bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibitory effects of Triptolide on interferon‐γ‐induced human leucocyte antigen‐DR, intercellular adhesion molecule‐1, CD40 expression on retro‐ocular fibroblasts derived from patients with Graves’ ophthalmopathy
Authors: Yan Shu‐xun , Wang Ying
Published: February 2006

Abstract

Purpose:  To explore the effects of Triptolide, the principal active diterpenoid from the Chinese Medicinal Herb Tripterygium Wilfordii Hook F that has immunosuppressive and anti‐inflammatory properties, on cell proliferation, hyaluronic acid (HA) synthesis, and the expressions of human leucocyte antigen‐DR (HLA‐DR), intercellular adhesion molecule‐1 (ICAM‐1) and CD40 on cultured retro‐ocular fibroblasts (RFs) from patients with Graves’ ophthalmopathy.

Methods:  After two to five passages, cultured RFs were incubated for 48 h within a medium alone or in the presence of recombinant human interferon‐γ (IFN‐γ) and various concentrations of Triptolide. Cell viability was assessed by MTT (3‐[4.5‐dimethylahiazol‐2‐yl]‐2,5‐diphenyltetrazolium Bromide). RFs proliferation was assessed by [3H]‐thymidine incorporation assay. Flow cytometry was used to investigate the amount of HLA‐DR, ICAM‐1 and CD40. HA synthesis was measured by radioimmunoassay.

Results:  Cell viability was not detrimentally affected when incubated with Triptolide from 0.01 µg/L to 10 µg/L for 48 h, and decreased with 20 µg/L Triptolide. The incorporation of [3H]‐thymidine of RFs was 55 476 ± 15 842 cpm incubated with medium alone or 18 352 ± 3568 cpm with 10 µg/L Triptolide (t = 5.600, P < 0.01). Initially, the percentage of positive cells of HLA‐DR, ICAM‐1 and CD40 on RFs were 4.75 ± 2.13%, 17.53 ± 10.12% and 6.38 ± 2.23%, respectively, and the synthesis of HA was 100 ± 12%. Compared with basal values, 48‐h incubation with IFN‐γ (100 U/mL) significantly enhanced the amount of HLA‐DR, ICAM‐1 and CD40, and HA synthesis. The values were 60.58 ± 10.12% (t = 13.224, P < 0.01), 62.66 ± 18.17% (t = 5.315, P < 0.01), 57.67 ± 13.61% (t = 9.110, P < 0.01) and 164 ± 22% (t = 9.238, P < 0.01), respectively. Triptolide 0.01 µg/L had little effect on IFN‐γ‐induced HLA‐DR, ICAM‐1 and CD40 amounts, as well as HA synthesis. When the concentration ranged from 0.1 µg/L to 10 µg/L, Triptolide inhibited IFN‐γ‐induced RFs activation in a dose‐dependent manner. It was also found that Triptolide had the same inhibiting effects on IFN‐γ‐induced RFs and skin fibroblasts from patients with normal individual conditions.

Conclusions:  Triptolide could inhibit IFN‐γ‐induced activation of RFs derived from patients with Graves’ ophthalmopathy.
Variable phenotypes in patients diagnosed with idiopathic multifocal choroiditis
Authors: MacLaren Robert E , Lightman Susan L
Published: February 2006

Abstract

Purpose:  To report investigations in a case series of patients diagnosed with idiopathic multifocal choroiditis (MFC) in order to determine whether or not a new clinical phenotype could be identified and to determine the long‐term visual prognosis.

Methods:  Twenty‐eight patients were identified from the clinic database of approximately 1200 and subsequently reviewed. After ocular examination, which included fluorescein angiography, 20 of these patients were determined to have idiopathic MFC. Visual outcome, patient demographics, presenting symptoms, the distribution of inflammatory cells, the pattern of chorioretinal lesions and the development of peripapillary atrophy, choroidal new vessels or cystoid macular oedema were compared.

Results:  The range of follow up was 1–27 years (mean 10 years). A Kaplan–Meier plot showed that approximately 60% of patients maintained their best‐corrected visual acuity for 10 years after diagnosis. Poor vision at final review was associated with eyes having choroidal new vessels or cystoid macular oedema. Oral steroids were used to treat 11 patients, of which 10 responded with a visual improvement. The one non‐responsive patient had foveal ischaemia angiographically. Generally the idiopathic phenotype was variable and only four patients showed some overlap with known subgroups of MFC. Unusual vascular features were observed in two patients.

Conclusions:  No specific phenotype was seen to emerge from this cohort of patients diagnosed with idiopathic MFC, although most were significantly different from the retinal white dot syndromes currently described. The visual prognosis was relatively good and most cases responded to oral steroids.
The mental health nurse: A valuable addition to the consultation‐liaison team
Authors: Sharrock Julie , Grigg Margaret , Happell Brenda , Keeble‐Devlin Barbara , Jennings Shirley
Published: February 2006

ABSTRACT:  Nurses, particularly those working in non‐psychiatric settings, report that they do not feel adequately prepared to meet the mental health needs of patients. The psychiatric consultation‐liaison nursing role has arisen in part, as a response to these difficulties and aims to facilitate access to mental health nursing expertise for general hospital patients and staff. The impact of the introduction of a nursing position into an established consultation‐liaison psychiatry service was evaluated using an activity audit, a staff attitude survey, and staff focus groups. The findings demonstrated that the addition of the nursing role to the consultation‐liaison psychiatry service improved access of general hospital patients to specialist mental health care. It also provided valued expert assistance to staff in the provision of care to this patient group, particularly those with complex problems and significant psychiatric comorbidity. The study found that the nursing consultation was particularly helpful because of its focus on practical and care‐orientated interventions. The model of practice that evolved out of this project is described and the findings support the use of both direct and indirect patient interventions as important psychiatric consultation‐liaison nurse activities.
Home clinic programme: An alternative model for private mental health facilities and sufferers of major depression
Authors: Blacklock Eddie
Published: February 2006

ABSTRACT:  Depression demands high emotional and social costs to people suffering it while private hospitals and health funds are economically affected in respect to elongated episodes of care and readmission rates. There is a dearth of nurse‐led initiatives aimed to reduce length of stay. An innovative model of care is proposed, offering the opportunity for depressed clients to return home earlier from hospital where they will receive the professional guidance and support of mental health registered nurses (RNs) providing contemporary counselling. Clinical links between the home and the hospital would be maintained by the RNs for a specified time frame. The framework of home clinic programme is to discharge clients from hospital into community within specified time frame (maximum 14 days hospitalization) and the clients will be visited by RNs in their homes five times in the first week, twice in the second week and once in the third week to ascertain their emotional and clinical needs and provide biopsychosocial support. The use of this model has potential benefits for mental health consumers, clinicians, services, and funders.
Multidisciplinary team working: Collaboration and conflict
Authors: Jones Adrian
Published: February 2006

ABSTRACT:  The aim of this paper is to report on findings identifying some of the difficulties encountered by the multidisciplinary team in the development and implementation of a care pathway for patients diagnosed with schizophrenia. Policy direction has shifted towards greater team working and blurring of professional boundaries. Moreover, there is greater need to deliver care according to set standards and for patients to reach particular outcomes of care. Care pathways are relatively new for psychiatry and will potentially uncover tensions within the team. Data were collected by participant observation and semistructured interviews over a period of 12 months on an acute psychiatric unit. The care team developed the care pathway and the process of development and implementation was observed through action research. Cross‐sectional indexing was used to analyse the data, and themes were developed using interview and observational data collection methods. Clinicians argued strongly for clear role boundaries but also defended their perceived control over health care from other professions. The findings indicate that designing a care pathway for people with schizophrenia may produce conflicting perceptions from the team. Conflict may arise through professions being unwilling to accept plurality over roles, which may hinder progress in meeting the needs of patients. The findings also counter the impression that care pathways can be implemented with little impact on the team.
Extending the boundaries: Autoethnography as an emergent method in mental health nursing research
Authors: Foster Kim , McAllister Margaret , O'Brien Louise
Published: February 2006

ABSTRACT:  An exploration of the ‘self’ is generally considered a fundamental and necessary place from which to commence practice as a mental health nurse. Self‐awareness and attention to one's own feelings, thoughts, and experiences can contribute to the therapeutic use of self in effective provision of mental health nursing care. This purposeful use of self, inherent in the role of the mental health nurse, may also be seen as synchronous to the role of the qualitative researcher who seeks to uncover the meaning of others’ experiences. Autoethnography is a qualitative research method that connects the researcher's personal self to the broader cultural context. Evocative writing, where the writer shares personal stories on their experiences, is used to extend understanding of a particular social issue. This paper will argue how this emerging method in social science research is of particular relevance to mental health nursing research and practice.
Demographic factors and clinical correlates of burden and distress in relatives of service users experiencing schizophrenia: A study from south‐western Nigeria
Authors: Ukpong Dominic I.
Published: February 2006

ABSTRACT:  Caregivers burden is an important area of clinical work that is often neglected, particularly in relatives of patients with psychosis. The aim of the present study is to examine if some demographic factors and symptoms of illness bear a relationship with burden and distress levels in their caregivers. This cross‐sectional study involved patients with chronic schizophrenia and their relatives. The Carer Burden Index and the 30‐item General Health Questionnaire was used to assess burden and distress in relatives, and positive and negative symptoms of schizophrenia in the patients were rated using the Brief Psychiatric Rating Scale and the Scale for Assessment of Negative Symptoms, respectively. High levels of emotional distress and burden were observed in the caregivers and they were significantly associated with some demographic variables. They were also significantly associated with positive and negative symptoms of schizophrenia. Because Nigerian families continue to play a primary caregiving role for their relatives experiencing schizophrenia, there is a need to focus on specific interventions that will reduce their high levels of distress and burden.
Cold drawn steel wires—processing, residual stresses and ductility—part I: metallography and finite element analyses
Authors: PHELIPPEAU A. , POMMIER S. , TSAKALAKOS T. , CLAVEL M. , PRIOUL C.
Published: February 2006

Cold drawing steel wires lead to an increase of their mechanical strength and to a drop of their ductility. The increase of their mechanical strength has long been related to the reduction of the various material scales by plastic deformation, but the mechanisms controlling their elongation to failure have received relatively little attention. It is usually found that heavily deformed materials show a tendency to plastic strain localization and necking. However, in this paper it is shown that, though the steel wires are plastically deformed up to strain levels as high as 3.5, a significant capability of plastic deformation is preserved in as‐drawn wires. This apparent contradiction is resolved by the existence of residual stresses inside the wire. Finite element analyses have been conducted in order to show that residual stresses, inherited from the drawing process, are sufficient to produce a significant hardening effect during a post‐drawing tensile test, without introducing any hardening in the local material behaviour. The main conclusion of this paper is that once the material has lost its hardening capabilities, residual stresses, inherited from the process, control the elongation of cold drawn wires. The finite element method allowed also the determination of the residual stress field that would lead to the best agreement between the simulated and the experimental stress strain curve of as‐drawn wires.
Prediction of rubber fatigue life under multiaxial loading
Authors: ZINE A. , BENSEDDIQ N. , ABDELAZIZ M. NAÏT , HOCINE N. AÏT , BOUAMI D.
Published: February 2006

The process of fatigue failure of materials is generally described by two phases: crack initiation and crack propagation. This study concerns the crack initiation in rubbers submitted to a cyclic loading. A parameter based on the strain energy density (SED) and predicting the onset of primary crack and its probable orientation has been identified for such materials according to the investigations of Mars and Fatemi. More precisely, this criterion has been analytically developed in the cases of simple tension, biaxial tension and simple shear loadings by assuming large strains. The results denote the possibility to predict the orientation plane in which the primary crack would be expected to occur in a material. Then, it was implemented in a finite‐elements (FE) program in order to be applied to structures under any kind of the strain states. A good agreement was obtained between FE and analytical results for the usual strain states. Finally, to evaluate lifetime up to crack nucleation, we have achieved a set of experimental fatigue tests using uniaxial tension (UT) and pure shear (PS) test specimens containing a hole in order to localize the crack initiation. The obtained results proved the efficiency of the criterion to describe the fatigue life of rubbers under multiaxial loading.
Corneal endothelial cell morphology of normal dogs in different ages
Authors: Rodrigues Geórgia N. , Laus José L. , Santos Jaime M. , Rigueiro Moacyr P. , Smith Ricardo L.
Published: February 2006

Endothelial cell function is essential to maintain corneal transparency, but unfortunately the regenerative capacity of the endothelium is limited. There are only a few reports describing the effect of age on morphologic appearance of corneal endothelial cells of dogs. Studies of normal corneal endothelial cells in humans and dogs have shown a decrease in endothelial cell density (ECD) and an increase in pleomorphism and polymegethism with advancing age. The purpose of this study was to investigate the effect of age on ECD and endothelial cell morphology in dogs. A total of 30 dogs were divided into three groups (10 dogs/group) based on age: group 1 (2–12 months old), group 2 (24–72 months old), and group 3 (84 months or older). Corneas were processed for light and scanning electron microscopy. Results showed only difference in cell density between group 1 and groups 2 and 3, showing an initial decrease in cell density as the animal matured. Whereas there was significantly greater variation in cell size within the dogs in group 3 than there was within the other two groups, suggesting that there was increased polymegethism and pleomorphism with advancing age.
Possible association of glaucoma with pectinate ligament dysplasia and narrowing of the iridocorneal angle in Shiba Inu dogs in Japan
Authors: Kato Kumiko , Sasaki Nobuo , Matsunaga Satoru , Mochizuki Manabu , Nishimura Ryohei , Ogawa Hiroyuki
Published: February 2006

The purpose of the study was to describe the shape of the pectinate ligament (PL) and to estimate the width of the iridocorneal angle (ICA) in glaucomatous and nonglaucomatous eye of Shiba Inu dogs in Japan. One hundred fourteen Shiba Inu dogs were presented to the Veterinary Medical Center at the University of Tokyo between June 1998 and June 2003. Among these, 46 dogs had glaucoma; the remaining 68 dogs were presented for routine vaccinations or heartworm testing and were used as a control population. Complete ophthalmic examination and gonioscopy were performed in all the dogs. PL and ICA were evaluated by gonioscopy and goniophotographs. Of the 46 dogs with glaucoma, 17 (37%) were affected bilaterally, and 29 (63%) were affected unilaterally. Of the 29 dogs with unilateral glaucoma, the ICA of the normotensive eye was slightly narrow in 2 eyes (7%), narrow in 12 eyes (41%), and closed in 15 eyes (52%). Among the normotensive control group, the ICA was open in 13 dogs (19%), slightly narrow in 29 (43%), narrow in 22 (32%), and closed in 4 (6%). In dogs with narrow and slightly narrow ICAs, the PLs were thickened, and in some cases, formed a solid sheet. The majority of dogs with glaucoma had changes in both ICA and PL. A narrow or slightly narrow ICA was also detected in the majority of normotensive control dogs. This study suggests that ICA narrowing and PL thickening is a common abnormality in Shiba Inu dogs in Japan and may predispose those dogs to glaucoma.
Effects of travoprost 0.004% compared with latanoprost 0.005% on the intraocular pressure of normal dogs
Authors: Carvalho Alex B. , Laus José L. , Costa Vital P. , Barros Paulo S. M. , Silveira Patrícia R.
Published: February 2006

Purpose  To compare the effects of travoprost 0.004% and latanoprost 0.005% on the intraocular pressure (IOP) of normal dogs.

Methods  Twenty mixed breed dogs were randomized to two groups: latanoprost was used in group A and travoprost in group B. The drugs were instilled in the right eye of the dogs, whereas the left eye received placebo. Both drugs were instilled once a day at 8 am during 5 days. IOP measurements were made at 8 am, 10 am, 2 pm and 8 pm during the 5 days of treatment, the 3 days that preceded treatment, and 3 days following treatment. Presence of blepharospasm, miosis, anterior chamber flare, and conjunctival hyperemia were evaluated during the study.

Results  Mean IOP was significantly reduced in the eyes treated with both latanoprost and travoprost, when compared with the eyes treated with placebo (P < 0.05). There was no statistically significant difference between the mean IOPs of eyes treated with latanoprost and travoprost at all time intervals during baseline, treatment, and recovery (P > 0.05). On the fifth day of treatment and on the first day of the recovery period, a severe ocular hypotension was noted with both drugs, resulting in imprecise readings with the tonometer. Miosis and conjunctival hyperemia were observed in the treated eyes of both groups, whereas flare was noticed in one latanoprost‐treated eye.

Conclusion  Travoprost 0.004% significantly reduces the IOP in normal dogs. The hypotensive effect obtained with travoprost 0.004% is comparable to that obtained with latanoprost 0.005%.
Ophthalmic examination findings of Thoroughbred racehorses in Australia
Authors: Hurn Simon D. , Turner Andrew G.
Published: February 2006

Objective To record the prevalence and document the types of eye disease in population of Thoroughbred racehorses in Victoria, Australia.

Design Prospective study.

Animals Two hundred four Thoroughbred racehorses.

Procedure All horses and both eyes were examined at four metropolitan and two country racing stable complexes. Ophthalmic exam was performed following dark adaptation with a transilluminator, biomicroscope, and direct ophthalmoscope. Intraocular pressures were measured when indicated. Both pupils were dilated with tropicamide when indicated.

Results One hundred eighty‐two (89.2%) flat‐racing and 22 (10.8%) jump‐racing (hurdle or steeple) horses were examined. Age range: 2–9 years (mean 3.7 years, median 3); 97 (47.5%) male‐neuter, 74 (36. 3%) female, 33 (16.2%) male. Potential vision‐threatening eye disease was present in 15 (7.4%) different horses: complete lenticular cataracts 3, posterior lens luxation and cataract 1, large peripapillary ‘butterfly’ inactive lesions 3, large peripapillary ‘butterfly’ active lesions 2, peripapillary focal inactive ‘bullet hole’ chorioretinal lesions (> 20) 5, optic nerve atrophy 1. Non‐vision threatening eye disease was present in 117 (57.4%) different horses, involving one or more ocular structures: lower eyelid scars 3; periocular fibropapillomatous disease 1; third eyelid squamous cell carcinoma 1; corneal scars 6; corneal band opacity 2; anterior iris synechia 1; developmental cataracts 36 (17.2%); peripapillary focal inactive ‘bullet hole’ chorioretinal lesions (< 20) 103 (50.0%); linear peripapillary hyperpigmentation bands 16 (7.9%). Unusual variations of normal ocular anatomy and colobomata was recorded in 11 (5.4%) different horses: granular iridica hypoplasia 3, granular iridica hyperplasia 2, multilobular granular iridica cyst 1, microcornea 1, hyaloid remnant 1, rotated optic nerve head 1, coloboma of the lens 1, atypical coloboma of the retina 1.

Conclusions This survey demonstrates that the prevalence of vision‐threatening eye disease in racing horses may be greater than previously perceived, and highlights the importance of ocular examination within any routine physical examination of horses.
Effects of systemic administration of 0.5% tropicamide on intraocular pressure, pupillary diameter, blood pressure, and heart rate in normal cats
Authors: Schmidt Kristiane S. , Hacker Dennis V. , Kass Philip H. , Barkhoodarian Alex L.
Published: February 2006

Objective  The objective of the study was to determine the effects of systemic 0.5% tropicamide on intraocular pressure (IOP), pupillary diameter (PD), blood pressure, and heart rate (HR) in normal felines with normotensive eyes.

Procedures  Intraocular pressure, PD, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and HR were measured in 18 clinically healthy cats. Each of the previously mentioned parameters was measured every 30 min during the trial period. At T60, each cat was treated with one to two drops of 0.5% tropicamide ophthalmic solution placed on the dorsal aspect of the tongue. Changes in SBP, DBP, MBP, and HR were evaluated using one‐way repeated measures analysis of variance, with time as the repeated factor. IOP and PD were evaluated using two‐way repeated measures analysis of variance, with time and side (OD vs. OS) as the repeated factors. P values less than or equal to 0.05 were considered statistically significant.

Results  After lingual tropicamide administration, the mean PD at T60 was 3.53 mm OD and 3.53 mm OS. The mean PD at T90 was 6.36 mm OD and 6.31 mm OS. The mean PD at T120 was 8.25 mm OD and 8.19 mm OS. This change in PD from T60, T90, and T120 was statistically significant, demonstrating a linear increase in PD over time after tropicamide application on the tongue (P < 0.0001). There was no statistically significant difference in PD when comparing the right to the left pupils (P = 0.10). The mean IOP at T60 was 14 mmHg OD and 12.94 mmHg OS. The mean IOP at T90 was 14.5 mmHg OD and 14.23 mmHg OS. The mean IOP at T120 was 14.94 mmHg OD and 14.89 mmHg OS. This change in IOP from T60, T90, and T120 was statistically significant, demonstrating a linear increase in IOP over time after tropicamide application on the tongue (P = 0.034). There was no statistically significant difference in IOP when comparing the right eye to the left eye (P = 0.28). There were no statistically significant differences in SBP, DBP, MBP, and HR values over time for the duration of the study.

Conclusions  We conclude that although lingual application of tropicamide appears to result in systemic absorption, causing significant pupillary dilation and elevations in IOP, systemic effects on SBP, DBP, MBP, and HR were not observed.
Canine limbal melanoma: 30 cases (1992–2004). Part 1. Signalment, clinical and histological features and pedigree analysis
Authors: Donaldson D. , Sansom J. , Scase T. , Adams V. , Mellersh C.
Published: February 2006

Objectives (1) To review the signalment, clinical, and histological features of canine limbal melanoma; (2) to perform pedigree analysis on breeds predisposed to limbal melanoma to establish if common ancestry exists; and (3) to investigate if any ancestral relationship exists between canine limbal melanoma and canine anterior uveal melanoma (CAUM).

Design Retrospective study.

Animals studied Thirty dogs with limbal melanoma.

Methods Medical records of patients were reviewed. Follow‐up information was obtained by re‐examination of patients or telecommunications with the referring veterinary surgeons or the owners. Pedigrees were analyzed for common ancestry amongst affected dogs.

Results The mean age (± SD) at diagnosis was 6.2 (± 2.75) years with a range from 1 to 11 years. There was a bimodal distribution of ages with a peak at 3–4 years and a peak at 7–10 years. There was no eye predilection or predisposition for sex or coat color. Twenty‐five (83%) of the limbal melanomas occurred within a dorsal arc from the dorsomedial to the ventrolateral limbus. Golden retrievers were four times more common in the melanoma group compared to the Animal Health Trust population (P < 0.0001). Labrador retrievers were three times more common in the melanoma group (P = 0.01). Pedigree analysis on eight Golden retrievers [limbal melanoma (n = 5), CAUM (n = 2) and diffuse ocular melanosis (n = 1)], revealed a pattern of inter‐relatedness consistent with the condition(s) being caused, at least in part, by a genetic mutation(s). A similar level of inter relatedness was evident in six Labrador retrievers (limbal melanoma (n = 2) and CAUM (n = 4)). In 5/22 cases (23%), histological features suggestive of malignancy were present including intratumor necrosis in 4/22 cases (18%) and cellular atypia in 1/22 cases (5%).

Conclusions In Golden and Labrador retrievers there is evidence that limbal melanomas, CAUM and ocular melanosis are at least in part heritable and that the same genetic mutation(s) may be causally associated with melanocytic disease at different ocular sites. The same genetic mutation(s) may be present in these two breeds. Histology should be performed on all cases to identify those with greater malignant potential.
Subjective vs. objective analysis of the corneal endothelial cells in the rabbit cornea by scanning electron microscopy – a comparison of two different methods of corneal fixation
Authors: Doughty Michael J.
Published: February 2006

Objective  To illustrate a method of quantitative scanning electron microscopy (SEM) for the evaluation of the corneal endothelia of small animals by comparing two commonly used fixation methods.

Animals studied  Female New Zealand white rabbits, aged 10–12 weeks.

Procedures  The corneas were either dissected from the eye and placed in fixative (2% glutaraldehyde in 80 mm cacodylate, pH 7.4) or the whole eyeball immersed in fixative solution and the cornea dissected later. Lower (×200) and high magnification (×1000–5000) images were inspected for overall appearance. Magnification images (×500) were used to measure the areas of 100 cells, and cell density (CD) calculated from the average area.

Results  Both fixation protocols yielded an intact endothelial surface, but the dissect‐ then‐fix protocol resulted in more creasing and distortion artifacts that were avoided with the whole‐eyeball fixation. Overall, the CD values were higher if the dissect‐then‐fix method was used, and the uniformity of the cell mosaic was less. The median CD values for the central, mid‐peripheral and peripheral regions following dissect‐then‐fix protocols were 7693, 7353, and 7071 cells/mm2 (average eight corneas at each location). If the whole‐globe fixation was used, the median CD values were 6098, 5747, and 4785 cells/mm2.

Conclusion  Cell density values in SEM can be very different according to the fixation method used. A distinct regional difference in CD was evident, which was more pronounced if the cornea was fixed prior to being dissected from the eye.
The natural history of benign prostatic hyperplasia
Authors: FITZPATRICK JOHN M.
Published: February 2006

The progression of benign prostatic hyperplasia (BPH) can be defined as a deterioration of clinical variables such as lower urinary tract symptoms (LUTS), health‐related quality of life and peak flow rate, increased prostate size, or unfavourable outcomes such as acute urinary retention (AUR) and BPH‐related surgery. The natural history of BPH is best analysed from longitudinal studies of community‐dwelling men. In the Olmsted county study, which followed for 12 years a randomly selected cohort of 2115 men aged 40–79 years, there was an average increase in the International Prostate Symptom Score (IPSS) of 0.18 points per year, ranging from 0.05 for men in their fifties to 0.44 for those in their seventies. There was also a decrease in peak flow rate of 2% per year and a median prostate growth of 1.9% per year. The cumulative incidence of AUR was low (2.7% over 4 years). Information can also be collected from the placebo arms of controlled studies of men with symptomatic BPH, although the strict trial inclusion criteria and indeed the taking of a placebo itself introduce biases which limit the analysis of the natural history of the disease in this way, and its applicability to the general population. Hence, in the Medical Therapy of Prostatic Symptoms study, there is clear evidence that symptom deterioration, defined by a worsening of the IPSS of ≥ 4 points, was by far the most prevalent progression event (79.5%), with a cumulative incidence of 14% over a mean follow‐up of 4.5 years. As in the longitudinal community‐based studies, AUR was rather uncommon (14.8% of overall progression events) with a cumulative incidence of 2%. BPH‐related surgery, which was a secondary criterion in the study, was required in 5% of men. Similar conclusions can be drawn from a 2‐year placebo‐controlled study (ALTESS) assessing the impact of alfuzosin 10 mg once daily on LUTS/BPH progression in 1522 men with symptomatic BPH at high risk of developing AUR. Symptom deterioration was clearly the main progression event, with a cumulative incidence of 16.8%, compared to BPH‐related surgery (6.5%) and AUR (2.2%). Thus, there is evidence from longitudinal studies, and to a lesser extent from the placebo arms of large controlled studies, that BPH is a progressive disease. Symptom worsening is by far the most frequently occurring progression event. Identifying those patients at risk of BPH progression is crucial to optimize their management.
Definition of at‐risk patients: baseline variables
Authors: ROEHRBORN CLAUS G.
Published: February 2006

Benign prostatic hyperplasia (BPH) represents a significant burden in ageing men due to frequently associated lower urinary tract symptoms (LUTS), which may impair their quality of life. Some men will have progressive disease, mainly characterized by symptom deterioration of ≥ 4 points on the International Prostate Symptom Score, but also by the occurrence of acute urinary retention (AUR) and BPH‐related surgery. Identifying those at risk of unfavourable outcomes is important to optimize their management. Community‐based longitudinal studies provide excellent data on the natural history of BPH. Baseline variables such as age, severe LUTS, low peak flow rate, high postvoid residual urine volume (PVR), enlarged prostate and high serum prostate‐specific antigen (PSA) levels, have been identified as risk factors for AUR and BPH‐related surgery in such studies. Placebo arms of controlled studies have more limited value for assessing the natural history, due to strong selection criteria which generate a regression to the mean artefact and narrow the applicability to the general population. Nevertheless, in these controlled studies, baseline serum PSA level and to a lesser extent prostate size consistently predicted the risk of AUR and BPH‐related surgery. Conversely, quantitative variables such as baseline symptom severity and peak flow rate behaved paradoxically, probably as a consequence of strict inclusion criteria, resulting regression to the mean, and ‘ceiling’ effects. Results from the Medical Therapy of Prostatic Symptoms study and the Alfuzosin Long‐Term Efficacy and Safety Study also suggest that using the PVR in clinical practice needs to be reconsidered as a predictor of BPH progression. Further research is needed to clarify the role of chronic inflammation in the process of BPH progression.
Definition of at‐risk patients: dynamic variables
Authors: EMBERTON MARK
Published: February 2006

Benign prostatic hyperplasia (BPH) is a progressive disease, mainly characterized by a deterioration of symptoms over time, but also the occurrence in some patients of serious outcomes such as acute urinary retention (AUR) and the need for BPH‐related surgery. The goals of therapy are not only to improve symptoms and restore an acceptable quality of life, but also to identify patients at risk of disease progression, to optimize their management. Baseline variables such as age, severe lower urinary tract symptoms (LUTS), a low peak flow rate, increased postvoid residual urine volume (PVR), enlarged prostate and high serum prostate‐specific antigen (PSA) levels have been identified as predictors of AUR and BPH‐related surgery in community‐based longitudinal studies. In the placebo arm of controlled studies, baseline serum PSA level and to a lesser extent prostate size consistently predict the risk of AUR and BPH‐related surgery, while quantitative variables such as baseline symptom severity and peak flow rate behave paradoxically and are poor predictors of BPH progression. There is increasing evidence from longitudinal community‐based studies and the Medical Therapy of Prostatic Symptoms study that dynamic variables (e.g. symptom and PVR worsening) serve as good predictors of AUR in men with LUTS suggestive of BPH. The ‘real‐life’ practice study Alf‐One also suggests that men not responding to alfuzosin treatment (International Prostate Symptom Score stable or worsening, and bother score >3 under treatment) have a greater risk of having AUR or requiring BPH‐related surgery. First‐line treatment with alfuzosin might thus help to select patients at risk of BPH progression, to optimize their management.
Management of acute urinary retention
Authors: FITZPATRICK JOHN M. , KIRBY ROGER S.
Published: February 2006

Acute urinary retention (AUR) is a common urological emergency, characterized by a sudden and painful inability to pass urine. There is high variability within and among countries in its management, which can be explained not only by differences in access to care but also by a lack of harmonization and consensus on the best way to proceed. Immediate treatment consists of bladder decompression, usually by a urethral catheter, although a suprapubic catheter offers several advantages not often exploited by urologists. Until recently, secondary management consisted almost exclusively of prostatic surgery within a few days (emergency surgery) or a few weeks (elective surgery) after a first AUR episode. The greater morbidity and mortality associated with emergency surgery, and the potential morbidity associated with prolonged catheterization, has led to the increasing use of a trial without catheter; this involves catheter removal after 1–3 days, allowing the patient to void in 23–40% of cases, and surgery, if needed, at a later stage. α1‐adrenergic blockers given before catheter removal improve the chances of success. A high prostate‐specific antigen level and postvoid residual urine volume, and response to alfuzosin treatment after a first AUR episode managed conservately, may help to identify patients at risk of an unfavourable outcome.
Lower urinary tract symptoms and sexual dysfunction: epidemiology and pathophysiology
Authors: McVARY KEVIN
Published: February 2006

There is ample evidence from many epidemiological studies that lower urinary tract symptoms (LUTS) and sexual dysfunction are strongly linked, independently of age and comorbidities such as hypertension, diabetes, dyslipidaemia and coronary heart disease. However, a causal link between both conditions is not yet established. Four pathophysiological mechanisms currently support the relationship between LUTS and erectile dysfunction (ED): (i) The nitric oxide synthase (NOS)/NO theory; there is a reduction in NOS‐containing nerves in the prostate and bladder/urethra in patients with bladder outlet obstruction (BOO), and that lack of NO or loss of protein kinase G causes ED; (ii) The autonomic hyperactivity and metabolic syndrome hypothesis: benign prostatic hyperplasia (BPH) may be part of the metabolic syndrome, which includes cardiovascular diseases (e.g. hypertension, ischaemic heart disease) and diabetes mellitus, known risk factors for ED. Hypertension, obesity, and hyperinsulinaemia have all been claimed to be associated with an increased sympathetic activity. Increased sympathetic activity is involved in LUTS/BPH and may have a role in ED/sexual dysfunction, with noradrenaline and α1‐adrenoceptors representing a common link; (iii) the Rho‐kinase activation/endothelin pathway; there can be increased Rho‐kinase activity, and consequently calcium sensitivity of the contractile machinery, in prostate smooth muscle in BPH, the detrusor in BOO, corpora cavernosa in ED, and in the resistance vessels in hypertension. The actions of several factors beside noradrenaline (e.g. endothelin‐1, angiotensin II), possibly involved in the increased smooth muscle activity found in both LUTS/BPH and sexual dysfunction, are dependent on Rho‐kinase activity. Thus increased Rho‐kinase activity might represent a common link between LUTS and sexual dysfunction; (iv) Pelvic atherosclerosis; animal models mimicking pelvic ischaemia and hypercholesterolaemia show similar smooth muscle alterations of the detrusor and corpora. Pelvic ischaemia may induce the biological modifications described above and may thus represent as well a common link between LUTS and sexual dysfunction. Studies treating one condition (e.g. ED) and measuring the impact on the other (e.g. LUTS) should further contribute to support this common link.
Assessment of sexual dysfunction in patients with benign prostatic hyperplasia
Authors: ROSEN RAYMOND C.
Published: February 2006

Sexual dysfunction is a highly prevalent condition in ageing men that considerably affects their quality of life, although it is a frequently neglected aspect of healthcare. The main predictors of sexual dysfunction are age and cardiovascular comorbidities such as hypertension, heart disease, hypercholesterolaemia and diabetes. Recently, the severity of lower urinary tract symptoms (LUTS) has also been identified as a crucial risk factor for sexual dysfunction, independent of age and comorbidities. Despite the increased prevalence of sexual dysfunction with age, health‐related problems and psychological factors, there is evidence that many older men remain sexually active. Currently available self‐administered questionnaires assessing male sexual dysfunction focus almost exclusively on erectile function. There is evidence from recent large‐scale epidemiological studies that ejaculatory dysfunction (EjD) is almost as prevalent as erectile dysfunction (ED), affecting nearly half of men aged ≥ 50 years. Other domains such as orgasm, desire, and satisfaction with sex life are important and should be considered. There is thus a need to develop and validate more comprehensive and multidimensional instruments for assessing sexual dysfunction in ageing men. A new instrument, the Male Sexual Health Questionnaire (MSHQ), was developed and validated to assess these specific aspects of male sexual dysfunction . It consists of a 25‐item self‐administered questionnaire including three core domains (erection, ejaculation, satisfaction with sex life) and additional items related to sexual activity, desire and bother related to sexual dysfunction. The MSHQ scale has excellent psychometric properties and is well suited for use in clinical and research settings. A short form of the MSHQ scale is currently under development.
Impact of medical treatments for benign prostatic hyperplasia on sexual function
Authors: GIULIANO FRANCOIS
Published: February 2006

Lower urinary tract symptoms (LUTS) and male sexual dysfunction are highly prevalent in ageing men, and are strongly linked. Various treatment strategies for benign prostatic hyperplasia (BPH)/LUTS may affect sexuality, with differences between drug classes and between drugs within a same class. The 5α‐reductase inhibitors, finasteride and dutasteride, are associated with a greater risk of erectile dysfunction (ED), ejaculatory dysfunction (EjD) and decreased libido than is placebo. α1‐adrenoceptor blockers (alfuzosin, doxazosin, tamsulosin, terazosin) show an incidence of decreased libido and ED closely similar to placebo, but differ in their impact on ejaculation, tamsulosin being associated with a higher incidence of EjD (10%) than other α1‐adrenoceptor blockers (0–1%) and placebo (1%), which is unrelated to retrograde ejaculation or higher efficacy. A randomized, placebo‐controlled, cross‐over study conducted in healthy volunteers showed that tamsulosin 0.8 mg once daily markedly decreased mean ejaculate volume in almost 90% of subjects, with 35% having no ejaculation. By contrast, there was no lack of ejaculation in subjects receiving alfuzosin 10 mg once daily or placebo. Sperm concentrations in urine after ejaculation were similar for the three treatment groups, confirming that the EjD with tamsulosin was unrelated to retrograde ejaculation. It may be related to a peripheral effect on seminal vesicles and/or the vas deferens. A central effect is also plausible, as tamsulosin shows a strong affinity for 5HT1A‐ and D2‐like receptors, both of which are involved in the central command of ejaculation. In conclusion, because treatment options for managing BPH have different effects on sexuality, the sexual dimension should be considered when assessing patients’ expectations and the choice of treatment.
Choice, Diversity and ‘Exit’ in Schooling — A Mixed Picture
Authors: SLIWKA ANNE , ISTANCE DAVID
Published: February 2006

Traditionally, most systems have required that parents send their children to a school within the district of residence and close to the family home, sometimes with an elite private system co‐existing alongside. In recent years, this basic model has been modified, with some countries witnessing more extensive changes than others. This article outlines the range of change that has taken place along the dual axes of promoting diversity and establishing room for the exercise of parental choice. The synthesis article draws on the material submitted by all the countries participating in the OECD study, and not only those which feature specifically in this issue.

The first section reviews the current situation regarding parental choice of school and evidence relating to how that choice is exercised by different groups of parents. For choice to be exercised, there must be alternatives to choose from, and hence there follows a review of some of the policies and practices for diversity. The article then examines diversity in more forms contrasting selective and non‐selective schools, public and private schools, and formal and home schooling. Several countries have moved to greater diversification of public education, allowing for different types of schools accommodating different student ability levels or parents’ educational preferences. The role of demand is clearly a central element in their emergence and differing fortunes. This in turn is closely, but not exclusively, related to the familiar factors of social advantage and reproduction as well as to issues of value choices and beliefs.
The Centros Concertados in Spain, Parental Demand and Implications for Equity
Authors: JACOTT LILIANA , RICO ANTONIO MALDONADO
Published: February 2006

In Spain, the exercise of choice by parents of a suitable school for their children is not practised by all families in the same way. The evidence shows that an increasing social polarisation and a substantial disequilibrium in schooling are taking place in compulsory education. There is a high concentration of immigrant students in public schools in contrast with what happened in the centros concertados (private schools with public funding). This situation is especially unbalanced in some Autonomous Communities, such as the Community of Madrid, Catalonia, Valencia and Andalusia. The inequalities in the distribution of students in the network of public schools and private schools financed by public funds are producing significant responses from parents, teachers, experts, and also from other social groups. Some of the proposals made by different experts and by the Spanish Ministry of Education are analysed in order to reach to a quality education in more equitable conditions for all students.
Cross‐border Higher Education Collaboration in Europe: lessons for the ‘two Irelands’?
Authors: OSBORNE ROBERT D.
Published: February 2006

This article examines three examples of cross‐border higher education collaboration in Europe in order to throw light on one European region where such collaboration is only in its early stages of development. The main region examined is the Öresund region covering the Skåne area of Southern Sweden centred on Malmo and the Zealand region of Denmark which incorporates the Copenhagen region. Additionally, and more briefly, the Upper Rhine collaboration of the EUCOR universities and the ALMA collaboration (Netherlands, Germany and Belgium) are considered. Lessons from these examples are then used to assist in the assessment of existing collaboration between higher education institutions in the Republic of Ireland and Northern Ireland and the possibilities for further collaboration.
Psychological Resilience After Disaster
Authors: Bonanno George A. , Galea Sandro , Bucciarelli Angela , Vlahov David
Published: February 2006

Research on adult reactions to potentially traumatic events has focused almost exclusively on post-traumatic stress disorder (PTSD). Although there has been relatively little research on the absence of trauma symptoms, the available evidence suggests that resilience following such events may be more prevalent than previously believed. This study examined the prevalence of resilience, defined as having either no PTSD symptoms or one symptom, among a large (n = 2,752) probability sample of New York area residents during the 6 months following the September 11th terrorist attack. Although many respondents met criteria for PTSD, particularly when exposure was high, resilience was observed in 65.1% of the sample. Resilience was less prevalent among more highly exposed individuals, but the frequency of resilience never fell below one third even among the exposure groups with the most dramatic elevations in PTSD.
Tracking Exceptional Human Capital Over Two Decades
Authors: Lubinski David , Benbow Camilla P. , Webb Rose Mary , Bleske-Rechek April
Published: February 2006

Talent-search participants (286 males, 94 females) scoring in the top 0.01% on cognitive-ability measures were identified before age 13 and tracked over 20 years. Their creative, occupational, and life accomplishments are compared with those of graduate students (299 males, 287 females) enrolled in top-ranked U.S. mathematics, engineering, and physical science programs in 1992 and tracked over 10 years. By their mid-30s, the two groups achieved comparable and exceptional success (e.g., securing top tenure-track positions) and reported high and commensurate career and life satisfaction. College entrance exams administered to intellectually precocious youth uncover extraordinary potential for careers requiring creativity and scientific and technological innovation in the information age.