bluuebunny/crossref_metadata_2025 huggingface dataset:
Nitric oxide prevents intestinal mitochondrial dysfunction induced by surgical stress
Authors: Thomas S , Anup R , Susama P , Balasubramanian K A
Published: March 2003

Background

The intestine is highly susceptible to free radical-induced damage and earlier work has shown that surgical stress induces generation of oxygen free radicals in enterocytes, resulting in intestinal damage along with changes in mitochondrial structure and function. Nitric oxide is an important mediator of gastrointestinal function and this study looked at the effect of nitric oxide on surgical stress-induced intestinal mitochondrial alterations.

Methods

Controls and rats pretreated with the nitric oxide donor l-arginine were subjected to surgical stress by opening the abdominal wall and handling the intestine. Enterocytes were isolated, mitochondria prepared and the protection offered by l-arginine against damage due to surgical stress was determined. Protection to structural as well as functional aspects of mitochondria was examined.

Results

Mild handling of the intestine affected the enterocyte mitochondrial structure as assessed by lipid composition and electron microscopy. Mitochondria were also functionally impaired with altered calcium flux and decreased respiratory control ratio. Pretreatment with the nitric oxide synthase substrate l-arginine prevented these damaging effects of surgical stress. Protection with arginine was abolished by the nitric oxide synthase inhibitor NG-nitro-l-arginine methyl ester, indicating the role of nitric oxide.

Conclusion

Surgical stress in the small intestine can affect enterocyte mitochondrial structure and function. These damaging effects can be prevented by nitric oxide, an important modulator of cellular function.
Sympathetic autoregulation in peripheral vascular disease
Authors: Delis K T , Lennox A F , Nicolaides A N , Wolfe J H
Published: March 2003

Background

Lower limb venous pressure increases on dependency, stimulating a local sympathetic axon reflex which triggers precapillary and arteriolar vasoconstriction. The resulting decrease in arterial calf inflow, known as the venoarteriolar response (VAR), is impaired in critical leg ischaemia. The aim of the study was to evaluate the VAR in symptomatic non-critical leg ischaemia and after restoration of leg perfusion following successful revascularization.

Methods

The study included 30 normal subjects, 30 patients with stable intermittent claudication and 30 patients with severe ischaemia who had undergone successful infrainguinal revascularization. In all patients the foot skin blood flow (flux) in the horizontal (HBF) and sitting (SBF) positions was measured using laser Doppler fluxmetry. The VAR was calculated as (HBF − SBF)/HBF × 100 per cent. The pressure that elicited the reflex (pVAR) was evaluated in the horizontal position.

Results

The median VAR was significantly lower in patients with stable claudication than in normal subjects or patients following successful revascularization (29·1 versus 59·5 and 63·9 per cent respectively; P < 0·0001). Similar results were obtained for the pVAR (22 versus 45 and 40 mmHg respectively; P < 0·001). There was no difference, however, in either the VAR or pVAR between normal individuals and patients following a successful bypass.

Conclusion

Patients with claudication had a significant impairment of orthostatic sympathetic autoregulation. After successful revascularization, and in spite of the extensive disease in the receiving circulation, this autoregulation returned to normal.
Prognostic factors after oesophagectomy and extended lymphadenectomy for squamous oesophageal cancer
Authors: Osugi H , Takemura M , Takada N , Hirohashi K , Kinoshita H , Higashino M
Published: March 2003

Background

The prognosis of patients without nodal metastasis of oesophageal cancer is generally good, but recurrence develops in some cases.

Methods

Data on 88 consecutive patients with squamous oesophageal cancer who underwent three-field lymph node dissection from 1986 to September 1998 and who had no evidence of nodal disease were reviewed retrospectively. Disease status was based on histological examination of the section of each node with the largest surface area, stained with haematoxylin and eosin.

Results

The 3- and 5-year survival rates of patients without lymph node metastasis were 85 and 81 per cent respectively, better than in patients with metastasis. Twelve patients died from recurrence. Recurrence was haematogenous in nine patients and locoregional in three. Survival was worse in men, for patients with lesions located in the upper thoracic oesophagus, and in those with lymphatic or blood vessel invasion. Only the presence of lymphatic invasion correlated with survival on multivariate analysis (P = 0·04).

Conclusion

Although survival was generally good in patients without nodal metastasis from oesophageal cancer following three-field lymph node dissection, patients with lymphatic invasion remained at risk for haematogenous dissemination.
Persistent popliteal fossa reflux following saphenopopliteal disconnection
Authors: Rashid H I , Ajeel A , Tyrrell M R
Published: March 2003

Background

This was a retrospective assessment of the technical adequacy of saphenopopliteal disconnection (SPD).

Methods

Patients scheduled for SPD underwent preoperative colour-coded duplex imaging to localize the saphenopopliteal junction (SPJ). Operations were conducted with the patients under general anaesthesia in the prone position with planned full popliteal fossa exposure. Patients were reimaged 6 weeks after operation.

Results

Some 69 patients had surgery over 4 years; complete data were available for 59 (27 men and 32 women, median age 55 (range 27–78) years). There were eight staged bilateral procedures. Postoperative duplex scans identified 23 (39 per cent) with ideal results (incompetent SPJ successfully disconnected), 12 (20 per cent) with satisfactory results (incompetent SPJ disconnected successfully but persisting venous reflux in superficial veins), eight duplex failures (14 per cent) (previously identified incompetent SPJ persisted but was competent after operation) and 13 surgical failures (22 per cent) (incompetent SPJ completely missed during surgery). There were three major postoperative complications (5 per cent) (two deep vein thromboses and one popliteal vein injury) and one patient suffered a sural nerve palsy.

Conclusion

Despite preoperative duplex localization of the SPJ, SPD proved an unreliable technique in this series.
Influence of implantation interval on the long-term biocompatibility of surgical mesh
Authors: Klosterhalfen B , Junge K , Hermanns B , Klinge U
Published: March 2003

Background

The aim was to study the long-term tissue response to polypropylene mesh.

Methods

This was a retrieval study that investigated 76 polypropylene meshes with a median implantation interval of 18 (range 2–180) months. Mesh was explanted following hernia recurrence, infection or pain. The median implantation interval was 20 (range 4–180) months in the recurrence group, 30 (range 5–48) months in the pain group and 10 (range 2–56) months in the infection group (P < 0·05, infection versus pain or recurrence). The inflammatory response was determined by immunohistochemistry of macrophages (CD68), polymorphonuclear granulocytes (CD15) and T and B lymphocytes (CD3 and CD20). The cell turnover within the interface mesh fibre–recipient tissue was measured by TUNEL for apoptosis or DNA strand breaks, Ki67 for cell proliferation and heat-shock protein (HSP) 70 for cell stress.

Results

With the exception of HSP-70, levels of all variables decreased over time. Sex, age, type of previous operation or location of the mesh did not have a significant influence.

Conclusion

Long-term incorporated polypropylene mesh in humans has a more favourable tissue response with increasing implantation interval.
Multiple sectioning and immunohistochemical staining of sentinel nodes in patients with breast cancer
Authors: Motomura K , Komoike Y , Inaji H , Hasegawa Y , Kasugai T , Noguchi S , Koyama H
Published: March 2003

Background

The aim of the present study was to investigate whether focused analysis of sentinel nodes is more useful than routine haematoxylin and eosin examination of axillary lymph nodes obtained by axillary lymph node dissection.

Methods

One hundred and fifty-two patients with breast cancer with clinically negative axillary nodes underwent successful sentinel node biopsy using a combination of dye and radioisotope, followed immediately by standard level I and II axillary lymph node dissection. Multiple sectioning, with haematoxylin and eosin and immunohistochemical analysis of sentinel nodes using cytokeratin antibody, was compared with single section and haematoxylin and eosin analysis of sentinel and non-sentinel nodes (routine examination).

Results

A mean of 1·9 (range 1–12) sentinel nodes and 11·2 (range 4–24) non-sentinel nodes were excised per patient. Metastases were detected in 44 patients (29 per cent) by single section and haematoxylin and eosin analysis of sentinel and non-sentinel nodes. An additional five patients (3 per cent) with metastases were detected by multiple sectioning and haematoxylin and eosin analysis of sentinel nodes. A further 20 patients (13 per cent) with metastases were identified by multiple sectioning and immunohistochemical analysis of sentinel nodes. Both haematoxylin and eosin and immunohistochemical analysis of sentinel nodes missed one patient with node metastases, which led to a false-negative rate of 1 per cent.

Conclusion

Multiple sectioning and immunohistochemical staining of sentinel nodes identified 16 per cent more patients with positive axillary lymph nodes than routine haematoxylin and eosin examination.
Microemulsion cyclosporin inhibits vascular remodelling and attenuates associated changes in profibrotic gene expression in an experimental model of allograft vasculopathy
Authors: Murphy G J , Bicknell G R , Nicholson M L
Published: March 2003

Background

Chronic allograft dysfunction (CAD), the leading cause of solid organ transplant failure, is characterized by histological evidence of extracellular matrix (ECM) accumulation (fibrosis). The aim of this study was to characterize the changes in fibrosis-associated gene expression in an experimental model of CAD and to measure the effect of the immunosuppressant cyclosporin on these changes.

Methods

Lewis recipients of F344 rat thoracic to abdominal transplants were administered cyclosporin or no treatment. Vascular remodelling and ECM accumulation (picrosirius red) were measured using computerized histomorphometry. Fibrosis-associated gene expression was studied by semiquantitative reverse transcription–polymerase chain reaction.

Results

Cyclosporin inhibited medial ECM accumulation and vascular remodelling in allografts. This was associated with an attenuation of the graft inflammatory infiltrate and a reduction in intragraft matrix metalloproteinase (MMP) 2 and MMP-9 messenger RNA (mRNA) levels. There was a significant negative correlation between neoadventitial ECM density and MMP-9 expression, as well as with vessel circumference. Neoadventitial ECM density was significantly higher in the cyclosporin-treated group than in animals with untreated allografts, as were mRNA levels of collagen 3 and tissue inhibitor of metalloproteinase 1.

Conclusion

The alloimmune injury itself may contribute directly to vascular remodelling and fibrosis in allograft vasculopathy. Cyclosporin attenuated this component of the pathophysiology of CAD effectively.
Perineural invasion has a negative impact on survival of patients with gallbladder carcinoma
Authors: Yamaguchi R , Nagino M , Oda K , Kamiya J , Uesaka K , Nimura Y
Published: March 2003

Background

The clinical significance of perineural invasion of gallbladder carcinoma remains unclear. The aim of this study was to elucidate the incidence and mode of perineural invasion of gallbladder carcinoma and clarify its prognostic significance.

Methods

A clinicopathological study was conducted on 68 patients who underwent attempted curative resection for gallbladder carcinoma. According to the pathological tumour node metastasis (pTNM) classification of the Union Internacional Contra la Cancrum, there were five (7 per cent), nine (13 per cent), 20 (29 per cent) and 34 (50 per cent) patients with pT1, pT2, pT3 and pT4 disease respectively. Twenty patients (29 per cent) had pM1 disease, including involved para-aortic nodes, liver metastases and localized dissemination.

Results

The overall incidence of perineural invasion was 71 per cent (48 of 68 patients). Forty-four (96 per cent) of 46 patients with extrahepatic bile duct invasion had perineural invasion. Although several histological factors were associated with perineural invasion, multivariate analysis demonstrated that extrahepatic bile duct invasion was the only significant factor correlated with perineural invasion (odds ratio 99·0, P < 0·001). The perineural invasion index, defined as the ratio of the number of involved nerves to the total number of nerves examined, was significantly higher at the centre than in the proximal and distal parts of the tumour in the 46 patients with extrahepatic bile duct invasion (P < 0·001). The 5-year survival rate for patients with perineural invasion was significantly lower than that for patients with no invasion (7 versus 72 per cent; P < 0·001). Cox proportional hazard analysis identified perineural invasion (relative risk (RR) 5·3, P < 0·001) and lymph node metastasis (RR 2·5, P = 0·008) as significant independent prognostic factors.

Conclusion

Perineural invasion is common in advanced gallbladder carcinoma and has a significant negative impact on patient survival.
Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands
Authors: Kapiteijn E , Putter H , van de Velde C J H
Published: March 2003

Background

Local control and survival following surgical treatment of rectal cancer have been improved by the introduction of total mesorectal excision (TME). The aim of this study was to determine the nationwide impact of the introduction and training of TME on recurrence and survival in rectal cancer.

Methods

Short- and long-term outcomes of a recently published trial of rectal cancer surgery (TME trial) were compared with results from an older trial (cancer recurrence and blood transfusion (CRAB) trial), in which conventional surgery was performed without quality control. Only patients who were operated on with curative intent and who did not receive neoadjuvant radiotherapy were studied. Differences in clinicopathological characteristics were corrected for by multivariate analysis. To ensure valid comparisons, only events that occurred within 2 years of operation were analysed with regard to long-term outcome.

Results

In the univariate analysis, a higher clinical anastomotic leak rate was found in patients following low anterior resection in the TME trial (P = 0·046), but this association was not significant in the multivariate analysis. The local recurrence rate decreased from 16 per cent in the CRAB trial to 9 per cent in the TME trial, and type of operation (conventional (CRAB trial) versus TME (TME trial)) was an independent predictor of local recurrence (P = 0·002). Type of operation was also an independent predictor of overall survival (P = 0·019); there was a higher survival rate in the TME trial.

Conclusion

The introduction and training of TME has led to improved long-term outcome of patients with rectal cancer in the Netherlands.
Pelvic exenteration for advanced colorectal cancer with reconstruction of urinary and sphincter functions
Authors: Koda K , Tobe T , Takiguchi N , Oda K , Ito H , Miyazaki M
Published: March 2003

Background

Total pelvic exenteration (TPE) for the treatment of advanced colorectal cancer usually involves a double stoma for faecal and urinary excretion, which reduces patient quality of life. In this study, a stomaless reconstruction method for patients normally requiring TPE was evaluated.

Methods

Five patients underwent stomaless TPE. After removal of the tumour with an adequate surgical margin, the urethra was transected at the urogenital diaphragm and the rectum at the anal canal. An ileal neobladder was constructed and coloanal anastomosis was performed. The major omentum was used to construct a septum between the anastomoses. A transgastric ileus tube was used as an intestinal stent to prevent ileus.

Results

All patients were alive 12–39 months after operation. Faecal continence was preserved in four patients whose diverting colostomies were closed. All five patients were able to void urine spontaneously, with daytime continence. All but one, in whom cancer recurred, were mobile in the community.

Conclusion

Stomaless TPE may be considered for locally advanced colorectal cancers that invade the genitourinary organs, provided that neither the anal canal nor the urogenital diaphragm is affected.
Karyotypic aberrations of chromosomes 16 and 17 are related to survival in patients with breast cancer
Authors: Hislop R G , Pratt N , Stocks S C , Steel C M , Sales M , Goudie D , Robertson A , Thompson A M
Published: March 2003

Background

Breast cancer has a high incidence and associated mortality rate, yet little is known of the sequence of genetic events that underlie the clinical course.

Methods

The study was a comparative genomic hybridization analysis of 40 primary breast cancers with survival data at a mean of 8·4 years.

Results

The mean number of aberrations was 9·0, with a mean of 5·5 gains and 3·5 deletions per tumour. The most common aberrations were: gain of 1q (27 of 40), 8q (19 of 40) and 17q (13 of 40), and deletion of 17p (12 of 40) and 8p (11 of 40). These results are consistent with a distinctive pattern of large-scale (karyotypic) genetic change in primary breast cancer.

Conclusion

The novel findings of this study were that only women who were disease-free had loss of 16q (E-cadherin) in association with a gain of 16p, and 17p13 (p53) loss combined with 17q12 (HER2) amplification was found only in the cancers of women who developed recurrent disease. The karyotypic changes seen in primary breast cancer seem to be associated with outcome and point to the underlying genetic events.
Estimation of directional division frequencies in vascular cambium and in marginal meristematic cells of plants
Authors: Barlow P. W. , Brain P. , Powers S. J.
Published: March 2003

Using simple arithmetical formulae, it is shown that, when the meristematic initial cells of a growing plant organ are arranged in a ring, the cellular dimensions predict the relative frequencies of anticlinal and periclinal divisions which these cells undergo. The pattern of cell file branching which appears during the course of development, and which is predicted by this mathematical model, is validated using data pertaining to the numbers and dimensions of initial cells within the secondary vascular cambium of hybrid aspen trees. Data pertaining to a second, simpler set of initial cells which comprises the outer cellular ring of the thallus of the alga Coleochaete orbicularis, and from which all the radial cell files of the circular disc‐like thallus are descended, have also been used for model validation. Combining the mathematical approach to division frequencies with data of actual cell sizes permits inferences about the course of the increase of the number of cell files (generated by the anticlinal divisions) and the number of cells within each file (generated by the periclinal divisions) during the earlier stages of secondary tissue or thallus development, and also about how they will develop at future stages. The question whether or not cell division patterns conform to the geometry of the system in which the cells are embedded is also discussed.
The role of various Bcl‐2 domains in the anti‐proliferative effect and modulation of cellular glutathione levels: a prominent role for the BH4 domain
Authors: Hoetelmans R. W. M. , Vahrmeijer A. L. , Van Vlierberghe R. L. P. , Keijzer R. , Van De Velde C. J. H. , Mulder G. J. , Van Dierendonck J. H.
Published: March 2003

Abstract. Reduced cell proliferation and increased levels of cellular glutathione (GSH) are characteristic for cells that overexpress the anti‐apoptotic Bcl‐2 protein. We investigated the influence of various Bcl‐2 domains on both these characteristics. Rat CC531 colorectal cancer cells were stably transfected with the human bcl‐2 gene (CCbcl2 cells) or with bcl‐2 gene constructs missing a coding sequence for a func‐tional domain, BH1 (CCΔBH1 cells), BH3 (CCΔBH3 cells), BH4 (CCΔBH4 cells) or the transmembrane region (CCΔTM cells). We measured GSH levels in exponentially and confluent growing bcl‐2‐transfected cell populations. The fraction of S‐phase cells during exponential growth was significantly reduced in CCbcl2, CCΔBH1, CCΔBH3, and CCΔTM cells compared with parental CC531, neo‐transfected CC531 and CCΔBH4 cells. GSH levels in these bcl‐2 transfectants were significantly higher than in the parental line measured at 50% confluence; at 100% confluence they reached a similar level as found in parental cells. Independently from the presence of BH1, BH3 or TM domains, overexpression of Bcl‐2 reduces cellular proliferation under conditions of increased GSH levels. This apparent link is lost in CCΔBH4 cells; these cells are not reduced in cellular proliferation and harbour significantly higher GSH levels than found in the other transfectants. Studies on the subcellular localization revealed an extremely low expression of the Bcl‐2 protein lacking the N‐terminal BH4 domain in nuclear fractions. Nuclear translocation of Bcl‐2 requires the presence of the BH4 domain and seems prominent in reducing cellular proliferation.
Mathematical models of hierarchically structured cell populations under equilibrium with application to the epidermis
Authors: Savill Nicholas J.
Published: March 2003

Abstract. There are three categories of keratinocytes in the germinative compartment of the epidermis – stem, transit‐amplifying and post‐mitotic. Their population structure is hierarchical. This means that stem cells differentiate into transit‐amplifying cells which, after a few rounds of division, become post‐mitotic cells. The cell processes of birth, differentiation, death and migration affect the composition and proliferation rate of the germinative compartment. These phenomena are quantified by various cell kinetic parameters. In this paper we derive equations that relate these parameters for different models of hierarchically structured cell populations in equilibrium. We include in the models asymmetric and symmetric division, variations in cell‐cycle times, apoptosis and variation in the number of transit generations. We conclude that variation in cell‐cycle times need only be considered if apoptosis is not negligible. If it is negligible, then only average cell‐cycle times are needed. Unfortunately, it is impossible to predict the importance of apoptosis from the available experimental data. However, the strength of its effect is determined by the other parameters, especially the fraction of cycling stem cells. We show that variation in the number of transit generations can have a potentially large effect on cell birth rate. We also show that cell birth rate does not directly depend on the mean transit‐amplifying cell‐cycle time, only on the mean stem cell‐cycle time. We argue that ‘homogeneous cell population’ equations should not be used to study hierarchical cell populations as has been done in the past. Finally we argue that stem cell parameters and transit‐amplifying cell parameters should not be lumped together.
The gene expression sequence of radiated mucosa in an animal mucositis model
Authors: Sonis S. T. , Scherer J. , Phelan S. , Lucey C. A. , Barron J. E. , O'Donnell K. E. , Brennan R. J. , Pan H. , Busse P. , Haley J. D.
Published: March 2003

Abstract. Oral mucositis is a common, dose‐limiting, acute toxicity of radiation therapy administered for the treatment of cancers of the head and neck. Accumulating data would suggest that the pathogenesis of mucositis is complex and involves the sequential interaction of all cell types of the oral mucosa, as well as a number of cytokines and elements of the oral environment. While a number of studies have reported on gene expression of particular cell types in response to radiation, the overall response of irradiated mucosa has only been evaluated in a limited way. The present study was undertaken to evaluate the expression of a target group of genes using RNA quantification assays and, more broadly, to assess patterns of mucosal gene expression using DNA microarray hybridization. Our results demonstrate the sequential upregulation of a series of genes that, when taken collectively, suggest an intricate functional interaction.
Radiation‐induced oral mucositis in mice: strain differences
Authors: Dörr W. , Spekl K. , Martin M.
Published: March 2003

Abstract. The present study was initiated to investigate strain differences in oral mucosal radiosensitivity in mice with regard to induction of clinically manifest ulceration. Mouse ventral tongue epithelium was used as an established animal model for radiobiological studies of radiation‐induced mucositis. Mice from two different strains, C3H/Neu (n = 40) from the Dresden colony, and B6D2F1 (n = 50) from the Harlan/Winkelmann UK colony were subjected to irradiation of tongue mucosa. Graded single doses were applied to a 3 × 3 mm2 test field in the centre of the lower tongue with 25 kV X‐rays in order to generate full dose‐effect curves for acute mucosal ulceration, as a clinically relevant reaction. For both groups, dose‐effect curves were computed by logit analysis; comparison of the curves was by maximum‐likelihood χ2 test. In addition, the time course of ulceration, i.e. latent time and individual ulcer duration, was analysed. In both mouse strains, a well‐defined dose effect was observed. The ED50 values, i.e. the doses at which ulceration is expected in 50% of the animals irradiated, and their standard deviation σ, calculated by logit analysis, can be used to describe radiosensitivity. The ED50 was 11.0 ± 3.4 Gy (95% confidence interval (7.2; 15.4), P for dose dependence: 0.014) and 13.4 ± 3.6 Gy (95% confidence interval (10.6; 16.1), P for dose dependence: 0.0002) in C3H and BDF1 mice, respectively. Hence, oral mucosa in BDF1 mice was found to be marginally more radioresistant (P = 0.1). The latent time to ulceration, i.e. the time between irradiation and first diagnosis of ulcer, was 11.6 ± 0.2 days (mean ± SEM, n = 18) in C3H mice and 5.6 ± 0.1 days (n = 27) in BDF1 mice (P = 0.0001). Both were independent of dose (PC3H = 0.94, PBDF1 = 0.33) and hence were calculated for all responding animals of the respective strain. Ulcer duration was 2.8 ± 0.2 days and 2.4 ± 0.1 days in C3H and B6 mice, respectively, and was also independent of dose (PC3H = 0.25, PBDF1 = 0.99), but was dependent on the mouse strain (P = 0.036). In conclusion, no statistically significant difference in oral mucosal radiosensitivity was observed between the mouse strains. This, however, may be attributed to the small number of animals used per dose group. The time course data, with a shorter latency and ulcer duration in BDF1 mice, are in good accordance with the higher proliferation rates reported for oral mucosa in this mouse strain.
Simulation of cell proliferation in mouse oral epithelium, and the action of epidermal growth factor: evidence for a high degree of synchronization of the stem cells
Authors: Appleton D. R. , Thomson P. J. , Donaghey C. E. , Potten C. S. , McGurk M.
Published: March 2003

Abstract. Computer simulation has been carried out to help to determine the cell‐proliferative mechanisms underlying data gathered from a double‐labelling experiment on the dorsal tongue of the mouse. Good fits to the data have been obtained by assuming that there is a high degree of synchrony in the stem cells, which have a 24‐h cell cycle time, and that daughters of these cells undergo two further divisions, with mean cell cycle times of 48 h, before differentiating. This results in one‐seventh of proliferative cells being stem cells, which ties in well with the concept of epidermal proliferative units. There is no need to assume that S‐phase duration changes diurnally. The administration of epidermal growth factor seems to increase the degree of synchrony. In such systems, the influx to S‐phase and the efflux from it have very sudden short peaks, which it is impossible to observe unless observations are taken very frequently. There are therefore implications for the designs of experiments that attempt to study diurnal rhythms or the effect of factors that disturb the normal proliferative pattern of cells.
Children Act 1948 and 1989: similarities, differences, continuities
Authors: Hughes Rupert
Published: March 2003

The paper comments on the Children Acts of 1948 and 1989. The 1989 Act was broader but built on the 1948 one. The legislative contexts had some important similarities.
Local authority family centre intervention: a statistical exploration of services as family support or family control
Authors: Pithouse  , Tasiran
Published: March 2003

This paper sets out findings from a statistical exploration into services arising from child protection referrals which became open cases allocated to local authority child care social workers employed by a large local authority social services department in South Wales. The workers operate from six local authority family centres located in areas of high social need. They offer a range of family support services as well as carrying out child protection investigations and related activities. In analysing the data a probability ratio was created to identify which offered services were more likely to be taken up. An activity index for services offered and taken up was then constructed followed by an attempt to delineate families’ likely orientation to a family support or ‘protection and control’ mode of intervention. This is achieved by creating a simple range of lower and upper bounds of perception by imputing service orientation from the position of three ‘representative individuals’: a ‘very suspicious client’, a ‘neutral third party’, and a ‘very optimistic social worker’. These three positions allow manipulation of the questionnaire data to estimate the probable interpretation of services from provider and recipient standpoints. From these sources parameter estimates to explore key variables associated with worker views about the sufficiency of their service in relation to family support and/or more controlling forms of intervention are deployed. The study suggests that child protection cases receive a family centre service strongly orientated to support rather than a narrow policing activity. However, there remain some notable differences of perception between worker and ‘representative individuals’ that imply potential difficulties over the role of local authority family centres.
Intensive family preservation services: an examination of critical service components
Authors: Berry  , Cash  , Brook
Published: March 2003

Prescribed models of intensive family preservation services are based on assumptions regarding the contribution of service intensity, short‐term duration of services and a home‐based approach to positive outcomes for children and families. A descriptive and exploratory study tests these assumptions by examining the association of service structure characteristics to case outcomes: child placement, child safety, and gains in family skills and child well‐being. This study finds that, while service intensity is indeed a predictor of short and long‐term placement outcomes for families, families’ gains while in treatment (as rated by caseworkers) are even better predictors of placement outcomes.
Short breaks for families caring for a disabled child with complex health needs
Authors: Robinson C. , Jackson P. , Townsley R.
Published: March 2003

Data from two research studies concerned with disabled children who have complex health needs were analysed in relation to families’ experiences of accessing short breaks (respite) services. Many families experience serious problems finding suitable services which can cater for both their child’s complex health needs and their own need for significant levels of support. This paper highlights which services families were using and the difficulties of obtaining a coherent and consistent package of support. Regulatory concerns relating to the piece‐meal provision of services and use of children’s hospices are raised along with recommendations for improving policy and practice.
Promoting child protection, welfare and healing: the case for developing best practice
Authors: Ferguson H.
Published: March 2003

This paper presents a ‘best practice perspective’ on child and family work. This involves moving beyond the ‘deficit perspective’ which dominates how the literature examines practice negatively in terms of what is not being done well to one which sets out best practice positively as a model for learning and developing systems and practice competencies. The paper focuses specifically on the meanings and development of best practice in family support in the context of child protection work. This involves work that is not only sensitive to achieving child protection and empowering practice in the context of power differences, but which meets the challenges of engaging therapeutically with and ultimately helping (often resistant) service users. The paper argues that issues of trauma and healing, and self‐actualization more broadly, need to move to the centre of how family support and child protection are theorized and done. The aim should be to promote child protec‐tion, welfare and healing through the development of egalitarian relationships in what Giddens calls the ‘democratic family’.
Transcending the fissure in risk theory: critical realism and child welfare
Authors: Houston Stan
Published: March 2003

Within risk theory a key fissure has emerged. On the one hand, objectivist theories continue to treat risk as a measurable entity, while on the other, subjectivist accounts approach risk as a socially constructed phenomenon. Arguably, we need to transcend this false opposition and harmonize important insights from both approaches. Building on an earlier paper in this journal, the author tries to achieve this synthesis by applying Bhaskar's critical realist perspective to this contested area. The reconciliation of objectivism and subjectivism within critical realism, it is argued, redirects our attention to the deep‐seated causes of harm or the underlying mechanisms that, when activated, give rise to situations involving risk. The paper concludes by reviewing the implications of these ideas for child and family social work. It is here that connections are made with attachment theory and the recent interest in childhood resilience.
Emotional labour and befriending in family support and child protection in Tower Hamlets
Authors: Gray Benjamin
Published: March 2003

This paper describes the emotional labour and befriending of families in East London by Family Support Workers (FSWs). The study is derived from an evaluation of the Family Welfare Association's Tower Hamlets Family Support Service. A key finding is that engaging the emotions of families enables high quality and effective support in the family home. FSWs win trust and elicit narratives from families, particularly from mothers and children. The narratives of families are a rich source of informing better practice. In line with Government objectives, the participatory work of FSWs helps to balance understanding on family support, health and child protection. According to Government and research, the early identification of child protection issues is particularly important in mitigating their worst effects. FSWs gain trust and early disclosure on child protection cases. This prevents child care problems from deteriorating into child protection issues. FSWs also act as informal advocates and help to balance social service assessments with the views of families. FSWs take a proactive, non‐stigmatizing, non‐intrusive approach to families. FSWs are sensitive and responsive to the emotions, ethnicity and specific needs of families.
The significance of a secure base: a psychosocial model of long‐term foster care
Authors: Schofield Gillian
Published: March 2003

ABSTRACT Long‐term foster care has been a much neglected area of social work practice and research. Yet there are obvious challenges that need to be understood when building a family for life in foster care. Is it possible for foster families, where there are no biological or legal ties between carers and children, to provide care, concern and family membership not only through childhood but also into adult life? The study on which this paper is based set out to explore that question by investigating the experiences of 40 adults, aged 18–30, who grew up in foster families. Qualitative interviews were conducted, transcribed and analysed. Theoretical frameworks from attachment and resilience were brought together with concepts such as ‘belonging’ and ‘family membership’ to make sense of the narratives provided. An integrated and dynamic psychosocial model of long‐term foster care was developed, which emphasizes the significance of a secure base and has some important implications for practice.
Child protection social work and men's abuse of women: an Irish study
Authors: Holt Stephanie
Published: March 2003

This paper reports the findings of an exploratory study of the response of social workers within a community care setting, in a large Dublin suburb, to cases involving men's abuse of women. This research aims to focus on what child protection workers do regarding this abuse, and what they say about what they do, thereby giving readers a sense of the action taking place in this social work team. The data, generated from both qualitative and quantitative methodological research, reflects this aim, as it taps into the working model of responses to men's abuse of women held by social workers, and identifies what influences that, thereby reflecting the realities and constraints of everyday work.

At the time the research was carried out (2000), the results confirm that the prevalence of cases involving men's abuse of women on this team was in line with international findings. This research revealed an absence of a team policy, an agreed definition of intimate violence in this context and agency practice guidelines, and illuminated how these gaps act as a deterrent to effective intervention. This paper explores some of the ethical and practical dilemmas that may arise for child protection social workers intervening in cases where the abuse of women by men is present. Recommendations arising from this research identify a need for a clear policy and best practice guidelines for social work staff in relation to this abuse.
Children and the city: a summary of recent environmental psychology research
Authors: Spencer C , Woolley H
Published: March 2003

The environmental psychology literature is reviewed as it focuses on children’s needs and experiences of towns and cities. Children are, we argue, the unacknowledged outsiders in the planning and management of urban areas; yet their enjoyment of and contribution to these areas is ignored at our peril. We discuss the importance of place attachment in the child’s developing personal identity; and the rich affordances of towns and cities for the child’s well‐being and development, alongside an assessment of the evidence about the social and physical dangers that are more frequently stressed in popular discussions: these range from strangers and street crime, to traffic and pollution. Other related topics reviewed include: children’s favourite places and their role in the child’s self‐regulation; the role of exploration of the local area as part of the child’s widening social and cognitive world; gender differences in patterns of exploration, and whether these might be changing; and examples of children’s involvement at more than a token level in the planning of their communities. The role of children as consumers in the local economy, and their use of public places, malls and plazas, has often been discussed as if they were inevitably socially problematic, and that their presence inevitably led to conflicts with adult users: yet we argue for a view of cityscapes which bring the different strands of society together. We conclude by discussing those Continental European city designs which foster the participation of children in the city’s social life.
Attention to infants in the first year
Authors: Baildam E M , Hillier V F , Menon S , Bannister R P , Bamford F N , Moore W M O , Ward B S
Published: March 2003

The time spent by 158 infants in contact with their carers at 6, 13, 26 and 52 weeks was reviewed prospectively. Periods of contact in the categories of (1) physical care, (2) holding the crying or sleeping infant, and (3) playing and interacting with the infant were recorded using 24‐h log diaries completed by the mother. The mean total carer contact time over a 24‐h day did not change significantly in the first year, varying between 6.5 and 7.3 h. Between 6 and 52 weeks, time spent by the mother in physical care declined significantly from 207 to 143 min and in holding the crying or sleeping infant from 61 to 17 min (P< 0.05 and 0.0001 respectively). There were no significant changes in the amount of time spent in playing and interacting with the infant over the first year by the mother and father, the time being on average 52.7 and 25.0 min respectively. Play and interaction with a non‐parental carer increased significantly from 14 to 69 min (P< 0.0001). Relationships between infant size and holding became weaker as the infant became older. Infant gender, socioeconomic status and duration of breast‐feeding did not influence infant contact time.
Adolescent girls and their babies: achieving optimal birthweight. Gestational weight gain and pregnancy outcome in terms of gestation at delivery and infant birth weight: a comparison between adolescents under 16 and adult women1
Authors: Buschman N A , Foster G , Vickers P
Published: March 2003

Aims Pregnancy amongst under 16s has been reported to result in worse outcomes for the baby, including low birthweight. This study aimed to find out whether the under 16s need to gain more weight during pregnancy to avoid this outcome.

Method A retrospective case control study of pregnancy outcomes in girls delivering before the age of 16 and women delivering aged 25–30. Data was collected from medical case notes, including maternal age, pregnancy weight gain and infant birth weight.

Results Although weight gain amongst under 16s was similar to that in the control group, average birthweight of babies born to under 16s was less than in the older group. For both girls and older women greater weight gain in pregnancy did result in higher birth weights.

Discussion As younger girls are still growing it may be necessary for them to achieve a greater pregnancy weight gain in order to achieve a satisfactory birth weight.
Antenatal inflammation and infection in chronic lung disease of prematurity
Authors: Miralles R. E. , Hodge R. , Kotecha S.
Published: March 2003

In spite of improved neonatal care, chronic lung disease of prematurity (CLD) remains a major cause of morbidity and mortality in extremely preterm infants. Our current understanding is that antenatal infection can trigger intra‐uterine inflammation which then promotes preterm labour. Recent studies suggest that antenatal infection and inflammation can also increase the preterm infant's susceptibility to develop CLD. It may be that exposure of the fetal lung to high concentrations of pro‐inflammatory cytokines is the cause of this increased susceptibility. One candidate for initiating intra‐uterine inflammation is ascending infection by the vaginal commensal Ureaplasma urealyticum (Uu). Antibiotics administered to mothers prior to delivery appear to improve the neonatal outcome in cases of preterm prolonged rupture of membranes, but not in cases of preterm labour with intact membranes. Uu can be transmitted vertically to the airways of the preterm infant, but the role of Uu in causing CLD remains uncertain. Small trials of antibiotics given to preterm infants after delivery have not shown any consistent benefit in reducing CLD. Although CLD remains a significant problem for the extremely preterm infant, it is likely that molecular biology techniques, such as the polymerase chain reaction, will enhance the detection of antenatal infection and further our understanding of the pathogenesis of CLD.
Can maternal depression increase infant risk of illness and growth impairment in developing countries?
Authors: Rahman A. , Harrington R. , Bunn J.
Published: March 2003

Despite relative improvement in living conditions and availability of modern healthcare, infant mortality rates continue to be very high in many developing countries. High rates of depression have also been reported in women in these countries. The continuous care and attention of children is a demanding task, and poor physicalormental health in mothers might be expected to have adverse consequences on their children’s health, nutrition and psychological well‐being. Review of published literature reveals very little research in developing countries on the association between poor mental health in mothers and the subsequent physical well‐being of their children. We hypothesize that the level of care provided by mothers with depression may put their infants at higher risk of infection and impaired growth, compared with infants of mothers without depression. We outline approaches to test such a hypothesis in a developing country, and discuss its implications.
Communicating about pupils in mainstream school with special health needs: the NHS perspective
Authors: Mukherjee S. , Lightfoot J. , Sloper P.
Published: March 2003

Aim
To add to previous research carried out with young people, parents and teachers, by investigating health staff’s perspectives on the difficulties, and possibilities for, achieving good communication with school staff with regard to children in mainstream school with a chronic illness or physical disability.

Research design and methods
A qualitative research study was carried out in one NHS Trust. Twenty semi‐structured interviews were carried out with a purposive sample of health staff to cover the spectrum of professionals who have responsibility for meeting the needs of children with a chronic illness or physical disability in mainstream schools (paediatricians, school doctors, school nurses, specialist nurses, health visitors, GPs, speech and language therapists, paediatric occupational therapists, paediatric physiotherapists, clinical psychologists and psychiatrists).

Results
The extent to which health professionals communicated with school staff, and the way in which they went about it, varied widely. Communication was facilitated by joint meetings, shared documentation, and local policy development. Sources of difficulty in communication between health and education staff were: the parent as a conduit of information; the practical difficulties of arranging meetings; and lack of knowledge about other professionals’ roles. The ethos of the school with regard to health matters, and the flow of information within health services, also had an impact on the communication process. Participants’ recommendations focused on two key issues: clarification of the roles of health and education staff with regard to this group of pupils; and how information should flow from health to school staff.

Discussion
Many of the findings parallel the previous research with teachers, indicating agreement between professionals from different agencies about aspects of the communication process which are problematic and require attention. The findings suggest that improving communication requires both joint work between health and education staff, and improvements to practice within each agency.