bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of the full moon on the number of admissions related to gastrointestinal bleeding
Authors: Román Eva María , Soriano Germán , Fuentes Mercedes , Gálvez María Luz , Fernández Clotilde
Published: November 2004

The objective of this study was to analyse whether the number of admissions for gastrointestinal bleeding to our bleeding unit increases during the full moon. In a prospective study, we included 447 consecutive patients with gastrointestinal haemorrhage admitted to our bleeding unit during a period of two years. The number of admissions was allocated to the corresponding day of the lunar cycle, and full moon and non‐full moon days were compared. A wide variation in the number of admissions throughout the lunar cycle was observed. There were 26 admissions on the 25 days of full moon and 421 admissions in the remaining 713 days of non‐full moon. This difference was mainly related to a higher incidence of haemorrhage in men and variceal haemorrhage at full moon. The results of this study suggest an increase in the number of admissions related to gastrointestinal haemorrhage in our bleeding unit during the full moon, especially in men and in patients experiencing variceal haemorrhage. However, the wide variation in the number of admissions throughout the lunar cycle could limit interpretation of the results. Therefore, further studies are needed to clarify the possible influence of the moon on gastrointestinal haemorrhage.
Thymalfasin (thymosin‐alpha 1) therapy in patients with chronic hepatitis B
Authors: LIAW YUN‐FAN
Published: November 2004

Abstract  Chronic hepatitis B virus (HBV) infection is a serious clinical problem because of its worldwide distribution and potential adverse sequelae. Globally, there are approximately 350 million people infected with chronic HBV, 75% of whom live in the Asia–Pacific region. Interferon‐alfa and direct antiviral agents such as lamivudine and adefovir are effective in the therapy of chronic HBV infection but the efficacy is far from satisfactory, particularly in perinatally infected patients, patients with lower ALT levels and those with HBeAg‐negative chronic hepatitis B. Thymalfasin (thymosin‐alpha1) is an immunoregulatory agent able to enhance Th1 response. It has been shown to trigger maturational events in lymphocytes, to augment T‐cell function, and to promote reconstitution of immune defects. Studies are underway in both monotherapy and combination therapy with thymalfasin and interferon and results are promising.

© 2004 Blackwell Publishing Asia Pty Ltd
Sarcomatoid carcinoma with components of small cell carcinoma and undifferentiated carcinoma of the gallbladder
Authors: Takahashi Yoshihisa , Fukushima Jun‐ichi , Fukusato Toshio , Shiga Junji
Published: November 2004

We report a case of sarcomatoid carcinoma with components of small cell carcinoma and undifferentiated carcinoma of the gallbladder. An 84‐year‐old woman was admitted to our university hospital with right upper abdominal pain and back pain. Clinical diagnosis of a gallbladder tumor was made based on the findings of abdominal ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography, and a cholecystectomy was carried out. On gross examination a pedunculated polypoid tumor protruded into the lumen of the gallbladder. Histologically the tumor was composed of carcinomatous and sarcomatous components; the carcinomatous component consisted mainly of small cell carcinoma and undifferentiated carcinoma. In general, the carcinomatous component of sarcomatoid carcinoma of the gallbladder consists of adenocarcinoma, and there have only been two previously reported cases in which the carcinomatous component consisted of small cell carcinoma or undifferentiated carcinoma. Because the patient's prognosis may be influenced by the peculiar carcinomatous component in such cases, it is important to accumulate case reports that clarify their clinicopathological features.
Horizontal dinoflage11ate cyst distribution, sediment characteristics and benthic flux in Manila Bay, Philippines
Authors: Azanza Rhodora V. , Siringan Fernando P. , Diego‐Mcglone Maria Lourdes San , Yñiguez Aletta T. , Macalalad Neil H. , Zamora Peter B. , Agustin Melissa B. , Matsuoka Kazumi
Published: November 2004

The lateral variation of sediment properties and associated cyst content of sediment in Manila Bay were determined and their possible role/s in the occurrences of Pyrodinium bahamense Plate var. compressum (Bohm) Steidinger, Tester et Taylor toxic blooms were assessed. Manila Bay's surface sediment was determined to be silt dominated. Clay generally increased towards the coast, probably as a result of flocculation and rapid deposition upon entry of sediments from the rivers. High sand content characterized the southeastern part of the bay attributed to the greater sand inputs and relatively strong currents in this area. Bulk densities were lower in the eastern side of the bay from dilution by high organic load from sewage and urban areas. Benthic flux calculations, particularly NH3, suggest more than 50% nutrient contribution comes from sediments.

In general, dinoflagellate cyst density increased from the center of the bay towards the coast, except in Pampanga Bay where it deceased near the coasts. A maximum of 23 dinoflagellate species were identified: 5 were autotrophic (Lingulodinium polyedrum (Stein) Dodge, Gonyaulax spp., Pyrophacus steinii (Schiller) Wall et Dale, Protoceratium reticulatum (Claparede et Lachmann) Butschli, and Pyrodinium bahamense var. compressum), and the rest were predominantly composed of Protoperidinium spp. and Diplopsalis spp. Heterotrophs comprised about 70% of the total cyst counts. Pyrodinium counts increased towards the northwestern part of the bay where it was the dominant autotroph species. Negative correlations were observed for live Pyrodinium cyst density and N flux, P flux, ratio of N to P and total organic carbon (TOC) content. However, areas with high N:P ratio contain abundant Pyrodinium live cysts.
Severity rating of hospital‐acquired pneumonia and classification
Authors:   The committee for The Japanese Respiratory Society guidelines in management of respiratory infections
Published: November 2004

Severity rating of hospital‐acquired pneumonia and classification

The committee for The Japanese Respiratory Society guidelines in management of respiratory infections. Respirology 2004; 9: S13–S15
Broadleaf privet, Ligustrum lucidum Aiton (Oleaceae), a late‐season host for Nezara viridula (L.), Plautia affinis Dallas and Glaucias amyoti (Dallas) (Hemiptera: Pentatomidae) in northern New South Wales, Australia
Authors: Coombs Marc
Published: November 2004

Abstract Seasonal abundances of the pentatomids Nezara viridula, Plautia affinis and Glaucias amyoti were monitored on the introduced weed, broadleaf privet, Ligustrum lucidum from January 1998 to July 2000 at Moree, New South Wales, Australia. All developmental stages (eggs, nymphal instars and adults) of N. viridula, P. affinis and G. amyoti were recovered from privet. For all species, adult and nymphal densities peaked from February to May, coincident with privet fruiting. Nymphs of each species successfully developed when fed L. lucidum berries in the laboratory. The importance of L. lucidum as a host is discussed in relation to its role in maintaining populations of pentatomid pest species and in particular as a late‐season host prior to overwintering.
Syphilis presenting as scleritis in an HIV‐positive man undergoing immune reconstitution
Authors: Moloney Gregory , Branley Michael , Kotsiou George , Rhodes Dennis
Published: November 2004

A 45‐year‐old HIV‐positive man receiving highly active antiretroviral therapy (HAART) presented with 6 weeks of right‐sided headache and right eye pain. He had been diagnosed seropositive 2 years previously and screened negative for syphilis at that time. Examination demonstrated focal anterior scleritis with underlying retinitis and a mild vitritis. He was found to have positive syphilis serology and further investigations were consistent with neurosyphilis. Parenteral penicillin was commenced with prompt clinical response. This initial presentation of syphilis as acute scleritis emphasizes the need for thorough work‐up of immunocompromised patients with inflammatory ocular disease.
Clinical Case Notes
Authors: Chan Fiona M , Lee Lawrence
Published: November 2004

Nanophthalmos is a rare ophthalmic condition with potential sight‐threatening complications. In addition, nanophthalmic eyes have a high incidence of intraoperative and postoperative complications, including uveal effusion and retinal detachment. Prophylactic measures to prevent these complications may be used. The case is presented where cataract extraction for a nanophthalmic eye was performed from a posterior approach in combination with a pars plana vitrectomy and gas procedure. To the authors’ knowledge, this method of cataract extraction has not been reported before for this condition.
Clinical Case Notes
Authors: Vote Brendan J , Hall Anthony , Cairns James , Buttery Robert
Published: November 2004

Sympathetic ophthalmia is a rare and potentially visually devastating bilateral panuveitis, typically following non‐surgical penetrating injury to one eye. Three patients are presented where sympathetic ophthalmia developed after repeated vitreoretinal surgery. Prompt and effective management with systemic immunosuppressive agents permitted control of their disease and retention of good visual acuity in their remaining eye. Vitreoretinal surgery is an important risk factor in sympathetic ophthalmia. Informed consent for vitreoretinal surgery (especially in the re‐operation setting) should now include the risk of sympathetic ophthalmia (approximately 1 in 800). Diverse clinical presentations are possible in sympathetic ophthalmia and any bilateral uveitis following vitreoretinal surgery should alert the surgeon to the possibility of sympathetic ophthalmia. Modern immunosuppressive therapy with systemic steroids and steroid‐sparing agents such as cyclosporin A and azathioprine have improved the prognosis. This is particularly so in cases where early diagnosis is made and prompt and suitable immunotherapy is commenced.
Clinical Case Notes
Authors: Wechsler David Z , Tay Thain S , McKay David L
Published: November 2004

Three cases are reported where life‐threatening haematological disorders requiring urgent medical intervention presented initially to the ophthalmologist. Case one, chronic myeloid leukaemia, presented with bilateral leukaemic retinopathy and central retinal vein obstruction due to hyperviscosity. Case two, acute myeloid leukaemia, presented with bilateral haemorrhagic retinopathy. Case three, aplastic anaemia, presented with bilateral retinopathy due to anaemia and thrombocytopaenia resembling bilateral central retinal vein occlusion. In all three cases the presence of simultaneous bilateral retinal vascular involvement and white‐centred haemorrhages suggested an underlying haematological disorder and differentiated them from typical retinal venous obstruction. Prompt identification of the underlying haematological disorder allows timely referral for potentially life‐saving treatment.
Malnutrition screening in hospitalised patients and its implication on reimbursement
Authors: Raja R. , Lim A. V. , Lim Y. P. , Lim G. , Chan S. P. , Vu C. K. F.
Published: November 2004

Abstract

Background : Several studies have cited the incidence of malnutrition in hospitals, which is correlated to negative clinical outcomes, to be up to 60%. Data in Singapore, however, are scarce. Its impact on casemix funding is not known.

Aims : The aims of the present study were to determine the prevalence of malnutrition, the predisposing risk factors and the impact of documentation and coding of malnutrition on casemix funding in a local population in Singapore.

Methods : Patients admitted to selected wards over a 1‐month period were screened for malnutrition. Those at risk were further assessed using subjective global assessment. Logistic regression was used to ascertain the impact of identified factors on malnutrition. Financial impact analysis of coding of malnutrition as a comorbidity was carried out and tested with Wilcoxon signed rank tests.

Results : Six hundred and fifty‐eight patients were eligible for screening. The overall prevalence of malnutrition in the selected wards was 14.7% (95% confidence interval (CI): 12.0−17.4%). Old age, the occurrence of cancer and the admitting unit were statistically significant in explaining the occurrence of malnutrition. Coding of malnutrition was found to significantly increase the complexity of 24 of 105 episodes (22.9%) of patient care as measured by expected cost weights (P < 0.001) and expected lengths of stay (P < 0.001). As a result, the expected financing for these 24 patients increased by 59.7%.

Conclusions : Malnutrition is prevalent in hospitalised medical and surgical patients. Certain clinical factors should heighten awareness and prompt detection for malnutrition. Coding for malnutrition impacts favour­ably on casemix funding for a subset of malnourished patients. (Intern Med J 2004; 34: 176−181)
Planned pregnancy in a heart transplant recipient
Authors: Wasywich C. A. , Ruygrok P. N. , Wilkinson L. , Gibbs H. , Coverdale H. A.
Published: November 2004

Abstract

Solid organ transplantation often leads to the return of fertility in recipients. In females of childbearing age this can be accompanied by a desire to have children. The present paper discusses a planned pregnancy in a heart transplant recipient and outlines important ­management issues. These principles of management can be applied to most solid organ transplant recipients. (Intern Med J 2004; 34: 206−209)
Guidelines for the use of antifungal agents in the treatment of invasive Candida and mould infections
Authors: Slavin M. A. , Szer J. , Grigg A. P. , Roberts A. W. , Seymour J. F. , Sasadeusz J. , Thursky K. , Chen S. C. , Morrissey C. O. , Heath C. H. , Sorrell And T.
Published: November 2004

ABSTRACT

Treatment of invasive fungal infections is increasingly complex. Amphotericin B deoxycholate has long been the mainstay of treatment. However, there has been increasing recognition of both the propensity for nephro­toxicity in haematology, transplant and intensive care patients as well as its adverse impact on morbidity and mortality. This has coincided with the availabilty of newer, and in certain settings, more effective antifungal agents. Although the newer agents clearly cause less nephrotoxicity than amphotericin B, drug interactions, hepatic effects and unique side‐effects need to be considered. The spectrum of the newer triazoles and echino­candins varies, highlighting the importance of accurate identification of the causative organism where possible. Consensus Australian guidelines have been developed to assist clinicians with treatment choices by reviewing the current evidence for the efficacy, the toxicity and the cost of these agents. (Intern Med J 2004; 34: 192−200)
Long‐term follow up of sequential mobilisation and autologous transplantation with CD34‐selected cells in multiple myeloma: a multimodality approach
Authors: Horvath N. , Hahn U. , Joshua D. , Dyson P. , Gibson J. , Stevens J. , Rawling T. , Barrow L. , Brown R. , Stephens S. , Gower G. , Norman J. , Mills B. , To L. B.
Published: November 2004

Abstract

Background:  Even after high dose chemotherapy (HDT) and autologous haemopoietic stem cell transplantation, the majority of patients with multiple myeloma eventually relapse.

Aim:  The aim of the present study was to study the ­feasibility and outcome of delivering a regimen including in vivo and in vitro purging and double HDT in patients with multiple myeloma.

Methods:  Thirty‐four patients with advanced multiple myeloma were enrolled in a program of vincristine, doxo­rubicin and dexamethasone chemotherapy, high dose cyclophosphamide/granulocyte macrophage colony stimulating factor (GM‐CSF) stem cell mobilisation, CD34 selection of harvested stem cells (in vitro purging), double HDT (cyclophosphamide/epirubicin in the first, busulphan/melphalan in the second) rescued by CD34+‐selected cells, the second rescue using cells harvested following the first HDT (in vivo purging) and interferon maintenance.

Results:  Forty‐four per cent of patients completed the program. Fifty‐three per cent of withdrawals were as a result of insufficient stem cells. This correlated to previous chemotherapy. Therapy‐related mortality was 6%. CD34+ selection achieved more than a 2‐log reduction of CD38++ cells; in vivo purging achieved 80%. Although similar numbers of CD34+ cells were reinfused at both HDT, platelet recovery was slower after the second HDT. Additional complete remissions were achieved after each phase of therapy, 3% at the end of vincristine, doxorubicin and dexamethasone and 33% after completing planned HDT. Factors associated with longer overall survival included age less than 60 years (P = 0.044), serum β‐2‐microglobulin below 3 µγ/L at entry (P = 0.042) and less than 2 months between the two HDT (P = 0.024). The only factor associated with a longer event‐free survival was less than 2 months between HDT on study (P = 0.038).

Conclusions:  (i) dose intensification with two HDT delivered within 2 months might be associated with a better patient outcome, (ii) early mobilisation should be incorporated in multiple myeloma HDT programs and (iii) higher CD34+ doses may be required for tandem transplants. (Intern Med J 2004; 34: 167−175)
Fibrosing alveolitis in systemic sclerosis: the need for early screening and treatment
Authors: Sahhar J. , Littlejohn G. , Conron M.
Published: November 2004

Abnormalities in lung function occur in 70% of patients with systemic sclerosis (SSc). Fibrosing alveolitis in SSc (FASSc) is more commonly seen in the diffuse cutaneous form of SSc, particularly in the presence of antitopoisomerase antibodies (Scl70), and with the decreasing incidence of scleroderma renal crisis it is now the major cause of mortality in this patient population. Screening of patients recently diagnosed with SSc by pulmonary function tests and the performance of high resolution computed tomography when physiological abnormalities are identified has resulted in the identification of significant numbers of patients with early, asymptomatic FASSc. Whether these patients should be further investigated with a surgical lung biopsy or receive immunosuppression is unclear, because it cannot yet be reliably predicted who will develop progressive disease and the evidence to support the efficacy of treatment is not strong. The objective of the present article was to review the evidence to support the use of immunosuppressive therapy in FASSc and, based on these data, to propose an algorithm for the investigation and management of this difficult clinical problem. (Intern Med J 2004; 34: 626−638)
Audit of community‐based anticoagulant monitoring in patients with thromboembolic disease: is frequent testing necessary?
Authors: Young L. , Ockelford P. , Harper P.
Published: November 2004

Oral anticoagulant monitoring is managed by general practitioners in Auckland. An audit of this service in 452 patients demonstrated that anticoagulant control was in line with recommended international guidelines, with 58.3% of international normalized ratio (INR) measurements in the therapeutic range. However, the frequency of testing was high, with the majority of patients (68%), including those on long‐term treatment, having INR measurements at weekly intervals. We question the need for such frequent INR testing. (Intern Med J 2004; 34: 639−641)
Gene therapy: applications and progress towards the clinic
Authors: Trent R. J. A. , Alexander I. E.
Published: November 2004

Gene therapy was originally conceived as an approach to the treatment of genetic disease, to repair or replace a faulty gene. Subsequently, gene therapy clinical trials have been undertaken for a wide range of conditions, particularly cancer and AIDS. Overall, the results from gene therapy have been disappointing. The reasons include the following: (i) low gene transfer efficiencies and (ii) shortcomings in the identification and manipulation of appropriate target cells, including progenitor cell populations required for the maintenance of long‐term effects. Today, the immense potential of gene therapy remains, but more basic research is required to improve technical aspects of this form of cellular therapy. (Intern Med J 2004; 34: 621−625)
Spinal cord plasticity in response to unilateral inhibition of the rat motor cortex during development: changes to gene expression, muscle afferents and the ipsilateral corticospinal projection
Authors: Clowry G. J. , Davies B. M. , Upile N. S. , Gibson C. L. , Bradley P. M.
Published: November 2004

In developing Wistar albino rats, ventral horn muscle afferent boutons are lost following corticospinal innervation. Motor cortex lesions rescue a proportion of these boutons and perturb activity dependent expression of cJun and parvalbumin (PV) in the spinal cord. Therefore, we tested whether activity‐dependent competition between corticospinal and proprioreceptive afferents determines the balance of these inputs to motor output pathways by delivering the inhibitory GABA agonist muscimol unilaterally to the forelimb motor cortex using slow release polymer implants from postnatal day 7 (P7) coincident with corticospinal synaptogenesis. Controls received saline. Inhibition of immature cortical neurons by muscimol was confirmed with separate in vitro electrophysiological recordings. After P28, spinal cord sections were immunostained for PV, cJun and muscle afferents transganglionically labelled with cholera toxin‐B (CTB). Unilateral inhibition reduced contralaterally the number of PV positive spinal cord neurons and muscle afferent boutons in the dorsolateral ventral horn, compared to controls, and significantly altered the distribution of motoneuronal cJun expression. Separately, descending tracts were retrogradely traced with CTB from the cervical hemicord contralateral to implants. Forelimb sensorimotor cortex sections were immunostained for either CTB or PV. In muscimol treated animals, significantly fewer neurons expressed PV in the inhibited hemicortex, but as many CTB labelled corticospinal neurons were present as in controls, along with an equally large corticospinal projection from contralateral to the implant, significantly greater than in controls. Unexpectedly, unilateral inhibition of the motor cortical input did not lead to an expanded muscle afferent input. Instead, this was reduced coincident with development of a bilateral corticospinal innervation.
The corticoid environment: a determining factor for neural progenitors' survival in the adult hippocampus
Authors: Wong Edmund Y. H. , Herbert Joe
Published: November 2004

New neurons continue to be generated in the adult dentate gyrus of the hippocampus. Corticosterone (CORT), a steroid secreted by the adrenal glands, had been shown to regulate progenitor proliferation. High levels of CORT suppress proliferation while low levels of the steroid stimulate it. Here we present an investigation into the regulation of survival by corticoids, with emphasis on the differential effects of the pre‐mitotic and post‐mitotic corticoid environments. Post‐mitotic adrenalectomy increased subsequent survival of progenitors at 28 days, while additional CORT administered during the post‐mitotic period decreased survival. In contrast, a corticoid‐free environment prior to progenitor division resulted in a reduced survival rate of new cells and, similarly, high levels of CORT before proliferation reduced subsequent survival. In addition, phased treatment with CORT during a 27‐day post‐mitotic interval showed that newly formed cells lose their sensitivity to administered CORT after about 18 days. These results are the first to show that the corticoid environment both before and after cell division regulates survival.
Reelin receptors in developing laminated brain structures of mouse and human
Authors: Perez‐Garcia C. G. , Tissir F. , Goffinet A. M , Meyer G.
Published: November 2004

Reelin is an extracellular matrix protein secreted by a variety of cell types throughout the developing brain. The target cells for reelin express the cytoplasmic adapter protein Dab1, which binds to the reelin receptors VLDLR and ApoER2. In the present work, we have studied the localization of both receptors in developing mouse and human cortex, olfactory bulb and cerebellum. In mouse, some Cajal–Retzius cells express reelin and VLDLR; in humans, all the components of the signalling pathway (Reelin, Dab1, VLDLR and ApoER2) are present in subsets of Cajal–Retzius cells. In the mouse cortical plate, VLDLR and ApoER2 are present from E15 to postnatal stages; in human cortical plate they are most prominent at ≈ 20 gestational weeks. In mice, cerebellar Purkinje cells only express VLDLR whereas in humans they express both VLDLR and ApoER2. Mitral cells of the mouse olfactory bulb are ApoER2‐positive and VLDLR‐negative. In sum, the receptor expression patterns are similar in the human and mouse cortical plate but differ in Cajal–Retzius and Purkinje cells, which in humans express additional components of the reelin–Dab1 pathway.
Fast onset of dopamine uptake inhibition by intravenous cocaine
Authors: Mateo Yolanda , Budygin Evgeny A. , Morgan Drake , Roberts David C. S. , Jones Sara R.
Published: November 2004

In vivo voltammetry in the nucleus accumbens of anesthetized rats was used to investigate the time of onset of dopamine uptake inhibition by intravenous cocaine. There is disagreement between behavioral and neurochemical studies concerning the time‐course of cocaine effects. Because of the high temporal resolution of voltammetry, the processes of dopamine release and uptake could be temporally separated to make evaluation of cocaine effects on uptake easier to address. Within 4 s after intravenous cocaine administration (1.5 mg/kg) there was significant inhibition of dopamine uptake that reached a plateau in 20 s. The peak heights of electrically evoked dopamine signals were also rapidly increased by cocaine. The signals returned to baseline values within approximately 1 h. In parallel behavioral studies, locomotor activity was significantly increased within 5–6 s following intravenous infusion of cocaine. Here we demonstrate that intravenous cocaine administration begins inhibiting the uptake of dopamine within a few seconds. This is at least 10‐fold faster than previous neurochemical estimates. The present findings may contribute to the understanding of the neurobiological mechanisms underlying the early behavioral responses to cocaine.
Expression profiling in laser‐microdissected hippocampal subregions in rat brain reveals large subregion‐specific differences in expression
Authors: Datson N. A. , Meijer L. , Steenbergen P. J. , Morsink M. C. , Van Der Laan S. , Meijer O. C. , De Kloet E. R.
Published: November 2004

Expression profiling in the hippocampus is hampered by its cellular heterogeneity. The aim of this study was to evaluate the feasibility of using laser‐microdissected hippocampal subregions for expression profiling to improve detection of transcripts with a subregion‐specific expression. Cornu ammonis (CA)3 and dentate gyrus (DG) subregions were isolated from rat brain slices using laser microdissection, subjected to two rounds of linear amplification and hybridized to rat GeneChips containing approximately 8000 transcripts (RG_U34A; Affymetrix). Analysis of the data using significance analysis of microarrays revealed 724 genes with a significant difference in expression between CA3 and DG with a false discovery rate of 2.1%, of which 264 had higher expression in DG and 460 in CA3. Several transcripts with known differential expression between the subregions were included in the dataset, as well as numerous novel mRNAs and expressed sequence tags. Sorting of the differentially expressed genes according to gene ontology classification revealed that genes involved in glycolysis and general metabolism, neurogenesis and cell adhesion were consistently expressed at higher levels in CA3. Conversely, a large cluster of genes involved in protein biosynthesis were expressed at higher levels in DG. In situ hybridization was used to validate differential expression of a selection of genes. The results of this study demonstrate that the combination of laser microdissection and GeneChip technology is both technically feasible and very promising. Besides providing an extensive inventory of genes showing differential expression between CA3 and DG, this study supports the idea that profiling in hippocampal subregions should improve detection of genes with a subregion‐specific expression or regulation.
Interneurone bursts are spontaneously associated with muscle contractions only during early phases of mouse spinal network development: a study in organotypic cultures
Authors: Rosato‐Siri Marcelo D. , Zoccolan Davide , Furlan Francesco , Ballerini Laura
Published: November 2004

For a short time during development immature circuits in the spinal cord and other parts of the central nervous system spontaneously generate synchronous patterns of rhythmic activity. In the case of the spinal cord, it is still unclear how strongly synchronized bursts generated by interneurones are associated with motoneurone firing and whether the progressive decline in spontaneous bursting during circuit maturation proceeds in parallel for motoneurone and interneurone networks. We used organotypic cocultures of spinal cord and skeletal muscle in order to investigate the ontogenic evolution of endogenous spinal network activity associated with the generation of coordinate muscle fibre contractions. A combination of multiunit electrophysiological recordings, videomicroscopy and optical flow computation allowed us to measure the correlation between interneurone firing and motoneurone outputs after 1, 2 and 3 weeks of in vitro development. We found that, in spinal organotypic slices, there is a developmental switch of spontaneous activity from stable bursting to random patterns after the first week in culture. Conversely, bursting recorded in the presence of strychnine and bicuculline became increasingly regular with time in vitro. The time course of spontaneous activity maturation in organotypic slices is similar to that previously reported for the spinal cord developing in utero. We also demonstrated that spontaneous bursts of interneurone action potentials strongly correlate with muscular contractions only during the first week in vitro and that this is due to the activation of motoneurones via AMPA‐type glutamate receptors. These results indicate the occurrence in vitro of motor network development regulating bursting inputs from interneurones to motoneurones.
Somatostatin receptors differentially affect spontaneous epileptiform activity in mouse hippocampal slices
Authors: Cammalleri Maurizio , Cervia Davide , Langenegger Daniel , Liu Yanqiang , Monte Massimo Dal , Hoyer Daniel , Bagnoli Paola
Published: November 2004

Somatostatin‐14 [somatotropin release‐inhibiting factor (SRIF)] reduces hippocampal epileptiform activity but the contribution of its specific receptors (sst1−5) is poorly understood. We have focused on the role of sst1 and sst2 in mediating SRIF modulation of epilepsy using hippocampal slices of wild‐type (WT) and sst1 or sst2 knockout (KO) mice. Recordings of epileptiform discharge induced by Mg2+‐free medium with 4‐aminopyridine were performed from the CA3 region before and after the application of SRIF compounds. In WT mice, SRIF and the sst1 agonist CH‐275 reduce epilepsy whereas sst1 blockade with its antagonist SRA‐880 increases the bursting discharge. Activation of sst2 does not affect the bursting frequency unless its agonist octreotide is applied with SRA‐880, indicating that sst1 masks sst2‐mediated modulation of epilepsy. In sst1 KO mice: (i) the bursting frequency is lower than in WT; (ii) SRIF, CH‐275 and SRA‐880 are ineffective on epilepsy and (iii) octreotide is also devoid of effects, whereas blockade of sst2 with the antagonist d‐Tyr8 Cyn 154806 increases the bursting frequency. In sst2 KO mice, the SRIF ligand effects are similar to those in WT. In the whole hippocampus of sst1 KO mice, sst2 mRNA, protein and binding are higher than in WT and reverse transcription‐polymerase chain reaction of the CA3 subarea confirms an increase of the sst2 messenger. We conclude that sst1 mediates inhibitory actions of SRIF and that interactions between sst1 and sst2 may prevent sst2 modulation of epilepsy. We suggest that, in sst1 KO mice, activation of over‐expressed sst2 reduces the bursting frequency, indicating that sst2 density represents the rate‐limiting factor for sst2‐mediated modulation of epilepsy.
The collapse of cycles in the dynamics of North American grouse populations
Authors: Williams Christopher K. , Ives Anthony R. , Applegate Roger D. , Ripa Jörgen
Published: November 2004

Cyclic dynamics of bird and mammal populations are commonly reported in northern latitudes throughout the world, and recent European observations on rodents and grouse suggest that cycle periods decline towards southern latitudes. To investigate latitudinal patterns of cyclic dynamics in North America, we assembled 27 long‐term data sets collected between 1939 and 2001 for three grouse species. By fitting the data with autoregressive models to measure direct and delayed density dependence, we show that, in contrast to European studies, North American grouse exhibit period increases from north to south, with cycles collapsing via period lengthening. This occurs because delayed density dependence decreases in southern latitudes, whereas direct density dependence increases. These results show that cyclic dynamics can dissipate by period lengthening as well as the period shortening postulated for European grouse and rodents.
Evolution of plant resistance and tolerance to frost damage
Authors: Agrawal Anurag A. , Conner Jeffrey K. , Stinchcombe John R.
Published: November 2004

Plant defence against any type of stress may involve resistance (traits that reduce damage) or tolerance (traits that reduce the negative fitness impacts of damage). These two strategies have been proposed as redundant evolutionary alternatives. A late‐season frost enabled us to estimate natural selection and genetic constraints on the evolution of frost resistance and tolerance in a wild plant species. We employed a genetic selection analysis (which is unbiased by environmental correlations between traits and fitness) on 75 paternal half‐sibling families of annual wild radish [Raphanus raphanistrum (Brassicaceae)]. In an experimental population in southern Ontario, we found strong selection favouring plant resistance to frost, but selection against tolerance to frost. The selection against tolerance may have been caused by a cost of tolerance, as we provide evidence for a negative genetic correlation between tolerance and fitness in the absence of frost damage. Although we found no evidence for the theoretically predicted trade‐off between frost tolerance and resistance among our families, we did detect negative correlational selection acting on the two traits, indicating that natural selection favoured high resistance combined with low tolerance and low resistance coupled with high tolerance, but not high or low levels of both traits together. There were few genetic correlations between the measured traits overall, but frost tolerance was negatively correlated with initial seed mass, and frost resistance was positively correlated with resistance to insect herbivory. Periodic episodes of strong selection such as that caused by the late‐season frost may be disproportionately important in evolution, and are likely becoming more common because of human alterations of the environment.
Darwin's cross‐promotion hypothesis and the evolution of stylar polymorphism
Authors: Cesaro Adeline C. , Thompson John D.
Published: November 2004

There is growing appreciation that the ecological factors which impact on rates of pollen transfer can contribute significantly to reproductive trait evolution in plants. In heterostylous species, several studies support Darwin's claim that the reciprocal positions of stigmas and anthers enhance inter‐morph mating in comparison to intra‐morph mating and thus the maintenance of the polymorphism. In this study, we evaluate the relative importance of intra‐morph and inter‐morph pollen transfers in Narcissus assoanus, a species with dimorphic variation in style length but non‐reciprocity of anther positions. This stigma‐height dimorphism represents a transitional stage in theoretical models of the evolution of distyly. Seed set variation on recipient plants with donor plants of a single morph in experimental arrays in a natural population illustrate that inter‐morph cross‐pollination is more efficient that intra‐morph cross‐pollination as a result of high rates of pollen transfer from long‐styled to short‐styled plants. The observed rates of pollen transfer satisfy the theoretical conditions for the establishment of a stigma‐height dimorphism in an ancestral monomorphic long‐styled population in pollen‐limited situations. These results provide experimental evidence for the Darwinian hypothesis that enhanced inter‐morph cross‐pollination facilitates not only the maintenance of heterostyly but also the establishment of transitional forms implicated in the evolution of this polymorphism.
The evolution of hippocampus volume and brain size in relation to food hoarding in birds
Authors: Garamszegi László Zsolt , Eens Marcel
Published: November 2004

Food‐hoarding birds frequently use spatial memory to relocate their caches, thus they may evolve a larger hippocampus in their brain than non‐hoarder species. However, previous studies testing for such interspecific relationships provided conflicting results. In addition, food hoarding may be a cognitively complex task involving elaboration of a variety of brain regions, even outside of the hippocampus. Hence, specialization to food hoarding may also result in the enlargement of the overall brain. In a phylogenetic analysis of distantly related birds, we studied the interspecific association between food hoarding and the size of different brain regions, each reflecting different resolutions. After adjusting for allometric effects, the relative volume of the hippocampus and the relative size of the entire brain were each positively related to the degree of food‐hoarding specialization, even after controlling for migration and brood parasitism. We also found some significant evidence for the relative volume of the telencephalon being associated with food hoarding, but this relationship was dependent on the approach we used. Hence, neural adaptation to food hoarding may favour the evolution of different brain structures.
Neobladder‐vaginal fistula after cystectomy and orthotopic neobladder construction
Authors: Rapp David E. , O'Connor R. Corey , Katz Erin E. , Steinberg Gary D.
Published: November 2004

OBJECTIVE

To determine the potential surgical and clinical factors that contribute to the development of neobladder‐vaginal fistula (NVF) after cystectomy and orthotopic neobladder (ONB) construction in women.

PATIENTS AND METHODS

Of 37 patients who had vaginal‐sparing cystectomy, the records of four who developed a NVF after radical cystectomy and ONB construction were reviewed. Retrospective clinical and surgical information was collected, including patient demographics, tumour pathology, surgical technique, presenting symptoms, and method and efficacy of surgical repair.

RESULTS

In two of the four patients who developed a NVF a small injury to the anterior vaginal wall was noted during surgery and closed primarily. All patients presented with severe urinary incontinence. The NVF was diagnosed after cystoscopy and/or speculum examination. Three of the four patients had an attempted surgical repair, including one obturator flap interposition, one rectus flap interposition, and one primary two‐layer closure. To date, one patient is fistula‐free and two were subsequently converted to an ileal conduit or continent cutaneous diversion because the fistula recurred. The fourth patient developed a NVF in association with local tumour recurrence and underwent conversion to an ileal conduit.

CONCLUSION

The development of a NVF is a significant complication after cystectomy. Inadvertent injury to the vaginal wall is an important predisposing factor to subsequent NVF development. The repair of a NVF is often difficult; upon diagnosis, conversion to a continent cutaneous urinary diversion may be considered.
Prostatic capsule‐ and seminal‐sparing cystectomy for bladder carcinoma: initial results for selected patients
Authors: Botto Henry , Sebe Philippe , Molinie Vincent , Herve Jean‐Marie , Yonneau Laurent , Lebret Thierry
Published: November 2004

OBJECTIVE

To evaluate the oncological outcome and functional results of prostate‐sparing cystectomy (PSC), proposed for treating bladder cancer, used since 1999 in our institution in an attempt to preserve male sexuality and to increase continence after cystectomy.

PATIENTS AND METHODS

Between January 1999 and December 2001, 111 men were candidates for cystectomy; 42 were selected for a prostatic capsule‐ and seminal‐sparing cystectomy with orthotopic urinary diversion. All patients had clinically organ‐confined tumours (clinical stage ≤ T2, N0M0). The first stage of the procedure was a transurethral resection of the prostate to exclude the involvement of transitional cell carcinoma (TCC) in the prostate.

RESULTS

Eight patients were excluded from PSC because they had TCC (seven) or prostate adenocarcinoma (one). The mean age of the remaining 34 patients was 61 years and all underwent PSC. After a mean follow‐up of 26 months, seven patients (21%) had a recurrence; one developed a local recurrence, there were widespread metastases in six (18%), and five had histologically confirmed organ‐confined tumour (T1‐2N0M0). Rates for daytime and night‐time continence were 90% and 85%, and in 29 patients potency was unchanged.

CONCLUSION

These early results suggest that PSC is not equivalent to radical cystoprostatectomy for bladder cancer control, despite marked improvements in the functional results. Moreover, in carefully selected patients this approach appears to dramatically increase an unusually high metastasis rate. Therefore, the indications for PSC should be either clearly well defined or abandoned in these patients.
Is laparoscopic adrenalectomy feasible for adrenocortical carcinoma or metastasis?
Authors: Porpiglia Francesco , Fiori Cristian , Tarabuzzi Roberto , Giraudo Giuseppe , Garrone Corrado , Morino Mario , Fontana Dario , Scarpa Roberto M.
Published: November 2004

OBJECTIVE

To review our experience with laparoscopic adrenalectomy (LA), to evaluate the effectiveness and safety of this procedure in patients with adrenal malignancy.

PATIENTS AND METHODS

The study included patients who underwent LA from 1995 to 2002, with histologically identified adrenocortical cancer (ACC) or metastasis. Indications for LA were adrenal masses with no radiological evidence of involvement of the surrounding structures, or solitary metastasis with well‐controlled primary cancer. The variables evaluated were: size of the lesion, operative duration, estimated blood loss, intraoperative complications, local, port‐site and intra‐abdominal recurrence, distant metastasis, and survival time.

RESULTS

Fourteen malignant adrenal lesions in 205 LAs (7%) were confirmed with histological diagnoses that showed a primary ACC in six and metastasis in another seven (in one there was bilateral metastasis). The mean (sd) size of the malignant lesions was 5.9 (2.8) cm. The 12 unilateral procedures required a mean operative duration of 164 (47) min; the bilateral procedure lasted 215 min. There was one conversion to open surgery caused by local infiltration, whereas there were no intraoperative complications. The mean follow‐up was 30 months, during which three patients died, one from endoperitoneal and trocar port‐site seeding.

CONCLUSION

When the malignancy is confined to the adrenal gland, LA seems to be a feasible option if the principles of oncological surgery are respected. Nevertheless, further investigations are required to evaluate the appropriateness of this operation.
Self‐inflicted male urethral foreign body insertion: endoscopic management and complications
Authors: Rahman Nadeem U. , Elliott Sean P. , McAninch Jack W.
Published: November 2004

OBJECTIVE

To evaluate the cause, diagnosis, management and complications of self‐inserted urethral foreign bodies in men, reviewing a 17‐year experience.

PATIENTS AND METHODS

From November 1986 to January 2004, 17 men were treated for self‐inflicted urethral foreign bodies; the records were analysed retrospectively for presentation, diagnosis, management and complications.

RESULTS

In all 17 patients the foreign bodies were clearly palpable. Objects included speaker wire, an AAA battery, open safety pins, a plastic cup, straws, a marble, and a cotton‐tipped swab. The most common symptom was frequency with dysuria, but there was sometimes gross haematuria and urinary retention. The cause for inserting the foreign body varied; psychiatric disorder was the most common, followed by intoxication, and erotic stimulation was the cause in only five patients. All patients had diagnostic imaging; plain pelvic images were sufficient in 14, ultrasonography or computed tomography was needed in three. Endoscopic retrieval was successful in all but one patient, where a perineal urethrotomy was required. The most common complications were mucosal tears and false passages. Urethral strictures were associated with multiple attempts to insert the foreign body.

CONCLUSION

Self‐inflicted urethral foreign‐body insertion in men is unusual. A radiological evaluation is necessary to determine the exact size, location and number of foreign bodies. Endoscopic retrieval is usually successful, and antibiotic coverage is necessary. A psychiatric evaluation is recommended for all patients, with appropriate medical therapy when indicated. Late manifestation has included urethral stricture disease, and a close follow‐up, albeit difficult in these patients, is desirable.
Ethnic differences and determinants of diabetes and central obesity among South Asians of Pakistan
Authors: Jafar T. H. , Levey A. S. , White F. M. , Gul A. , Jessani S. , Khan A. Q. , Jafary F. H. , Schmid C. H. , Chaturvedi N.
Published: November 2004

Aims  To study the within ethnic subgroup variations in diabetes and central obesity among South Asians.

Methods  Data from 9442 individuals age ≥ 15 years from the National Health Survey of Pakistan (NHSP) (1990–1994) were analysed. Diabetes was defined as non‐fasting blood glucose ≥ 7.8 mmol/l, or known history of diabetes. Central obesity was measured at the waist circumference. Distinct ethnic subgroups Muhajir, Punjabi, Sindhi, Pashtun, and Baluchi were defined by mother tongue.

Results  The age‐standardized prevalence of diabetes varied among ethnic subgroups (P = 0.002), being highest among the Muhajirs (men 5.7%, women 7.9%), then Punjabis (men 4.6%, women 7.2%), Sindhis (men 5.1%, women 4.8%), Pashtuns (men 3.0%, women 3.8%), and lowest among the Baluchis (men 2.9%, women 2.6%). While diabetes was more prevalent in urban vs. rural dwellers [odds ratio (OR) 1.50, 95% confidence interval (CI) 1.24, 1.82], this difference was no longer significant after adjusting for central obesity (OR 1.15, 95% CI 0.95, 1.42). However, the ethnic differences persisted after adjusting for major sociodemographic risk factors (unadjusted OR for Pashtun vs. Punjabi 0.59, 95% CI 0.42, 0.84, adjusted OR 0.54, 95% CI 0.37, 0.78). Ethnic variation was also observed in central obesity, which varied with gender, and did not necessarily track with ethnic differences in diabetes.

Conclusions  Unmeasured environmental or genetic factors account for ethnic variations in diabetes and central obesity, and deserve further study.