bluuebunny/crossref_metadata_2025 huggingface dataset:
Daily, seasonal and annual patterns of transpiration from a stand of remnant vegetation dominated by a coniferous Callitris species and a broad‐leaved Eucalyptus species
Authors: Zeppel Melanie J. B. , Yunusa Isa A. M. , Eamus Derek
Published: July 2006

Quantifying water use of native vegetation is an important contribution to understanding landscape ecohydrology. Few studies provide long‐term (more than one growing season) estimates of water use and even fewer quantify interseasonal and interannual variation in transpiration. Globally, changes in land use are significantly altering landscape ecohydrology, resulting in problems such as dryland salinity and excessive groundwater recharge. Estimating stand water use is complex in multispecies forests, due to the differences in relationships among sapwood area, basal area and tree size for co‐occurring species. In this article, we examine seasonal and interannual variation in transpiration rate of the tree canopy of two co‐occurring species (a conifer Callitris glaucophylla J. Thompson & L.A.S. Johnson and a broad‐leaved Eucalyptus crebra F. Muell.) in an open woodland in eastern Australia. Evapotranspiration of understorey species was measured using an open‐top chamber, and tree water use was measured using heat‐pulse sap flow sensors. Annual stand transpiration was 309 mm in 2003, a year of below average rainfall, and 629 mm in 2004, a year with higher‐than‐average rainfall. Despite an almost doubling (522 vs. 1062 mm) of annual rainfall between 2003 and 2004, annual tree water use remained a constant fraction (59%) of rainfall, indicative of compensatory mechanisms linking annual rainfall, leaf area index and tree water use. Deep drainage was estimated to be 4% of rainfall (20.8 mm) in 2003 and 2% (21.2 mm) in 2004, indicating that this native woodland was able to minimize deep drainage despite large interannual variability in rainfall.
Variation in hydraulic conductivity of mangroves: influence of species, salinity, and nitrogen and phosphorus availability
Authors: Lovelock Catherine E. , Ball Marilyn C. , Feller Ilka C. , Engelbrecht Bettina M. J. , Ling Ewe Mei
Published: July 2006

We investigated how species identity and variation in salinity and nutrient availability influence the hydraulic conductivity of mangroves. Using a fertilization study of two species in Florida, we found that stem hydraulic conductivity expressed on a leaf area basis (Kleaf) was significantly different among species of differing salinity tolerance, but was not significantly altered by enrichment with limiting nutrients. Reviewing data from two additional sites (Panamá and Belize), we found an overall pattern of declining leaf‐specific hydraulic conductivity (Kleaf) with increasing salinity. Over three sites, a general pattern emerges, indicating that native stem hydraulic conductivity (Kh) and Kleaf are less sensitive to nitrogen (N) fertilization when N limits growth, but more sensitive to phosphorus (P) fertilization when P limits growth. Processes leading to growth enhancement with N fertilization are probably associated with changes in allocation to leaf area and photosynthetic processes, whereas water uptake and transport processes could be more limiting when P limits growth. These findings suggest that whereas salinity and species identity place broad bounds on hydraulic conductivity, the effects of nutrient availability modulate hydraulic conductivity and growth in complex ways.
Propofol acts at the sigma‐1 receptor and inhibits pentazocine‐induced c‐Fos expression in the mouse posterior cingulate and retrosplenial cortices
Authors: Yamada M. , Nakao S. , Sakamoto S. , Takamori Y. , Tamura Y. , Mochizuki‐Oda N. , Kataoka Y. , Yamada H. , Shingu K.
Published: July 2006

Background: The sigma‐1 receptor is functionally linked with psychotomimetic effects of various drugs. A sigma‐1 receptor agonist enhances bradykinin‐induced intracellular Ca2+concentration ([Ca2+]i) increase and induces c‐Fos expression in a part of the brain. The aim of this study was to investigate the effects of several intravenous anaesthetics on the sigma‐1 receptor.

Methods: First, using Wistar rat brains, (+)[3H]SKF‐10,047, a selective sigma‐1 receptor agonist was displaced by propofol, dexmedetomidine, droperidol, and thiopental. Second, Fura‐2 loaded NG‐108 cells were incubated with (+)pentazocine, a selective sigma‐1 receptor agonist, and propofol and then its fluorescence was observed after stimulation with bradykinin. Third, male ICR mice received Intrafat® or propofol intraperitoneally (i.p.), followed by pentazocine i.p. Brain slices were prepared and Fos‐like immunoreactivity was detected using an immunohistochemical method.

Results: Propofol, droperidol, and dexmedetomidine displaced (+)[3H]SKF‐10,047 binding in a concentration‐dependent manner with Ki50s of 10.2 ± 0.6, 0.17 ± 0.03, 5.73 ± 1.2 μM, respectively. Thiopental sodium was practically ineffective. Propofol produced a statistically significant reduction in the maximal binding capacity (Bmax) but did not affect the dissociation constant (Kd). (+)Pentazocine significantly enhanced bradykinin‐induced [Ca2+]i increases, but propofol did not affect it. Pentazocine induced marked Fos‐LI positive cells in the posterior cingulate and retrosplenial cortices (PC/RS), which was significantly reduced by propofol.

Conclusions: These results suggest that propofol may be a sigma‐1 receptor antagonist, and that various effects of propofol on the brain may be mediated, at least partly, by the sigma‐1 receptor.
The effect of gabapentin on post‐operative pain following tonsillectomy in adults
Authors: Mikkelsen S. , Hilsted K. L. , Andersen P. J. , Hjortsø N.‐C. , Enggaard T. P. , Jørgensen D. G. , Hansen M. , Henriksen J. , Dahl J. B.
Published: July 2006

Background:  The aim of the present study was to investigate whether a combination of rofecoxib and gabapentin could improve pain relief and reduce opioid requirements, compared with rofecoxib alone, during the first 5 days after tonsillectomy.

Methods:  In a randomized, double‐blind, placebo‐controlled study, 49 patients received gabapentin 1200 mg pre‐operatively, followed by gabapentin 2 × 600 mg on the day of operation and gabapentin 3 × 600 mg for the next 5 days, or placebo. Both groups were given rofecoxib 50 mg daily. In the post‐operative care unit, intravenous morphine was administered in doses of 2.5 mg on request. From 4 h to 5 days post‐operatively, ketobemidone was offered as escape drug. Pain at rest and during swallowing, and side‐effects, were assessed using a four‐point verbal rating scale.

Results:  As a result of the global withdrawal of rofecoxib, the study had to be terminated prematurely. This report comprises the results from 22 patients in the gabapentin group and 27 patients in the placebo group. Gabapentin reduced ketobemidone requirements during the first 24 h post‐operatively [4.5 mg (standard deviation, 3.0 mg) in the placebo group vs. 2.0 mg (standard deviation, 2.0 mg) in the gabapentin group; P < 0.003]. Gabapentin induced more dizziness (P < 0.002), gait disturbance (P < 0.02) and vomiting (P < 0.05) during days 0–5 than placebo. No other statistically significant differences were observed.

Conclusion:  Gabapentin reduced opioid requirements in the first 24 h after tonsillectomy. The benefits of the reduced opioid intake may be overshadowed by the drawbacks of side‐effects.
Association of μ‐opioid receptor gene polymorphism (A118G) with variations in morphine consumption for analgesia after total knee arthroplasty
Authors: Chou W.‐Y. , Yang L.‐C. , Lu H.‐F. , Ko J.‐Y. , Wang C.‐H. , Lin S.‐H. , Lee T.‐H. , Concejero A. , Hsu C.‐J.
Published: July 2006

Background:  Morphine consumption after a given surgical procedure can vary considerably. Studies show that single nucleotide polymorphism involving the nucleotide position 118 at exon 1 of the μ‐opioid receptor gene (OPRM1) may play a role in mediating the effects of opioids. This study was performed to correlate the A118G polymorphism at OPRM1 with morphine consumption in patients undergoing total knee arthroplasty.

Methods:  Post‐operative pain was relieved by patient‐controlled analgesia (PCA). The analgesic effect was evaluated using a visual analogue scale. Side‐effects, such as sedation, nausea and vomiting, and pruritus, were recorded systematically. The genotypes were determined by sequencing polymerase chain reaction‐amplified DNA. The differences in demographics and consumed morphine from the PCA device between the different genotypes were tested using one‐way analysis of variance. The prevalence of side‐effects from morphine and sex distribution were compared using the Kruskal–Wallis test.

Results:  One hundred and forty‐seven patients were included in the study. Twenty‐seven patients who required rescue analgesia were excluded; these patients did not differ demographically or genetically from the 120 who completed the study. Of the latter, 74 were A118 homozygous (AA), 33 were heterozygous (AG) and 13 were G118 homozygous (GG). Group GG consumed significantly more morphine (40.4 ± 22.0 mg) than group AA (25.3 ± 15.5 mg) and group AG (25.6 ± 11.7 mg) during the first 48 h post‐operatively. The groups did not differ with respect to reported pain, age, sex, weight and adverse effects.

Conclusions:  G118 homozygotes have a poorer response to morphine for post‐operative pain control than A118 homozygotes or heterozygotes. The genotype may thus influence the post‐operative response to pain and cause differences in the amounts of analgesic consumed by patients after total knee arthroplasty.
Effect site concentrations of propofol producing hypnosis in children and adults: comparison using the bispectral index
Authors: Muñoz H. R. , Cortínez L. I. , Ibacache M. E. , León P. J.
Published: July 2006

Background:  No study has determined the concentration of propofol producing a degree of hypnosis compatible with anaesthesia in children. As a result, concentrations determined in adults are recommended for children. As this can result in an inadequate depth of anaesthesia, we determined the predicted effect site concentration (Ce) of propofol necessary to obtain a bispectral index (BIS) of 50 in 50% (ECe50) of children and adults.

Methods:  Twenty adults (aged 33–44 years) and 20 children (aged 3–11 years) undergoing surgery under general anaesthesia were studied. All were monitored with a BIS monitor, and a target controlled infusion of propofol aiming for a constant Ce value was started. After 10 min, patients were evaluated using a sedation scale, and the last 5 min was used to determine the mean BIS for this Ce value. The Ce value of propofol was defined using the up‐and‐down method of Dixon and Massey. The first patient in each group received Ce= 6 μg/ml; thereafter, it was modified in 0.5 μg/ml decrements/increments with positive or negative responses, respectively. A positive response was BIS < 50 and a negative response was BIS ≥ 50. The ECe50 value was compared using unpaired Student’s t‐test. The prediction probability (PK) was used to study the association between BIS and the sedation score.

Results:  The mean ECe50 (95% confidence interval) values were 3.75 μg/ml (2.97–4.75 μg/ml) in adults and 3.65 μg/ml (3.36–3.96 μg/ml) in children (not significant). All patients with BIS < 50 were unarousable with tactile stimulation. The PK value was 0.99 in both groups.

Conclusions:  The predicted Ce value of propofol resulting in BIS = 50 was similar in adults and children aged 3–11 years. The predicted Ce value of propofol producing hypnosis in adults also seems to be useful in this paediatric population.
Low‐dose bupivacaine spinal anaesthesia for percutaneous nephrolithotomy: the suitability and impact of adding intrathecal fentanyl
Authors: Atallah M. M. , Shorrab A. A. , Abdel Mageed Y. M. , Demian A. D.
Published: July 2006

Background:  Unilateral spinal anaesthesia has been used for lower limb surgery with a stable cardiovascular state and a short recovery unit stay. We sought to test the suitability of low‐dose bupivacaine spinal anaesthesia for percutaneous nephrolithotomy, a procedure hitherto performed under general anaesthesia. Furthermore, we hypothesized that adding intrathecal fentanyl to bupivacaine may improve the quality of anaesthesia.

Methods:  We randomly allocated, through computer‐generated randomization, 108 patients subjected to percutaneous nephrolithotomy to receive either 7.5 mg of hyperbaric bupivacaine 5 mg/ml alone or with the addition of 10 μg of fentanyl. Drugs were given at the L2–L3 interspace with the patient in the lateral decubitus position. The patients remained in this position for 10 min, after which the sensory and motor blocks were assessed. Intra‐operative analgesic supplementation, when deemed necessary, was achieved with intravenous fentanyl boluses (25 μg).

Results:  The sensory and motor blocks after intrathecal bupivacaine and bupivacaine–fentanyl were similar. Sensory block, in both groups, reached the fifth and eighth thoracic dermatomes on the operative and non‐operative sides, respectively. Deep motor block occurred on the operative side in all patients and in nearly 50% of patients on the non‐operative side. The patients in the bupivacaine–fentanyl group required less intra‐operative and post‐operative analgesics, and both patients and endoscopists were better satisfied.

Conclusion:  This study demonstrated, for the first time, that intrathecal low‐dose bupivacaine and fentanyl offers a reliable neuraxial block for patients subjected to percutaneous nephrolithotomy, with stable haemodynamics, good post‐operative analgesia and acceptable patient and endoscopist satisfaction.
The former preterm infant and risk of post‐operative apnoea: recommendations for management
Authors: Walther‐Larsen S. , Rasmussen L. S.
Published: July 2006

The preterm infant presenting for anaesthesia during the first 6 months of life is a major anaesthetic challenge. One of the most serious post‐operative complications is apnoea with or without bradycardia. For this review, we conducted a search of the current literature in order to formulate a set of evidence‐based clinical guidelines to help clinicians in the management of the former preterm infant to avoid post‐operative apnoea. Only a small number of patients have been enrolled into prospective, randomized, controlled studies. Based on the current literature, regional anaesthesia is strongly recommended, preferably neuraxial block, but general anaesthesia is also used and in this setting, opioids and muscle relaxants should be avoided. Infants with a post‐conceptual age of less than 46 weeks should be admitted for continuous monitoring for at least 12 h post‐operatively. In infants with a post‐conceptual age (PCA) between 46 and 60 weeks, a careful assessment of the child is mandatory and 12 h of respiratory monitoring is recommended if the patient’s history reveals episodes of apnoea at home, chronic lung disease (CLD), neurological disease or anaemia. The otherwise healthy infant could be scheduled for theatre as the first patient on the list and subsequently monitored in the post‐anaesthetic care unit for 6 h. The risk of apnoea in former preterm infants can be further reduced by the administration of intravenous caffeine (10 mg/kg). All of these patients should be referred to a tertiary centre for anaesthesia and surgery.
Trendelenburg positioning does not prevent a decrease in cardiac output after induction of anaesthesia with propofol in children
Authors: Kardos A. , Földesi C. , Nagy A. , Sáringer A. , Kiss A. , Kiss G. , Marschalkó P. , Szabó M.
Published: July 2006

Background and objective:  Induction of anaesthesia may cause decreased cardiac output and blood pressure. Head‐down tilt is often the first clinical step to treat hypotension. The objective of this randomized single centre study was to determine, with the use of impedance cardiography (ICG), whether Trendelenburg positioning modifies the haemodynamic response to propofol/fentanyl induction of anaesthesia in ASA I children.

Methods:  Thirty ASA I children aged between 7 and 16 years scheduled for elective minor orthopaedic surgery were included. After intravenous induction with propofol and fentanyl in the head‐down group (HDG, n = 15), 5 min of 20° head‐down tilt was applied. In the supine group (SG, n = 15), no change in the supine position was made. Heart rate (HR), mean arterial blood pressure (MABP), end‐tidal carbon dioxide (ETCO2), stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI) and Heather index (HI) were recorded before (B), at 3 (A3), 5 (A5) and 8 (A8) minutes after induction in each group.

Results:  After induction, a significant decrease in CI, MABP, HR and HI was recorded in both groups. In the study group, significantly lower values of HR (66 vs. 78 beat/min) and higher values of SVI (42.9 vs. 40.6 ml/min/m2) were measured at A3 compared with the control group. After induction, no difference in CI and SVRI was found between the two groups.

Conclusion:  The present study shows that cardiac performance is not improved by Trendelenburg positioning after propofol/fentanyl induction of anaesthesia in children.
Positive end‐expiratory pressure optimization using electric impedance tomography in morbidly obese patients during laparoscopic gastric bypass surgery
Authors: Erlandsson K. , Odenstedt H. , Lundin S. , Stenqvist O.
Published: July 2006

Background:  Morbidly obese patients have an increased risk for peri‐operative lung complications and develop a decrease in functional residual capacity (FRC). Electric impedance tomography (EIT) can be used for continuous, fast‐response measurement of lung volume changes. This method was used to optimize positive end‐expiratory pressure (PEEP) to maintain FRC.

Methods:  Fifteen patients with a body mass index of 49 ± 8 kg/m2 were studied during anaesthesia for laparoscopic gastric bypass surgery. Before induction, 16 electrodes were placed around the thorax to monitor ventilation‐induced impedance changes. Calibration of the electric impedance tomograph against lung volume changes was made by increasing the tidal volume in steps of 200 ml. PEEP was titrated stepwise to maintain a horizontal baseline of the EIT curve, corresponding to a stable FRC. Absolute FRC was measured with a nitrogen wash‐out/wash‐in technique. Cardiac output was measured with an oesophageal Doppler method. Volume expanders, 1 ± 0.5 l, were given to prevent PEEP‐induced haemodynamic impairment.

Results:  Impedance changes closely followed tidal volume changes (R2 > 0.95). The optimal PEEP level was 15 ± 1 cmH2O, and FRC at this PEEP level was 1706 ± 447 ml before and 2210 ± 540 ml after surgery (P < 0.01). The cardiac index increased significantly from 2.6 ± 0.5 before to 3.1 ± 0.8 l/min/m2 after surgery, and the alveolar dead space decreased. PaO2/FiO2, shunt and compliance remained unchanged.

Conclusion:  EIT enables rapid assessment of lung volume changes in morbidly obese patients, and optimization of PEEP. High PEEP levels need to be used to maintain a normal FRC and to minimize shunt. Volume loading prevents circulatory depression in spite of a high PEEP level.
Development of renal failure during the initial 24 h of intensive care unit stay correlates with hospital mortality in trauma patients
Authors: Ala‐Kokko T. , Ohtonen P. , Laurila J. , Martikainen M. , Kaukoranta P.
Published: July 2006

Background:  Although multiple organ failure is the leading late cause of death, there is controversy about the impact of acute organ dysfunction and failure on trauma survival.

Methods:  Consecutive adult trauma admissions between January 2000 and June 2003, excluding isolated head traumas and burns, were analysed for parameters of organ function during the first 24 h following intensive care unit (ICU) admission using the Sequential Organ Failure Assessment (SOFA) scoring system. A national prospectively collected ICU data registry was used for analysis, including data from 22 ICUs in university and central hospitals in Finland.

Results:  The study population consisted of 1044 eligible trauma admissions; 32% of the cases were treated at university hospital level, the rest being secondary referral central hospital admissions. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15 (SD8), ICU mortality was 5.6% and a further 1.6% of patients died during their post‐ICU hospital stay. Forty‐five per cent of the patients were categorized as having multiple traumas. In univariate analysis, APACHE II ≥ 25 [odds ratio (OR), 35; 95% confidence interval (CI), 18–66] and renal failure (OR, 29.5; 95% CI, 14–63) produced the highest ORs for ICU mortality. In the APACHE II‐, sex‐ and age‐adjusted logistic regression model, renal failure was a significant risk factor for both ICU and hospital mortality (OR, 11.8; 95% CI, 3.9–35.4; OR, 8.2; 95% CI, 2.9–23.2, respectively).

Conclusion:  The development of renal failure during the initial 24 h of ICU stay remained an independent risk factor for mortality in trauma patients requiring intensive care treatment even after adjusting for the APACHE II score, age and sex.
Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section*
Authors: Orbach‐Zinger S. , Friedman L. , Avramovich A. , Ilgiaeva N. , Orvieto R. , Sulkes J. , Eidelman L. A.
Published: July 2006

Aim::  To identify parturients at risk of inability to extend labor epidural analgesia in whom alternative methods of anesthesia should be considered for Cesarean section (CS).

Methods::  For 6 months, we prospectively studied women undergoing CS with a functioning epidural catheter in place from the delivery ward. All parturients received the same epidural protocol: bolus of bupivacaine 0.1% and fentanyl, followed by bupivacaine 0.1% and fentanyl (2 μg/ml) 10–15 ml/h and an additional 5 ml of bupivacaine 0.125% as top‐up according to patient request. Sixteen milliliters of lidocaine 2%, 1 ml of bicarbonate and 100 μg of fentanyl were given for CS. Failed epidural analgesia was defined as the need to convert to general anesthesia.

Results::  Of the 101 parturients studied, 20 (19.8%) required conversion to general anesthesia. In univariate analysis, the likelihood of failed epidural anesthesia was inversely correlated with parturient age (P = 0.014) and directly correlated with pre‐pregnancy weight (P = 0.019), weight at the end of pregnancy (P = 0.003), body mass index at the end of pregnancy (P = 0.0004), gestational week (P = 0.008), number of top‐ups (P = 0.0004) and visual analog scale (VAS) score 2 h before CS (P = 0.03). In multivariate analysis, the number of top‐ups in the delivery ward was the best predictor of epidural anesthesia failure (odds ratio, 4.39; P = 0.005).

Conclusion:  Younger, more obese parturients at a higher gestational week, requiring more top‐ups during labor and having a higher VAS score in the 2 h before CS are at risk for inability to extend labor epidural analgesia to epidural anesthesia for CS.
A broad-scale analysis of population differentiation for Zn tolerance in an emerging model species for tolerance study: Arabidopsis halleri (Brassicaceae)
Authors: Pauwels Maxime , Frérot Hélène , Bonnin Isabelle , Saumitou-laprade Pierre
Published: July 2006

Although current knowledge about the overall distribution of zinc (Zn) tolerance in Arabidopsis halleri populations is scarce, the species is an emerging model for the study of heavy metal tolerance in plants. We attempted to improve this knowledge by testing the Zn tolerance of scattered European metallicolous (M) and nonmetallicolous (NM) populations of A. h. subsp. halleri and A. h. subsp. ovirensis in hydroponic culture. The occurrence of constitutive tolerance was unconditionally established in A. h. halleri and tolerance was extended to the subspecies ovirensis. M populations were the most tolerant but there was a continuous range of variation in tolerance from NM to M populations. Finally, relatively high levels of tolerance were detected in some NM populations, suggesting that enhanced tolerance could be present at high frequency in populations that have not experienced metal exposure. We used our results to argue the evolutionary dynamics and origin of Zn tolerance in A. halleri.
Anti‐HBc screening of blood donors: a comparison of nine anti‐HBc tests
Authors: Schmidt M. , Nübling C. M. , Scheiblauer H. , Chudy M. , Walch L. A. , Seifried E. , Roth W. K. , Hourfar M. K.
Published: July 2006

Background and Objectives Since voluntary introduction of hepatitis B virus (HBV) minipool nucleic acid amplification technology (NAT) at the German Red Cross, the expected residual risk of a transfusion‐associated HBV infection has been estimated to be 1 : 500 000 – about 10 times higher than for human immunodeficiency virus (HIV) or hepatitis C virus (HCV) infection. Donors demonstrating chronic positivity for antibody to hepatitis B core antigen (anti‐HBc), negativity for hepatitis B surface antigen (HBsAg) and polymerase chain reaction (PCR)‐negative with a low virus load are a major cause of this increased risk.

Materials and Methods Ten‐thousand blood donors from our blood‐donation centre were screened for anti‐HBc using the current PRISM® HBc and the new PRISM® HBcore assay to evaluate the diagnostic sensitivity and specificity of these tests. PRISM® HBc‐ or PRISM® HBcore‐reactive samples were further analysed using seven additional tests for anti‐HBc, two tests for antibody to hepatitis B surface antigen (anti‐HBs), one test for antibody to hepatitis B envelope antigen (anti‐HBe) and three HBV NAT assays.

Results From a total of 10 000 donors, nine and 14 samples were reactive only in the PRISM® HBc and the PRISM® HBcore, respectively, whereas 165 samples were reactive in both anti‐HBc assays. Further analysis of these 188 anti‐HBc‐reactive specimens in a total of nine different anti‐HBc assays revealed concordant results for 162 (86·2%) specimens. Sample cut‐off values for anti‐HBc were significantly (P < 0·01) lower for anti‐HBc‐only reactive samples compared with specimens that were also reactive for anti‐HBs or anti‐HBe.

Conclusions Both PRISM anti‐HBc assays revealed that ≈ 1·8% of non‐prescreened blood donors from Germany were reactive for anti‐HBc. Although sensitivity was comparable between both assays, specificity was increased significantly with the PRISM® HBcore. High anti‐HBc sample cut‐off values were indicative for reactivity in other HBV parameters and for concordant results in the nine different anti‐HBc assays. Look‐back investigations are necessary to estimate the infection risk both of anti‐HBc‐only positive and of anti‐HBc/anti‐HBs‐positive blood transfusions.
Low‐molecular‐weight protein (LMP)2/LMP7 abnormality underlies the downregulation of human leukocyte antigen class I antigen in a hepatocellular carcinoma cell line
Authors: Shen Yu‐Qing , Zhang Jian‐Qiong , Xia Mei , Miao Feng‐Qing , Shan Xiang‐Nian , Xie Wei
Published: July 2006

Background:  Tumor cells may alter the expression of numerous components involved in antigen‐processing machinery to decrease human leukocyte antigen (HLA) class I expression, allowing the tumor cells to escape immune surveillance. The purpose of the present study was to investigate the involvement of these components in the downregulation of HLA class I expression in human hepatocellular carcinoma cell line BEL7404.

Methods:  Expression of HLA‐I and antigen presentation‐related genes were analyzed by flow cytometry and polymerase chain reaction. The HLA class I‐deficient BEL7404 cell was transfected with the low‐molecular‐weight protein (LMP) 2 and LMP7 gene and were analyzed by flow cytometry for restoration of surface HLA class I expression.

Results:  The BEL7404 cells downregulated the expression of HLA class I antigen and lacked expression of LMP2 and LMP7. Interferon (IFN)‐γ treatment increased the expression of LMP2 but not LMP7. The LMP2‐transfected BEL7404 cells or LMP2 and LMP7‐cotransfected cells restored surface HLA class I expression while LMP7‐transfected cells did not. However, in IFN‐γ‐treated BEL7404 cells, transfection with the LMP7 gene induced more HLA class I expression than mock transfection.

Conclusions:  The LMP2 gene was required for the expression of HLA class I molecules in BEL7404. The LMP7 was not the major reason for loss of HLA class I in BEL7404 cells, although the supply of exogenous LMP7 could increase surface expression of HLA class I antigen.
Clinical outcomes and learning curve of a laparoscopic adrenalectomy in 103 consecutive cases at a single institute
Authors: ETO MASATOSHI , HARANO MASAHIKO , KOGA HIROFUMI , TANAKA MASATOSHI , NAITO SEIJI
Published: July 2006

Objective:  We examined the clinical outcomes and the learning curve for a laparoscopic adrenalectomy (LA) in 103 consecutive cases performed by three surgeons at our institute, according to the type of adrenal disorder.

Patients and Methods:  One hundred and three patients with adrenal tumors, including 38 cases of primary aldosteronism, 33 cases of Cushing syndrome (including preclinical Cushing syndrome), 15 cases of pheochromocytoma, and nine cases of non‐functioning adenoma were evaluated, while focusing on the approaches, intraoperative and postoperative data, and the learning curve of LA, according the type of adrenal disorder.

Results:  There was no significant difference in the operation time, estimated blood loss, incidence of conversion to open surgery and blood transfusion, or postoperative recovery among the patients treated by LA for aldosteronoma, Cushing adenoma, pheochromocytoma, and non‐functioning adenoma. In the cases of aldosteronoma and Cushing adenoma, the learning curve for the operation time and blood loss in each operator tended to decrease as the number of operations increased. On the other hand, in the cases treated by LA for pheochromocytoma, no trends in either the operation time or blood loss were observed. However, there has been neither any conversion to open surgery nor blood transfusion in cases treated by LA since 1998 (our 42nd case), even after the changes in the operators.

Conclusions:  Our results clearly indicate that LA is becoming safer than before, probably due to improvements in the technique, education, and training of surgeons, in addition to the increased number of cases now treated by LA.
Effectiveness of local anaesthesia techniques in patients undergoing transrectal ultrasound‐guided prostate biopsy: A prospective randomized study
Authors: SONG SEUNG‐HUN , KIM JEONG KON , SONG KANGHYON , AHN HANJONG , KIM CHOUNG‐SOO
Published: July 2006

Aim:  This study was designed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound (TRUS)‐guided prostate biopsy.

Methods:  Ninety men undergoing transrectal prostate biopsy from July through December 2004 were randomized into three groups of 30 patients each. Before the biopsy, patients in Group 1 received 20 mL of 2% lidocaine gel intrarectally; patients in Group 2 received 5 mL (2.5 mL per side) of 2% lidocaine solution injected near the junction of the seminal vesicle with the base of the prostate (along the neurovascular bundles), and patients in Group 3 (control group) received 5 mL (2.5 mL per side) of normal saline injected along the neurovascular bundles. Pain level after the biopsy was assessed using a 10‐point linear visual analog scale (VAS). Results were statistically compared by the Wilcoxon Rank Sum test.

Results:  Patients in Group 2 had significantly lower VAS scores than those in Group 3 (3.6 ± 2.1 vs 5.8 ± 1.9, P < 0.0001), but those in Group 1 did not (5.5 ± 2.7 vs 5.8 ± 1.9, P = 0.67). Gross hematuria, rectal bleeding, and hemospermia occurred in 36 (40.0%), 6 (7%) and 5 (6%) patients. One patient had temporary vasovagal syncope. No patient reported febrile urinary tract infection or urinary retention.

Conclusions:  Periprostatic injection of local anaesthetic is a safe technique that significantly reduces pain during prostate biopsy, whereas intrarectal lidocaine injection did not reduce pain. This safe, simple technique should be applied in men undergoing TRUS‐guided prostate biopsy to limit patient discomfort.
Clinical outcome of 36 male patients with primary urethral carcinoma: A single center experience
Authors: THYAVIHALLY YUVARAJA B , TONGAONKAR HEMANT B , SRIVASTAVA SHYAM K , MAHANTSHETTY UMESH , KUMAR PRABHASH , RAIBHATTANAVAR SRINIVAS G
Published: July 2006

Aim:  Retrospective analysis of male urethral carcinoma to assess the best therapeutic approach to the management of this tumor.

Methods:  A review of 36 cases of male urethral carcinoma diagnosed and treated at our center was performed. Clinical features, treatment modality and outcomes were analysed.

Results:  The overall median survival time was 55.16 months. The 5‐year overall and disease‐free survival rate for the cohort was 49% and 23%, respectively. The 5‐year survival is 67% for low‐stage versus 33% for high‐stage tumors and is significantly different (P = 0.001). The survival was 72% for tumors of the distal urethra versus 36% for tumors of the proximal, with a P‐value of 0.02.

Conclusion:  The tumor location and clinicopathological stage were the most important predictors of the disease‐free and overall survival. Multimodal approach is necessary for achieving local control especially for proximal and higher stage tumors.
Efficacy and safety of on‐demand tadalafil for the treatment of erectile dysfunction in South‐East Asian men
Authors: GUO YING LU , ZHU JI CHUAN , PAN TIAN MING , DING QIANG , WANG YI XIN , CHEONG NG FOO , LIM EDWIN , SHEN WEI , VENUGOPALAN MURALI , CHAN MELANIE
Published: July 2006

Aim:  Tadalafil is an inhibitor of phosphodiesterase type 5 used for the treatment of erectile dysfunction (ED). The efficacy and safety of tadalafil have been evaluated extensively in Western populations. Our aim was to assess the efficacy and safety of on‐demand tadalafil for the treatment of ED in South‐East Asian men.

Methods:  This was a randomized, double‐blind, placebo‐controlled study of men with mild to severe ED of various etiologies randomized to receive placebo (n = 122), tadalafil 10 mg (n = 120), or tadalafil 20 mg (n = 125), taken as needed (maximum once daily) for 12 weeks. Efficacy assessments included the International Index of Erectile Function (IIEF), the Sexual Encounter Profile (SEP) diary, and a Global Assessment Question (GAQ).

Results:  Men from China, Singapore, and the Philippines participated in this trial (n = 367). Compared with placebo, tadalafil significantly improved erectile dysfunction on all efficacy outcomes (P < 0.001). Patients receiving tadalafil 10 mg and 20 mg experienced a significant mean improvement of 8.1 and 8.7, respectively, in the IIEF Erectile Function (IIEF‐EF) domain score from baseline (vs placebo 2.4, P < 0.001). In patients receiving tadalafil 10 mg and 20 mg, the mean per‐patient success rate for intercourse attempts (SEP3) was 62% and 70%, respectively, compared with 32% for the placebo group (P < 0.001). Of patients who received tadalafil 10 mg and 20 mg, 81% and 86% reported improved erections at endpoint (GAQ) compared with 44% in the placebo group (P < 0.001). The most common adverse events reported by patients were headache, back pain, dyspepsia, and dizziness.

Conclusions:  Tadalafil was an effective and well‐tolerated treatment for South‐East Asian men with ED.
Fibronectin inhibits endocytosis of calcium oxalate crystals by renal tubular cells
Authors: TSUJIHATA MASAO , YOSHIMURA KAZUHIRO , TSUJIKAWA KOZO , TEI NORIHIDE , OKUYAMA AKIHIKO
Published: July 2006

Background:  Fibronectin (FN; 230 kDa) is a multifunctional α2‐glycoprotein distributed throughout the extracellular matrix and body fluids. We recently reported that FN has a protective effect against injury of renal tubular cells by exposure to oxalate and calcium oxalate (CaOX) crystals and inhibits the adhesion of CaOX crystals to renal tubular cells. In the study presented here, we investigated whether FN has inhibitory effect on crystal endocytosis by renal tubular cells.

Methods:  The inhibitory effect of FN on endocytosis of CaOX crystals by MDCK cells was examined by using a radioactivity uptake assay. Also, crystal endocytosis by cells was morphologically assessed by means of transmission electron microscopy (TEM).

Results:  FN had inhibitory effects on CaOX crystal endocytosis by MDCK cells. The morphological TEM study showed that few crystals were taken into cells when FN was added compared to the number of crystals when FN was not added.

Conclusion:  We found that FN had the inhibitory effects on the interaction between crystals and renal tubular cells, including the adhesion or endocytosis of crystals by cells.
Clinical validity of proliferating cell nuclear antigen as an objective marker for evaluating biologic features in patients with untreated prostate cancer
Authors: MIYAMOTO SHIGEHITO , ITO KAZUTO , KUROKAWA KOHEI , SUZUKI KAZUHIRO , SUZUKI KEIJI , YAMANAKA HIDETOSHI
Published: July 2006

Background:  Although Gleason grading may be the most useful system for evaluating biological activity of untreated prostate cancer, lack of interobserver validity with Gleason scores (GS) is an unsolved issue. In this study, the proliferating cell nuclear antigen labeling index (PCNA LI) in untreated prostate cancer was investigated in order to clarify the usefulness of supplemental and objective markers for evaluating the biologic features of prostate cancer.

Methods:  Sixty cases of prostate cancer were randomly selected from the cancer registry in Gunma University Hospital for this study. PCNA LI were evaluated using paraffin‐embedded biopsy cores taken at diagnosis. Correlation of PCNA LI with the Gleason grading system, clinical stage, serum prostate‐specific antigen (PSA) levels and age were evaluated. Cumulative rates of freedom from cause‐specific death were also evaluated stratified by various clinicopathologic features, including PCNA LI using Kaplan–Meier analysis.

Results:  Proliferating cell nuclear antigen labeling index was significantly higher in patients with PSA levels over 100 ng/mL, advanced clinical stage (>T4, N1 or M1 disease), higher Gleason grade or with a higher GS than in those with other clinicopathologic features. The 5‐year cumulative rate of death from prostate cancer was significantly higher at 62% in patients with a PCNA LI of 20 or more than those with PCNA LI of less than 20, who accounted for 4%.

Conclusions:  Proliferating cell nuclear antigen labeling index in combination with Gleason grading system may be of clinical value in evaluating biologic features and also in predicting cause specific survival of prostate cancer in an objective, reliable and reproducible manner.
Serum calcitonin gene‐related peptide levels in untreated prostate cancer patients
Authors: SUZUKI KAZUMI , KOBAYASHI YUTAKA , MORITA TATSUO
Published: July 2006

Background:  The role of calcitonin gene‐related peptide (CGRP) in prostate cancer has not been fully understood. Moreover, the serum CGRP level in prostate cancer patients has never been reported. We measured the serum CGRP levels in untreated prostate cancer patients to elucidate its clinical significance.

Materials and methods:  We used 36 serum samples from prostate cancer patients. All patients had never received any treatment. Serum CGRP was measured by immunoradiometric assay, and we analysed the association between serum CGRP level and clinicopathological factors.

Results:  Serum CGRP levels in the patients with higher clinical stages and histological grade were significantly higher than in those with lower stages and grade, respectively. But the levels did not correlate with the patient’s age, liver or renal functions, serum prostate‐specific antigen levels.

Conclusion:  Serum CGRP levels were significantly elevated in the patients with high grade or high stage untreated prostate cancer patients. Measurement of the serum CGRP may be a useful predictor of staging or grading of prostate cancer in the untreated prostate cancer patients.
Bilateral adrenal myelolipoma associated with adrenogenital syndrome
Authors: SAKAKI MANABU , IZAKI HIROFUMI , FUKUMORI TOMOHARU , TAUE RYUICHI , KISHIMOTO TOMOTERU , KANAYAMA HIRO‐OMI
Published: July 2006

Abstract  Adrenal myelolipoma is a rare benign tumor, occasionally reported in association with endocrine disorders. We report herein a case of bilateral adrenal myelolipoma associated with adrenogenital syndrome caused by 21‐hydroxylase deficiency. A diagnosis of 21‐hydroxylase deficiency was confirmed by mutation analysis of the CYP21 gene. Our case represents only the second case of bilateral adrenal myelolipoma associated with adrenogenital syndrome caused by 21‐hydroxylase deficiency.
Neurologic toxicity associated with interferon α therapy for renal cell carcinoma
Authors: WADA YOSHIHIRO , KUWAHARA TOMOHIRO , UYAMA EIICHIRO , NAKANISHI JURO , TAKAHASHI WATARU , HONDA JIRO , KIKUKAWA HIROAKI , JINNOUCHI YOSHITERU , UEDA SHOICHI
Published: July 2006

Abstract  A 67‐year‐old man received interferon α (IFN α) therapy for lung metastases of renal cell carcinoma (RCC). Multiple pulmonary metastases disappeared completely. However, neurological toxicity was detected by magnetic resonance imaging (MRI) as abnormal brain lesions. After discontinuation of IFN α therapy, his neurological symptoms and abnormal lesions on MRI disappeared completely. Complete remission of RCC has continued, and results of neurological study have remained normal for 5 years after discontinuation of IFN α therapy.
Rapid progression of small cell carcinoma in a renal transplant recipient
Authors: RANNIKKO ANTTI , KROGERUS LEENA , NYBERG MARCUS , SALMELA KAIJA , RUUTU MIRJA
Published: July 2006

Abstract  Immunosuppression is thought to be responsible for the increased incidence of tumor development after organ transplantation. Natural history of these tumors may be more aggressive than would be expected for a similar tumor in a patient without transplant. We describe the fulminant course of small cell carcinoma, likely of prostatic origin, in a kidney transplant patient. Small cell carcinoma (SCC) and especially SCC of the prostate is an aggressive and rare type of tumor. Due to its rarity, only case reports have been published. To our knowledge, this is the first case of SCC, likely of prostatic origin, in an organ transplant recipient (OTR). The case illustrates the aggressiveness of the disease as reflected by its fulminant progression, which may have been further accentuated by the immunosuppression.
Symphysitis following transrectal biopsy of the prostate
Authors: ADAM CHRISTOPH , GRASER ANNO , KOCH WALTER , TROTTMANN MATTHIAS , ROHRMANN KARL , ZAAK DIRK , STIEF CHRISTIAN
Published: July 2006

Abstract  Transrectal ultrasound‐guided needle biopsy of the prostate is a widely accepted technique to obtain prostatic tissue for histological examination. Severe complications are rarely seen. We report a case of symphysitis causing hospitalization and severe pain and discomfort of the patient. Possible etiologic factors are traumatic osseous lesions and transport of rectal bacteria to the periosseous region. Especially in small prostates, care should be taken to avoid this condition. Prolonged perioperative antibiotic prophylaxis is mandatory.
MAGNIFICATION ENDOSCOPIC VIEW OF AN EARLY GASTRIC CANCER USING ACETIC ACID AND NARROW‐BAND IMAGING SYSTEM
Authors: Toyoda Hideki , Tanaka Kyosuke , Hamada Yasuhiko , Kosaka Ryo , Imoto Ichiro
Published: July 2006

A 62‐year‐old woman was referred to Mie University Hospital, Tsu, Japan, for examination of upper gastrointestinal tract. The conventional endoscopy showed a slightly depressed lesion on the greater curvature at the gastric body. The surface of surrounding non‐neoplastic mucosa using magnification endoscopy with acetic acid was gyrus‐villous pattern whereas the surface of the lesion was rough. Furthermore, magnification endoscopy using acetic acid and narrow‐band imaging system visualized clearer fine surface pattern of carcinoma. The lesion had a rough mucosa with irregularly arranged small pits. The lesion was resected completely by endoscopic mucosal resection with insulated‐tip electrosurgical knife. Narrow‐band imaging system with acetic acid may be able to visualize not only the capillary pattern but also the fine surface pattern of gastric carcinoma.
MANAGEMENT AND PROBLEM OF ENDOSCOPIC BILIARY DRAINAGE
Authors: Okabe Yoshinobu , Tsuruta Osamu , Saitou Fumihiko , Suga Hideya , Toyonaga Atsushi , Sata Michio
Published: July 2006

Transpapillary biliary drainage has developed as an applied technique of endoscopic retrograde cholangiopancreatography and spread as a routine procedure. Particularly, endoscopic biliary drainage (EBD), which is characterized by physiologic nature, mild invasiveness, and no restriction of life, is a reasonable and efficient method for temporary or permanent biliary drainage. Also, improvements in the stent material, increases in the stent diameter, and advent of metallic stents have solved many problems with EBD. However, despite the improvements in various imaging techniques and development of surgical procedures and multidisciplinary treatment, many old as well as new problems such as the selection of the drainage method, stenting method, stent patency rate, stent material, and concomitant treatments still remain. For a more effective clinical use of EBD, the selection of the optimal drainage method and stent for individual patients and the development of stents and basic clinical research from the viewpoints of concomitant treatments are necessary.
Ontogeny of the electric organ discharge in two parapatric species of the dwarf stonebasher, Pollimyrus castelnaui and P. marianne (Mormyridae, Teleostei)
Authors: Baier Bernd , Lamml Michael , Kramer Bernd
Published: July 2006

This is the first description of the ontogenetic development of the electric organ discharge (EOD) in two parapatric mormyrid sibling species, Pollimyrus castelnaui (Boulenger, 1911) and P. marianne Kramer et al. 2003, from the first appearance during the early larval stages at about 0.7 cm total length to the fully developed adult discharge at about 3.0 cm total length. At around day 20 the biphasic larval discharge (which is similar to that of P. adspersus larvae) is followed by the emerging triphasic adult discharge with a delay of about 0.7 ms. Both discharge types coexist for about 3 weeks. As the development advances, the amplitude of the adult discharge increases rapidly while that of the larval discharge diminishes. Whereas the adult EOD waveform of P. marianne remains triphasic later in life, in P. castelnaui an ‘initial flourish’, in the form of additional small phases, is added and develops at an age of about 40 days, when larval and adult EOD are present. Possible evolutionary scenarios are discussed.