bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibition of caffeine metabolism by 5‐methoxypsoralen in patients with psoriasis
Authors: BENDRISS E. K. , BECHTEL Y. , BENDRISS A. , HUMBERT Ph. , PAINTAUD G. , MAGNETTE J. , AGACHE P. , BECHTEL P. R.
Published: November 2003

Eight patients with psoriasis were given 200 mg caffeine orally with or without 1.2 mg kg−1 of 5‐methoxypsoralen. Blood and urine samples were collected over a 2‐day period. During 5‐methoxypsoralen coadministration, the apparent volume of distribution of caffeine remained unchanged, but oral clearance (CLp.o.) decreased from 9.5±3.8 (mean±s.d.) to 3.2±0.5 l h−1 (P<0.01). The area under the plasma concentration‐time curve (AUC) increased from 24±9 to 73±29 mg l−1 h (P<0.001). This decrease in CLp.o. with increased AUC was consistent with a CYP1A2‐dependent inhibition of caffeine N‐demethylation which was further supported by significant decreases in the (AFMU+1U+1X)/17U and (AFMU+1U+1X)/17X urinary metabolic ratios.
Debrisoquine 4‐hydroxylation and sulphamethazine N‐acetylation in patients with schizophrenia and major depression
Authors: HADAŠOVÁ EVA , FRANKE GERD , ZSCHIESCHE MICHAEL , ČEŠKOVÁ EVA , ZELENKOVÁ OLGA , SIEGMUND WERNER
Published: November 2003

Debrisoquine 4‐hydroxylation and sulphamethazine N‐acetylation phenotypes were determined in 115 Czech drug‐free in‐patients with schizophrenia (n=64) or major depressive disorder (n=51). These data were compared with a control group of 321 healthy volunteers from the North‐East German area of Greifswald. The distribution of debrisoquine hydroxylator phenotypes was almost identical in patients and healthy controls. Thus, there were 8.7% (95% CI 5.4–12.0%) of poor metabolizers (PM) among patients while 8.7% (95% CI 3.6–13.8%) PM among the control group. The prevalences of PM amongst patients with chronic schizophrenia and major depression were 10.9% (95% CI 4.5–21.3%) and 5.9 % (95% CI 1.24–16.3%), respectively (χ2 schizophrenics vs control=0.315, NS; χ2 depressive patients vs control=0.450, NS). However, within the group of EM patients there was a significant (P<0.01) shift towards higher debrisoquine metabolic ratios, reflecting a lower hydroxylation capacity in EM patients compared with EM healthy controls. The proportion of slow acetylators (SA) was 60.0% (95% CI 51.0–68.9%) in the entire group of psychiatric patients and 57.5% (95% CI 52.1–62.9%) in the control group (χ2 all patients vs control=0.195, NS). Furthermore, there were no significant differences in the prevalence of the SA phenotype between controls and schizophrenics or patients with major depression. Although the results of this modest study were negative, the presence of subtle differences in the metabolic capacity between psychiatric patients and a healthy population cannot be ruled out.
Analysis of the dihydropyrimidine dehydrogenase polymorphism in a British population
Authors: McMURROUGH J. , McLEOD H. L.
Published: November 2003

Subjects with low or absent dihydropyrimidine dehydrogenase activity (DPD) are at risk of excessive toxicity or death when undergoing fluoropyrimidine chemotherapy. The DPD polymorphism has not been well characterized in the general population and the frequency of the enzyme deficiency is not known. In preparation for a population multicentre analysis of DPD activity, a comparison of sample preparation methods and a pilot study in normal volunteer subjects was performed. The stability of peripheral blood mononuclear cell DPD activity at −70° C was determined in 35 mm sodium phosphate buffer with 10% glycerol, 100% fetal calf serum (FCS) or as a dry pellet. DPD activity declined in FCS and increased in glycerol buffer, both reaching a plateau value 14 days after blood sampling. The glycerol buffer method was then used to study DPD activity in 50 British subjects (36 M:14F; 20–56 years). A 8.4‐fold range in DPD activity was observed (30.4–256 pmol min−1 mg−1 protein). DPD activity was not influenced by age or cigarette smoking. This information will facilitate analysis of the DPD polymorphism in populations from different countries and ethnic groups.
The inlaid black marble of Ashford‐in‐the‐Water, Derbyshire
Authors: FORD TREVOR D.
Published: November 2003

The rise and fall of a local geology‐based industry.
Alginite, a raw material for environmental control
Authors: VASS DIONÝZ , ELEČKO MICHAL , KONEČNÝ VLASTIMIL
Published: November 2003

Alginite, a material derived in part from ancient yellow‐green algae, is an excellent natural fertilizer.
A new lead mine in the northern Pennines
Authors: YOUNG BRIAN , FORBES IAN
Published: November 2003

Plans by Durham County Council, owners of the Killhope Lead Mining Centre in Weardale, to open parts of the oroginal underground workings of Park Level Mine to visitors were frustrated when exploration of the mine revealed the seriously collapsed state of the workings. This disappointment has now been turned to advantage by the building of a new, ‘artificial’, specially constructed mine on the site, planned to be geologically consistent with the original mine. The new mine was recently officially opened by Tony Blair MP.
Genetic structure of the forest herb Primula elatior in a changing landscape
Authors: Jacquemyn Hans , Honnay Olivier , Galbusera Peter , Roldán‐Ruiz Isabel
Published: December 2003

To investigate whether changes in land use and associated forest patch turnover affected genetic diversity and structure of the forest herb Primula elatior, historical data on landscape changes were combined with a population genetic analysis using dominant amplified fragment length polymorphism markers. Based on nine topographic maps, landscape history was reconstructed and forest patches were assigned to two age classes: young (less than 35 years) and old (more than 35 years). The level of differentiation among Primula populations in recently established patches was compared with the level of differentiation among populations in older patches. Genetic diversity was independent of population size (P > 0.05). Most genetic variation was present within populations. Within‐population diversity levels tended to be higher for populations located in older forests compared with those for populations located in young forests (Hj = 0.297 and 0.285, respectively). Total gene diversity was also higher for old than for young populations (Ht = 0.2987 and 0.2828, respectively). The global fixation index FST averaged over loci was low, but significant. Populations in older patches were significantly more differentiated from each other than were populations in recently established patches and they showed significant isolation by distance. In contrast, no significant correlations between pairwise geographical distance and FST were found for populations in recently established patches. The location of young and old populations in the studied system and altered gene flow because of increased population density and decreased inter‐patch distances between extant populations may explain the observed lower genetic differentiation in the younger populations. This study exemplifies the importance of incorporating data on historical landscape changes in population genetic research at the landscape scale.
The genetic pattern of population threat and loss: a case study of butterflies
Authors: Schmitt T. , Hewitt G. M.
Published: December 2003

Recent decreases in biodiversity in Europe are commonly thought to be due to land use and climate change. However, the genetic diversity of populations is also seen as one essential factor for their fitness. Genetic diversity in species across the continent of Europe has been recognized as being in part a consequence of ice age isolation in southern refugia and postglacial colonization northwards, and these phylogeographical patterns may themselves affect the adaptability of populations. Recent work on butterfly species with different refugia, colonization paths and genetic structures allows this idea to be examined. The ‘chalk‐hill blue’ pattern is one of decreasing genetic diversity from south to north, whereas the ‘woodland ringlet’ pattern shows greater genetic diversity in eastern than in western lineages. Comparison of population demographic trends in species with these biogeographical patterns reveals higher rates of decrease with lower genetic diversity. This indicates reduced adaptability due to genetic impoverishment as a result of glacial and postglacial range changes. Analysis of phylogeographical pattern may be a useful guide to interpreting demographic trends and in conservation planning.
Toward a New Sexual Selection Paradigm: Polyandry, Conflict and Incompatibility (Invited Article)
Authors: Zeh Jeanne A. , Zeh David W.
Published: December 2003

Darwin's recognition that male–male competition and female choice could favor the evolution of exaggerated male traits detrimental to survival set the stage for more than a century of theoretical and empirical work on sexual selection. While this Darwinian paradigm represents one of the most profound insights in biology, its preoccupation with sexual selection as a directional evolutionary force acting on males has diverted attention away from the selective processes acting on females. Our understanding of female reproduction has been further confounded by discreet female mating tactics that have perpetuated the illusion of the monogamous female and masked the potential for conflict between the sexes. With advances in molecular techniques leading to the discovery that polyandry is a pervasive mating strategy, recognition of these shortcomings has brought the study of sexual selection to its current state of flux. In this paper, we suggest that progress in two key areas is critical to formulation of a more inclusive, sexual selection paradigm that adequately incorporates selection from the female perspective. First, we need to develop a better understanding of male × female and maternal × paternal genome interactions and the role that polyandry plays in providing females with non‐additive genetic benefits such as incompatibility avoidance. Consideration of these interaction effects influencing natural selection on females is important because they can complicate and even undermine directional sexual selection on males. Secondly, because antagonistic coevolution maintains a balance between opposing sides that obscures the conflict itself, many more experimental evolution studies and interventionist investigations (e.g. gene knockouts) are needed to tease apart male manipulative adaptations and female counter‐adaptations. It seems evident that the divisiveness and controversy that has plagued sexual selection theory since Darwin first proposed the idea has often stalled progress in this important field of evolutionary biology. What is now needed is a more pluralistic and integrative approach that considers natural as well as sexual selection acting on females, incorporates multiple sexual selection mechanisms, and exploits advances in physiology and molecular biology to understand the mechanisms through which males and females achieve reproductive success.
Effect of Daily Body Mass Variation on the Foraging Behaviour of Tit Species (Parus spp.)
Authors: Barluenga Marta , Barbosa Andrés , Moreno Eulalia
Published: December 2003

We studied the effect of daily body mass increase on the foraging preferences of two tit species, crested tit, Parus cristatus and blue tit, P. caeruleus, contrasting in morphology and behaviour. We found that both species show a diurnal increase in body mass during winter. Using an experiment with feeders we show that in the crested tit, the proportion of time spent foraging while hanging decreased as body mass increased. In contrast, in the blue tit, foraging behaviour did not change with mass gain. We propose that the species with a morphological design providing a high ecological plasticity in terms of foraging postures can counteract the negative effect of body mass on the ecological options (foraging niche) more than species with a morphological design providing a low ecological plasticity in terms of foraging postures. Our results suggest that blue tits had the advantage of being able to choose to feed on different patches in the habitat throughout the day, which makes resources more predictable for them. In contrast, crested tits might be more restricted in their foraging options as their body mass increases, and this might explain why they hoard food.
Disseminated trichosporonosis in China
Authors: Yang R. , Ao J. , Wang W. , Song K. , Li R. , Wang D.
Published: November 2003

A 20‐year‐old female patient presented with erythematous plaques on the nose which were progressively spreading to the trunk and the extremities, sometimes with erosions and scars. The patient was misdiagnosed as having seborrhoeic dermatitis and subacute cutaneous lupus erythematosus. The histopathological biopsy revealed mycotic infectious granuloma. Samples taken from skin lesions and other locations grew Trichosporon asahii in cultures. The identification was confirmed by molecular biological methods. The patient was treated successfully with liposomal amphotericin B in combination with fluconazole orally.
Provision of optimal dialysis for peritoneal dialysis patients
Authors: IBELS Lloyd , GARCHOW Stephen , MORAN John
Published: November 2003

Prescription of optimal dialysis is of major importance in determining the overall prognosis and nutritional status of patients receiving chronic peritoneal dialysis (PD). A mathematical model of peritoneal dialysis kinetics was used to examine typical dialysis prescriptions for patients receiving continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD), and using a new automatic night‐time dialysis machine. Based on the recommendations of the CANUSA and other studies, a creatinine clearance delivery target of 70 L per week (the equivalent of 6.9 mL/min) was selected. At the start of dialysis, creatinine clearances of greater than 70 L/week are achieved in most patients on PD, but by 2 years deterioration of residual renal function (RRF) results in standard dialysis prescriptions of 4×2 L exchanges per day providing adequate solute clearance to only a minority of patients. Prescriptions of 4×2.5 or 4×3.0 L exchanges per day may be required to provide optimal solute clearance to most patients without RRF. Automated peritoneal dialysis, especially when prescribed without day‐time fluid, often delivers inadequate solute clearance. In order to achieve optimal solute clearance with APD it is essential that patients have dialysate in the abdomen by day, and most need to perform a mid‐day exchange. Five exchanges per day can be easily achieved, using the new technology that performs a night‐time exchange, and this often results in optimal solute clearance. Optimization of dialysis prescriptions may be expected to result in improvement in objective measures of morbidity and mortality. For the individual patient, it is essential to take into account the creatinine clearances achieved with the dialysis prescribed, the body surface area, peritoneal transport rates and the contribution of measured residual renal function.
Mild gentamicin nephrotoxicity reduces the progression of chronic adriamycin nephrosis
Authors: RANGAN Gopala , WANG Yiping , TAY Yuet‐Ching , CHEN Liguang , HARRIS David
Published: November 2003

The effect of mild acute tubular injury on the progression of tubulointerstitial fibrosis was studied in pair‐fed uninephrectomized male Wistar rats with established adriamycin nephrosis (n=34). Rats were stratified into three groups according to endogenous creatinine clearance (CrCl), proteinuria (Upr) and body weight (BW): (i) group 1 (Fe, n=12) received a single intraperitoneal injection of ferric nitrilotriacetate (5 mg Fe/kg BW); (ii) group 2 (G, n=10) three daily subcutaneous injections of gentamicin (60 mg/kg BW) and; (iii) group 3 (C, n=12) saline injections. Serial CrCl (day 2, day 5, weeks 2, 4, 6 and 8) and renal histology (week 8) were examined following administration of nephrotoxin. CrCl was reduced on d2 (Fe: 0.78±0.23 mL/min; mean±SD) and day 5 (G: 0.91±0.36 mL/min) as compared with C (1.22±0.12 mL/min; P<0.05). There was no change in the serum creatinine and functional recovery occurred by d5 (Fe) and week 2 (G). Upr decreased transiently in G at week 2 (G: 482±208 mg/day vs C: 716±233; P=0.05) despite similar food intake, baseline Upr and CrCl. At week 8, CrCl in Fe (0.84±0.40 mL/min) was similar to C (0.84±0.58 mL/min), whereas in G it remained stable (1.27±0.39 mL/min; P<0.05). By morphometric analysis, mean relative interstitial volume (RIV) and glomerulosclerosis (GS) in Fe (RIV: 28.5±13.4%; GS: 10.3±12.3%) was no different to C (RIV: 24.5±12.5%; GS: 20.9±20.0%), whereas both parameters were reduced in G (RIV: 14.1±8.1%; GS: 4.0±4.8%; P<0.05). Mild gentamicin nephrotoxicity therefore reduced the progression of adriamycin nephrosis. The mechanism of this finding is unclear, but it may relate to altered glomerular and tubular cell handling of protein.
A randomized prospective comparison of nadolol, captopril with or without ticlopidine on disease progression in IgA nephropathy
Authors: CHENG Ignatius , FANG GX , WONG MC , JI YL , CHAN KW , YEUNG Henry
Published: November 2003

To determine if angiotensin converting enzyme inhibitors (ACEI) and antiplatelet agents have any added advantages over beta‐blockers in preventing disease progression in IgA nephropathy (IgAN), 52 patients with IgAN with at least two features suggestive of progressive disease, namely, proteinuria >1 gm/day, mean blood pressure (MBP)>107 mmHg, serum creatinine 0.12–0.4 mmol/L and the presence of glomerulosclerosis and/or tubulointerstitial fibrosis on initial biopsy were randomized to receive nadolol (N), captopril (C) and captopril plus ticoplidine (CT). In hypertensive subjects, the dose N and C was adjusted to normalize MBP. In normotensive subjects the dose was adjusted to achieve a reduction of MBP of 5–10mmHg. Five patients withdrew prematurely before reaching the end of the study period. The results after a minimal period of 3 years follow‐up were available in the remaining 47 patients (n=16, 12 and 19 in groups N, C and CT, respectively). Target of blood pressure (BP) treatment was achieved in all patients and the post‐treatment MBP was comparable among the three groups. In C and CT, peripheral blood renin increased significantly while in CT, in vitro platelet aggregation decreased significantly following treatment. Urinary protein and albumin excretion decreased significantly in all treatment groups but there was no difference among the three groups. Progression of renal failure as measured by life table analysis of the percentage of patients with doubling of serum creatinine and by the slope of the reciprocal of serum creatinine (mean±SEM: −0.021±0.014; −0.016±0.010 and −0.017±0.008 for N, C and CT, respectively) and of glomerular filtration rate as measured by plasma disappearance of injected Cr51EDTA over time (mean±SEM: −0.556±0.157, −0.739±0.304 and −0.543±0.274 for N, C and CT) were similar among the three groups. In this small comparative study, ACEI does not appear to be better than long‐acting beta‐blocker in retarding disease progression in patients with IgAN and ticlopidine confers no additional benefit.
Stimulation of PAI‐1 in rabbit anti‐GBM glomerulonephritis
Authors: GALLICCHIO Marisa , McFARLANE Jim , HUFNAGL Peter , HOLDSWORTH Stephen , TIPPING Peter
Published: November 2003

It has previously been shown in human disease and animal models of glomerulonephritis (GN) that fibrin deposition is associated with a net reduction of glomerular fibrinolytic activity as a result of reduced expression of plasminogen activators and increased expression of plasminogen activator inhibitor type 1 (PAI‐1). Conditioned media (CM) prepared from cultured glomeruli of normal rabbits and rabbits 24 (Day 1) and 96 (Day 4) h after induction of anti‐GBM GN were compared for their effects on the synthesis of fibrinolytic molecules in human endothelial cells (EC). Only CM from Day 4 GN rabbits showed PAI‐1 protein stimulatory activity of up to 148% (P<0.05; n=3) above that of untreated EC. This was also seen at the mRNA level. Glomerulonephritis Day 4 CM showed significantly higher amounts of tumour necrosis factor (TNF) and thrombin and transforming growth factor‐β (TGF‐β) bioactivity in comparison to glomerular CM from normal rabbits. After high performance liquid chromatography (HPLC) of Day 4 GN CM, PAI‐1 stimulatory activity was found to correlate with the presence of interleukin 1 (IL‐1), TNF and TGF‐β. These results suggest a correlation between severity of anti‐GBM GN in a rabbit model, increased PAI‐1 synthesis and increased expression of TNF and TGF‐β. This may potentiate glomerular fibrin and extracellular matrix deposition in anti‐GBM GN, leading to glomerular crescent formation and eventual renal failure.
Primary focal sclerosing glomerulonephritis: A clinicopathological analysis
Authors: IBELS Lloyd , GYORY Akos , MAHONY John , CATERSON Robyn , POLLOCK Carol , WAUGH David , COULSHED Susan
Published: November 2003

The clinical and laboratory features, renal biopsy findings, and outcome of 68 patients with primary focal sclerosing glomerulonephritis were studied. The cumulative probability of not progressing to end‐stage renal failure (ESRF) was 0.92 at 5 years and 0.73 at 10 years after presentation, and was significantly worse in patients with hypertension or severe renal impairment (serum creatinine >0.24 mmol/L) at presentation. Proteinuria of up to 1gm/day was associated with an excellent prognosis, whereas proteinuria of 1–3 gm/day and >3 gm/day had similar and poorer survivals. An adverse outcome was associated with, at presentation, age less than 30 years, hypertension, a family history of glomerulonephritis, cigarette smoking, impaired renal function, and heavy proteinuria. Renal biopsy findings which correlated with progressive renal failure included a higher percentage of glomeruli with global or segmental sclerosis, and the degrees of tubular atrophy, interstitial fibrosis, interstitial inflammation and arterial thickening. During follow‐up the degrees of renal impairment and proteinuria, persistence or development of hypertension, transient decreases of renal function of >10%, and the total number of red cells and casts on centrifuged urine microscopy were all predictive of progressive renal disease. Multivariate analysis demonstrated that the indices with adverse effects on outcome included all of the above except tubulointerstitial and vascular changes on renal biopsy. It is concluded that the prognosis may be better than has been suggested in the literature. It is possible to predict which patients are likely to have an adverse outcome, and this should assist with therapeutic decisions likely to retard progression of disease.
Experience of iron saccharate supplementation in haemodialysis patients treated with erythropoietin
Authors: HUSSAIN R , CHISHTI SH , NAQVI SAJ
Published: November 2003

We assessed the efficacy of intravenous (i.v.) iron saccharate (VENOFER) vs oral iron supplementation in haemodialysis patients treated with low‐dose erythropoietin (EPO). Twenty haemodialysis patients with serum ferritin >200 ng/mL and transferrin saturation >30% were assigned to one of the two groups. In Group 1, 10 were given i.v. iron saccharate (100 mg i.v. twice weekly) post dialysis. In Group 2, oral ferrous sulphate 200 mg was given thrice daily. In both groups, subcutaneous EPO 25 units/kg body weight (BW) was started simultaneously, twice weekly. After 3 months (study completion) the mean haemoglobin and haematocrit was significantly increased in Group 1 than in Group 2 (Hb 11.60±0.64 G/dL vs 10.5 G/dL±1.14 P<0.01). The final mean EPO dose was 25% lower in Group 1 than in Group 2 (3400±1356 U/week vs 4600±1356 U/week P=0.10) and the mean serum ferritin was higher in the i.v. iron group than the oral group (671 ng/mL±388 vs 367 ng/mL±238 P=NS). The same was also observed with transferrin saturation (44.6%±19.8 in Group 1 vs. 29%±11.0 in Group 2 P=NS). No adverse effects were seen during the study. In conclusion, we observed that regular use of i.v. iron had a significantly enhanced haemoglobin response, better maintained serum ferritin and lower EPO dosage requirement than the oral iron group.
Malaysian Dialysis and Transplant Registry Report
Authors: LIM TO , LIM YN , TAN CC , LEE DG , MORAD Zaki
Published: November 2003

This report summarizes data for dialysis and transplant patients up to the end of 1995. We estimate coverage to be about 30% of dialysis patients and near complete ascertainment of transplant patients. On the 31 December 1995, there were 2224 patients on renal replacement therapy (RRT), comprising 50% on haemodialysis (HD), 12% on continuous ambulatory peritoneal dialysis (CAPD) and 38% with functioning transplants. The prevalence rate for dialysis was 68 per million population (p.m.p.) and that of transplant 42 p.m.p. The new dialysis acceptance rate was 15 p.m.p. and transplant 5 p.m.p. Forty‐seven per cent of new patients had unknown primary renal disease and 30% was due to non‐insulin dependent diabetes mellitus. Mean age of prevalent HD patients was 42 years, CAPD 46 years and 34 years for transplant. Patient survival on CAPD was 85% at 1 year and for HD was 88%. One year transplant patient survival was 94% and graft survival 91%.
Cell kinetics and tissue contraction following renal parenchymal cell death
Authors: KELYNACK Kristen , HEWITSON Tim , NICHOLLS Kathy , BECKER Gavin , JONES Colin
Published: November 2003

The kinetics of interstitial extracellular matrix remodelling in the kidney following parenchymal cell death were studied after injury was produced by a single application of liquid nitrogen to the surface of the kidney. The size of the injury decreased to 30% of the original size at 4 days and to 5% at 16 days after injury. The primary response to injury consisted of an acute polymorphonuclear infiltration followed by monocyte/macrophage and myofibroblast accumulation from day 2 to 8. Collagen III accumulation increased progressively until day 16 and was inversely related to lesion size. These results demonstrate the time course of cellular events and collagen synthesis in renal tissue remodelling following renal parenchymal cell death.
Fibromuscular dysplasia of the renal artery: Management and outcome
Authors: JAGOSE Jinni , BAILEY Ross , YOUNG Antony
Published: November 2003

Renovascular hypertension may be caused by atherosclerotic disease or less commonly by fibromuscular dysplasia (FMD) of the renal arteries. Fibromuscular dysplasia is the commonest cause of renal artery stenosis in the younger age group and affects women predominantly. A review of our clinical database identified all patients with renovascular hypertension. All relevant clinical, biochemical and radiological findings on those with FMD were noted. The outcome of percutaneous transluminal renal angioplasty (PTRA) or reconstructive surgery was evaluated. Eight out of 62 (13%) patients with hypertension secondary to renovascular disease had FMD (all female; bilateral in four; mean age at diagnosis 37.6 years; age range 12–70 years). The mean duration of hypertension before the diagnosis of FMD was 3.3 years (range 3 months–10 years). A renal artery bruit was detected in five, hypertensive retinopathy in three and one had mild renal insufficiency. Twelve PTRAs were attempted on 10 stenotic lesions in six women. This cured the hypertension in three, while the other three have required less antihypertensive therapy. Percutaneous transluminal renal angioplasty was complicated by a trivial renal artery dissection in one, and a small upper pole infarction in another. One patient required a repeat PTRA. The other two women presented before the availability of PTRA and had successful reconstructive surgery. Fibromuscular dysplasia was the cause of hypertension in eight out of 62 (13%) patients with renovascular hypertension. Percutaneous transluminal renal angioplasty has shown encouraging results with a low complication rate. If technically feasible, PTRA should be attempted on all patients with FMD of the renal artery.
11β hydroxysteroid dehydrogenase type 2 enzyme is expressed in normotensive and hypertensive patients with renal disease
Authors: STEIN‐OAKLEY Alicia , MAGUIRE Julie , DOWLING John , PERRY Greg , KROZOWSKI Zygmunt , THOMSON Napier
Published: November 2003

The enzyme 11β hydroxysteroid dehydrogenase type 2 (11βHSD2) converts glucocorticoids to their 11‐keto metabolites, permitting binding of aldosterone to the non‐selective mineralocorticoid receptor. Recent studies have suggested that 11βHSD deficiency may be implicated in essential hypertension and renal disease. Using an antibody against a peptide deduced from the cDNA sequence, the renal expression of 11βHSD2 was examined in patients with advanced stages of renal disease and associated hypertension, patients with primary hypertension resulting in renal damage, and patients with preserved or mildly damaged renal architecture without concomitant hypertension. Despite variable degrees of tubulointerstitial damage, 11βHSD2 was expressed in distal convoluted tubules and collecting ducts in all patient groups. Collapsed tubules retained strong immunoreactivity, but decreased staining was apparent in dilated tubules. There was weak staining of the thick ascending limb of Henle. Variable glomerular expression of 11βHSD2 was observed. Our results therefore suggest that absence of renal 11βHSD2 is not a prominent feature of hypertensive nephrosclerosis, or primary renal disease associated with hypertension.
Detection of serum and urinary lipoprotein(a) in patients with renal diseases
Authors: WANG Jun‐Jun , YAO Xiao‐Dan , ZHUANG Yi‐Yi
Published: November 2003

We measured and analysed serum and urinary lipoprotein(a) [Lp(a)] in 73 patients with various renal diseases, and 168 control subjects. The results revealed that serum Lp(a) levels were significantly elevated in patients with mesangial proliferative glomerulonephritis, membranous nephropathy, chronic renal failure and diabetic nephropathy, except patients with IgA nephropathy (IgAN) with gross haematuria. Serum Lp(a) concentrations were found to be significantly correlated with serum albumin (r=−0.5033, P<0.001) and urinary protein excretion (r=0.3541, P<0.005), while not with serum creatinine (r=−0.0144, P>0.05). Patients with selective urinary protein excretion had a lower serum Lp(a) level than those with non‐selective urinary protein excretion. The correlation between serum albumin and serum Lp(a) levels remained significant (P<0.001) after adjustment for serum creatinine, urinary protein excretion and the selectivity of urinary protein by multivariate regression analysis. Urinary Lp(a) excretion was decreased and related to the serum creatinine level (r=−0.312, P<0.01). Our conclusion is that renal patients with proteinuria and hypoalbuminemia tend to have elevated levels of Lp(a) which are more significantly correlated to serum albumin levels than other parameters such as serum 24‐h urinary protein, selectivity of urinary protein and serum creatinine; while urinary Lp(a) excretion varies inversely with serum creatinine levels.
Lipid risk factors for atherosclerotic carotid artery disease in patients on continuous ambulatory peritoneal dialysis
Authors: YORIOKA Noriaki , TANIGUCHI Yoshihiko , ITO Takafumi , Chang SHAO Jin , MASAKI Takao , YAMASHITA Kazuomi , YAMAMOTO Maki , YAMAKIDO Michio
Published: November 2003

We investigated the relationship between abnormalities of lipid metabolism and carotid atherosclerosis in 20 patients on continuous ambulatory peritoneal dialysis (11 men and nine women). Carotid ultrasonography was used to determine the combined thickness of the intima and media (I‐M thickness). The apo A‐I/apo B ratio showed a significant negative correlation with I‐M thickness (P<0.05). In the patients with carotid plaque, the triglycerides (TG) level and the remnant‐like particle cholesterol level (RLP‐C) were significantly higher than in the patients without plaque (P<0.05), and high density lipoprotein (HDL) cholesterol and the apo AI/apo B ratio were significantly lower than in the patients without plaque (P<0.05). Moreover, there was a strong relationship between the severity of plaque and TG, the apo AI/apo B ratio, and RLP‐C. Thus, abnormal lipid metabolism may contribute to progressive atherosclerosis, while TG, the apo A‐I/apo B ratio, and RLP‐C levels may be useful indicators of atherosclerotic risk in peritoneal dialysis patients.
Effect of Sairei‐to on irreversible glomerular sclerotic lesions in rats
Authors: LI Ping , KAWACHI Hiroshi , ORIKASA Michiaki , Sheng SHI Zhen , SHIMIZU Fujio
Published: November 2003

The effects of Sairei‐to and its active components on a model of irreversible mesangial proliferative glomerulonephritis induced by injecting monoclonal antibody (MoAb) 1‐22‐3 into uninephrectomized rats were examined. The significant suppressive effects of Sairei‐to and its active components on proteinuria were demonstrated on days 7, 14, 21 after MoAb 1‐22‐3 injection compared with phosphate‐buffered saline (PBS)‐treated controls. On day 21, light microscopy revealed that the drugs reduced mesangial cell proliferation, mesangial matrix expansion (matrix score: 84.5±41.6 for Sairei‐to, 76.1±31.9 for Syo‐saiko‐to, 66.7±46.3 for its three components vs 162.4±26.1 for PBS, P<0.005) and crescent formation (mean percentage: 2.25% for Sairei‐to, 1.71% for Syo‐saiko‐to, 1.43% for its three components vs 18.86% for PBS, P<0.005). The kidney weights of the groups given the drugs were significantly lower than the PBS group value (1.03±0.08 g with Sairei‐to, 1.11±0.12 g with Syo‐saiko‐to, 1.06±0.12 g with its three components vs 1.39±0.20 g with PBS, P<0.01 or P<0.05). Immunofluorescence analysis revealed that the drugs suppressed the expression of transforming growth factor‐β (TGF‐β), α‐smooth muscle actin (α‐SMA) and collagen type I in the glomeruli, and reduced the numbers of ED1‐positive cells in the glomeruli and OX8‐positive cells in the glomeruli and in the tubular interstitium. The blood biochemistry results revealed significant differences between the total cholesterol levels (70.0±5.9 mg/dL with Sairei‐to, 66.0±6.4 mg/dL with Syo‐saiko‐to, 76.6±8.4 mg/dL with its three components vs 104.3±26.6 mg/dL with PBS, P<0.05). We conclude that Sairei‐to and its active components have suppressive effects on proteinuria and mesangial matrix expansion in rats with irreversible renal sclerosis. Transforming growth factor‐β, collagen type I and α‐SMA expression and infiltration by ED1‐ and OX8‐positive cells were also suppressed by these drug preparations.
Transforming growth factor‐β (TGF‐β) activity in urine of patients with glomerulonephritis is related to their renal functional and structural changes
Authors: DOMINGUEZ  , COSTA RS , DANTAS M , KIMACHI T , PIUCI CR
Published: November 2003

Transforming growth factor‐β (TGF‐β) has been considered the principal cytokine involved in the pathogenesis of renal fibrosis. In the present study, we evaluated TGF‐β activity in occasional samples from 22 normal individuals and 29 patients (11 with focal glomerulosclerosis, 11 with membranous nephropathy, five with Berger disease, one with type I membranoproliferative glomerulonephritis and one with postinfectious glomerulonephritis) using a CCL‐64 mink lung cell growth inhibition assay.

A significantly increased urinary TGF‐β activity (reported in relation to urine creatinine, Ucreat. and median) was observed in patients with glomerulonephritis compared with normal individuals (P<0.01). The patients with Berger disease [median (Md)=9.96/10 μg Ucreat.], membranous glomerulonephritis (Md=7.23/10 μg Ucreat.) and focal glomerulosclerosis (Md=16.6/10 μg Ucreat.) showed higher urinary TGF‐β than normal individuals (Md=1.09/10 μg Ucreat.) (P<0.01). We found a positive correlation between the TGF‐β activity in the urine of these patients and the incidence of segmental glomerulosclerosis (r=0.45, P<0.05) and their plasma creatinine levels (r=0.87, P<0.01). A negative correlation was observed between the TGF‐β activity in the urine of these patients and their creatinine clearance (r=−0.75, P<0.01).

Our data suggest that measurement of urinary TGF‐β activity could be a useful non‐invasive procedure for the evaluation of renal TGF‐β production, permitting the assessment of prognosis and the evaluation of therapeutic efficacy in patients with renal disease.
Retinitis pigmentosa associated with autosomal dominant polycystic kidney disease
Authors: PERNG Chan , SEGASOTHY Murugasu
Published: November 2003

We report a case of a 35‐year‐old man with autosomal dominant polycystic kidney disease (ADPKD) who presented for the first time with end‐stage renal failure. He had a long history of blurred vision and on examination had retinitis pigmentosa. To our knowledge, this is the second report on the association of retinitis pigmentosa with polycystic kidney disease.
Prevalence of hepatitis B and hepatitis C in haemodialysis patients
Authors: SANTOS MARISA , DANGUILAN ROMINA , QUE ERNESTO , BALMACEDA RENE , PADILLA BENITA
Published: November 2003

The prevalence of hepatitis B surface antigen (HBsAg), hepatitis B exposure and antibodies against the hepatitis C virus (anti‐HCV) was assessed in 86 haemodialysis patients at the National Kidney and Transplant Institute (NKTI) using the commercial radioimmunoassay and ortho HCV ELISA assay. Of the 86 patients included in the study, 42 were male with a mean age of 44.9 years and a mean duration of dialysis of 2.4 years. Forty‐four were female with a mean age of 48.4 years and a mean duration of dialysis of 2.3 years. Hepatitis B exposure was 57% and 12.8% of haemodialysis patients were positive for HBsAg, whereas 39.8% of patients were positive for anti‐HCV. There was a significant correlation (P=0.00007) between anti‐HCV positivity and the length of time on haemodialysis. However, there was no significant correlation found between the number of blood transfusions received and anti‐HCV positivity. There was also no significant correlation found between HBsAg and antibodies to hepatitis B core antigen (anti‐HBc) positivity and the number of blood transfusions or the length of time on haemodialysis, nor between hepatitis B and C exposure and elevated aminotransferase levels.
Macrophages and HLA‐DR(+) cells in acutely rejecting kidney transplants, predict subsequent graft survival, even after reversal of the acute episode
Authors: ALEXOPOULOS Efstathios , LEONTSINI Maria , PAPADIMITRIOU Menelaos
Published: November 2003

Renal graft biopsies from 19 selected patients with acute cellular rejection (ACR) were analysed using a panel of monoclonal antibodies. All patients had only one episode of ACR, which was completely reversible. In 11 patients (group 1) graft function slowly deteriorated over a period of 14 (±17) months after the episode. In the remaining eight (group 2) graft function remained stable over a similar period of observation. In group 1 there was a significantly increased inflitrate of glomerular and interstitial monocytes/macrophages (MM) when compared with group 2. Also, the expression of HLA‐DR antigen by the tubular cells were stronger in group 1, while T‐cells in the glomeruli and the interstitium were equally distributed in both groups. We conclude that large numbers of MM and HLA‐DR expressing cells (glomerular, interstitial and tubular) in rejecting kidneys predict a more rapid decline of follow‐up renal function despite reversal of the acute episode. This may suggest that subclinical ongoing injury continues in some patients and perhaps more intense immunosuppression is necessary to prevent graft loss.
Probucol inhibits intercellular adhesion molecule‐1 expression on cultured rat mesangial cells
Authors: SUGIURA Toshihiro , WADA Akira , YAMAUCHI Atsushi , HORIO Masaru , IMAI Enyu , HORI Masatsugu
Published: November 2003

Interleukin‐1 (IL‐1) has been reported to participate in the progression of glomerulonephritis by, in part, up‐regulating intercellular adhesion molecule‐1 (ICAM‐1) expression in experimental glomerulonephritis. In the present study, we examined whether probucol, an antihyperlipidemic agent, inhibited IL‐1‐induced inflammatory processes in mesangial cells in culture. Northern blot analysis demonstrated that 200 U/mL IL‐1 up‐regulated ICAM‐1 messenger RNA (mRNA) expression with its peak at 4–6 h after stimulation. Ten μg/mL lipopolysaccharide (LPS), a stimulant to release IL‐1 from mesangial cells, induced ICAM‐1 mRNA expression by five‐fold within 6 h and 10 μg/mL probucol notably reduced this induction. Immunoblotting also confirmed that LPS increased ICAM‐1 protein by two‐fold within 24 h and probucol inhibited this increase. IL‐1 receptor antagonist (IL‐1ra; 1–100 ng/mL) suppressed LPS‐induced ICAM‐1 mRNA expression in a dose‐dependent manner and 100 ng/mL IL‐1ra completely inhibited ICAM‐1 induction, indicating that LPS increased ICAM‐1 expression through the action of secreted IL‐1. Interleukin‐1 activity in culture media, measured by thymocyte proliferation assay, was significantly enhanced by LPS and inhibited by probucol. However, neither LPS nor probucol substantially affected IL‐1 mRNA expression, suggesting that the IL‐1 activity might be regulated at post‐translational level. These results suggest that probucol may act as an anti‐inflammatory drug by suppressing IL‐1 activity from mesangial cells in the progression of glomerulonephritis.
Relationships between blood pressure variability and left ventricular parameters in haemodialysis and renal transplant patients
Authors: COVIC Adrian , GOLDSMITH David , George GEORGESCU , ACKRILL Peter
Published: November 2003

Blood pressure (BP) elevation and left ventricular hypertrophy (LVH) are important factors in the high cardiovascular mortality on the renal replacement programme. The relationship between these, predictable in essential hypertension, is less well defined in uraemia. We wished to examine the contribution of abnormal blood pressure variability (BPV) to the cardiovascular changes seen in uraemia and after renal transplantation. Twenty‐four hour ambulatory blood pressure monitoring (ABPM), and simultaneous echocardiography, on a cohort of 35 long‐term, long‐hours haemodialysis survivors and 28 patients with stable renal transplants was undertaken. We also retrospectively compiled biochemical and clinical data. There were strong relationships between both diurnal and standard deviation measures of BPV and left ventricular cavity size and function: per cent fall in awake to asleep diastolic BP with fractional shortening index (FSI), r=0.28, P=0.039; with left ventricular mass index (LVMI), r=−0.35, P=0.011. This study suggests that reduced diurnal and short‐term BP variability is cross‐sectionally associated with a dilated, heavier left ventricle (LV) with worse systolic function. Thus, BPV may independently contribute to the abnormal LV structure and function commonly seen in uraemia.
Respiratory depression following administration of low dose buprenorphine as postoperative analgesic after fentanyl balanced anaesthesia
Authors: ZANETTE G. , MANANI G. , GIUSTI F. , PITTONI G. , ORI C.
Published: November 2003

Opioids are among the most ancient and widely used drugs in anaesthesiology. The pharmacology of opioid analgesics and their receptors is a complex and not fully understood matter; even more complex are the interactions between different classes of opioids at both molecular and clinical levels. We want to report here a clinical observation to emphasize the importance of the theoretical basis of anaesthesiology. This paper contains a clinical observation of respiratory depression following the administration of buprenorphine as postoperative analgesic after balanced anaesthesia with fentanyl. The observed case is interpreted in the light of the pharmacokinetics and pharmacodynamics of the different classes of opioid drugs (agonists, agonists–antagonists, antagonists) and of the interactions with their respective receptors.
Heart rate variability in premature neonates pre‐ and postmethylxanthine administration
Authors: KIBBLEWHITE DAVID , SLEIGH JAMES
Published: November 2003

Methylxanthines are used to treat or prevent respiratory failure (apnoea) in premature infants both perinatally and perioperatively. Heart rate variability (HRV) is being increasingly used to measure autonomic function. In this study various indices of HRV were compared pre‐ and postmethylxanthine dosing in 22 infants (aged 24–36 weeks). HRV significantly increased postdosing, particularly in the high frequency (HF) band (P=0.001 by ANOVA). This increase was more pronounced in the sickest infants. This pattern of increased HRV and %HF is the same that occurs with normal maturation. This suggests that methylxanthine may stimulate and normalize autonomic function.
Left ventricular functions are not impaired after lumbar epidural anaesthesia in young children
Authors: TSUJI MARIKO HAYASAKI , HORIGOME HITOSHI , YAMASHITA MASAO
Published: November 2003

We studied the haemodynamic and cardiovascular effects of epidural anaesthesia with plain bupivacaine 0.75 ml·kg−1 in 13 unpremedicated ASA 1 children using measurements of heart rate, blood pressure and M‐mode echocardiography. Under general anaesthesia, M‐mode echocardiographic evaluation of left ventricular function in each patient was performed at four points (after general anaesthesia, point A; 5 min, 10 min and 25 min after epidural anaesthesia, point B; point C; and point D, respectively). Results were compared between point A and B, A and C, A and D, B and C, B and D, C and D. HR decreased significantly at 10 min (point C) and 25 min (point D) and MBP decreased at 5 min (point B) and 10 min (point D) compared to point A. No other M‐mode cardiographic indices were changed at any point. Epidural anaesthesia using 0.25% bupivacaine 0.75 ml·kg−1 did not affect LV function in young children.
Oxygen enrichment of entrained room air during Venturi jet ventilation of children undergoing bronchoscopy
Authors: BARAKA ANIS
Published: November 2003

Intermittent oxygen jet ventilation at an inspiratory:expiratory ratio of 1:3 was used to ventilate 15 children undergoing rigid Storz bronchoscopy for removal of inhaled foreign body. Oxygenation of the patient was continuously monitored by pulse oximetry. In all children SpO2 was above 95% when the bronchoscope was above the carina. When the bronchoscope was introduced into one of the bronchi, SpO2 decreased to 70–85% in five children. Delivery of a continuous flow of oxygen via a T‐piece attached to the side‐arm of the bronchoscope increased the SpO 2 >95% in the five children. Oxygen jet ventilation during bronchoscopy is based on the Venturi principle; the oxygen jet will entrain room air from the side arm of the bronchoscope which functions as an entrainment orifice. This will decrease the FIO2. The FIO2 can be increased by flowing oxygen continuously via the T‐piece attached to the side arm of the bronchoscope.
Right bevelled tube for selective left bronchial intubation in a child undergoing right thoracotomy
Authors: BARAKA ANIS
Published: November 2003

Left bronchial intubation was used to achieve selective left lung ventilation in a five‐year‐old child, undergoing thoracotomy for excision of a hydatid cyst of the right lung. Intubation of the left main stem bronchus was easily achieved from the first attempt by a right bevelled tracheal tube. Using a right bevelled tube facilitates left bronchial intubation, since the bevel of the tube faces the right side while its tip lies left to the axis of the trachea. Chest auscultation confirmed selective left lung ventilation. One lung ventilation using 1–2% halothane in 100% oxygen was associated with SpO2 that ranged between 95–97%, and endtidal PETCO2 ranging between 3.9–4.5 kPa (30–35 mmHg). Following excision of the hydatid cyst, the tube was withdrawn above the carina into the trachea, and two lung ventilation was continued until the end of surgery.