bluuebunny/crossref_metadata_2025 huggingface dataset:
Pretectal neurons responding to slow wide‐field retinal motion: could they compensate for slow drift during fixation?
Authors: Price Nicholas SC , Ibbotson Michael R
Published: March 2003

The visual response properties are described of a group of retinal slip neurons in the wallaby pretectum, referred to as slow cells. Their responses to motion are direction‐selective: tempero‐nasal and naso‐temporal motion over the contralateral eye increase and decrease, respectively, the firing rate relative to the spontaneous level. Slow cells are maximally sensitive to image velocities from 0.08 to 10°/s. The present study focuses on slow cells that are maximally sensitive to image velocities below 1°/s. An interesting characteristic of 82% of slow cells is that once motion stops, the firing rate exhibits a same‐sign after‐response. This is characterized by a slow exponential return from the firing rate during motion to the spontaneous rate. The time constants of the after‐responses are independent of the temporal frequency, velocity, duration and direction of the motion stimulus. It is proposed that the neurons may assist the stabilization of eye position during fixation.
Expression of macrophage migration inhibitory factor during Pseudomonas keratitis
Authors: Thakur Archana , Xue Mei Lang , Wang Wen , Lloyd Andrew , Wakefield Denis , Willcox Mark DP
Published: March 2003

Macrophage migration inhibitory factor (MIF) is a recently rediscovered pro‐inflammatory cytokine, and has been shown to play a role in the regulation of neutrophil chemokines and angiogenesis. Corneal epithelial and endothelial cells have been shown to express MIF. This study evaluated the expression of MIF during Pseudomonas keratitis in mice and in vitro using a corneal epithelial cell line. Three strains of P. aeruginosa, 6294 (invasive strain), 6206 (cytotoxic strain) and Paer1 (non‐ infectious strain) were used. Both cytotoxic and invasive strains were isolated from human corneal ulcers and the Paer1 strain was isolated from a non‐infectious condition. Following challenge in mouse corneas or a corneal epithelial cell line, corneal homogenates or lysed corneal epithelial cells were used to isolate RNA. Migration inhibitory factor mRNA expression in the mouse cornea or human corneal epithelial cells was examined by reverse transcription–polymerase chain reaction analysis, and was found to be expressed as early as 4 h after the injury (scratch controls) or infection in the mouse corneas. Migration inhibitory factor mRNA in scratch controls and Paer1‐inoculated corneas showed peak levels at 4 h post‐challenge and this dropped by 24 h post‐challenge. Corneas challenged with invasive and cytotoxic strains showed peak expression 24 h post‐challenge. Migration inhibitory factor mRNA levels were significantly higher in invasive and cytotoxic strain inoculated corneas compared to Paer1 inoculated corneas. Challenging the corneal epithelial cell line with Pseudomonas 6294 and 6206 strains induced peak expression at 8 h and levels were decreased by 12 h. Epithelial cells inoculated with recombinant human interleukin‐1β protein induced very high levels of MIF mRNA at all time points compared to infected and control corneal epithelial cells. High expression of MIF in the infected corneas suggests that it may have a role in the pathogenesis of corneal disease induced by invasive and cytotoxic strains of P. aeruginosa.
Prevalence and associations with ectropion in an older population: the Blue Mountains Eye Study
Authors: Mitchell Paul , Hinchcliffe Peter , Wang Jie Jin , Rochtchina Elena , Foran Suriya
Published: March 2003

The aim of this study was to describe the prevalence of eyelid ectropion and its associations with sunlight‐related and other ocular variables, plus systemic factors, in an older Australian population. The Blue Mountains Eye Study examined 3654 persons aged 49–97 years. Examination recorded ectropion and other ocular signs. The questionnaire assessed sunlight‐related and systemic variables. Ectropion was present in either eye of 143 subjects (3.9%) and was bilateral in 101 (70.6%). A marked age‐related increase in prevalence was observed with ectropion found in 0.3% of persons aged < 60 years, 1.2% of ages 60–69 years, 6.7% of ages 70–79 years and 16.7% of those aged 80 years or older. Ectropion prevalence was higher in men (5.1%) than women (3.0%), age‐adjusted odds ratio 2.1 (95% confidence interval 1.5–3.0). Statistically significant associations were found between ectropion and history of skin cancer removal, increased skin sun sensitivity, lighter iris colour and presence of pingueculum, as well as current smoking, hypertension, diabetes and stroke.
Lower nasal distribution of cortical cataract: the Blue Mountains Eye Study
Authors: Rochtchina Elena , Mitchell Paul , Coroneo Minas , Wang Jie Jin , Cumming Robert G
Published: March 2003

Previous reports have indicated that cortical cataract commences in the lower nasal lens, possibly due to sunlight exposure because of the shallow brow temporally. The present study aimed to assess the lens sector distribution of cortical cataract in a population. The Blue Mountains Eye Study assessed 3654 residents aged 49–97years; 3270 phakic subjects had retroillumination lens photographs graded using the Wisconsin method, which divides the lens into eight radial sectors with a grid overlay. Graders estimated percentage of cortical opacity in each sector. The lower nasal area consistently had the greatest opacity, a pattern present at each age and similar in both sexes, despite the 20% greater cortical cataract in women. The mean area of lens cortex involved by opacities in the lower nasal hemisphere was four fold greater than in the upper temporal hemisphere at each age. The lower nasal distribution was highly symmetrical when both eyes were affected. When > 20% of the lower nasal lens quadrant had cortical opacity, 88% of bilaterally affected subjects had cortical cataract in the same quadrant of the fellow eye. The lower nasal distribution may indicate a role for sunlight in the aetiology of cortical cataract, which could be considered when examining other cortical cataract risk factors, such as diabetes, vascular disease and hormonal factors in women.
Melanoma‐associated retinopathy: does autoimmunity prolong survival?
Authors: Chan Colin , O'Day Justin
Published: March 2003

Purpose: To discuss the autoimmune basis of melanoma‐associated retinopathy (MAR) and its implications for management and prognosis.

Methods: An unusual history of a woman with melanoma‐associated retinopathy is presented in detail. A review of published reports and a summary of 19 reported cases of MAR provide a basis for discussion.

Results: This case report and other published reports highlight a number of points regarding MAR including the male predominance, prolonged survival in several patients and lack of response to immunosuppression.

Conclusions: Melanoma‐associated retinopathy may prolong the survival of patients with metastatic melanoma through the autoimmune response. Therefore, treatment of visual symptoms with immunosuppression needs to be considered carefully.
Scedosporium endophthalmitis: two fatal disseminated cases of Scedosporium infection presenting with endophthalmitis
Authors: McKelvie Penelope A , Wong Elaine YH , Chow Li Ping , Hall Anthony JH
Published: March 2003

The incidence of disseminated infection with Scedosporium species is increasing in patients with haematological malignancy. Two fatal cases are reported of patients with acute myeloid leukaemia and neutropenia who presented with Scedosporium endophthalmitis. Diagnosis of fungal infection was delayed as blood and vitreous cultures were positive only after 3 days in patient 1 and blood culture was positive at 7 days in patient 2. Despite antifungal therapy with amphotericin B and additional fluconazole in patient 2, both patients died of overwhelming fungal septicaemia. Post‐mortem examination of the right globe in patient 1 showed haemorrhagic necrotizing chorioretinitis with numerous fungal hyphae in choroidal vessels, choroid, retina and vitreous. Scedosporium species are often resistant to conventional antifungal therapy including amphotericin B. Diagnosis is difficult and mortality in disseminated infection is high.
Acute dacryocystitis presenting as an orbital abscess
Authors: Ataullah Sajid , Sloan Brian
Published: March 2003

Acute dacryocystitis usually presents as a preseptal infection, but can uncommonly be associated with orbital cellulitis. Orbital abscess formation is, however, very rare. The case is presented of a 60‐year‐old woman with an extraconal abscess secondary to acute dacryocystitis. The clinical, radiological and intraoperative findings are discussed.
Ethanol effects on volitional versus reflexive saccades
Authors: Vassallo Suzane , Abel Larry A
Published: March 2003

The effects of a moderate alcohol dose on reflexive and volitional saccades were compared. Healthy male subjects (n = 17) made horizontal reflexive saccades, antisaccades and self‐paced saccades before and after the ingestion of a body‐weight‐related dose of alcohol. At a mean blood alcohol concentration of 0.044%, reflexive saccade latency significantly increased although accuracy remained unimpaired at each target amplitude. No significant ethanol effects were noted for antisaccade accuracy and latency. Antisaccade error rates decreased significantly, likely demonstrating a learning effect. The mean rate of self‐paced saccades did not sig­­nificantly change post‐ethanol and their accuracy was also unimpaired. All saccades share a final common pathway for their execution. It thus seems reasonable to propose that ethanol modulated connections between the posterior parietal cortex and superior colliculus to increase reflexive saccade latency. Higher‐order paradigms, which require inhibition and are mediated by frontal areas, might be impaired at greater blood alcohol concentrations.
In vivo and ex vivo in situ confocal analysis of a rat model demonstrating transient ‘epithelialization of the endothelium’
Authors: Grupcheva Christina N , Laux Fenton Wilda T , Green Colin R , McGhee Charles NJ
Published: March 2003

The purpose of this study was to identify the in vivo microstructural
characteristics of an animal model of ‘epithelialization
of the endothelium’ that are similar in appearance to the in
vivo confocal microscopical appearance of corneal endo­thelium
previously thought to be diagnostic of irido‐corneal endothelial
syndrome, and correlate these observations with ex vivo in situ confocal
microscopical analysis. A rat model (n = 8 eyes)
of transient ‘epithelialization of the endothelium’ resulting
from superficial corneal trauma, was developed and analysed using in
vivo confocal microscopy. One animal was killed at 48 h
and the cornea was immuno­labelled and analysed, using ex
vivo in situ confocal digital image reconstruction. Reversible ‘epithelialization
of the endothelium’ was observed by in vivo confocal
microscopy 48 h after superficial corneal trauma in all
eight eyes. Ex vivo in situ analysis failed to demonstrate
immunohistological characteristics of epithelialization. In vivo confocal microscopy is based on optical principles, and as a result various structural alterations may present with apparently identical characteristics that should be interpreted cautiously, on the basis of the presented clinicopathological observations.
Talc retinopathy
Authors: Fraser‐Bell Samantha , Capon Malcolm
Published: March 2003

A 45 year old man presented with talc retinopathy that had been present for decades. The static nature of this condition indicates that, in the absence of ongoing intravenous drug use, ophthalmological follow up is not necessary
Late orbital haemorrhage around alloplastic orbital floor implants: a case series and review
Authors: Gilhotra Jagjit Singh , McNab Alan A , McKelvie Penny , O'Donnell Brett A
Published: March 2003

Background: Alloplastic implants have been used to repair orbital wall fractures and correct anophthalmic enophthalmos (or volume deficiency in an anophthalmic socket). Orbital haemorrhage is a rare complication of these implants.

Method: A retrospective review of patient files of two consultant oculoplastic surgeons.

Results: Four cases of orbital haemorrhage following alloplastic implants were identified. The haemorrhages occurred 5−18 years after surgery, and occurred within the pseudocapsule of the implant. In one case, recurrent haemorrhages were noted.

Conclusion: Although rare, orbital haemorrhage is a potential complication of alloplastic orbital floor implants, which may present many years after surgery.
Vascular endothelial growth factor‐B and retinal vascular development in the mouse
Authors: Reichelt Melissa , Shi Shunning , Hayes Mark , Kay Graham , Batch Jennifer , Gole Glen A , Browning Jay
Published: March 2003

Purpose: Vascular endothelial growth factor‐A (VEGF‐A) is crucial to retinal vascular growth, both normal and pathological. VEGF‐B, recently characterized, is reported to be expressed in retinal tissues, but the importance of VEGF‐B to retinal vascular development remained unknown. The aim of this study was to analyse retinal vascular growth in the Vegfb−/− knockout mouse.

Methods: Retinal vascular growth was measured in Vegfb−/− knockout mice raised under normal conditions, and Vegfb−/− knockout mice with an oxygen‐induced proliferative retinopathy. Wild type Vegfb+/+ mice served as controls. Vessels were perfused with ink and retinal flatmounts secondarily labelled with FITC‐lectin (BS‐1, Griffonia simplicifolia). Area and diameter of retinal growth and retinal vascular growth were recorded over days 0−20, and capillary density and mean diameter recorded from day 17 pups.

Results: A variety of techniques confirmed that Vegfb+/+ mice expressed VEGF‐B and that VEGF‐B expression was absent in Vegfb−/− mice. Vegfb−/− mice raised in room air showed no significant differences from Vegfb+/+ controls. No differences were found in oxygen‐induced retinopathy between Vegfb−/− and Vegfb+/+ pups in either the extent of the initial oxygen‐induced ablation, or in the regrowth of retinal vessels or vitreal (neovascular) sprouts; vitreal sprouts are important markers of the abnormal proliferative response, and are maximally expressed on day 17 in this model of oxygen‐induced retinopathy.

Conclusions: These results indicate that a lack of VEGF‐B does not significantly affect development of the retinal vasculature under normal conditions, nor does it appear to affect the proliferative retinal responses seen in oxygen‐induced retinopathy.
Newly Developed Ultrasonic Probe With Ropeway System for Transpapillary Intraductal Ultrasonography of the Bilio–Pancreatic Ductal System
Authors: Fujita Naotaka , Noda Yutaka , Yokohata Kazuki , Tanaka Masao , Maguchi Hiroyuki , Komatsu Yutaka , Omata Masao , Inui Kazuo , Nakazawa Saburo , Mukai Hidekazu , Yasuda Kenjiro
Published: March 2003

Background:
Intraductal ultrasonography of the bile/pancreatic duct using a thin‐caliber ultrasonic probe (IDUS) provides excellent images of these ducts and the surrounding structures. Insertion of the device through the papilla of Vater is essential to carry out this examination. We developed a new probe with a ropeway system (XUM5RG‐29R; Olympus, Tokyo) for transpapillary IDUS. Its usefulness such as ease of application and safety were prospectively evaluated.

Patients and methods:
During the period of October 1997 to April 1998, transpapillary IDUS using the probe was performed in 194 patients at seven medical institutions. The success rates of insertion of the probe into the bile/pancreatic duct, observation of the area of interest, and the incidence of complications were evaluated.

Results:
Passage of the probe through the papilla was successful without difficulty in all the patients. Successful introduction of the probe into the pancreatic duct, bile duct and both of the ducts was achieved in 98.4, 100 and 85% of the patients, respectively. Once the probe was introduced into the aimed duct, it was possible to obtain IDUS images of the area of interest in all but five patients. Mild acute pancreatitis developed in eight patients (4.1%), all of whom recovered with conservative therapy only.

Conclusions:
It is possible to introduce the new ultrasonic probe into the desired duct once a guide wire has been inserted. This type of ultrasonic probe is quite useful when performing transpapillary IDUS of the bile and/or pancreatic duct.
Application of endoscopic mucosal resection for hypopharyngeal cancer
Authors: Fujishiro Mitsuhiro , Yamaguchi Hajime , Nakanishi Yukihiro , Ooyama Waichiro , Watanabe Hiroshi , Gotoda Takuji , Ono Hiroyuki , Kozu Takahiro , Kondo Hitoshi , Saito Daizo
Published: March 2003

Endoscopic mucosal resection (EMR) was applied in an 80‐year‐old Japanese man with stage I hypopharyngeal cancer because he refused further radical therapy after esophagogastrectomy for gastric and esophageal cancers. Although EMR was successfully performed without complications, histopathologic investigation revealed cancer‐positive lateral margins. Furthermore, another biopsy from the right aryepiglottic fold yielded a diagnosis of laryngeal cancer. Radiation therapy was ultimately performed because of the possibility of residual tumor and coexistent laryngeal cancer. Endoscopic mucosal resection as a curative treatment for hypopharyngeal cancer is associated with several problems that must be resolved before general application is feasible. However, the present case, at least, shows the possibility of using EMR as a diagnostic procedure and as a less invasive palliative treatment.
Technique of Vagus‐Nerve Sparing Laparoscopy‐Assisted Distal Gastrectomy
Authors: Kojima Kazuyuki , Yamashita Toshiki , Inokuchi Mikito , Sugihara Kenichi
Published: March 2003

Vagus‐nerve sparing distal gastrectomy (Vs‐DG) is a procedure that has been introduced to improve the quality of life for patients with early gastric cancer. We successfully performed this novel procedure for 40 consecutive patients with early gastric lesions located in the middle or lower thirds of the stomach between January 1999 and April 2001 using laparoscopic techniques (Vagus‐nerve sparing laparoscopy‐assisted distal gastrectomy). Vagus‐nerve sparing distal gastrectomy involves preserving the hepatic and celiac branches of the vagus, preservation that is expected to be beneficial in lowering the incidence of post–gastrectomy syndromes compared with standard distal gastrectomy. The mean operating time was 247 min. None of the patients had a postoperative complication. The mean postoperative hospital stay was 14 days, and all patients were alive without recurrence after the median follow‐up of 14 months. Thus, this procedure is technically feasible and safe, and might be one of the better treatments for early gastric cancer.
Treatment of malignant esophageal/cardiac stricture with self‐expanding antireflux metallic stents: A preliminary report from 17 patients
Authors: Guoming Xu , Zhaoshen Li , Na Wang , Suqin Xie , Ning Yin , Zhen Wang , Kai Meng , Zinguan Zhou , Bosheng Zhang , Youmin Li , Zhengbu Sha
Published: March 2003

BACKGROUND: Different types of self‐expanding metallic stents are available for the palliative treatment of malignant strictures at the gastroesophageal junction. To overcome some of the disadvantages in the design of these metallic stents, we designed a silicone‐covered self‐expanding antireflux metallic stent that can prevent free gastroesophageal reflux after stent placement.

METHODS: Seventeen silicone‐covered antireflux prototypes were used in 17 patients with dysphagia caused by inoperable malignant tumors involving the gastroesophageal junction.

RESULTS: Stent implantation was technically successful in all 17 patients. There were no procedure‐related perforations or deaths. As a group, the mean dysphagia grade improved significantly (2.56 ± 0.49 vs 1.00 ± 0.51, P < 0.001) and the mean lumenal diameter was greatly increased (4.11 ± 1.02 vs 14.72 ± 4.01, P < 0.001) after stent placement. Ten patients received ambulatory 24‐h esophageal pH monitoring and compared with the healthy volunteers, there were no postprocedural abnormal gastroesophageal refluxes in any patient. Three patients had substantial chest pain requiring long‐term analgesics. No other complications were observed.

CONCLUSIONS: The newly developed self‐expanding antireflux metallic stent is safe and effective for use in the palliation of dysphagia caused by malignant strictures at the gastroesophageal junction. A larger patient population would be required to give valid conclusions.
Psychological factors in functional dyspepsia and its treatment
Authors: Xiaoping Pan , Yuyuan Li , Weihong Sha , Fuying Yang
Published: March 2003

OBJECTIVE: To investigate the role of psychological factors in functional dyspepsia (FD) and the effects of antidepressant drugs on FD.

METHODS: The psychological status of 24 FD patients and 24 healthy people was analyzed using the Hamilton Rating Scale for Depression (HRSD), the Hamilton Anxiety Scale (HAS) and the Symptom Checklist 90 (SCL‐90) scale. Antidepressants were used to treat FD patients for 8 weeks; 13 patients received Prozac, 11 patients received Seroxat. Psychometric analysis was carried out before and after treatment.

RESULTS: There were significant differences in somatic and psychometric scores on the HAS and SCL‐90 scales in the two groups (P < 0.001). The scores of the FD patients improved significantly after 8 weeks of treatment (P < 0.001).

CONCLUSIONS: Psychological factors played a role in the etiology of FD. The patients commonly had depression or anxiety. Antidepressants were effective in the treatment of FD for improving both somatic and psychological symptoms.
Effect of all‐trans retinoic acid on apoptosis and expression of regulatory genes (Bcl‐2, Fas, ICE) in experimentally induced gastric epithelial cell dysplasia in rats
Authors: Rutao Cui , Gan Cai , Yong Cheng , Qiuhong Yang , Tao Tian
Published: March 2003

OBJECTIVE: To study the mechanism and effect of all‐trans retinoic acid on apoptosis and the expression of Bcl‐2, Fas and ICE in experimentally induced dysplastic gastric epithelial cells.

METHODS: Apoptosis and expression of Bcl‐2, Fas and ICE in gastric epithelial cells was studied using the terminal dUTP nucleotide end‐labeling (TUNEL) technique. The immunohistochemistry of Wistar rats enrolled in three groups was studied: group 1, blank controls; group 2, dysplasia induced by N‐methyl‐N‐nitro‐N‐nitrosoguanidine (MNNG) and then treated with all‐trans retinoic acid; and group 3, dysplasia induced by MNNG and treated with a placebo.

RESULTS: In the three groups, the rates of dysplasia were 0, 26.7 and 73.3%; the apoptosis indices were 8.3 ± 3.1, 7.8 ± 2.6 and 2.2 ± 0.4; the expression of Bcl‐2 was 13.3, 33.3 and 66.7%; and overexpression of Bcl‐2 was 6.7, 6.7 and 33.3%, respectively. There were significant differences between group 2 and group 3 (P < 0.05), but no significant differences were found between group 2 and group 1 (P > 0.05). The expression rates of Fas were 46.7, 40 and 6.7%; the overexpression rates were 13.3, 26.7 and 13.3%, respectively; the expression rates of ICE were 20, 60 and 13.3%; the overexpression rates were 0, 13.3 and 6.7% in the three groups, respectively. The expression rates of Fas and ICE in group 2 were significantly different from that of group 3 (P < 0.05), but there were no significant differences in overexpression rates between group 2 and group 3. No significant differences were found either in expression or overexpression of Fas and ICE between group 2 and group 1.

CONCLUSIONS: These results suggest that all‐trans retinoic acid inhibits Bcl‐2 expression, promotes Fas expression, enhances ICE expression and gastric mucosal epithelial cell apoptosis, and thus may reverse or inhibit the progression to cancer.
Expression of cyclooxygenase‐2 protein in colon disease
Authors: Lu Hong , Ge Zhizheng , Liu Wenzhong , Chen Xiaoyu , Peng Yanshen , Xiao Shudong
Published: March 2003

OBJECTIVE: Several epidemiological studies have indicated that the long‐term administration of non‐steroidal anti‐inflammatory drugs (NSAIDs) may reduce the incidence of colorectal cancer. The best known action of NSAIDs is to block cyclooxygenase, the key enzyme required for the conversion of arachidonic acid to prostaglandins. Two cyclooxygenase isoforms have been identified and these are referred to as COX‐1 and COX‐2. Recent studies indicate that inducible COX‐2 plays an important role in gastrointestinal inflammation and carcinogenesis. The present study was undertaken to investigate the expression and clinical implications of COX‐2 and COX‐1 in normal and diseased colons.

METHODS: COX‐2 and COX‐1 protein expression in specimens from normal controls and diseased colon tissues were examined semiquantitatively by using immunohistochemical methods.

RESULTS: By using immunohistochemical detection methods, low COX‐2 protein expression in colonic epithelial cells was observed in 20.0% (2/10) of normal controls. Eighty percent (16/20) of specimens from inflammatory bowel disease (IBD) had a high COX‐2 expression, 46.40% (13/28) of adenomas and 64.3% of (9/14) well‐differentiated colonic carcinomas had some COX‐2 protein expression. Expression of COX‐2 protein was increased in IBD and colonic carcinomas compared with normal controls. There were no significant differences between colonic adenomas and colonic carcinomas. No correlation was found between COX‐2 protein expression and patient gender, patient age, tumor size, tumor location or the degree of differentiation/ metastasis of the tumor. Strong immunoreactive COX‐2 was expressed in clusters in interstitial cells (mainly mononuclear cells) in 53.6% (15/28) of adenomas and 64.3% (9/14) of colonic carcinomas. Strong COX‐2 protein expression was also displayed in the normal glands that were adjacent to the adenomas and carcinomas. Expression of COX‐1 protein was observed in the epithelial cells and interstitial cells or tumor cells of normal colon, IBD, colonic adenomas and colonic carcinomas.

CONCLUSIONS: Our results indicated that COX‐2 protein overexpression may contribute to the development of IBD and colonic carcinogenesis.
Clinical value of electrogastrography and the gastric emptying test
Authors: Luo Jinyan , Zhu Youling , Wang Xueqin , Qi Huibin
Published: March 2003

OBJECTIVE: To: (i) assess the clinical value of electrogastrography (EGG) and the gastric emptying test; and (ii) investigate the relationship between gastric myoelectrical activity and gastric emptying (GE).

METHODS: One hundred and forty patients with functional dyspepsia (FD), 30 patients with non‐insulin‐dependent diabetes mellitus (NIDDM) and 20 healthy volunteers were studied. Gastric myoelectrical activity was recorded by using cutaneous EGG. The gastric emptying time was measured by using isotopic, radiopaque marker (Rom’s) and ultrasound methods.

RESULTS: The dysrhythmia rates in patients with NIDDM were 70.0% (21/30) before meals and 66.7% (20/30) after meals, and the tachygastria rates of these patients were 36.7% before meals and 33.3% after meals. In NIDDM patients, the dominant frequency (DF) after meals (2.60 ± 0.30 cycles per minute; c.p.m.), the fed DF/fasting DF ratio (1.01 ± 0.11), the dominant power (DP) after meals (121.45 ± 67.00 V2 c.p.m.) and the fed DP and fasting DP ratios (0.81 ± 0.07) were significantly lower than those in normal controls (P < 0.05 or P < 0.01). The DP after meals in patients with FD (210.60 ± 68.40 V2 c.p.m.) was significantly lower than that in normal controls (P < 0.01). Delayed gastric emptying was more common in patients with FD and NIDDM. The rate of delayed gastric emptying in 121 cases with normal myoelectrical rhythm was 39.7% (48/121). In 69 cases with dysrhythmia, 45.9% (17/37) with bradygastria and 78.1% (25/32) with tachygastria had delayed gastric emptying.

CONCLUSIONS: Electrogastrography and the gastric emptying test are feasible methods for evaluating gastric myoelectrical activity and gastric motility. The precise relationship between gastric myoelectrical activity and gastric motility has not been proven, but there is a close relationship between tachygastria and delayed gastric emptying.
Clinicopathological analysis of non‐alcoholic steatohepatitis
Authors: Ni Yanjun , Liu Houyu , Hu Dechang , Zhe Weirong , Li Mingsheng
Published: March 2003

OBJECTIVE: Based on liver biopsy samples collected during the past 10 years, the present study aimed to investigate the incidence of fatty liver, the relationship between fatty liver and other underlying liver diseases, and the clinical and pathological characteristics, and the risk factors of fatty liver.

METHODS: From a total of 658 liver biopsy specimens collected from 1988 to 1997, there were 71 cases of fatty liver and 68 cases of non‐alcoholic fatty liver. Matched by sex and age, 155 specimens of non‐fatty liver were used as controls. All patients from which the biopsies were taken were tested for liver function, blood lipid profile, blood glucose and hepatitis virus markers. The liver biopsy samples were all investigated by the same pathologist.

RESULTS: The prevalence of fatty liver among all the liver biopsies was 10.8%. The alanine aminotransferase, aspartate aminotransferase, total bilirubin and con‐jugated bilirubin levels in the fatty liver group were significantly lower than those in the non‐fatty liver group, whereas the triglyceride levels were higher. Pathologically, steatosis in patients with fatty liver was mainly located around the hepatic lobules, and macrovesicular steatosis was common. Of the 68 cases of non‐alcoholic fatty liver, hepatic cell necrosis was found in 35 cases (51.5%), inflammatory cell infiltration in 46 cases (67.6%) and fibrosis to various degrees in 19 cases (27.9%).

CONCLUSION: Non‐alcoholic fatty liver is closely related to hyperlipidemia. In asymptomatic subjects with abnormal liver function, a liver biopsy is the only way to establish the type and severity of liver lesions.
Construction of an attenuated Salmonella typhimurium vaccine carrying the Helicobacter pylori hpaA gene
Authors: ZHU Sen Lin , CHEN Min Hu , LIAO Wen Jun , CHEN Jie , HU Pin Jin
Published: March 2003

OBJECTIVE: Helicobacter pylori is documented to have infected more
than half of the world’s population. It colonizes the human stomach and is
associated with the development of chronic active gastritis, peptic ulcer disease,
gastric adenocarcinoma and gastric mucosa‐associated lymphoid tissue (MALT) lymphoma.
Immunization against this bacterium represents a cost‐effective strategy to reduce
global gastric cancer rates and would have a major impact on H. pylori‐related
peptic ulcer disease. HpaA, a subunit protein of H. pylori adhesin, is known
to be the pathogenic factor and attenuated Salmonella typhimurium is a live
vaccine vector. The present study aimed at constructing and identifying a live attenuated
S. typhimurium vaccine carrying the hpaA gene of H. pylori.

METHODS: The hpaA gene was amplified from H. pylori genomic
DNA by polymerase chain reaction (PCR) and cloned into the NcoI‐SalI
site of the prokaryotic expression plasmid pTrc99A. After sequence analysis of the
hpaA gene, the identified recombinant plasmid was then used to transform a
live attenuated S. typhimurium, namely SL3261, and positive clones were screened by PCR and restriction enzyme digestion.

RESULTS: Confirmed by PCR, restriction enzyme digestion and sequence analysis,
a recombinant prokaryotic expression plasmid, namely pTrc99A‐hpaA, harboring approximately
560 bp hpaA was constructed and the recombinant plasmid was then successfully
introduced into a live attenuated S. typhimurium SL3261.

CONCLUSION: A recombinant live attenuated S. typhimurium vaccine
harboring the H. pylori hpaA gene was constructed and identified. This work
will help develop an oral recombinant live vaccine against H. pylori infection.
Risk factors for postoperative pancreatitis associated with diagnostic and therapeutic endoscopic retrograde cholangiopancreatography
Authors: YE Li Ping , XU Guo Ming , SUN Zhen Xing , LI Zhao Shen
Published: March 2003

OBJECTIVE: To investigate the risk factors for postoperative pancreatitis following endoscopic retrograde cholangiography (ERC), endoscopic retrograde pancreatography (ERP), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic biliary stenting.

METHODS: Four hundred and twelve patients referred to the endoscopy unit were divided into seven groups: (i) double ducts (pancreatic duct and biliary duct) contrast media filling group (ERCP group); (ii) biliary duct contrast media filling group (ERC group); (iii) pancreatic duct contrast media filling group (ERP group); (iv) ERCP plus biliary stenting group (ERCP + stent group); (v) ERC plus stenting group (ERC + stent group); (vi) ERCP plus EST and stone extraction (SE) group (ERCP + EST + SE group); and (vii) ERC plus EST and SE group (ERC + EST + SE group). Differences in postoperative serum amylase at 4 and 24 h, as well as clinical symptoms, were compared among the different groups.

RESULTS: The incidence of postoperative hyperamylasemia at 4 and 24 h was 17.7 and 4.4%, respectively. The overall incidence of postoperative acute pancreatitis was 3.9% and the ERP group had the highest incidence of postoperative acute pancreatitis among the seven groups.

CONCLUSIONS: Repeated pancreatic duct contrast filling during ERCP manipulation is the main risk factor for postoperative pancreatitis and therapeutic ERCP, such as EST, stenting and SE, does not increase the incidence of postoperative pancreatitis.
Diagnosis of gastric cancer by using autofluorescence spectroscopy
Authors: XIAO Shu Dong , GE Zhi Zheng , ZHONG Liang , LUO Hong Yu
Published: March 2003

AIMS: To evaluate the clinical use of laser‐induced fluorescence (LIF) spectra for diagnosing gastric cancer during gastroscopy.

METHODS: A helium−cadmium laser system (excitation wavelength = 442 nm) was used to detect autofluorescence in 38 patients with endoscopically and histologically diagnosed gastric cancer and chronic gastritis.

RESULTS: The LIF spectra produced by the helium− cadmium laser from gastric cancer tissue had one major peak (510 nm) and three minor peaks (590, 670, 710 nm). The intensity and shape of the LIF spectra in gastric cancer and normal gastric tissue were significantly different. Using the integral fluorescence intensities (FI) at 662−677 and 701−716 nm and the FI ratio of 510 nm/710 nm as the diagnostic parameters, it was possible to diagnose gastric cancer with a sensitivity of 83%, a specificity of 91%, a positive predictive value of 88% and a negative predictive value of 88%. The diagnostic accuracy was 88%.

CONCLUSIONS: Using autofluorescence spectro­scopy to detect gastric cancer allows real‐time detection of gastric cancerous lesions and it serves as a guide for taking biopsy specimens. The technique may become a useful tool in the diagnosis of early gastric cancer.
Esophageal pH and bile monitoring for detecting duodenogastroesophageal reflux and evaluating the effectiveness of treatment
Authors: LIN Jin Kun , HU Pin Jin , LI Chu Jun , DENG Hui Fen , CHEN Wei
Published: March 2003

OBJECTIVE: To study methods of diagnosing duo­denogastroesophageal reflux (DGER) and to evaluate the role of bile reflux in gastroesophageal reflux disease (GERD).

METHODS: Simultaneous 24‐h esophageal mucosal bilirubin level and pH monitoring were performed in 20 healthy subjects and 52 patients with symptoms suggesting gastroesophageal reflux. Data were gathered by using an ambulatory duodenogastric reflux monitoring system (Bilitec 2000) and an ambulatory pH recorder (Digitrapper MKIII). An absorbance value of ≥0.14 was designated as the threshold value for the presence of bile reflux. Patients suffering from mixed pathological reflux of acid and bile were treated with hydrotalcite and cisapride for 4 weeks, then the monitoring was repeated.

RESULTS: No pathological acid reflux was found in the 20 healthy subjects. Based on findings from 24‐h esophageal pH monitoring, 47 of 52 patients (including 12 with esophagitis) were found to have patho­logical reflux. The total fraction of time with bile reflux was greater in the patients (n
= 52) than in the healthy subjects (n
= 20; 2.67 ± 3.23%vs 0.47 ± 0.71%; P < 0.05) and was greater in the patients with esophagitis (n
= 12) than in the patients without esophagitis (n
= 35; 5.41 ± 4.93%vs 1.68 ± 1.76%; P < 0.05). Of the 47 patients with GERD, 15 (32%) had abnormal mixed acid and bile reflux. Eight of the 15 patients with esophagitis were found to have mixed reflux and only four of 32 had acid reflux only (P < 0.05). After treatment with hydrotalcite and cisapride, the total fraction of time with acid and bile reflux in the 15 patients with mixed reflux decreased significantly (P < 0.05). Esophagitis was cured in seven of eight patients.

CONCLUSION: The ambulatory duodenogastric reflux monitoring system is a useful tool for detecting DGER and evaluating the efficacy of treatment. Approximately 32% (15/47 cases) of patients with GERD were found to have DGER. Bile reflux may play a significant role in causing esophageal mucosal damage in patients suffering from GERD.
Risk factors for pressure ulcers in bedridden elderly subjects: Importance of turning over in bed and serum albumin level
Authors: Mino Yoshio , Morimoto Shigeto , Okaishi Kohya , Sakurai Shoroku , Onishi Miyuki , Okuro Masashi , Matsuo Akiko , Ogihara Toshio
Published: March 2003

Background:

The purpose of the present paper was to determine clinical risk factors for the development of pressure ulcers in bedridden elderly inpatients.

Methods:

A case‐control study was performed for 117 subjects with pressure ulcers (mean age: 80.6 ± 7.2 years) with a 1‐year observation period, and 351 age‐ and sex‐matched controls. Factors examined were subitems of the Braden scale; convenient clinical assessment (continence, sitting, turning, oral intake, and sitting up); underlying chronic conditions (stroke and diabetes mellitus); and circulating levels of albumin, total cholesterol, total lymphocyte count, and hemoglobin.

Results:

Compared to the controls, test cases showed lower scores of the Braden scale and lower levels of circulating factors, and higher incidences of incapability of the subitems of convenient clinical assessment, and of diabetes mellitus (P < 0.20). Three models of multiple logistic regression analysis revealed that decreased serum level of albumin and impaired self‐positioning in bed were significant independent risk factors. The relative risk for the development of pressure ulcers after full adjustment in the group with both hypoalbuminemia (< 35 g/L) and incapability of turning over in bed, the group with the former risk alone, and the group with the latter risk alone, was 14.0 (95% confidence interval (CI): 4.2–46.6), 4.9 (1.6–14.9), and 5.9 (1.8–19.0), respectively, compared to subjects without the two risk factors. Moreover, decreased circulating levels of albumin and hemoglobin were associated with aggravation of pressure ulcers.

Conclusion:

A combined measure of albumin and incapability of self‐positioning may serve as a simple but useful index for the risk of pressure ulcers in bedridden elderly inpatients.
Neurochemical regulation of swallowing reflex in guinea pigs
Authors: Jia Yu X , Li Jian Q , Matsui Toshifumi , Yamaya Mutsuo , Ohrui Takashi , Sekizawa Kiyohisa , Sasaki Hidetada
Published: March 2003

Background:

Most peripheral afferent fibers involved in swallowing travel through the glossopharyngeal and vagus nerves and terminate in the nucleus of the tractus solitarius (NTS) and nodose ganglion (NG). Sensory neurons within the NTS and NG contain several neurotransmitters, including acetylcholine, histamine, serotonin and dopamine. The roles of these four neurotransmitters were investigated.

Methods:

The effects of atropine (muscarinic cholinergic receptor antagonist); pyrilamine maleate (PM, histamine H1 receptor antagonist); cimetidine (histamine H2 receptor antagonist); 8‐hydroxy‐2‐(di‐n‐propylamino)‐tetralin (8‐OH‐DPAT, specific 5‐HT1A receptor agonist); and selective dopamine D1 receptor antagonist (Sch‐23390) on the number of swallows elicited by distilled water in anesthetized guinea pigs were investigated.

Results:

Atropine (0.2 mg/kg) inhibited swallowing by approximately 70%; PM (30 mg/kg) inhibited swallowing by approximately 60%; cimetidine (30 mg/kg) inhibited swallowing by approximately 52.9% and Sch‐23390 (chronic treatment) inhibited swallowing by approximately 40%. In contrast, 8‐OH‐DPAT did not alter the number of swallows. Chronic pretreatment of Sch‐23390 markedly decreased the substance P (SP) content in the pharyngeal mucosa and the esophagus.

Conclusion:

These findings indicate that acetylcholine, histamine and dopamine are involved in the regulation of the swallowing reflex, whereas it is unlikely that serotonin is involved.
Preoperative assessment scale for elderly Japanese patients (part I): basic study design and clinical trial
Authors: Tatematsu Mitsuyoshi , Kawamoto Takahiro , Hayashida Kazutaka , Yoshioka Hideyuki , Wada Taizo , Ueyama Kazuhisa , Nakajima Yasuyo , Nagano Yutaka , Takechi Hajime , Tanaka Makoto , Horiuchi Hisanori , Ishii Kenji , Arai Hidenori , Kume Noriaki , Wakatsuki Yoshio , Murakami Motonobu , Matsubayashi Kozo , Kita Toru , Yokode Masayuki
Published: March 2003

Background:The aim of the present paper was to propose a general assessment system for elderly patients undergoing surgical operations.

Methods:A protocol was designed to compare preoperative comorbidities and post‐operative complications.

Results:When the data from 51 consecutive elderly patients (≥ 65 years) were applied to the protocol and analyzed by chi‐squared test and Cox proportional hazards regression models, left ventricular hypertrophy and myocardial ischemia on electrocardiogram (ECG) were revealed to be significantly associated with development of postoperative complications (P< 0.05).

Conclusion:The current results serve as a basic data to design an assessment system to predict the prognosis of surgical patients.
Clostridium septicum and malignancy
Authors: Chew Simon S. B. , Lubowski David Z.
Published: March 2003

Background:  Clostridium septicum is known to be associated with malignancy or immunosuppression. It has a variable clinical presentation and is associated with a high mortality. The aim of the present study was to review the experience at St George Hospital, Sydney, over a 10‐year period, with particular reference to the association of this condition with colorectal cancer.

Methods:  The records of five patients with blood culture‐proven Clostridium septicum infection, among a larger group of 31 patients with clostridial infections, presenting to St George Hospital between 1990 and 2000 were reviewed.

Results:  Associated malignancy was found in four (80%) of the patients with Clostridium septicum infection. Two infections were related to colorectal cancer, two to haematological malignancies and one to radiation‐induced recto‐urethral fistula. Those patients who had colorectal cancer presented with septicaemia and vague abdominal symptoms.

Conclusions:  Clostridium septicum infections have a strong association with malignancy. When this infection occurs without an obvious underlying aetiology there should be a high index of suspicion about associated malignancy. In the absence of haematol­ogical malignancy a colonoscopy is warranted. Early diagnosis and aggressive treatment is essential in order to improve prognosis.
Treatment of the axilla in early breast cancer: past, present and future
Authors: Chua Boon , Ung Owen , Boyages John
Published: March 2003

Background:  The optimal treatment of the axilla in early breast cancer is controversial. The present study reviews the pattern and predictors of regional recurrence (RR) and prognosis after RR in patients with early breast cancer treated by conservative surgery and radiotherapy (CS + RT). Implications of the results on current practice and future directions are explored.

Methods:   Between 1979 and 1994, 1158 patients with stage I or II breast cancer were treated with CS + RT at Westmead Hospital. Two groups of patients were compared: 782 patients who underwent axillary dissection (axillary surgery group) and 229 patients who received radiotherapy (axillary RT group) as the only axillary treatment. At least 10 lymph nodes were dissected in 82% of the axillary surgery group. Of the women in the RT group, 90% received RT to the axilla and supraclavicular fossa (SCF) only and 10% also received RT to the internal mammary chain (IMC).

Results:  With a median follow‐up period of 79 months for the axillary surgery group and 111 months for the axillary RT group, 27 patients developed a RR (2.8% and 2.2%, respectively). Seven patients (0.9%) in the axillary surgery group and three patients (1.3%) in the axillary RT group developed a RR in the axilla (P, not significant). Of the patients with SCF recurrences, 14 (1.8%) were in the axillary surgery group and one (0.4%) in the axillary RT group (P, not significant). One patient in the axillary surgery group developed concurrent axillary and SCF recurrences, while a patient in the axillary RT group developed an IMC recurrence. Twenty (74%) of the 27 patients with a RR developed a concurrent or subsequent distant relapse (30% and 44%, respectively). In the pathologically node‐positive patients, the axillary recurrence rate was higher in those who had less than five nodes removed (17%) than those who had 10 or more nodes removed (0%; P = 0.01). The SCF recurrence rate was higher in patients with four or more positive axillary nodes (9.5%) than in those with 0–3 positive nodes (1.5%; P = 0.003).

Conclusion:  Adequate treatment of the axilla by surgery or RT alone is associated with a low rate of RR. The incidence of distant relapse was substantial in patients who developed a RR, which gives emphasis to the importance of optimizing local–regional control.
Computer‐based logbook for surgical registrars
Authors: Brouwer Richard , Kiroff George
Published: March 2003

Background: The documentation and monitoring of operative experience is an important component of advanced surgical training. The Royal Australasian College of Surgeons (RACS) monitors the adequacy of training by use of the surgical logbook. The logbook has been a paper‐based record that does not permit longitudinal evaluation of the progress of an individual trainee or comparison of different surgical units.

Methods: An electronic logbook has been developed in FileMaker Pro version 5.03 (FileMaker, Santa Clara, California, USA).

Results: The electronic logbook has been employed for 1 year and has been used on both Windows and Macintosh platforms without difficulty. Appropriate summaries of the training experience were provided for the RACS at the conclusion of each rotation.

Conclusions: The use of a relational database for logbook purposes provides trainees with a convenient and versatile record of their experience while meeting RACS requirements for documentation of surgical experience.