bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of quality of life in Chinese patients with gynaecological cancer: Assessments by patients and nurses
Authors: Zhao Hong , Kanda Katsuya , Liu Shao‐Jin , Mao Xiu‐Ying
Published: March 2003

Quality of life (QOL) has recently become one of the most important focuses in oncology nursing practice and research. The aims of this study were to evaluate the QOL in Chinese cancer patients under chemotherapy and to explore the discrepancy between patients’ and nurses’ assessments of the patients’ conditions. The study participants included gestational trophoblastic disease patients (n = 68), ovarian cancer patients (n = 105), patients with other gynaecological cancer (n = 18), and their attending nurses (n = 25) at hospitals affiliated with universities in Beijing. The high level of some symptom subscales/items in patients suggested that innovative and more effective interventions should be developed and utilised in nursing practice. Patients with metastasis reported lower levels of QOL than those without metastasis. The nurses in this study tended to estimate the patients’ QOL inaccurately, except for a few objective aspects. The results of this study can help nurses in planning interventions to enhance the QOL of patients with gynaecological cancer undergoing chemotherapy. The nurses need to be trained to become more sensitive and competent in assessing patients’ subjective information.
Effects of sleep loss in men and women with insufficient sleep suffering from chronic disease: A model for supportive nursing care
Authors: Edéll‐Gustafsson Ulla M. , Gustavsson Gunilla , Yngman Uhlin Pia
Published: March 2003

This study evaluated self‐reported subjective health and effects of sleep loss according to perceived interfering cognitive anxiety related to falling asleep in patients with and without insufficient sleep and gender differences in these aspects 5 years after coronary artery bypass graft and transluminal coronary angioplasty. A total of 145 patients, five years after intervention, responded to a mailed questionnaire. Nearly 60% had severe combined sleep disturbances; 35.9% of these had complained of insufficient sleep and 15% also perceived difficulty falling asleep related to cognitive anxiety. Measurable gender differences were small. A theoretical framework is presented which can increase understanding among nurses, patients and their relatives concerning the quality and quantity of sleep and sleep loss related to quality of life. These results suggest that there are significant relationships between sleep quality, resilience to stress and coping strategy in patients with a chronic disease, indicating the need for more individualised supportive nursing care.
Pulmonary thromboendarterectomy in the UK
Authors: Doughty Natalie , Pontin Megan , Saunders Michelle , Donn Lorraine
Published: March 2003

This paper describes the disease of chronic thromboembolic pulmonary hypertension. This is a disease with an extremely poor prognosis, and the surgical procedure of pulmonary thromboendarterectomy represents the only possibility of a cure for patients with this condition. Further the paper describes the role and responsibilities of critical care nurses, specialist nurses in palliative care and pulmonary hypertension when caring for these patients before and after surgery.
Blueschist blocks at Mochimaru in the Tari‐Misaka ultramafic complex: Their petrologic characteristics and significance
Authors: Nozaka Toshio
Published: March 2003

Blueschist tectonic blocks occur in serpentinites at Mochimaru, Hiroshima Prefecture, Southwest Japan. They contain alkali amphibole coexisting with pumpellyite and chlorite, with or without calcic amphibole. Textural and chemical analyses reveal that the blueschists, together with other mafic schists, have similar metamorphic history. After their capture by serpentinites and before the emplacement of the serpentinites into the present geological position, the tectonic blocks were subjected to high P/T metamorphism around the boundary between the blueschist and pumpellyite–actinolite facies. The amphiboles formed by this metamorphism change from tremolite through glaucophane to ferroglaucophane with increasing FeO/MgO of whole rock compositions. The P–T conditions are estimated to be within 200–350°C and 5–7 kbar. These are higher P/T conditions than those of the regional metamorphism of Southwest Japan. The difference in the P–T conditions implies differences in tectonic situation and timing of metamorphism between the blocks and regional metamorphic rocks. In addition, the high P/T metamorphism of the tectonic blocks probably occurred in more reducing environments than the regional metamorphism. Because the ferric/ferrous iron ratios of the tectonic blocks are within a narrow range, it is stressed that oxygen fugacity was externally buffered during the high P/T metamorphism by the serpentinization process of the host ultramafic rocks. The reducing effect of serpentinization is common throughout the high P/T metamorphic terranes of Southwest Japan.
Volcanic history and tectonics of the Southwest Japan Arc
Authors: Kamata Hiroki , Kodama Kazuto
Published: March 2003

Abstract Remarkable changes in volcanism and tectonism have occurred in a synchronous manner since 1.5–2 Ma at the junction of the Southwest Japan Arc and the Ryukyu Arc. Although extensive volcanism occurred in Kyushu before 2 Ma, the subduction‐related volcanism started at ca 1.5 Ma, forming a NE–SW trend volcanic front, preceded by significant changes in whole‐rock chemistry and mode of eruptions at ca 2 Ma. The Median Tectonic Line has intensified dextral motion since 2 Ma, with a northward shift of its active trace of as much as 10 km, accompanied by the formation of rhomboidal basins in Central Kyushu. Crustal rotation and incipient rifting has also occurred in South Kyushu and the northern Okinawa Trough over the past 2 million years. We emphasize that the commencement age of these events coincides with that of the transition to the westward convergence of the Philippine Sea plate, which we interpret as a primary cause of these synchronous episodes. We assume that the shift in subduction direction led to an increase of fluid component contamination from subducted oceanic slab, which then produced island‐arc type volcanism along the volcanic front. Accelerated trench retreat along the Ryukyu Trench may have caused rifting and crustal rotation in the northern Ryukyu Arc.
Generation of rhyolite magmas by melting of subducting sediments in Shodo‐Shima island, Southwest Japan, and its bearing on the origin of high‐Mg andesites
Authors: Shimoda G. , Tatsumi Y.
Published: March 2003

Abstract Geochemical characteristics of rhyolites from the Miocene Setouchi volcanic belt in the Southwest Japan arc were examined. The following observations may be best explained by the derivation of rhyolite magmas by melting of subducting sediments as follows. (i) Sr‐Nd‐Pb isotope compositions of Setouchi rhyolites are close to those of the local trench‐fill sediments; (ii) major element compositions of rhyolites are identical to those of experimentally produced sediment melts; and (iii) concentrations of incompatible elements in rhyolites are consistent with partial melting of the local trench‐fill sediments in the presence of residual garnet. Furthermore, trace element and isotope signatures of Setouchi high‐Mg andesites can be also rationalized by interaction of such rhyolitic sediment melts with overlying mantle peridotites.
Tectonic implication of Lower Cretaceous chromian spinel‐bearing sandstones in Japan and Korea
Authors: Hisada Ken‐Ichiro , Arai Shoji , Il Lee Yong
Published: March 2003

AbstractIn Japan and Korea, some Lower Cretaceous terrigenous clastic rocks yield detrital chromian spinels. These chromian spinels are divided into two groups: low‐Ti and high‐Ti. The Sanchu Group and the Yuno Formation in Japan have both groups, whereas the Nagashiba Formation in Japan and the Jinju Formation in Korea have only the low‐Ti spinels. High‐Ti spinels are thought to have originated in intraplate‐type basalt. Low‐Ti spinels (higher than 0.6 Cr#) were probably derived from peridotites, which are highly correlated with an arc setting derivation and possibly with a forearc setting derivation. Low‐Ti spinels are seen in the Sanchu Group, the Nagashiba Formation and the Jinju Formation. Low‐Ti spinels from the Yuno Formation are characterized by low Cr# (less than 0.6) and these chromian spinels appear to have been derived from oceanic mantle‐type peridotite, including backarc. According to maps reconstructing the pre‐Sea of Japan configuration of the Japanese Islands and the Korean Peninsula, the Korean Cretaceous basin was comparatively close to the Southwest Japan depositional basins. It is possible that these Lower Cretaceous systems were sediments mainly in the forearc and partly in the backarc regions. The peridotite might have infiltrated along major tectonic zones such as the Kurosegawa Tectonic Zone (= serpentinite melange zone) in which left lateral movement prevailed during the Early Cretaceous.
New age data from the Lesnaya Group: A key to understanding the timing of arc‐continent collision, Kamchatka, Russia
Authors: Soloviev Alexei V. , Shapiro Mikhail N. , Garver John I. , Shcherbinina Ekaterina A. , Kravchenko‐Berezhnoy Igor R.
Published: March 2003

Abstract The Lesnaya Group is part of a thick, poorly dated turbidite assemblage that sits in the footwall of a regionally extensive collision zone in which the Cretaceous–Paleocene Olutorsky island arc terrane was obducted onto continental margin basin strata. Nannoplankton from 18 samples from the upper part of the Lesnaya Group yield Paleocene through Middle Eocene assemblages. Detrital zircons from nine sandstone samples have a young population of fission‐track ages that range from 43.7 ± 3.4 to 55.5 ± 3.5 Ma (uppermost Paleocene to Middle Eocene). The deformed footwall rocks of the Lesnaya Group and the overlying thrusts of the Olutorsky arc terrane, are unconformably overlain by neoautochthonous deposits which are Lutetian (lower Middle Eocene) and younger. Together, these new data indicate that thrusting, which is inferred to have been driven by collision of the Cretaceous–Paleocene island arc with north‐eastern Asia, took place in the mid‐Lutetian, at about 45 Ma.
Structural position of the Seba eclogite unit in the Sambagawa Belt: Supporting evidence for an eclogite nappe
Authors: Aoya Mutsuki
Published: March 2003

Abstract  Eclogite‐bearing units in the Sambagawa Metamorphic Belt have long been considered tectonic blocks that have disparate tectonic and metamorphic histories that are distinct from each other and from the major non‐eclogitic Sambagawa schists. However, recent studies have shown that eclogite facies metamorphism of the Seba eclogite unit is related to the subduction event that caused the metamorphism of the non‐eclogitic Sambagawa schist. New structural data further show that the Seba eclogite unit, which appears to be isolated from the other eclogite units, is in fact in structural continuity with them, occupying the highest structural levels in the Sambagawa Belt. This suggests that eclogitic metamorphism of the other eclogite units is also related to the Sambagawa subduction event. It is, therefore, possible that all eclogite units in the Sambagawa Belt constitute a single coherent unit, the eclogite nappe, members of which underwent the same eclogitic metamorphism related to the Sambagawa subduction event.
Hepatic transport systems
Authors: FERENCI PETER , ZOLLNER GERNOT , TRAUNER MICHAEL
Published: March 2003

The identification of the genes responsible for various genetic liver disorders lead to a better understanding of basic physiology of hepatic transport systems. In this review we focus on transport systems involved in the generation of bile and in the maintenance of copper homeostasis. Abnormal function of these transporters results in diseases like Wilson’s disease, progressive familial cholestasis syndromes, Dubin–Johnson syndrome and cystic fibrosis. Beyond these well defined diseases, functional impairments of transport proteins may predispose to non‐genetic diseases ranging from intrahepatic cholestasis of pregnancy to neurodegenerative disorders including Alzheimer’s disease.
A new enzyme immunoassay for the detection of antibody to hepatitis E virus
Authors: OBRIADINA A , MENG JH , ULANOVA T , TRINTA K , BURKOV A , FIELDS HA , KHUDYAKOV YE
Published: March 2003

Background and Aim
: The purpose of the present study was to develop enzyme immunoassay (EIA) for the detection of IgG anti‐hepatitis E virus (HEV) activity using two new recombinant proteins as antigenic targets, and to evaluate these EIA with the aid of statistical methods.

Methods
: Two proteins, a mosaic protein and pB166 containing region 452–617 aa of the ORF2 of the HEV Burma strain, were used to develop the new HEV EIA. This EIA was evaluated using several panels of serum specimens obtained from: (i) acutely HEV‐infected patients; (ii) patients with non‐A, non‐C hepatitis; (iii) normal blood donors (NBD) from non‐endemic countries; and (iv) experimentally infected chimpanzees.

Results
: A new HEV EIA was developed using two new recombinant proteins. This assay was able to detect anti‐HEV activity in all specimens from acutely HEV‐infected patients. When NBD were tested, more than 15% of specimens were found to be IgG anti‐HEV positive. All NBD anti‐HEV‐positive specimens were tested with overlapping synthetic peptides spanning the entire HEV ORF2‐encoded protein. More than 90% of the anti‐HEV‐positive NBD specimens immunoreacted with an average of 15 synthetic peptides derived from different regions of the HEV ORF2 protein. These data suggest that the HEV EIA is at least 90% specific in detecting remote HEV infections.

Conclusion
: The new HEV EIA developed in the present study is a highly specific diagnostic assay for the detection of anti‐HEV activity in serum specimens obtained from different epidemiologic settings.

© 2002 Blackwell Publishing Asia Pty Ltd
Autoimmune hepatitis and overlap syndromes
Authors: VOGEL ARNDT , WEDEMEYER HEINER , P MANNS MICHAEL , STRASSBURG CHRISTIAN P
Published: March 2003

Abstract  Autoimmune hepatitis is a well‐established chronic liver disease. It primarily affects women, is characterized by circulating autoantibodies and elevated gammaglobulins and is associated with extrahepatic immune‐mediated syndromes. Treatment regimens have remained unchanged for a number of years because of the high efficacy of steroid monotherapy, or combination therapy of azathioprine and steroids. In approximately 90% of patients remission of the disease is reached by medical therapy, which is usually administered lifelong because long‐term remission after drug withdrawal is achieved in only 17% of patients. In 10% of patients treatment failure is observed. The challenge of remission induction involves the use of transplant immunosuppressants such as cyclosporine, mycophenolate moffetil, and tacrolimus. The challenge of maintenance therapy minimizing steroid side‐effects involves the evaluation of topical steroids and the use of azathioprine monotherapy. Overlap syndromes occur in approximately 20% of autoimmune liver diseases. The diagnosis is broadly based on serological, biochemical, clinical and histological parameters. Most common are the overlap of autoimmune hepatitis and primary biliary cirrhosis, as well as autoimmune hepatitis with primary sclerosing cholangitis. These yet incompletely defined syndromes are an important differential diagnosis in the diffcult‐to‐treat patient with autoimmune hepatitis.

© 2002 Blackwell Publishing Asia Pty Ltd
Proliferation of hepatic metastases of colorectal carcinoma: Relationship to primary tumours and prognosis after hepatic resection
Authors: Nanashima Atsushi , Yamaguchi Hiroyuki , Shibasaki Shinichi , Sawai Terumitsu , Yasutake Toru , Tsuji Takashi , Nakagoe Tohru , Ayabe Hiroyoshi
Published: March 2003

In this study, we determined the proliferation indices of liver metastatic tumours originating from colorectal carcinomas using Ki67 and argyrophil nucleolar organizer region associated proteins (AgNOR) stain. We examined the primary and metastatic tumours in 27 patients with liver metastasis and eight cases with non‐metastatic colorectal carcinoma as a control. The number of AgNOR dots in metastatic tumours was significantly higher than in the respective primary tumours of the metastasis group or in non‐metastatic colorectal carcinomas. The Ki67 labelling index was similar in all groups. The Ki67 labelling index and AgNOR counts did not correlate with each other. There was no significant relationship between proliferation indices and the duration of the disease‐free period following hepatic resection for metastases or with prognosis after hepatectomy. We conclude that Ki67 and AgNOR are not useful indicators of prognosis in patients who undergo operation for liver metastasis of colorectal carcinomas.
CASE REPORT: Patent ductus venosus
Authors: Nagano Ken’Ichi , Hoshino Hiroshi , Nishimura Daisaku , Katada Naoyuki , Sano Hiroshi , Kato Katsumoto
Published: March 2003

Background: Patent ductus venosus is extremely rare with only 14 cases reported in the world literature. We present a case of patent ductus venosus.

Methods and Results: A 29‐year‐old male was admitted with melaena stool caused by gastric haemorrhagic ulcers. Laboratory data disclosed severe anaemia; however, liver function tests were normal. Serum ammonia was also within the normal range. Serological viral markers for hepatitis B or C were all negative. The abdominal ultrasonography and computed tomography indicated a 12 mm diameter shunt located in the left lobe of the liver, which connected the portal vein with the left hepatic vein. After treatment for gastric ulcers, percutaneous transhepatic portography was performed and an enormous shunt connecting the umbilical portion of the portal vein with the left hepatic vein was revealed.

Conclusions: Histological findings of the liver biopsy showed that portal venules could not be observed in the portal areas and that no fibrosis or inflammatory cell infiltration were shown. Because of the anatomical position of the shunt, the case was diagnosed as patent ductus venosus.
Characterization of anti‐hepatitis C virus‐positive sera not genotyped by restriction fragment length polymorphism or serology
Authors: Gish Robert , Qian Keping , Brooks Linda , Leung Janet , Xu Yiling , Pike Ian , Lau Johnson
Published: March 2003

Background: The hepatitis C virus genome is extremely heterogeneous and has been classified into six major genotypes. Genotyping of hepatitis C has been achieved through both direct molecular approach and indirect detection of host genotype‐specific antibodies by serological methods. The purpose of this study was to characterize anti‐hepatitis C positive sera samples that were not genotyped either by restriction fragment length polymorphism or by serology.

Methods: Two hundred and two patients from northern California with established chronic hepatitis C virus infection were studied by restriction fragment length polymorphism analysis of the 5′‐ untranslated region amplicon. A serological genotyping assay, based on synthetic peptides derived from non‐structural region 4 of the hepatitis C virus genome, was used to determine serological genotype.

Results: Of the 202 patients studied, 187 (93%) were polymerase chain reaction‐positive. One hundred and eighty‐six patients were able to be genotyped by restriction fragment length polymorphism, compared with 144/202 (71%) of patients genotyped by serology (P < 0.0001). Only two of 202 samples showed discordant genotyping results. The distribution of hepatitis C virus genotypes in northern California was found to be type 1a, 41%; 1b, 35%; 2a, 3%; 2b, 10%; 3a, 11%; and 4, < 1%. There was no association between hepatitis C genotypes and age, gender distribution, ethnic origin, presumptive mode of transmission, serum alanine aminotransferase levels and the proportion of patients with cirrhosis. Of the 15 patients who were not genotypable by the molecular assay, four patients were genotyped by serology, with hepatitis C virus genotypes 1, 2 and 3 represented. Of the 58 samples that were not genotyped by serology, 47 were genotyped based on the molecular assay, and the distribution of hepatitis C virus genotypes was similar to that of the overall study population.

Conclusions: These data showed that: (i) molecular genotyping assay based on 5′‐untranslated region is more sensitive than serologic genotyping based on the non‐structural‐4 region but the results were highly concordant; (ii) hepatitis C virus genotypes 1–4 are present in northern California, with genotype 1 being the most prevalent; and (iii) the failure to determine hepatitis C virus genotype based on molecular or serological genotyping assay does not appear to be related to specific hepatitis C genotypes.
Relationship between the effect of interferon therapy and the change of hepatitis C virus non‐structural 5B gene
Authors: Horiike Norio , Michitaka Kojiro , Masumoto Toshikazu , Okura Izumi , Akbar Sm , Onji Morikazu
Published: March 2003

Background: Hepatitis C virus (HCV)‐RNA titre has been regarded as a factor affecting the response to interferon (IFN) therapy of patients with chronic hepatitis C (CHC). The focus of our study is the investigation of the nucleotide sequence of HCV‐RNA NS5B, which may code RNA‐dependent RNA polymerase and NS5A in the sera of 33 patients with CHC prior to IFN therapy.

Methods: Hepatitis C virus genotype and HCV‐RNA titre were examined by polymerase chain reaction (PCR) and competitive reverse transcriptase‐PCR.

Results: The sequence for HCV‐RNA NS5B (nt 8331–8600 in 1b and 8410–8679 in 2a) was determined by direct sequencing. The changes of the predicted amino acids in the genotype‐specific sites of HCV‐J, HCV‐BK, HC‐J4/83, HCV‐JT, HCV‐N, HC‐J6 and HCV‐K2a were examined, and the mutation was defined when changes of amino acids in sites specific to different reported genotypes were revealed. The mutations were observed in 6/19 (32%) in genotype 1b and 9/14 (64%) in 2a. In the 1b group, complete response (CR) was achieved in 5/6 of the mutant and in 2/13 of the wild type groups (P < 0.05). No relationship was observed between IFN effectiveness and HCV‐RNA titre in the 1b wild type group. In the 2a group, CR was achieved in 4/9 of the mutant and in 4/5 of the wild type groups. An inverse relationship between IFN responsiveness and HCV‐RNA titre was apparent in 1b mutant, 2a wild and 2a mutant.

Conclusions: These data suggest the possible relationship between changes in the HCV‐NS5B gene and the effect of IFN therapy in CHC patients with genotype 1b.
Rapid elimination of Helicobacter pylori and reduction of histocompatibility leucocyte antigen‐DR expression 12 h after a single dose of omeprazole, amoxycillin and metronidazole triple therapy
Authors: Chen Wangxue , Shu Dairu , Wilson Ian R , Tie Andy , Chadwick Vint
Published: March 2003

Background: Studies of eradication of Helicobacter pylori and subsequent resolution of H. pylori‐related gastritis, have focused mainly on medium and long‐term change following eradication therapies. Results from those studies have shown that both acute and chronic inflammatory changes found in gastric mucosa eventually return to normal. However, the early events in the stomach, particularly the effects on bacterial density and acute inflammatory markers of anti‐H. pylori treatment, are largely unknown. The objective of this study was therefore to examine changes in the number of H. pylori, and the severity of gastric mucosal inflammation in the gastric biopsy specimens of patients before (0 h group, n = 14) and 12 h (12 h group, n = 14) after initiating anti‐H. pylori treatment.

Methods: Biopsies were assessed, either quantitatively or semi‐quantitatively, for the presence of H. pylori, neutrophils, mast cells, intraepithelial lymphocytes and the expression of histocompatibility leucocyte antigen (HLA)‐DR by gastric epithelium and the results were compared between groups.

Results: Median H. pylori scores were 5 (range 2–5) and 0 (range 0–2) in biopsies from untreated and 12 h post‐treatment groups, respectively (P < 0.001). In most 12 h post‐treatment biopsies, H. pylori organisms could not be identified. There was a significant reduction in HLA‐DR expression by gastric epithelium (median 3.5 with range 2–4 at 0 h group vs median 2 with range 0–4, P < 0.05), but there was no significant difference in the number of intraepithelial lymphocytes, CD3+ cells, mast cells or the distribution and density of neutrophils (all P > 0.05). Furthermore, the severity of gastritis as scored with the Sydney system was similar in both untreated and treated groups.

Conclusions: The results of this study indicate that elimination of H. pylori organisms and resolution of some inflammatory markers occurs as early as 12 h following a single dose of omeprazole 40 mg, amoxycillin 1.0 g and metronidazole 400 mg, which suggests that rational therapeutic strategies with shorter duration using the currently available drugs may be possible.
Helicobacter pylori in Meckel’s diverticulum with heterotopic gastric mucosa in a population with relatively high H. pylori prevalence rate
Authors: Chan Gavin , Yuen Siu , Chu Kent , Ho Judy , Leung Suet , Ho Joana
Published: March 2003

Background: Helicobacter pylori (H. pylori) colonize only foveolar gastric‐type mucosa and are associated with active chronic gastritis and peptic ulcer. The aim of this study was to investigate whether H. pylori can also be found in Meckel’s diverticulum which contains heterotopic gastric mucosa.

Methods: Biopsy specimens of Meckel’s diverticulum resected in Queen Mary Hospital, University of Hong Kong, during the 10 year period 1986–1995 were retrieved and reviewed. Those containing gastric heterotopia were examined for the presence of H. pylori, using Warthin–Starry silver stain.

Results: In the 59 cases of Meckel’s diverticula studied, 16 were found to contain heterotopic gastric mucosa. Helicobacter pylori were not identified in any of these cases. In one of the 16 patients a concomitant gastric biopsy was performed. Although the gastric mucosa of this patient was heavily colonized by H. pylori, again no H. pylori was found in the heterotopic gastric mucosa in the Meckel’s diverticulum.

Conclusions: The absence of H. pylori in all the Meckel’s diverticula examined, even when the stomach was heavily colonized by the organisms, suggests that colonization of Meckel’s diverticulum by H. pylori is a rare event. This, together with the overall rarity of H. pylori in all reported series of Meckel’s diverticulum, argues against its causative role in complications of Meckel’s diverticulum.
Comparison of two methods for quantification of hepatitis B viral DNA
Authors: Kao Jia‐Horng , Wood Michael , Chen Pei‐Jer , Lai Ming‐Yang , Chen Ding‐Shinn
Published: March 2003

Background: Quantitation of serum hepatitis B virus (HBV) DNA has proven useful in assisting with patient management and treatment and several commercially available assays have been developed to quantify serum HBV‐DNA levels.

Methods: The performance of the cross‐linking assay and the branched‐DNA signal amplification (bDNA) assay for the quantitative measurement of HBV‐DNA was studied in 99 hepatitis B surface antigen‐positive and viraemic patients.

Results: Of these samples, 82 (83%) were positive for HBV‐DNA by both assays and four (4%) were below the cut‐off for both assays. Of the remaining 13 samples, 10 contained measurable levels of HBV‐DNA by the cross‐linking assay alone and three other samples contained measurable levels of HBV‐DNA by the bDNA assay alone. The sensitivity gain of the cross‐linking assay relative to bDNA assay in this study population was 10/92 (11%). In addition, a linear regression analysis showed that the HBV‐DNA levels obtained from both assays was significantly correlated (γ = 0.974, P < 0.0001).

Conclusions: These findings suggest that the recently developed cross‐linking assay is more sensitive than the bDNA assay for the quantitative determination of HBV‐DNA.
Haemodynamic changes in non‐alcoholic (viral) liver cirrhosis studied by computed tomography (CT) arterial portography and CT arteriography
Authors: Takayasu Kenichi , Yoshie Kouichi , Muramatsu Yukio , Iwata Ryoko , Nakanishi Yukihiro , Sakamoto Michiie , Fukuda Haruhiko , Satake Mitsuo , Moriyama Noriyuki , Makino Yasuhiro
Published: March 2003

Aims
: To evaluate haemodynamic and vascular changes in non‐alcoholic (viral) cirrhosis on conventional computed tomography (CT), CT arteriography (CTA) and CT arterial portography (CTAP), and to determine the cause of the observed reticular stain on angiography.

Methods
: Using surgically resected liver specimens from 31 patients with viral hepatitis associated hepatocellular carcinoma, images of conventional CT, CTA, CTAP and the sinusoidal phase of hepatic arteriography were retrospectively analysed and compared with pathology of the non‐cancerous portion of the liver.

Results
: Computed tomography arteriography showed inhomogeneous enhancement (diffuse, low‐density nodules) in a total of 16 samples (52%); in eight of 10 (80%) cirrhotic livers, three of six (50%) precirrhotic livers, five of 12 (42%) livers with chronic active hepatitis and none of three with no active liver disease. The frequency of inhomogeneous enhancement became significantly higher with increasing severity of parenchymal damage (P < 0.05). In contrast, conventional CT and CTAP showed homogeneous enhancement in all 31 (100%) patients. There was no correlation between inhomogeneous enhancement on CTA and reticular staining on sinusoidal‐phase hepatic angiograms. Inhomogeneous enhancement was frequently seen in patients with hepatitis B surface antigen and/or anti‐hepatitis C virus antibody compared with those without them (P < 0.05).

Conclusion
: The CTA was much more sensitive in detecting haemodynamic changes in the cirrhotic liver than CTAP, conventional CT and sinusoidal‐phased hepatic angiography. Further study is required to clarify the mechanism of inhomogeneous enhancement on CTA and homogeneous enhancement on CTAP seen in cirrhosis.
Intravenous glycyrrhizin for the treatment of chronic hepatitis C: A double‐blind, randomized, placebo‐controlled phase I/II trial
Authors: Rossum Tekla Gj Van , Vulto Arnold G , Hop Wim Cj , Brouwer Johannes T , Niesters Hubert Gm , Schalm Solko W
Published: March 2003

Background
: In Japan, glycyrrhizin therapy is widely used for chronic hepatitis C and reportedly reduces the progression of liver disease to hepatocellular carcinoma. The aims of this study were to evaluate the effect of glycyrrhizin on serum alanine aminotransferase (ALT), hepatitis C virus (HCV)‐RNA and its safety in European patients.

Methods
: Fifty‐seven patients with chronic hepatitis C, non‐responders or unlikely to respond (genotype 1/cirrhosis) to interferon therapy, were randomized to one of the four dose groups: 240, 160 or 80 mg glycyrrhizin or placebo (0 mg glycyrrhizin). Medication was administered intravenously thrice weekly for 4 weeks; follow up also lasted for 4 weeks.

Results
: Within 2 days of start of therapy, serum ALT had dropped 15% below baseline in the three dosage groups (P < 0.02). The mean ALT decrease at the end of active treatment was 26%, significantly higher than the placebo group (6%). A clear dose–response effect was not observed (29, 26, 23% ALT decrease for 240, 160 and 80 mg, respectively). Normalization of ALT at the end of treatment occurred in 10% (four of 41). The effect on ALT disappeared after cessation of therapy. During treatment, viral clearance was not observed: the mean decrease in plasma HCV‐RNA after active treatment was 4.1 × 106 genome equivalents/mL (95% confidence interval, 0–8.2 × 106; P > 0.1). No major side‐effects were noted. None of the patients withdrew from the study because of intolerance.

Conclusions
: Glycyrrhizin up to 240 mg, thrice weekly, lowers serum ALT during treatment, but has no effect on HCV‐RNA levels. The drug appears to be safe and is well tolerated. In view of the reported long‐term effect of glycyrrhizin, further controlled investigation of the Japanese mode of administration (six times weekly) for induction appears of interest.

© 1999 Blackwell Science Asia Pty Ltd
Magnesium citrate–bisacodyl regimen proves better than castor oil for colonoscopic preparation
Authors: Chen Chun‐Chia , Ng Wai‐Wah , Chang Full‐Young , Lee Shou‐Dong
Published: March 2003

Background: A clean colon preparation prior to endoscopy or X‐ray examination is essential to obtain an accurate diagnosis. In order to determine which of two easily made preparations is better, this study compares colon cleansing efficacy, patient acceptance and side effects in patients given either a magnesium citrate–bisacodyl or a castor oil regimen prior to colonoscopy.

Methods: Seventy outpatients scheduled for colonoscopy were randomized to receive one of two bowel evacuation regimens on the day prior to the examination. Group 1 (n= 36) received a magnesium citrate solution (250 mL) and bisacodyl (10 mg, orally). Group 2 (n= 34) received castor oil (60 mL, orally).

Results: The cleansing effect of the magnesium citrate–bisacodyl regimen was significantly better than that of castor oil in the ascending colon and caecum (cleansing scores 5.2 ± 1.2vs3.5 ± 1.3,P< 0.0001), but similar to that of castor oil in the recto‐sigmoid, descending and transverse colon. Abdominal pain (38vs11%,P< 0.01) and nausea (29vs8%,P< 0.05) were significantly more common in patients receiving the castor oil preparation than in patients administered with the magnesium citrate–bisacodyl regimen. More patients complained of poor acceptance with the castor oil regimen than with the magnesium citrate–bisacodyl regimen (24vs8%,P= 0.06).

Conclusions: A combined oral magnesium citrate and bisacodyl regimen is effective and better than castor oil for colonoscopic preparation.

© 1999 Blackwell Science Asia Pty Ltd
Mucosa‐associated lymphoid tissue lymphoma of the rectum that regressed spontaneously
Authors: Takenaka Ryuta , Tomoda Jun , Sakata Tatsuro , Ichiba Toshio , Motoi Makoto , Mizuno Motowo , Tsuji Takao
Published: March 2003

We report a case of mucosa‐associated lymphoid tissue (MALT) lymphoma of the rectum that regressed spontaneously. A 76‐year‐old man visited our hospital because of positive faecal occult blood testing. Colonoscopic examination revealed a slightly yellowish protruded lesion with a grooved depression in the lower rectum and two flat elevations in the upper rectum. Microscopic and immunohistological studies led to a diagnosis of MALT lymphoma. As the patient exhibited severe renal dysfunction and angina pectoris, the lesions were left untreated. Three months later, the protruded lesion became flat and the other lesions became unclear. He was followed up closely with endoscopy, but no relapse of these lesions was detected 19 months after the diagnosis.

© 2000 Blackwell Science Asia Pty Ltd
Indications for liver transplantation in patients with chronic hepatitis B and C virus infection and hepatocellular carcinoma
Authors: Fan St , Cheung St , Lo Cm
Published: March 2003

Patients with chronic hepatitis B virus (HBV) infection were not accepted for liver transplantation in Asia in the past because the hepatitis B immune globulin (HBIG) used to prevent post‐transplantation recurrence was very expensive and it was generally believed that Asians with hepatitis B fared worse than Caucasians after liver transplantation. The availability of lamivudine has altered the indication of liver transplantation for these patients. Twenty‐five Chinese patients with chronic HBV infection were given lamivudine as primary prophylaxis against HBV re‐infection before transplantation. Five patients died within 40 days of transplantation. After a median follow‐up period of 14 months (range, 5–39), 17 patients had lost serum HBsAg from 4 days to 27 months post transplantation, but it reappeared in three patients 4–12 months later. Antibody to HBsAg was detected periodically in the serum of 11 patients who had lost HBsAg. At the last follow‐up, six patients were HBsAg‐positive and HBV DNA was detected in only one of them. The indication for liver transplantation for chronic hepatitis C virus (HCV) infection is not as strict as for patients with chronic HBV infection because the long‐term survival is similar to that of non‐hepatitis C patients, even though re‐infection by HCV in the recipients is nearly universal. The main issue in the selection of patients with HCV for liver transplantation is therefore identification of criteria that can predict re‐infection and development of cirrhosis. These include factors such as multiple episodes of rejection, use of OKT3, pre‐transplant viral load and genotype, but reports are not consistent and so there are no well‐defined selection criteria. The selection criteria for patients with hepatocellular carcinoma are now well defined. Many studies have confirmed that a tumour > 5 cm, and showing vascular invasion, and poor differentiation adversely affects survival. In practice, only patients with a tumour < 5 cm and Child’s C cirrhosis are accepted for liver transplantation. Transarterial oily chemoembolization and intralesional alcohol injection are used to control or down‐stage the tumour while patients wait for a cadaveric liver graft.
Gastro‐oesophageal reflux disease in Asia
Authors: Goh Khean‐Lee , Chang Chi‐Sen , Fock Kwong‐Ming , Ke Meiyun , Park Hyo‐Jin , Lam Shiu‐Kum
Published: March 2003

Gastro‐oesophageal reflux disease (GORD) occurs more frequently in Europe and North America than in Asia but its prevalence is now increasing in many Asian countries. Many reasons have been given for the lower prevalence of GORD in Asia. Low dietary fat and genetically determined factors, such as body mass index and maximal acid output, may be important. Other dietary factors appear to be less relevant. Increased intake of carbonated drinks or aggravating medicines may influence the increasing rates of GORD in some Asian countries but no strong evidence links other factors, such as the age of the population, smoking or alcohol consumption, to GORD. The management of GORD in Asia is similar to that in Europe and North America but the lower incidence of severe oesophagitis in Asia may alter the approach slightly. Also, because Asians tend to develop stomach cancer at an earlier age, endoscopy is used routinely at an earlier stage of investigation. Gastro‐oesophageal reflux disease is essentially a motility disorder, so short‐term management of the disease can usually be achieved using prokinetic agents (or histamine (H2)‐receptor antagonists). More severe and recurrent GORD may require proton pump inhibitors (PPI) or a combination of prokinetic agents and PPI. The choice of long‐term treatment may be influenced by the relative costs of prokinetic agents and PPI.

© 2000 Blackwell Science Asia Pty Ltd
Probiotics in infective diarrhoea and inflammatory bowel diseases
Authors: Gionchetti Paolo , Rizzello Fernando , Venturi Alessandro , Campieri Massimo
Published: March 2003

Bacteria are present throughout the gastrointestinal tract, but their pattern and concentration vary greatly. Probiotics are living organisms that supply beneficial health effects to the host. So far the beneficial effects of probiotics have been shown, almost exclusively, under poorly defined experimental conditions. There are little convincing data from well‐designed, double‐blind controlled trials supporting health‐promoting effects. The use of probiotics to treat gastrointestinal infections has produced contrasting results. Apart from information on rotavirus infection in children, there is no convincing evidence from controlled studies on the efficacy of probiotics in the prevention or treatment of infective diarrhoea. However, experimental and clinical studies suggest that there are potential therapeutic roles for probiotics in the treatment of inflammatory bowel diseases. This review focuses on the available data concerning the mechanisms of action of probiotics, and on the results from clinical studies using probiotics to treat infective diarrhoea and inflammatory bowel disease.
Pathophysiological role of cholecystokinin in humans
Authors: Otsuki Makoto
Published: March 2003

Cholecystokinin (CCK) is a major gastrointestinal hormone that plays an important role in stimulation of pancreatic secretion and gall‐bladder contraction, regulation of gastrointestinal motility and induction of satiety. Ingestion of fat and protein induces significant increases in plasma CCK. Intraluminal mediators of CCK secretion, luminal CCK releasing factor and diazepam‐binding inhibitor, were purified from rat intestinal secretion. These CCK‐releasing factors (RF) are secreted tonically by the small intestine and stimulate CCK release. Another kind of CCK‐RF named ‘monitor peptide’ was purified from the rat pancreatic juice that stimulates CCK secretion when introduced into rat intestine. Bile exclusion from the duodenum causes an increase in basal CCK and enhances stimulated plasma CCK release, and bile salt replacement reverses these effects. Thus, the CCK‐RF are spontaneously secreted into the intestinal lumen in humans, while the CCK‐producing cells are under constant suppression by intraduodenal bile acids. In acute pancreatitis, plasma CCK levels are high in patients with gallstone pancreatitis, but not in patients with pancreatitis from other causes, such as alcoholic and idiopathic pancreatitis. A transient disturbance of bile flow into the duodenum by stones or oedema of the pancreas together with impairment of pancreatic exocrine function might cause the increase in plasma CCK release in gallstone pancreatitis. Patients with chronic pancreatitis with mild to moderate impairment of exocrine function and abdominal pain, had significantly higher plasma CCK concentrations, whereas patients with pancreatic insufficiency had a significantly lower plasma CCK response to a test meal than the healthy subjects. The increased CCK may further aggravate pancreatitis and worsen the prognosis of pancreatitis by stimulating the injured pancreas, resulting in the vicious circle via endogenous CCK release. The CCK‐A receptor antagonist might be therapeutically useful in acute pancreatitis by stopping the vicious circle.
Branched‐chain amino acids
Authors: Platell Cameron , Kong Sung‐Eun , McCauley Rosalie , Hall John C
Published: March 2003

The branched‐chain amino acids (BCAA), isoleucine, leucine and valine, are unique in that they are principally metabolized extrahepatically in the skeletal muscle. This observation led to the investigation of these nutrients in a number of clinical scenarios. By far the most intensively studied applications for BCAA have been in patients with liver failure and/or patients in catabolic disease states. However, the resulting studies have not demonstrated a clear clinical benefit for BCAA nutritional supplements. In patients with liver failure, the BCAA did improve nitrogen retention and protein synthesis, but their effect on patient outcome was less clear. Similarly, in critically ill septic patients, BCAA did not improve either survival or morbidity. The BCAA are important nutrients, and it seems that any specific benefits associated with their use will be based upon a greater understanding of the underlying cellular biology. Potential areas of further research may include the combination of BCAA supplements with other anabolic factors (e.g. growth hormone) in managing patients with catabolic disease states.
A short‐term eradication therapy for Helicobacter pylori acute gastritis
Authors: Nomura Hideyuki , Miyake Katsuhisa , Kashiwagi Seizaburo , Sugiyama Toshiro , Asaka Masahiro
Published: March 2003

Background and Aims

Acute gastritis, caused by an initial infection of Helicobacter pylori (H. pylori), may resolve spontaneously, but the infection sometimes becomes chronic. We examined the efficacy of a short‐term H. pylori eradication therapy on acute gastritis.

Methods

Among the 15 patients with hemorrhagic acute gastritis who were randomly allocated to group A (eradication therapy) or group B (Lansoprazole, LPZ), 10 of them started to receive treatment within 1 day after the disease onset. The other five patients began the eradication therapy 4–6 days after disease onset (group C). Eradication therapy consisted of a daily oral administration of each of 30 mg lansoprazole (LPZ), once a day; 400 mg clarithromycin, twice a day; 1000 mg amoxicillin, twice a day; and 300 mg rebamipide, three times a day, for one week. If the endoscopy was normal, medication was stopped for the following 4 weeks before gastric endoscopy was performed again in order to assess H. pylori eradication.

Results

All group A patients were cured after the 1‐week treatment and therefore, they became H. pylori negative. Group B and C patients had erosions or ulcers after the 1‐week treatment and so received an additional 3‐week administration of LPZ. Four weeks later, their gastritis was cured and except for one group B patient, they became H. pylori‐negative.

Conclusion

In patients with acute gastritis, caused by an initial H. pylori infection, eradication therapy was efficacious in achieving early healing. This therapy should be started as soon as possible after disease onset.
Magnetic resonance imaging and diseases of the liver and biliary tract. Part 2. Magnetic resonance cholangiography and angiography and conclusions
Authors: Macdonald Graeme A , Peduto Anthony J
Published: March 2003

Abstract Magnetic resonance cholangiography (MRC) relies on the strong T2 signal from stationary liquids, in this case bile, to generate images. No contrast agents are required, and the failure rate and risk of serious complications is lower than with endoscopic retrograde cholangiopancreatography (ERCP). Data from MRC can be summated to produce an image much like the cholangiogram obtained by using ERCP. In addition, MRC and conventional MRI can provide information about the biliary and other anatomy above and below a biliary obstruction. This provides information for therapeutic intervention that is probably most useful for hilar and intrahepatic biliary obstruction. Magnetic resonance cholangiography appears to be similar to ERCP with respect to sensitivity and specificity in detecting lesions causing biliary obstruction, and in the diagnosis of choledocholithiasis. It is also suited to the assessment of biliary anatomy (including the assessment of surgical bile‐duct injuries) and intrahepatic biliary pathology. However, ERCP can be therapeutic as well as diagnostic, and MRC should be limited to situations where intervention is unlikely, where intrahepatic or hilar pathology is suspected, to delineate the biliary anatomy prior to other interventions, or after failed or inadequate ERCP. Magnetic resonance angiography (MRA) relies on the properties of flowing liquids to generate images. It is particularly suited to assessment of the hepatic vasculature and appears as good as conventional angiography. It has been shown to be useful in delineating vascular anatomy prior to liver transplantation or insertion of a transjugular intrahepatic portasystemic shunt. Magnetic resonance angiography may also be useful in predicting subsequent variceal haemorrhage in patients with oesophageal varices.