bluuebunny/crossref_metadata_2025 huggingface dataset:
P59 Involvement of CD9 in Erythroid Progenitor Cell Apoptosis
Authors: Webster K. , Green C. A. , Singleton B. K. , Daniels G. L.
Published: September 2006

Introduction  The study of erythroid progenitor cell proliferation and differentiation in vitro is essential if we are to achieve our goal of producing therapeutic quantities of red cells by cell culture. The mechanisms of cell regulation need to be appreciated and a cell culture environment developed for optimal cell renewal and growth. Changes in cell surface molecules and understanding of their function form an important part of the study together with knowledge about the genes involved in the erythropoietic process, including those genes involved in apoptosis. CD9, a member of the tetraspanin super family, is reportedly involved in tumour progression and metastasis and has been implicated in apoptosis of cancer cells.

Methods  Apoptosis was induced in erythroid progenitor cells by depriving the cultures of erythropoietin (EPO). CD34+ cells were isolated from the peripheral blood of adults and cultured for 5 days in serum free medium with IL‐3 (1 ng mL−1), SCF (10 ng mL−1) and EPO (3 IU mL−1). On day 6 the culture was divided and half the cells deprived of EPO; both cultures were analysed on day 8. Total RNA was extracted and run on Affymetrix microarray chips to compare the mRNA profile of the apoptotic and control cells.

Results  One gene that was consistently upregulated in the apoptotic cells was CD9. This result was confirmed by real‐time PCR. Immunofluorescent staining and confocal microscopy revealed that CD9 protein expression changed during apoptosis from low level expression within the cell membrane to a much higher level, which was cytoplasmic as well as membranous. To determine whether this CD9 upregulation was an initiator of apoptosis or a consequence, CD34+ cells were cultured with anti‐CD9 (ALB6) antibody added to the culture medium. Ligation of CD9 by anti‐CD9 did not change the apototic profile of the cultures.

Conclusion  It can be concluded that although CD9, by itself, is not an initiator of apoptosis in erythroid progenitor cells it is obviously an important target in the subsequent apoptotic pathway. Continued research into CD9 and other mechanisms of apoptosis may allow manipulation of cells in culture with a possible extension of their life span and increase in the number of cells produced.
P65 National Blood Service Directed Sibling Cord Blood Banking for Transplantation
Authors: Smythe J. , Armitage S. , McDonald D. , Pamphilon D. , Green A. , Guttridge M. , Navarette C. , Warwick R. M. , Brown C. , Briggs D. , Lankester A. , Contreras M. , Watt S. M.
Published: September 2006

Umbilical cord blood (UCB) is an important source of stem cells for transplantation and may cause less GvHD than non‐T‐depleted bone marrow (BM). Only 25% of paediatric patients have an HLA matched sibling and for the remainder an unrelated BM or UCB donation may also not be available. A directed UCB (DCB) collection from a newborn sibling may be the only opportunity for a transplant until the sibling can donate BM. Matched DCB donations have been shown to give better long‐term results than matched unrelated UCB or BM but DCB collection is not as easy to control as unrelated banking in hospitals established as collection sites. In the context of mandatory licensing under the European Union Tissues and Cells Directive introduced in April 2006, we have reviewed NBS DCB banking. Over ten years, 268 DCB collections were made, 233 (87%) for an existing sibling with a disease treatable by transplantation, and the remainder for families with a history of an inherited high risk disease. Diagnoses included 114 haematological malignancies, 68 hereditary anaemias and 53 immune or metabolic deficiencies. Collections were cryopreserved within 24 h without volume reduction.

Volume mL
Total TNC ×108
Total CD34 ×106
TNC Viability %

Median
73
8.8
2.3
99.0

Mean ± S.D.
76 ± 32
9.9 ± 5.5
3.3 ± 3.4
98.2 +3.7

Range
14–173
1.0–31.0
0.13–26.7
73.0–100.0

88% of collections exceeded 40 ml UCB, the cut‐off used by some banks including NHS‐CBB. Despite the logistical difficulties in organising collections from many hospitals the cell counts and viabilities of DCB collections compare favourably with collections for UCB banks. The decision to continue storage was made once the cell counts and tissue typing results were also known. Of units collected for existing siblings, 67 (28%) were a 10:10 match for HLA ‐A, ‐B, ‐Cw, ‐DRB1 and ‐DQB1. Of these, 13 units were transplanted, with 10 for non‐malignant disorders, including one collected following pre‐implantation tissue typing for a sibling affected by DBA. Median time to neutrophil engraftment was 18 days (range 14–28) and 30 days (range 11–59) for platelets. DCB collection provides the option of immediate transplant with the potential of future sibling donation of stem cells or lymphocytes. DCB banking for high‐risk families is therefore a useful service to provide and complements the work of unrelated UCB banks.
P66 The UK Blood Service/Wellcome Trust Control Collection: a unique public resource of control samples for disease association studies
Authors: Winzer T. , Cant B. , Taylor N. , Masters J. , Kneight A. , Attwood T. , Boorman J. , Koch K. , Nutland S. , Watkins N. , Ouwehand W. H.
Published: September 2006

Disease association studies, designed to identify genetic risk factors for common diseases (e.g. obesity and diabetes), require large numbers of samples from both patients and controls. The existence of a common control cohort that can be used in all diseases would have significant benefits. The National Blood Service and Cambridge University, funded by a grant from the Wellcome Trust, have collected DNA, plasma and viable lymphocytes from approximately 3600 UK blood donors. These samples form the UK Blood Service/Wellcome Trust Control Collection (UK‐BS/WT‐CC). A training pack was developed for collection teams of the blood services involved. Following training of team staff, donors attending regional blood collection sessions over a 6‐month period from September 2005 to February 2006 were asked to consent. For isolation of viable lymphocytes an ACD anti‐coagulated blood aliquot was collected. Corresponding plasma and leukocyte filters for DNA isolation were provided by the blood services after the processing of the whole blood donation. The samples were assigned unique numeric identifiers and following sample processing a controlled anonymisation process was performed in which all identifiers linking the sample to the donor were destroyed. In addition, a number of biometric measurements (gender, BMI, height, weight, year of birth) were obtained from each donor at the time of sample collection. This anonymised collection represents a unique public resource of control samples collected from donors throughout the geographical regions of the UK. Currently, 1500 DNA samples are being genotyped on the Affymetrix GeneChip® Human Mapping 500K Array Set as part of the Wellcome Trust Case Control study (http://www.wtccc.org.uk). Here we give an overview of the sample collection and processing together with a description of the phenotypic data that characterise the collection. The UK‐BS/WT‐CC represents a unique resource that will be available to eligible users via an access committee. The UK‐BS/WT‐CC places the NHSBT at the forefront of ongoing disease association studies.
P08 Role of a National Cell Salvage Co‐ordinator
Authors: Grainger H. , Jones J. , Benton A.
Published: September 2006

Background  Management of the supply of allogeneic red cells is an important issue in the UK due to the unquantifiable risk of transmission of vCJD( Llewellyn CA et al.Lancet. 2004; 363: 417–421) The Health Circular, Better Blood Transfusion ‐ The Appropriate use of Blood, instructed hospitals to address the ‘appropriate use of autologous transfusion’. Historically various methods of cell salvage have been used sporadically, driven only by the occasional enthusiastic clinician. Increased awareness of potential threats to the blood supply as well as the benefit for patients of autologous blood, have prompted a more focused approach to cell salvage development. In Wales this has been addressed by the establishment of a structured programme under the direction of a dedicated cell salvage co‐ordinator.

Approach  Initial discussions with trusts highlighted common themes and the following needs were identified: (i) Practical information on how to set up a cell salvage programme; (ii) Training; and (iii) National data to support appropriate use of cell salvageA ‘toolkit’ was developed and subsequently a coordinator appointed to take forward the initiative. A strategy was developed following a review of current practice.

• Establish a plan of action within each Trust

• Undertake training of key personnel and raise awareness of all staff

• Develop and facilitate competency assessments for all trainees and existing staff

• Produce National policies, protocols and SOP's to promote standard practice

• Establish a National database

Conclusion  1. All hospitals in Wales now undertake cell salvage and there is increasing use in Obstetrics following the published NICE guidelines

2. A National database is being established

3. Training package, including a resource folder for staff available for use4. National policies under development.
P09 Intra‐operative Cell Salvage in Abdominal Aortic Aneurysm Repair in the South West Region
Authors: Birchall J. ,   on behalf of the South West Regional Blood Transfusion Committee
Published: September 2006

Background  The Department of Health circular, Better Blood Transfusion two requires hospitals to avoid unnecessary use of donor blood and to explore effective alternatives. The National Blood Conservation Strategy 2004 recommends that intra‐operative cell salvage (IOCS) should be considered for surgical patients where the anticipated blood loss exceeds 1000 mL. The Southwest Regional Blood Transfusion Committee selected abdominal aortic aneurysm (AAA) repair to audit the use of IOCS within the region. The aims were to identify the percentage of cases where IOCS is used and determine the reasons why IOCS is not used.

Method  All Trusts/hospitals in the region were invited to participate. A simple proforma was completed by theatre staff on each AAA repair for a 3 month period from November 2005 to February 2006. Co‐ordinators at each Trust/hospital returned these to the NBS Clinical Audit department for analysis.

Results  A total of 14 NHS Trusts/hospitals took part and only 1 eligible Trust/hospital declined to participate. All Trusts/hospitals used IOCS and in 6/14 (43%) this was used in all cases. There were 127 cases of AAA repair during the audit period and IOCS was used in 100 (79%) and not used in 27 (21%). Most cases (69%) were performed as elective procedures and in 85% IOCS was used. Emergency surgery was associated with a lower incidence of IOCS although this was still high at 72%. The most common reason for not using IOCS was lack of trained staff and this was not out of hours related. This accounted for 15 out of the 27 cases where IOCS was not used and in two Trusts/hospitals occurred in 50% or more of all cases. In the 100 cases when IOCS was used 124 units of donor red cells were transfused (average 1.24 units, range 1–15 units). In the 27 cases where IOCS was not used 102 units of donor red cells were transfused (average 3.8 units, range 1–30 units). In the 15 cases when lack of trained staff prevented IOCS, 93 donor units were transfused (average 6.2 units).

Conclusions  All Trusts/hospitals who participated have access to cell salvage machines. IOCS was used in 79% of all cases which compares favourably with 43% of cases reported nationally by the Vascular Society of Great Britain and Ireland 2004. Trained staff must be available for IOCS to be a valuable resource both from a clinical governance and cost‐effective perspective.
Seed longevity and dormancy of four summer annual grass weeds in turf
Authors: MASIN R , ZUIN MC , OTTO S , ZANIN G
Published: September 2006

Digitaria sanguinalis, Eleusine indica, Setaria glauca and S. viridis are troublesome summer annual weeds in turf. For taking rational decisions on the necessity for the level and type of weed management, it is important to know when weeds are ready to emerge (dormancy status) and also how long weed seeds can survive in the soil. Seeds of these four species were buried 4.0–4.5 cm deep in steel mesh net bags placed under permanent turf and periodically exhumed for 3 years to evaluate viability and determine the dormancy/non‐dormancy cycle. D. sanguinalis, S. glauca and S. viridis showed the typical dormancy cycle of summer annual species, and their seed viability declined completely after 3 years of burial. In contrast, E. indica demonstrated unusual behaviour, with long persistence and no dormancy.
Assessing the opportunity for site‐specific management ofAvena sterilisin winter barley fields in Spain
Authors: RUIZ D , ESCRIBANO C , FERNÁNDEZ‐QUINTANILLA C
Published: September 2006

The abundance ofAvena sterilisin dryland barley fields was studied in four Spanish provinces. During two growing seasons, differential geopositioning system (DGPS)‐geo‐referencedA. sterilisinfestations were obtained in 31 fields. The majority of the infestations were concentrated in few large but irregularly shaped patches, with a higher number of smaller and more regular patches accounting for a small proportion of the infestation. A multitude of very small and irregular patches completed the inventory. The implications of this spatial structure were studied. Site‐specific adjusted‐dose herbicide application offered 61–74% potential herbicide savings. However, given the low levels of infestation and the low economic returns obtained in most of the provinces, the most profitable strategy was generally no herbicide application. Site‐specific treatments were advantageous only in high‐returns systems. Because few large patches provided the majority of the infestation, zone‐specific treatments would be advisable, until such time that weed detection and site‐specific application technologies become more efficient.
Presymptomatic and predictive genetic testing in minors: a systematic review of guidelines and position papers
Authors: Borry P , Stultiens L , Nys H , Cassiman J‐J , Dierickx K
Published: September 2006

The objective of this study is to review ethical and clinical guidelines and position papers concerning the presymptomatic and predictive genetic testing of minors. The databases Medline, Philosopher’s Index, Biological Abstracts, Web of Science and Google Scholar were searched using keywords relating to the presymptomatic and predictive testing of children. We also searched the websites of the national bioethics committees indexed on the websites of World Health Organization (WHO) and the German Reference Centre for Ethics in the Life Sciences, the websites of the Human Genetics Societies of various nations indexed on the website of the International Federation of Human Genetics Societies and related links and the national medical associations indexed on the website of the World Medical Association. We retrieved 27 different papers dealing with guidelines or position papers that fulfilled our search criteria. They encompassed the period 1991–2005 and originated from 31 different organizations. The main justification for presymptomatic and predictive genetic testing was the direct benefit to the minor through either medical intervention or preventive measures. If there were no urgent medical reasons, all guidelines recommend postponing testing until the child could consent to testing as a competent adolescent or as an adult. Ambiguity existed for childhood‐onset disorders for which preventive or therapeutic measures are not available and for the timing of testing for childhood‐onset disorders. Although the guidelines covering presymptomatic and predictive genetic testing of minors agree strongly that medical benefit is the main justification for testing, a lack of consensus remains in the case of childhood‐onset disorders for which preventive or therapeutic measures are not available.
L/I‐11 Simultaneous adult‐to‐adult (A/A) split liver transplants
Authors: Panaro F. , Andorno E. , Ravazzoni F. , Di Domenico S. , Ghinolfi D. , Miggino M. , Morelli N. , Bottino G. , Casaccia M. , Valente U.
Published: September 2006

Introduction:  Split liver transplants (SLTs) and living related liver transplants (LRLTs) were developed to increase the number of available organs for adult recipients. We review our experience in performing both the split procedure and the 2‐graft transplant at the same division.

Patients and methods:  From 1997 to 2005, we performed 96 in situ SLTs (82 adult donor‐to‐pediatric recipient [A/P] and 14 adult‐to‐adult [A/A]). We used 9 right grafts (SV‐VIII) and 5 left grafts (SI‐IV) for the A/A group. Two of these grafts were procured from a single donor and transplanted into 2 recipients by our team. The in situ SL procedure was performed in the emergency department OR and the 2 transplants in our dedicated ORs.

Results:  The splitting procedure required 110 minutes with a blood loss of 350 ml. The entire procedure (from procurement to last transplant) took 18 hours to be completed. Donor: 17 yrs, 170 cm,78 kg, ICU stay 2 days, SLV 1341 gr (right 737 gr, left 604 gr). Recipients: see below.

The overall survival rate of the A/A group was 66% for right grafts (median follow‐up, 46 months) and 80% for left grafts (median follow‐up, 62 months). The recipients with the same donor are still alive with normal LFTs at 47 months posttransplant.

Conclusion:  A “simultaneous” transplant of 2 liver grafts at the same center may increase graft quality and improve organ survival. Conversely, it requires excellent technical facilities and organizational skills. This approach has the potential to decrease mortality on the adult waiting list, to optimize LT timing with outcome improvement, and to decrease the need for LRLDs.

Left Graft Recipient
Right Graft Recipient

Graft weight (gr)
600
580

Age (yrs)
51
53

Diagnosis
HCV+ALCOHOL
HCV+HBV+HDV+ALCOHOL

Status/MELD
2B/13
3/14

Weight (kg)
56
57

GRWR (%)
1.07
0.98

Blood transfusions (units)
11
6

Length (h)
6h36min
9h30min

Discharge (POD)
23
58*

Liver volume after 2 mos
1515 ml
1522 ml

*comorbidity: renal failure requiring hemodialysis.

*Chi‐squared p = .046 comparing Clavien 0/I vs. II/III/IV.
L/I‐12 Living donor hepatectomies: program experience and lessons learned
Authors: Tan H.P. , Marsh J. , Tom K. , Thai N. , Shaw‐Stiffel T. , Lopez R. , Boig L. , Caponi T. , Starzl T. , Marcos A.
Published: September 2006

Introduction:  Living donor hepatectomies are technically challenging and we continue to modify our techniques to decrease morbidities.

Patients and methods:  We present our program experience with 114 living donor hepatectomies (95 right lobes, 3 left lobes, 16 left lateral segments) from 3/4/03 to 2/28/06 at the Starzl Transplantation Institute. A total of 208 potential donors were screened, resulting in 114 (54%) living donor hepatectomies and living donor liver transplants (98 adults, 16 pediatric recipients).

Results:  In all, 94 potential donors (46%) were declined for the following reasons: fatty livers (43), availability of a deceased donor liver (15), small liver volume (12), workup (6), biopsy consistent with fibrosis (4), polycystic liver disease (3), cardiovascular contraindications (2), mental illnesses (2), hepatitis B (2), and hepatic vascular/biliary anomalies (2). There was no donor mortality and the donor morbidity rate was 8.8%. Three (2.6%) donors had bile leak from cut liver edges with JP removed by 3 weeks (all managed conservatively). Other morbidities included 1 unit pRBC transfusion (2), pneumonia (1), incisional hernia (1), prolonged LFTs (1), deep venous thrombosis (1), and narcotic pscyhosis (1). The mean donor hospital stay was 7 days. Blood loss did not correlate with liver volume but correlated with technique of liver parenchymal dissection. With technique modifications (combination of Tissue Link, Erbe HELIX hydro‐jet, endovascuar GIA stapler, and CUSA) during the last 70 right lobe hepatectomies, the mean estimated blood loss has dropped to about 250 mL, with no blood transfusion. Operative time for liver parenchymal dissection has also dropped from about 200 minutes to 90 minutes.

Discussion:  With intraoperative technical experience and refinements, previous surgical contraindications are decreasing. A higher percentage of potential living liver donors screened are allowed to donate, with decreasing morbidities.
L/I‐2 Living related liver transplants: preliminary report on an initial experience in Italy
Authors: Gruttadauria S. , Mandala’ L. , Cintorino D. , Biondo D. , Panarello G. , Verzaro R. , Spada M. , Marsh J.W. , Marcos A. , Gridelli B.
Published: September 2006

Introduction:  Living related liver transplantation has become the treatment for many liver diseases. We present our initial analysis on 42 cases of adult‐to‐adult living related liver transplants (ALRLTs) performed in a single institution in Italy.

Materials and methods:  From January 2002 to February 2006, we performed 42 ALRLTs. The donors (age 18 to 53) all had genetic or emotional relationships; they were all ABO‐identical or ABO‐compatible. Recipients (age 18 to 68) suffered from cirrhosis secondary to viral etiology (n=13), hepatocellular carcinoma on viral cirrhosis (n=21), cystic fibrosis (n=2), primary biliary cirrhosis (n=2), hepatocellular carcinoma on nonviral cirrhosis (n=2), alcoholic cirrhosis (n=1), and metastatic carcinoid to the liver (n=1). Donor liver resection resulted in 40 right hepatectomies and 2 left hepatectomies. Graft body weight ratio was always above 1%; graft implantation was performed with the piggyback technique, and in 32 cases with the use of venovenous bypass.

Results:  There was no donor mortality; 4 donors had biliary complications. The actuarial recipient survival rate at 3 years was 89.25% and the graft survival rate was 82.69%. Graft loss occurred in 7 patients: 5 patients underwent retransplants (4 because of hepatic artery thrombosis, 1 because of graft dysfunction), and 2 patients had 1 episode of acute cellular rejection.

Conclusion:  ALRLTs represent a resource to face the organ shortage in a region where the deceased donor donation rate is 7.2 donors per year per million.
L/I‐3 Biliary complications in adult‐to‐adult living donor right lobe liver transplants
Authors: Cotterell A. , Fisher R. , Maluf D. , Stravitz R. , Sterling R. , Luketic V. , Sanyal A. , Shiffman M. , Posner M.
Published: September 2006

Introduction:  Biliary complications are a major cause of morbidity after living donor right lobe liver transplantation. The purpose of this study was to compare the incidence of biliary complications after Roux‐en‐Y vs. duct‐to‐duct reconstruction in adult‐to‐adult right lobe liver transplantation.

Patients and methods:  This study reports on 75 patients who underwent 77 right lobe liver transplants. During the initial experience beginning in June 1998, a Roux limb was used routinely for biliary reconstruction. Since September 2000 a duct‐to‐duct biliary anastomosis was performed if technically feasible.

Results:  Of 49 procedures involving Roux‐en‐Y reconstruction, 15 patients (30.6%) experienced 18 biliary complications, including 7 cases of biliary anastomotic strictures, 3 cut surface leaks requiring intervention, 1 anastomotic leak, 1 anastomotic obstruction, and 1 excluded segmental duct. In addition, 5 patients experienced episodes of cholangitis unrelated to strictures. Of the 47 patients with Roux‐en‐Y reconstruction, 32 are alive a mean of 75 months posttransplant. Of 28 patients with duct‐to‐duct reconstruction, 8 (28.6%) experienced 9 biliary complications including 5 anastomotic strictures (3 of which required operative intervention), 2 anastomotic leaks, 1 cut surface leak requiring intervention, and 1 excluded segmental duct. Twenty‐four of 28 patients with duct‐to‐duct reconstruction are alive a mean of 39 months posttransplant.

Conclusion:  The incidence of biliary complications after right lobe living donor liver transplantation is about 30% regardless of the method used for biliary reconstruction. A duct‐to‐duct biliary anastomosis is an acceptable alternative to Roux‐en‐Y reconstruction if technically feasible.
L/I‐7 Comparison of HCV outcomes in recipients of expanded‐criteria, living donor, and standard liver grafts
Authors: Kinkhabwala M. , Mayerfield A. , Kin C. , Renz J. , Gaglio P. , Emond J. , Brown R.
Published: September 2006

Introduction:  Living donor (LD) and expanded‐criteria donor (ECD) livers are important sources of organ transplants in some regions. Hepatitis C virus (HCV) remains the most common reason for end‐stage liver disease in the United States. It is unclear whether ECD and LD grafts are associated with poorer outcomes in hepatitis C recipients, as compared with non‐ECD (standard [STD]) MELD‐allocated livers. The aim of this retrospective study was to compare long‐term hepatitis C recurrence rates and outcomes in recipients of ECD, LD, and STD grafts.

Methods:  The cohort of patients analyzed comprised all adult hepatitis C transplant recipients between 1/1/01 and 11/1/04 (minimum follow‐up, 1 year). Recipients not surviving the immediate perioperative period (90 days) were excluded. Censored events were defined by disease‐free graft survival. Disease recurrence was defined by histologically confirmed hepatitis C and at least stage II fibrosis. ECDs were identified according to accepted criteria (e.g., age, steatosis, ischemia, donation after cardiac death, abnormal biopsy).

Results:  In all, 120 patients formed the study cohort, with 79 ECD, 27 LD, and 14 STD grafts. The mean recipient MELD was 19.8 overall (range, 6 to 43), 20.1 (ECD), 14.1 (LD), and 24.7 (STD). The mean time to censored event was 709 days overall, 631 (ECD), 884 (STD), and 846 (LD). The 2‐year disease‐free survival rate was 44% (ECD), 55.6% (LD), and 70.7% (STD), by Kaplan‐Meier analysis. Comparison of the curves indicated a significant difference between ECD and STD recipients, but no difference between ECD and LD recipients.

Conclusions:  Recipients with hepatitis C who received ECD grafts had poorer outcomes in our experience, as compared with those receiving STD grafts. LD grafts, which can be viewed as a subset of ECD grafts, also had poorer outcomes than STD whole grafts, but this difference was not statistically significant.
L/I‐8 Adult living donor liver transplants: biliary morbidity
Authors: Giacomoni A. , Lauteri A. , Slim A. , Mangoni I. , Aseni P. , Pirotta V. , Mariani A. , De Carlis L.
Published: September 2006

Introduction:  Biliary problems are very common complications in adult living donor liver transplants (ALDLTs), with a reported negative incidence of 22% to 64%.

Patients and methods:  From March 2001 through February 2006, we performed 27 ALDLTs, grafting segments V‐VIII without the middle hepatic vein. Biliary anatomy was investigated using intraoperative cholangiography in the first 5 patients and with magnetic resonance cholangiography alone in the remaining 22. In 15 patients, we found a single right biliary duct (55.55%) and in 12 we found multiple biliary ducts (44.45%). We performed single biliary anastomoses in 20 patients (74.07%) and multiple anastomoses in the remaining 7 (25.93%).

Results:  With a mean follow‐up of 675 days (range, 8 to 1,804 days), patient and graft survival rates were 85% and 74%. The following biliary complications were observed: 4 biliary leaks from the cut surface, 3 anastomotic leaks, 6 late anastomotic strictures, and 1 early kinking of the choledochus.

These 14 biliary complications (51.85%) occurred in 11 patients (40.74%).

Conclusion:  Biliary complications affected our series of ALDLTs at a high percentage, but none of the grafts transplanted was lost due to biliary problems. Magnetic resonance cholangiography seems to be a reliable instrument to investigate biliary anatomy.

Multiple biliary reconstructions are strongly associated with a high risk of complications.
Host inbreeding increases susceptibility to ectoparasitism
Authors: LUONG L. T. , HEATH B. D. , POLAK M.
Published: September 2006

Inbreeding, which increases homozygosity throughout the genome by increasing the proportion of alleles that are identical by descent, is expected to compromise resistance against parasitism. Here, we demonstrate that host inbreeding increases susceptibility to ectoparasitism in a natural fruit fly (Drosophila nigrospiracula) – mite (Macrocheles subbadius) association, and that this effect depends on host genetic background. Moreover, flies generated from reciprocal crosses between susceptible inbred lines exhibited elevated levels of resistance similar to that in the mass‐bred base population, confirming in reverse direction the causative link between expected heterozygosity and resistance. We also show that inbreeding reduces the host's ability to sustain energetically expensive behaviours, and that host exhaustion dramatically increases susceptibility. These findings suggest that inbreeding depression for resistance results from an inability to sustain defensive behaviours because of compromised physiological competence.
Trait‐associated expressed hepatic and intestine genes in cattle of different metabolic type – putative functional candidates for nutrient utilization
Authors: Schwerin M. , Kuehn C. , Wimmers S. , Walz C. , Goldammer T.
Published: September 2006

The present study aimed at identifying bovine hepatic and intestinal DNA sequences expressed breed specifically as potential functional candidate genes for nutrient transformation. Transcript levels of 29 expressed sequence tags (ESTs) were analysed comparatively in the liver and intestine of growing Charolais and German Holstein bulls by real‐time RT‐PCR. In previous studies, these ESTs were characterized as differentially displayed in mRNA differential display of cows varying in metabolic type and harbouring single nucleotide polymorphisms. Breed‐specific gene expression levels indicate significantly increased hepatic metabolic activity in Charolais and increased intestinal metabolic activity in German Holstein bulls. Transcript levels of six functional genes measured in liver (NDUFB8, NACA, UAP1, SAH) and intestine (FUS/TLS, APOC3), respectively, support this assumption. The observed coincidence of metabolic type‐specific expressed ESTs with variant ESTs showing breed‐specific allele distribution points to functional genetic variants located in the vicinity of the analysed sequences. In addition, location of most of the breed specifically expressed ESTs within chromosome regions known to be affecting carcass and growth traits in cattle supports the putative candidate gene character of the ESTs identified.
High incidence of single nucleotide polymorphisms in the prion protein gene of native Brazilian Caracu cattle
Authors: Kues W.A. , Ollhoff R.D. , Carnwath J.W. , De Souza F.P. , Madeira H.M.F. , Niemann H.
Published: September 2006

Different alleles of the human and ovine prion protein gene correlate with a varying susceptibility to transmissible spongiform encephalopathies. However, the pathogenic implications of specific polymorphisms in the bovine prion protein gene (PRNP) are only poorly understood. Previous studies on the bovine PRNP gene investigated common European and North American cattle breeds. As a consequence of decades of intensive breeding for specific traits, these modern breeds represent only a small fraction of the bovine gene pool. In this study, we analysed PRNP polymorphisms in the native Brazilian Caracu breed, which developed in geographical isolation since the 16th century. A total of 10 single nucleotide polymorphisms (SNPs) were discovered in the coding region of the Caracu PRNP gene. Eight of the SNPs occurred at high frequencies in Caracu cattle (variant allele frequencies = 0.10–0.76), but were absent or only rarely observed in European and North American breeds. One of the Caracu SNPs was associated with an amino acid exchange from serine to asparagine (f = 0.17). This SNP was not detected in Holstein–Friesian, Simmental and German Gelbvieh and was only rarely detected in beef cattle (f = 0.01). We found 17 haplotypes for PRNP in the Caracu breed.
Adefovir dipivoxil therapy in liver transplant recipients for recurrence of hepatitis B virus infection despite lamivudine plus hepatitis B immunoglobulin prophylaxis
Authors: Akyildiz Murat , Karasu Zeki , Zeytunlu Murat , Aydin Unal , Ozacar Tijen , Kilic Murat
Published: September 2006

Background:  Treatment of post‐transplantation recurrence of hepatitis B virus (HBV) infection despite prophylaxis with hepatitis B immunoglobulin (HBIG) and lamivudine combination therapy is not easy. Because HBV reinfection has a severe course and could result in graft failure in liver transplant recipients, prompt medication is essential. Herein is reported the authors’ experience with adefovir dipivoxil (AD) therapy in 11 liver transplant recipients who had HBV reinfection despite the administration of lamivudine and HBIG.

Method:  Two‐hundred and nine patients underwent liver transplantation (100 deceased donor liver transplantations [DDLT], 109 living donor liver transplantation [LDLT]) due to chronic hepatitis B infection between April 1997 and May 2005 in Ege University Medical School, Liver Transplantation Unit. Patients had prophylaxis with lamivudine and low‐dose HBIG combination after liver transplantation. Treatment of recurrence consisted of AD 10 mg once a day and lamivudine 300 mg/daily and HBIG was discontinued in those patients.

Results:  In total there were 11 HBV recurrences: five occurred in DDLT recipients and six in LDLT recipients, at a median follow up of 18 months (range, 6–48 months). In one of 11 patients, pretransplant HBV‐DNA and HBeAg were positive. Three patients had a severe course and one patient had fibrosing cholestatic hepatitis. After AD treatment, HBV‐DNA level decreased in all patients and became negative in seven patients. Two patients died due to hepatocellular carcinoma recurrence after 12 and 14 months of follow up. Serum creatinine level increased mildly in one patient and no other side‐effect was observed, and all patients continued therapy.

Conclusion:  Adefovir dipivoxil is a safe, effective treatment option for post‐transplant HBV recurrence even among patients with fibrosing cholestatic hepatitis caused by lamivudine‐resistant HBV.
Endoscopic diagnoses and CLO test results in 9239 cases, prevalence of Helicobacter pylori in Istanbul, Turkey
Authors: Sarı Yavuz Selim , Sander Ersan , Erkan Esin , Tunalı Vahit
Published: September 2006

Background:  Helicobacter pylori is implicated in the etiology of gastric and duodenal ulcer, non‐ulcer dispepsia, atrophic gastritis, gastric adenocarcinoma and lymphoma.

Methods:  Between November 1995 and December 2004, the presence of H. pylori was investigated using the CLO test in 9239 patients who underwent upper gastrointestinal endoscopy at a single institution in Istanbul, Turkey. The results were evaluated as early–late positive, and negative.

Results:  There were 4667 women (50.51%) with a mean age of 44.5 years (range, 13–90 years), and 4572 men (49.49%) with a mean age of 45.7 years (range, 11–85 years). The CLO test was positive in 41.44% of cases. The most frequent symptoms on admission were epigastric pain (46.2%) and burning (19.6%). The most frequent endoscopic diagnosis was pangastritis (64%) and non‐erosive duodenitis (30.5%). The H. pylori positivity was 61.53% during the first 5‐year period and 38.47% during the second 5‐year period. The H. pylori positivity was significant in patients using non‐steroidal anti‐inflamatory drugs and tobacco (P < 0.001).

Discussion and Conclusion:  Helicbacter pylori prevelance remains an important health problem for Turkey although it has diminished in parallel to the national development during the last years. Helicbacter pylori, as a first‐degree carcinogen, should be investigated and eradicated particularly in high‐risk patients.
Prevalence and etiology of elevated serum alanine aminotransferase level in an adult population in Taiwan
Authors: Chen Chien‐Hua , Huang Min‐Ho , Yang Jee‐Chun , Nien Chiu‐Kue , Yang Chi‐Chieh , Yeh Yung‐Hsiang , Yueh Sen‐Kou
Published: September 2006

Background:  The prevalence and etiologies of elevated alanine aminotransferase (ALT) have geographic variations and they are rarely reported in Taiwan. Through a population‐based screening study, the prevalence and etiologies of elevated ALT in an adult population of Taiwan were assessed.

Methods:  A cross‐sectional community study in a rural village of Taiwan was conducted in 3260 Chinese adults (age ≥18 years) undergoing ultrasonography (US), blood tests, and interviews with a structured questionnaire. The diagnostic criteria of non‐alcoholic fatty liver disease (NAFLD) included alcohol intake <20 g/week for women or <30 g/week for men, negative hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, no known etiologies of liver disease, and US consistent with fatty liver.

Results:  The prevalence of elevated ALT was 11.4% (372/3260). The probable cause of this elevation was excess alcohol consumption in 0.8%, HBV in 28.5%, HCV in 13.2%, both HBV and HCV in 2.2%, NAFLD in 33.6%, and unexplained cause in 21.8%. The etiologic distribution of elevated ALT was similar in both genders, although elevation was more common in men compared to women (17.3%vs 6.1%, P < 0.05). The prevalence of elevated ALT in NAFLD was 18.1% (125/691), and the positive predictive value was 33.6% (125/372). The development of NAFLD was related to increasing age (age between 40 years and 64 years, odds ratio [OR] 1.59, 95% confidence interval [CI]: 1.25–2.01; age ≥ 65 years, OR 1.46, 95%CI: 1.08–1.96), fasting plasma glucose (FPG) ≥ 126 mg/dL (OR 1.54, 95%CI: 1.11–2.14), bodymass index (BMI) ≥ 25 kg/m2 (OR 5.01, 95%CI: 4.13–6.26), triglyceridemia ≥ 150 mg/dL (OR 1.96, 95%CI: 1.58–2.42), and hyperuricemia (OR 1.50, 95%CI: 1.22–1.84). Elevated ALT was related to male gender, BMI ≥ 25 kg/m2, and triglyceridemia ≥ 150 mg/dL in subjects without known etiologies of liver disease (all P < 0.05).

Conclusions:  Non‐alcoholic fatty liver disease appears to be the commonest cause of elevated ALT and presumed liver injury in Taiwan. The development of NAFLD is closely associated with many metabolic disorders. Metabolic disorders are also related to elevated ALT in subjects without known etiologies of liver disease.
Insulin‐induced oedema in children and adolescents
Authors: Mamoulakis Dimitrios , Bitsori Maria , Galanakis Emmanouil , Raissaki Maria , Kalmanti Maria
Published: September 2006

Abstract:  Oedema is an uncommon complication of insulin therapy, which has only rarely been reported in childhood. We describe a case of a 12‐year‐old girl with newly diagnosed type 1 diabetes, who presented with oedema of the lower extremities and periorbitally, one day after the initiation of insulin treatment. Other causes of oedema were excluded. Following administration of frusemide, oedema resolved within ten days. An extended review of the literature revealed only nine cases of insulin‐induced oedema in children and adolescents aged ≤16 years. In conclusion, insulin‐induced oedema should be considered during the introduction of insulin therapy in children and adolescents with newly diagnosed type 1 diabetes. Loop diuretics and ephedrine may be beneficial when spontaneous resolution does not occur.
Critical appraisal of the management of severe malnutrition: 3. Complications
Authors: Brewster David R
Published: September 2006

Abstract:  The high case‐fatality of severe malnutrition is due to infections, dehydration, electrolyte disturbances and heart failure. We focus on the evidence about managing these complications of severe malnutrition. Signs of circulatory collapse in severely malnourished children should be treated with intravenous or bone marrow infusion of Ringer’s lactate with additional dextrose and potassium at a rate 20–40 mL/kg fast with close monitoring of vital signs. Recommendations for slow or restricted fluids in the face of shock are unsafe, and hypotonic or maintenance solutions must be avoided to prevent hyponatraemia. However, the evidence that severely malnourished children do not tolerate excessive fluid administration is good, so caution must be exercised with regards to fluids in the initial phase of treatment. There is also good evidence that wide spectrum antibiotics need to be given empirically for severe malnutrition to prevent the otherwise unavoidable early mortality. There is a need for improved protocols for tuberculosis diagnosis, HIV management and treatment of infants under 6 months with severe malnutrition. The contribution of environmental enteropathy to poor growth and nutrition during the weaning period means that there should be more priority on improving environmental health, particularly better hygiene and less overcrowding. A T‐cell mediated enteropathy contributes to growth failure and malnutrition, and it is related to environmental contamination of enteric organisms in the weaning period rather than allergic responses.
Antibiotic prescribing for childhood febrile illness by primary care doctors in Malaysia
Authors: Teng CL , Nik‐Sherina Hanafi , Ng CJ , Chia YC , Atiya Abdul Sallam
Published: September 2006

Aim:  Fever in children, a mostly benign and self‐limiting illness, is often viewed with consternation by the care givers. It results in early consultation and excessive use of antipyretics and antibiotics. In this study, we document the prescribing practice of doctors from three primary care settings in Malaysia and identify the predictors of antibiotic prescription.

Methods:  Interview of care givers bringing febrile children (age ≤ 12 years) to three primary care settings: public primary care clinics, private general practice clinics and a university‐based primary care clinic.

Results:  Data from 649 children were analysed. Mean age of children 4.1 years and 55% were boys. One‐third of the children had prior consultation for the same episode of fever. About 80% of the febrile children were diagnosed to have upper respiratory tract infection, viral fever and gastroenteritis. Overall antibiotic prescribing rate was 36.6% (public primary care clinic 26.8%, private general practice clinic 70.0% and university‐based primary care clinic 32.2%). Independent predictors of antibiotic prescription were: clinic setting, longer duration of fever (>7 days), higher temperature (>38°C) and the diagnosis of upper respiratory tract infections. After controlling for demographic and clinical factors, antibiotic prescription in private general practice clinic was seven times higher than public primary care clinic (odds ratio 7.1, 95% confidence interval 4.0–12.7), and 1.6 times higher than university‐based primary care clinic (odds ratio 1.6, 95% confidence interval 1.0–2.5).

Conclusion:  Differences in the patients’ demographic and clinical characteristics could not adequately explain the high antibiotic prescribing rate in private general practice clinics. This inappropriately high antibiotic prescribing for febrile children in private general practice clinics is a suitable target for future intervention.
Effects of extremely early enteral feeding on plasma glicentin levels in very‐low‐birthweight infants
Authors: Shimizu Toshiaki , Tadokoro Rieko , Kaneko Noritsugu , Suzuki Mitsuyoshi , Tanaka Kyoko , Shinohara Kouich , Shiga Seigo , Yamashiro Yuichiro
Published: September 2006

Aim:  Glicentin, an active component of enteroglucagon, is considered to have a significant trophic action on the intestinal mucosa. We examined the effects of extremely early enteral feedings on the postnatal and postprandial changes in plasma glicentin levels in very‐low‐birthweight (VLBW) infants.

Methods:  We measured the plasma glicentin concentrations before and after feedings at 1 or 2 days, 5 or 6 days and 14 days after birth in 21 VLBW infants. The subjects were randomly divided into an extremely early feeding group, which was started on breast milk within 24 h after birth, and a control group, which was started on breast milk more than 24 h after birth.

Results:  Plasma basal concentrations of glicentin at 5 or 6 days and at 14 days after birth were significantly higher than those at 1 or 2 days after birth in the early feeding group. The basal glicentin level at 14 days after birth was significantly higher than that at 1 or 2 days. The basal levels at 5 or 6 days and at 14 days after birth in the early feeding group were significantly higher than those in the control group. Plasma glicentin concentrations after feeding were significantly higher than those before feeding at 5 or 6 days and 14 days after birth in the early feeding group, but those levels were significantly higher only at 14 days after birth in the control group.

Conclusion:  Our results suggest that extremely early enteral feedings may play an important role in the development of glicentin secretion and intestinal mucosal growth in the early period of life in VLBW infants.
Treatment burden and health‐related quality of life of children with diabetes, cystic fibrosis and asthma
Authors: Ziaian Tahereh , Sawyer Michael G , Reynolds Katherine E , Carbone Josephine A , Clark Jennifer J , Baghurst Peter A , Couper Jennifer J , Kennedy Declan , Martin A James , Staugas Rima Em , French Davina J
Published: September 2006

Aim:  To identify the time required by children with cystic fibrosis (CF), diabetes or asthma to complete daily treatment tasks and the hassle they experienced when completing these tasks. To compare parent and child reports of daily treatment time and hassle. To investigate the relationship between treatment time and hassle, and (i) children’s health‐related quality of life (HRQL); and (ii) disease severity.

Methods:  160 children aged 10–16 years with CF, type 1 diabetes, or asthma were followed over a 2‐year period. Information about children’s treatment time and hassle, and their HRQL was obtained from parents and children at baseline, 1‐year and 2‐year follow‐up assessments.

Results:  On average, children with CF reported spending 74.6 ± 57.0 min completing treatment tasks, children with diabetes spent 56.9 ± 27.8 min and children with asthma spent 6.4 ± 9.3 min. Parents reported that children spent less time that was reported by their children. Over the two years, parent and child reports describing treatment time for children with CF did not vary significantly (P = 0.3). Treatment time for children with diabetes increased (P = 0.02) whereas that for children with asthma reduced (P = 0.001). The level of hassle experienced by children when completing individual treatment tasks was low for all three conditions. There was no significant relationship between treatment time and children’s HRQL.

Conclusion:  Children with CF or diabetes spent a substantial amount of time each day completing the treatment tasks. Although this was not related to HRQL, it could impact the ability to comply with complex and all home‐based‐therapies for some children.
Vaginal foreign body in childhood: A multidisciplinary approach
Authors: Deligeoroglou Efthimios , Deliveliotou Aikaterini , Laggari Varvara , Tsimaris Pandelis , Creatsas George
Published: September 2006

Abstract:  A 5‐year‐old girl referred to our division for evaluation of persisting foul‐smelling brown vaginal discharge with pruritus for over 2 years, not corresponding to antibiotic therapy. Transabdominal ultrasound identified a heterogeneous mass intensely fixed in the upper third of vaginal wall. Vaginography revealed a filling defect in the upper part of vagina, confirming the diagnosis of an intravaginal foreign body. The foreign body was grasped and removed by traction; it turned out to be a thin double‐wrapped piece of sponge. Psychological assessment of the girl was undertaken, in order to illuminate the potential of an underlying emotional and behavioural problem and revealed the existence of psychological disturbances mostly affecting social competence and adaptiveness.