOPIC ULTRASONOGRAPHY‐GUIDED PANCREATICOGASTROSTOMY FOR A CASE OF OCCLUSION OF GASTRO‐PANCREATIC ANASTOMOSIS AFTER PANCREATICODUODENECTOMY
Authors: Katanuma Akio , Maguchi Hiroyuki , Fukazawa Mituharu , Kurita Akira , Ichiya Tamaki , Kin Toshifumi , Osanai Manabu , Takahashi Kuniyuki
Published: June 2009

Background:  EUS‐guided pancreaticogastrostomy is described as an alternative to surgery for ductal decompression when endoscopic transpapillary access is impossible. We report a case where EUS‐guided pancreaticogastrostomy of the pancreatic duct was effective for dilatation of the pancreatic duct caused from occlusion of gastro‐pancreatic anastomosis constructed after resection of pancreaticoduodenectomy.

Patients and methods:  The patient was a 79‐year‐old woman who had undergone operation for IPMN in the pancreatic head in 1998. Nine years after the operation, she visited us for back pain, and conspicuous dilatation of the main pancreatic duct was found. By observing curved liner array EUS scope, we successfully punctured the main pancreatic duct and placed a plastic stent.

Results:  After the treatment, the subjective symptom was alleviated and reduction of the dilatation of pancreatic duct was observed in image findings.

Conclusion:  Endoscopic ultrasonography guided pancreaticogastrostomy appears to be an effective treatment for a case of occlusion of gastro‐pancreatic anastomosis after pancreaticoduodenectomy.
ENDOSCOPIC ULTRASOUND‐GUIDED CHOLEDOCHODUODENOSTOMY FOR PALLIATIVE BILIARY DRAINAGE IN CASES WITH INOPERABLE PANCREAS HEAD CARCINOMA
Authors: Hanada Keiji , Iiboshi Tomohiro , Ishii Yasutaka
Published: June 2009

Background:  Endoscopic transpapillary biliary drainage (EBD) or stenting is the gold standard treatment for inoperable malignant biliary obstruction. When the papilla cannot be traversed because of pyloric or duodenal stenosis, or the catheter cannot be introduced, or because of previous surgery, the usual alternative method is considered to be percutaneous transhepatic biliary drainage (PTBD). We herein report our experiences with four cases with inoperable pancreatic head carcinoma associated with obstructive jaundice treated by endoscopic ultrasonography‐guided biliary drainage (EUS‐BD).

Methods:  Between September 2006 and December 2007, methods of EUS‐BD were performed in four cases with inoperable pancreas head carcinoma. In three out of four cases, EBD and PTBD were unsuccessful because of previous surgery, or duodenal stenosis, or nondilated intrahepatic bile ducts. In one case, although PTBD was successful, internal drainage could not be established.

Results:  EUS‐BD was successful for all cases. The obstructed biliary system was successfully decompressed by the creation of a choledochoduodenal fistula and the insertion of a transduodenal biliary plastic stent. No complication was encountered in all cases.

Conclusions:  EUS‐BD may have the potential of replacing PTBD in cases with inoperable pancreatic head carcinoma associated with obstructive jaundice.
ROLE OF ENDOSCOPY IN SCREENING OF EARLY PANCREATIC CANCER AND BILE DUCT CANCER
Authors: Tanaka Kiyohito , Kida Mitsuhiro
Published: June 2009

In the screening of early pancreatic cancer and bile duct cancer, the first issue was ‘what are the types of abnormality in laboratory data and symptoms in case of early pancreatic cancer and bile duct cancer?’ Early cancer in the pancreaticobiliary region has almost no symptoms, however epigastralgia without abnormality in the gastrointestinal (GI) tract is a sign of early stage pancreaticobiliary cancer. Sudden onset and aggravation of diabetes mellitus is an important change in the case of pancreatic cancer. Extracorporeal ultrasonography is a very useful procedure of checking up changes of pancreatic and biliary lesions. As the role of endoscopy in screening, endoscopic ultrasonography (EUS) is the most effective means of cancer detection of the pancreas, and endoscopic retrograde cholangiopancreatography (ERCP) is most useful of diagnosis tool for abnormalities of the common bile duct. Endoscopic retrograde cholangiopancreatography is an important modality as the procedure of sampling of diagnostic materials. Endoscopic ultrasonography‐fine needle aspiration (EUS‐FNA) has the role of histological diagnosis of pancreatic mass lesion also. Especially, in the case of pancreas cancer without evidence of cancer by pancreatic juice cytology and brushing cytology, EUS‐FNA is essential. Intra ductal ultrasonography (IUDS) and perotral cholangioscopy (POCS) are useful for determination of mucosal extent in extrahepatic bile duct cancer. Further improvements of endoscopical technology, endoscopic procedures are expected to be more useful modalities in detection and diagnosis of early pancreatic and bile duct cancers.
KNACK AND PRACTICAL TECHNIQUE OF COLONOSCOPIC TREATMENT FOCUSED ON ENDOSCOPIC MUCOSAL RESECTION USING SNARE
Authors: Tanaka Shinji , Oka Shiro , Chayama Kazuaki , Kawashima Koichi
Published: June 2009

Endoscopic mucosal resection (EMR) is one of the main treatment modalities for broad‐based protruded‐type or flat‐type lesions of colorectal tumors. In this report, the procedures and skills required for EMR, which forms the basis of colonoscopic treatment, are described based on the current situation. The knack of EMR is to understand the characteristics and selection of an adequate snare in each situation, selection of adequate local injection drug, to learn techniques of local injection, to master skilful snaring techniques, to estimate the degree of radial cure of locally resected regions using magnifying observation and the practice of additional trimming. As a result of the practice and learning of these points, EMR, including piecemeal resection, can be enough for curative treatment of colorectal tumor. We can and should differentiate EMR from endoscopic submucosal dissection (ESD) for various types of colorectal tumor according to detailed endoscopic diagnosis using magnification prior to treatment.
SECOND LOOK COLONOSCOPY: INDICATION AND REQUIREMENTS
Authors: Rey Jean‐Francois , Lambert Rene
Published: June 2009

Background:  There are circumstances when a colonoscopy should be repeated after a short interval following the first endoscopic procedure which has not completely fulfilled its objective.

Review of the literature:  A second look colonoscopy is proposed when there remains a doubt about missed neoplastic lesions, either because the intestinal preparation was poor or because the video‐endoscope did not achieved a complete course in the colon. The second look colonoscopy is also proposed at a short interval when it is suspected that the endoscopic removal of a single or of multiple neoplastic lesions was incomplete and that a complement of treatment is required. When the initial endoscopic procedure has completely fulfilled its objective, a second look colonoscopy can be proposed at longer intervals in surveillance programs. The intervals in surveillance after polypectomy are now adapted to the initial findings according to established guidelines. This also applies to the surveillance of incident focal cancer in patients suffering from a chronic inflammatory bowel disease.

Conclusion:  Finally, in most developed countries, a priority is attributed to screening of colorectal cancer and focus is given on quality assurance of colonoscopy which is considered as the gold standard procedure in the secondary prevention of colorectal cancer.
CURRENT STATUS AND FUTURE PERSPECTIVE OF INTERVENTIONAL ENDOSCOPIC ULTRASOUND IN JAPAN
Authors: Kida Mitsuhiro , Itoi Takao
Published: June 2009

Vilmann and Grimm made the first reports of endoscopic ultrasound (EUS)‐fine needle aspiration (FNA), and since then EUS‐FNA has become popular in the clinical fields, especially in Western countries. Furthermore interventional EUS such as pseudocyst drainage, EUS‐guided biliary drainage, celiac plexus neurolysis, and dendritic cell injection, etc. have been introduced.

We have investigated the current status and future perspectives of interventional EUS in Japan. Standardization of EUS‐guided pseudocyst drainage has been achieved, but EUS‐guided biliary dranage is still controversial, and EUS‐fine needle injection (FNI) including EUS‐celiac plexus neurolysis (CPN) and dendritic cell injection have been under investigation. In any case, EUS‐FNA seems to be a promising future technique and new applications have to be invented.
ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE UPPER GASTROINTESTINAL TRACT: PRESENT AND FUTURE VIEW OF EUROPE
Authors: Neuhaus Horst
Published: June 2009

In Western countries endoscopic mucosal resection (EMR) has been widely accepted for treatment of early Barrett`s neoplasia and flat or depressed colorectal adenomas. In contrast endoscopic submucosal dissection (ESD) is infrequently performed for several reasons. It seems to be difficult to overcome the learning curve of this difficult technique because of the low case volume of early gastric cancer. On the other hand ESD of esophageal or colorectal lesions is even more challenging and is considered to be inappropriate for learning. In addition the indication for esophageal or colorectal ESD is controversial in view of excellent results of the well established EMR technique which is less time‐consuming and safer than ESD. A recent survey of leading Western endoscopy centers indicated the limited experience with ESD with a low number of cases for all potential indications. Only a few training courses have been established and the number of ongoing clinical studies is limited. Only 12 out of 340 published articles on “endoscopic mucosal dissection” were reported from Western countries.

A better acceptance of ESD requires improvement of the technique to allow an easier, faster and safer approach. There is a strong demand for structured training courses and limitations of human cases to selected centers which participate in prospective trials. A close collaboration between Western and Asian centers is recommended for improvement of the ESD technique and its clinical application.
CURRENT STATUS OF COLONIC ENDOSCOPIC MUCOSAL RESECTION IN THE WEST AND THE INTERFACE WITH ENDOSCOPIC SUBMUCOSAL DISSECTION
Authors: Bourke Michael
Published: June 2009

Endoscopic Mucosal Resection (EMR) is now widely practised by western endoscopists to treat large sessile colonic polyps or laterally spreading tumours. Despite its widespread application, the technique of colonic EMR is not standardised. A lesion specific endoscopic treatment approach is also lacking. For lesions larger than 25mm, EMR is limited by its inability to achieve en‐bloc resection. En‐bloc resection has many theoretical advantages including more accurate histological assessment, reduced recurrence and potentially curative treatment for low risk submucosal invasive neoplasia particularly in patients with significant co‐morbidity. Hence, Japanese endoscopists, having pioneered endoscopic submucosal dissection (ESD) in the upper gastrointestinal tract for the en‐bloc resection of superficial neoplasia, now advocate the use of ESD for laterally spreading tumours of the colon greater than 25‐30mm. This treatment strategy is not widely accepted or practised in the west and has its own inherent problems. The absence of suitable gastric lesions on which to develop ESD skills is also another significant barrier to the development of colonic ESD. It is also possible that modification and refinement in EMR technique may increase the size limit for colonic EMR.
THERAPEUTIC STRATEGY FOR COLORECTAL LATERALLY SPREADING TUMOR
Authors: Oka Shiro , Tanaka Shinji , Kanao Hiroyuki , Oba Sayaka , Chayama Kazuaki
Published: June 2009

Most colorectal tumors larger than 20 mm in diameter are called laterally spreading tumors (LST), most of which are adenomatous lesions. Laterally spreading tumors are classified into two types according to their morphology, granular type (LST‐G) and non‐granular type (LST‐NG). Each type has two subtypes. The former consists of a ‘homogenous type’ and a ‘nodular mixed type’, while the latter consists of a ‘flat elevated (FE) type’ and a ‘psedodepressed (PD) type’. In LST‐G and LST‐NG FE types, type V pit pattern with magnification enables the recognition of the carcinomatous or submucosal invasive area. Most of these adenomatous large lesions can be cured by scheduled endoscopic piecemeal mucosal resection (EPMR). However, LST‐G with large whole nodular type or type V pit pattern, which cannot be resected en bloc with a snare, is an indication for endoscopic submucosal dissection (ESD). The LST‐NG PD has a high frequency of submucosal invasion and the submucosal invasive area cannot be recognized correctly in the pseudodepression with magnification prior to endoscopic treatment. Therefore, en bloc resection with ESD should be applied to LST‐NG PD. The therapeutic strategy for choosing between EPMR and ESD for large LST lesions should therefore be determined based on the macroscopic findings of their subtype and pit pattern findings.
EFFECTIVENESS OF PERORAL CHOLANGIOSCOPY AND NARROW BAND IMAGING FOR ENDOSCOPICALLY DIAGNOSING THE BILE DUCT CANCER
Authors: Igarashi Yoshinori , Okano Naoki , Ito Ken , Suzuki Takuya , Mimura Takahiko
Published: June 2009

CHF‐B260 has thinner diameters, and the quality of the endoscopic images has improved. Recently, narrow band imaging (NBI) system has been developed for high‐contrast observation of mucosal structures and vascular patterns. It is available to diagnose for the bile duct cancer endoscopically and it is useful for desciding of surgical margin before operation.

As for its applicability to investigating the progression of superficially infiltrated bile duct cancer, additional cases must be examined in the future.
EVALUATION OF THE CLINICAL OUTCOMES ASSOCIATED WITH EXERA II AND LUCERA ENDOSCOPES
Authors: Rey Jean‐Francois , Tanaka Shinji , Lambert Rene , Tajiri Hisao
Published: June 2009

Aim:  Regarding the assessment of colonic lesions, important differences between Japan and the Western world have emerged during the last decade. The aim of this study was to compare the clinical outcomes of the same equipment when used in Japan or in France.

Method:  Chromoscopy has not been extensively accepted in the West, in contrast to the wide acceptance in Japan which is probably due to the national screening programme for early gastric cancer. With the development of narrow‐band imaging (NBI) we might expect a more generalized approach to the clinical use of various classifications. Narrow band imaging might be an important step towards virtual chromoscopy. A total of 48 patients were examined with back‐to‐back colonoscopy, using a non‐sequential (EXERA II, Olympus Medical Systems Corp., Tokyo, Japan) endoscope, and a sequential endoscope (LUCERA, Olympus Medical Systems Corp.).

Results:  Education differences also play a role in the evaluation of the clinical outcome of the endoscopy. In Japan, detailed classification of the morphology of the detected lesion is done as a preliminary characterization step before the treatment decision. In the West a treatment decision immediately leads to the therapeutic outcome (non‐neoplastic or neoplastic; removed or not). This study showed clearly that, with the same equipment, we obtained identical results for image quality of image in Japan and France. Non‐Japanese endoscopists could achieve the same results as Japanese colleagues if knowledge of the minute classification is more widely accepted.

Conclusion:  While the differences in the evaluation of the clinical outcome are mostly cultural, the analysis of endoscopic imaging indicates that the LUCERA and EXERA series provide the same clinical benefit.
ENDOSONOGRAPHY‐GUIDED PANCREATIC DUCT DRAINAGE FOR CHRONIC PANCREATITIS
Authors: Ito Kei , Fujita Naotaka , Noda Yutaka , Kobayashi Go , Horaguchi Jun
Published: June 2009

Although endoscopic transpapillary treatment of chronic pancreatitis (CP) is gaining acceptance, it is not always possible, especially in patients with inflammatory stenosis of the duodenum due to CP or with a history of a Whipple's procedure. Linear array echoendoscopes (ES) provide high‐quality images of the pancreas along with adjacent organs and allow therapeutic applications. echoendoscope‐related procedures, such as ES‐guided pancreatic duct drainage (ESPD) are feasible and useful in selected patients with CP suffering from PD stricture in whom conventional endoscopic retrograde cholangiopancreatography (ERCP) is impossible.
EUS‐GUIDED PANCREATIC PSEUDOCYST DRAINAGE
Authors: Yasuda Ichiro , Iwata Keisuke , Mukai Tsuyoshi , Iwashita Takuji , Moriwaki Hisataka
Published: June 2009

Background:  Endoscopic ultrasound‐guided pancreatic pseudocyst drainage (EUS‐PPD) has recently become popular. However, this technique has not yet been standardized, and the available instruments have not been sufficiently developed. Therefore, it is difficult to determine the treatment strategy and the choice of devices.

Aims:  To evaluate the current status of EUS‐PPD.

Methods:  Between May 2001 and February 2008, EUS‐PPD was attempted in 26 patients. Initially, an external drainage was placed, which was replaced with an indwelling tube in cases where the discharge continued more than 2 weeks. The early and late outcomes of EUS‐PPD were retrospectively analyzed.

Results:  Placement of a naso‐cystic drainage was successful in 24 (92%) of the 26 patients. Insertion of the drainage tube failed in other 2 patients due to a thickened cystic wall. The pseudocyst was completely resolved after the placement in 23 patients, while the remaining patient underwent a surgical operation. Discharge of the cystic fluid was stopped and the naso‐cystic tube was removed in 12 patients after a median duration of 14.5 days. In the remaining 11 patients, it was replaced with indwelling tubes due to continuous discharge after 2 weeks. Thereafter, the indwelling tubes were removed in all cases after a median duration of 4 months. Recurrence of the pseudocyst occurred in 4 patients during a median follow‐up period of 48 months. All 15 patients without cystic infection were successfully treated by EUS‐PPD, and 9 (60%) of them were treated by only an external drainage. On the other hand, one patient (11%) failed treatment by EUS‐PPD and 5 patients (56%) required subsequent internal drainage among the 9 patients with cystic infection.

Conclusions:  Endoscopic ultrasound‐guided pancreatic pseudocyst drainage is a promising treatment for a pancreatic pseudocyst. However, the insertion of the tube is difficult in cases with a thickened cystic wall. Infected pseudocysts are often difficult to treat by only short‐term external drainage, thus additional treatments should be considered at an early stage.
Versatility of the capsular genes during biofilm formation by Streptococcus pneumoniae
Authors: Domenech Mirian , García Ernesto , Moscoso Miriam
Published: June 2009

Streptococcus pneumoniae forms part of the natural microbiota of the nasopharynx. For the pneumococcus to cause infection, colonization needs to occur and this process is mediated by adherence of bacteria to the respiratory epithelium. Although the capsular polysaccharide (CPS) of S. pneumoniae is known to be important for infection to occur, its role in colonization is controversial. Biofilm models are starting to emerge as a promising tool to investigate the role of CPS during nasopharyngeal carriage, which is the first step in the dissemination and initiation of a pneumococcal infection. Using a well‐defined model system to analyse in vitro biofilm formation in pneumococcus, here we explore the molecular changes underlying the appearance of capsular mutants using type 3 S. pneumoniae cells. Spontaneous colony phase variants show promoter mutations, as well as duplications, deletions and point mutations in the cap3A gene, which codes for a UDP‐glucose dehydrogenase (UDP‐GlcDH). Increased biofilm‐forming capacity could usually be correlated with a reduction both in colony size and in the relative amount of CPS present on the cell surface of each colony variant. However, a mutation in Cap3A Thr83Ile (a strictly conserved residue in bacterial UDP‐GlcDHs) that resulted in very low CPS production also led to impaired biofilm formation. We propose that non‐encapsulated mutants of pneumococcal type 3 strains are essentially involved in the initial stages (the attachment stage) of biofilm formation during colonization/pathogenesis.
Immunostimulation to reduce recurrence after surgery for anal condyloma acuminata: a prospective randomized controlled trial
Authors: Mistrangelo M. , Cornaglia S. , Pizzio M. , Rimonda R. , Gavello G. , Dal Conte I. , Mussa A.
Published: June 2009

Aim  Human papillomavirus is the most common cause of sexually transmitted disease. It is associated with immunosuppression and shows a marked tendency to recur. We investigated a natural immunostimulant aimed to reduce recurrence.

Method  A randomized controlled study was carried out including 261 patients allocated to surgical excision alone (control group; n = 122) and surgical excision plus postoperative immunostimulation for 30 days with a natural product (STET; study group; n = 139). Patients with HIV positivity were excluded. All patients gave fully informed consent.

Results  The patients were followed for 6 months after surgery. Recurrence occurred in 7.2% (10/139) in the study group and in 27.1% (33/122) in the control group (P < 0.0001). There were no significant differences in the sex, sexual orientation, number of lesions, time to diagnosis and treatment or localization of lesions in the two groups.

Conclusions  Immunostimulation using a natural product significantly reduced the incidence of recurrence of anal condylomata in patients undergoing surgical excision.
Phylogenetic relationships of fantails (Aves: Rhipiduridae)
Authors: Nyári ÁRpád S. , Benz Brett W. , Jønsson Knud A. , Fjeldså Jon , Moyle Robert G.
Published: June 2009

We explore the phylogenetic relationships of fantails (Aves: Rhipiduridae) using molecular characters derived from two nuclear introns and two mitochondrial genes. Our results indicate thatRhipidura hypoxanthais not a true fantail, but rather a member of the Stenostiridae clade that is morphologically and behaviourally convergent with fantails. Within the true Rhipiduridae, we identified six distinct clades; however, phylogenetic relationships among these groups were unresolved. The only well‐supported sister relationship was between members of the grey and the rufous fantail complexes. Clades recovered through our model‐based phylogenetic analyses generally correspond to previously proposed fantail complexes based on morphological characters. The phylogenetic position ofR. atraandR. dilutaremain unclear, as sister relationships varied between analyses for the prior whereas the latter was placed as sister to the New Guinea thicket fantails,R. leucothoraxandR. threnothorax; yet significant node support was not recovered for either taxa. Biogeographically, fantails appear to have radiated rapidly and the six clades are not geographically restricted, but instead span South‐east Asia, New Guinea, Australia and Pacific Islands.
Hypersensitivity to Social Rejection and Perceived Stress as Mediators between Attachment Anxiety and Future Burnout: A Prospective Analysis
Authors: Ronen Sigalit , Baldwin Mark W.
Published: June 2009

Drawing on Sociometer Theory, the current study examined whether the tendency to focus on and worry about social rejection at the workplace can predict stress and burnout. Data were collected at two time points from 231 hotel employees. Prospective‐longitudinal design, structural equation modeling analyses revealed that participants' hypersensitivity to social rejection at the workplace predicted an increase in stress and in burnout across the 1 month of participation. Furthermore, the findings revealed that hypersensitivity to social rejection fully mediated the link between attachment anxiety and future stress and that hypersensitivity to social rejection and stress fully mediated the link between attachment anxiety and future burnout. Approximately 64 per cent of the variance in future burnout was explained by these variables. The results demonstrate the significant role social evaluative stressors play in the development of stress responses at the workplace.

S’appuyant sur la sociometer theory, la présente étude examine si la tendance à se préoccuper et s’inquiéter du rejet social sur le lieu de travail peut prédire le stress et l’épuisement. Les données ont été collectées par deux fois auprès de 231 employés d’hôtellerie. Le traitement des études longitudinales par des analyses de modélisation par équations structurelles révèle que l’hypersensibilité des sujets au rejet sur le lieu de travail contribue à une augmentation du stress et de l’épuisement au cours du mois de participation. Les conclusions soulignent que l’hypersensibilité au rejet social est totalement influencée par le lien entre anxiété, attachement et stress futur et que l’hypersensibilité au rejet social et au stress est totalement influencée par le lien entre anxiété, attachement et épuisement à venir. Approximativement 64% de la variance de l’épuisement à venir est expliqué par ces variables. Les résultats montrent le rôle significatif joué par des sources de stress liées au jugement social d’autrui dans le développement des réponses de stress sur le lieu de travail.