bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integrated water management of the Brahmaputra basin: Perspectives and hope for regional development
Authors: Rahaman Muhammad Mizanur , Varis Olli 
Published: April 2009

Abstract Water is strongly linked with the overall development framework of the Brahmaputra basin. However, the absence of integrated management of Brahmaputra water resources and lack of coordination among the riparian states constitutes an ongoing threat to future development plans within the basin. Brahmaputra's abundant hydropower potential can help give riparian countries a safer energy future that is the key driving force behind the prospect of potential cooperation. This paper analyses the current status of Brahmaputra water resources and identifies the perspectives of riparian countries regarding the development of the Brahmaputra basin. It also identifies the opportunities for cooperation and regional development through integrated water development and management of the Brahmaputra basin. It is essential to develop an integrated water resources management approach involving all riparians to foster regional development and overcome the prospect of severe water conflict along the Brahmaputra basin.
Critical review of Integrated Water Resources Management: Moving beyond polarised discourse
Authors: Saravanan V. S. , McDonald Geoffrey T. , Mollinga Peter P. 
Published: April 2009

Abstract Integrated Water Resource Management (IWRM) emerged as a popular concept in the water sector in the 20th century. From a highly techno‐centric approach in the past, it has taken a new turn embracing Habermasian communicative rationality as a place‐based nexus for multiple actors to consensually and communicatively integrate decisions in a hydrological unit. The ‘how to integrate’ approach had remarkable appeal worldwide in promoting authentic participation of all stakeholders. However, critics argue that the domain of water resource management is a political process of contestation and negotiation; the emphasis is on complexities, contextuality, power dynamics and the importance of analysing real world situations. They demonstrate ‘how integration cannot be achieved’ given the power dynamics in social interactions. These apparently contradictory discourses draw on different theoretical paradigms and polarise the discourse on IWRM, without offering constructive alternatives. To this end, this paper offers an option to complement this polarised discourse by examining ‘how integration actually does take place’ in a strategic context thereby facilitating consensual decisions to integrate water management for a sustainable future.
Carbon monoxide produced by intrasinusoidally located haem‐oxygenase‐1 regulates the vascular tone in cirrhotic rat liver
Authors: Van Landeghem Lien , Laleman Wim , Vander Elst Ingrid , Zeegers Marcel , Van Pelt Jos , Cassiman David , Nevens Frederik 
Published: April 2009

AbstractBackground/Objective: Carbon monoxide (CO) produced by haem‐oxygenase isoforms (HO‐1 & HO‐2) is involved in the regulation of systemic vascular tone. We aimed to elucidate the vasoregulatory role of CO in the microcirculation in normal and thioacetamide cirrhotic rat livers.Methods: Haem‐oxygenase expression was examined by Western blot. Total HO enzymatic activity was measured spectrophotometrically. Sensitivity of hepatic stellate cells (HSCs) to CO‐mediated relaxation was studied by a stress‐relaxed‐collagen‐lattice model. To define the relative role of CO, the CO‐releasing molecule CORM‐2, the HO‐inhibitor zinc protoporphyrin‐IX and the HO‐1 inducer hemin were added to an in situ liver perfusion set‐up. The topography of vasoactive CO production was evaluated by applying different CO‐ and nitric oxide‐trapping reagents in the liver perfusion set‐up and by immunohistochemistry.Results: Western blot showed decreased expression of both HO isoenzymes (P<0.036 for HO‐1; P<0.001 for HO‐2) in cirrhotic vs normal rat livers, confirmed by the HO‐activity assay (P=0.004). HSCs relaxed on exposure to CORM‐2 (P=0.013). The increased intrahepatic vascular resistance (IHVR) of cirrhotic rats was attenuated by perfusion with CORM‐2 (P=0.016) and pretreatment with hemin (P<0.001). Inhibition of HO caused a dose‐related increase in IHVR in normal and cirrhotic liver. In normal liver, the haemodynamically relevant CO production occurred extrasinusoidally, while intrasinusoidally HO‐1 predominantly regulated the microcirculation in cirrhotic livers.Conclusion: We demonstrate a role for CO and HO in the regulation of normal and cirrhotic microcirculation. These findings are of importance in the pathophysiology of portal hypertension and establish CO/HO as novel treatment targets.
Elevated concentrations of 15‐deoxy‐Δ12,14‐prostaglandin J2 in chronic liver disease propose therapeutic trials with peroxisome proliferator activated receptor γ‐inducing drugs
Authors: Gressner Olav A. , Gao Chunfang , Rehbein Katharina , Lahme Birgit , Siluschek Monika , Berg Thomas , Müller Tobias , Gressner Axel M. 
Published: April 2009

AbstractBackground/Aims: Current knowledge confers a crucial role to connective tissue growth factor (CTGF/CCN2) in hepatic fibrogenesis. Hepatocytes are likely to be the major cellular source of CTGF in the liver in which CTGF is sensitively upregulated by TGF‐β. Recently, we demonstrated that the methylxanthine derivate caffeine leads to an upregulation of peroxisome proliferator activated receptor γ (PPARγ) expression in hepatocytes, thus sensitizing these cells to the well‐known inhibitory effect of 15‐deoxy‐Δ12,14‐prostaglandin J2 (15‐d‐PGJ2) on CTGF expression. However, upregulation of the receptor alone is not sufficient per se; its physiological ligand 15‐d‐PGJ2 is required to exert an inhibitory effect on transforming growth factor‐β (TGF‐β) target genes such as CTGF.Methods: This study compared serum concentrations of 15‐d‐PGJ2 in Caucasian patients with fibrotic liver diseases (n=289), Caucasian controls (n=136) and Caucasian non‐liver disease (NLD) sick (n=307), as well as of Chinese patients with hepatocellular carcinoma (HCC) (n=43) and Chinese healthy controls (n=63) in order to characterize their suitability for therapeutic approaches with PPARγ‐inducing (i.e. CTGF inhibitory) drugs such as caffeine.Results: The presented data showed that Caucasian patients with ongoing hepatic fibrogenesis (mean 6.2±5.9 μg/L) displayed strikingly higher serum concentrations of 15‐d‐PGJ2 than healthy probands (mean 2.3±1.0) and Caucasian patients with NLD (mean 2.7±1.4 μg/L). Similar results were found in Chinese patients with fully developed HCC (mean 1.3±0.7 μg/L) compared with Chinese healthy controls (mean 0.4±0.2 μg/L).Conclusions: In conclusion, our data thus proposed an increased suitability of these patient groups for therapeutic approaches with drugs inducing PPARγ expression, such as methylxanthine derivates.
Altered factor VII activating protease expression in murine hepatic fibrosis and its influence on hepatic stellate cells
Authors: Roderfeld Martin , Weiskirchen Ralf , Atanasova Srebrena , Gressner Axel M. , Preissner Klaus T. , Roeb Elke , Kanse Sandip M. 
Published: April 2009

AbstractBackground: Platelet‐derived growth factor‐BB (PDGF‐BB) is a profibrotic factor in liver fibrosis through its ability to stimulate hepatic stellate cells (HSC). The liver‐derived serine protease factor VII activating protease (FSAP) regulates the activities of PDGF‐BB in a cell‐specific manner.Aims: Our aim was to determine the influence of FSAP on the activation of HSC and to analyse the regulation of FSAP in hepatic fibrogenesis.Methods: The effect of FSAP on PDGF‐stimulated p42/p44 mitogen‐activated protein kinase (MAPK) activation in primary rat HSC was determined by Western blotting. Migration and proliferation of HSC was evaluated in Boyden chamber experiments and 3H‐thymidine incorporation assays respectively. Expression of FSAP was analysed in a CCl4 mouse model of liver fibrosis by Western blot, quantitative real‐time polymerase chain reaction and immunohistochemistry.Results: FSAP inhibited PDGF‐BB‐stimulated p42/p44 MAPK phosphorylation, proliferation and migration of HSC. FSAP mRNA expression level was increased 3 h after CCl4 application and decreased after 18 h and, in established fibrosis, after chronic CCl4 administration. In parallel, there was a decrease in the circulating FSAP protein in chronic fibrosis. Concurrently, the homogenous hepatic expression pattern of FSAP was disturbed. Immunohistochemistry revealed a decrease of FSAP in hepatocytes in inflammatory and fibrotic lesions.Conclusions: Our results demonstrate an inhibitory effect of FSAP on PDGF‐mediated activation of HSC. In addition, FSAP expression is transiently increased in acute‐phase reaction but decreased during chronic fibrogenesis, which in turn may influence PDGF‐BB availability and myofibroblast activity.
Predictive factors of advanced recurrence after curative resection of small hepatocellular carcinoma
Authors: Hosaka Tetsuya , Ikeda Kenji , Kobayashi Masahiro , Hirakawa Miharu , Kawamura Yusuke , Yatsuji Hiromi , Sezaki Hitomi , Akuta Norio , Suzuki Fumitaka , Suzuki Yoshiyuki , Saitoh Satoshi , Arase Yasuji , Kumada Hiromitsu 
Published: April 2009

AbstractBackground: The tumour recurrence rate after resection is still high even in patients with small hepatocellular carcinoma (HCC). The advanced patterns of recurrence occasionally occur after resection. In this study, we analysed the clinical and histological characteristics of small HCC and evaluated the predictive factors of advanced tumour recurrence.Methods: One hundred and sixty‐five patients underwent resection of small HCC measuring 3 cm or less in greatest dimension. Patterns of tumour recurrences were classified into advanced recurrence and minor recurrence based on size, number, vascular invasion and extrahepatic metastasis of recurrent tumour. We created a simple index to closely evaluate the malignant potential of small HCC, named α‐foetoprotein–size ratio index (ASRI).Results: Overall tumour recurrence was significantly associated with tumour multiplicity (P<0.001) and ASRI (P=0.001). Tumour multiplicity, ASRI and tumour differentiation were independent and significant predictive factors of advanced recurrences. The overall survival rates were lower in the advanced recurrence group than the minor recurrence or the no recurrence group.Conclusions: Patients with advanced recurrences have a poor prognosis, although they have undergone curative resection of small HCC. On the other hand, patients with minor recurrences have a relatively good prognosis. ASRI was a useful index to predict advanced recurrence after curative resection of small HCC. The therapeutic management to prevent advanced recurrences is needed.
Atropine for prevention of cardiac dysrhythmias in patients with hepatocellular carcinoma undergoing percutaneous ethanol instillation: a randomized, placebo‐controlled, double‐blind trial
Authors: Arnulf Ferlitsch , Monika Schmid , Herwig Schmidinger , Monika Homoncik , Johannes Pleiner‐Duxneuner , Gregor Ulbrich , Alfred Gangl , Markus Peck‐Radosavljevic 
Published: April 2009

AbstractIntroduction:Percutaneous ethanol injection (PEI) is an established method in the treatment of hepatocellular carcinoma (HCC). During this procedure, severe cardiac bradyarrhythmias can occur. A preemptive injection of atropine is recommended by professional guidelines to prevent these dysrhythmias.Methods:Patients scheduled for PEI were randomized 1:1 to receive 0.5 mg atropinehydrochloride or placebo in a double‐blind randomized placebo‐controlled trial. Patients were electrocardiogram monitored, which were then analysed by an experienced rhythmologist blinded to the treatment arm.Results:Patients in 40 consecutive PEI sessions were included. During PEI, a significant reduction in the mean heart rate (>15%) was seen in 15% of patients in the placebo group (median, −37%; range, 15–41%) and in 25% of patients receiving atropine (median, −20%; range, 16–64%). There was no significant difference between both groups.During PEI, two patients (10%) in the placebo group developed a sinuatrial block (SAB). Four patients in the atropine group (20%) developed arrhythmias: three patients SAB, one of them with escape rhythm and one AV‐bundle block. Blood ethanol levels post‐PEI, amount of instilled ethanol, tumour size and location were not different between patients with or without dysrhythmias.Conclusion:In this randomized‐controlled trial, a preprocedure atropine injection did not prevent the occurrence of bradyarrhythmias. Prophylactic use of atropine might not be effective and therefore cannot be recommended as a routine procedure. Clinicaltrials.gov‐identifier: NCT00575523.
Characteristics and outcome of patients with dual hepatitis B and C‐associated hepatocellular carcinoma: are they different from patients with single virus infection?
Authors: Huo Teh‐Ia , Huang Yi‐Hsiang , Hsia Cheng‐Yuan , Su Chien‐Wei , Lin Han‐Chieh , Hsu Chia‐Yang , Lee Pui‐Ching , Lui Wing‐Yiu , Loong Che‐Chuan , Chiang Jen‐Huei , Chiou Yi‐You , Lee Shou‐Dong 
Published: April 2009

AbstractsBackground: Patients with hepatocellular carcinoma (HCC) caused by dual hepatitis B and C virus (HBV, HCV) infection may constitute a distinct disease group that is different from patients with single virus infection. This study compared the clinical characteristics and outcomes of patients with HBV, HCV and dual virus infection.Methods: A prospective database of 1215 HCC patients with chronic hepatitis B, C or dual virus infection was investigated.Results: Patients with HCV infection (n=388) were significantly older (mean age, 69 years) than patients with dual virus (n=75, 65 years) and HBV (n=752; 60 years) infection (P<0.0001). The male‐to‐female ratios for the HBV, dual virus and HCV groups were 5.2, 3.4 and 1.3 respectively (P<0.0001). Patients in the HBV group more often had higher total tumour volume (mean, 409 cm3) than those in the dual virus group (244 cm3) and HCV (168 cm3) group (P<0.0001). No significant differences of the severity of liver cirrhosis, performance status, cancer staging and tumour cell differentiation were noted among the three groups. Patients in the HCV group had a significantly poor survival in comparison with the HBV group only in the subset of patients with small tumour volume (<50 cm3) in the Cox proportional hazards model (relative risk, 1.44; P=0.041).Conclusions: Dual HBV and HCV virus infection does not accelerate the speed of HCC formation in patients with chronic hepatitis B, and appears to have a modified course of carcinogenesis pathway that is diverted away from the biological behaviour of HBV and HCV infection.
Factors associated with adherence to combination therapy of interferon and ribavirin for patients with chronic hepatitis C: importance of patient's motivation and physician's treatment experience
Authors: Tanioka Daisuke , Iwasaki Yoshiaki , Araki Yasuyuki , Osawa Toshiya , Ikeda Hiroshi , Ando Masaharu , Kobashi Haruhiko , Sakaguchi Kohsaku , Shiratori Yasushi , Yamamoto Kazuhide 
Published: April 2009

AbstractBackground/Aims: Adherence to combination therapy with interferon (IFN) or pegylated IFN plus ribavirin for chronic hepatitis C patients is important for a better virological response. However, the impact of the patient's treatment experience and treatment centre on adherence to combination therapy has not been fully analysed. In this prospective study, we analysed the factors that might have an effect on adherence to therapy in patients who had initial or retreatment IFN therapy.Patients and methods: We consecutively enrolled 363 patients with chronic hepatitis C; 221 were IFN naïve and 142 were undergoing retreatment. The mean ages of the naïve and retreatment groups were 54.8 and 55.7 years respectively. IFN α‐2b was administered daily for 2 weeks, followed by three times per week for 22 weeks, while ribavirin was administered daily. We evaluated the tolerability and response to combination therapy and analysed its relevant factors.Results: Of the 363 patients, 189 (52%) achieved 80% adherence. The multivariate logistic regression analysis revealed that retreatment, centre with more patients treated, patient age (<55 years), male, genotype 2 and dosage of IFN per weight (<0.13 million units/kg) were associated with achievement of 80% adherence to combination therapy. Accordingly, the achievement of 80% adherence was more frequent in the retreatment (62%) than that in the naïve group (46%) (P<0.01) and in centres with more patients treated (57%) than in those with less patients treated (46%) (P=0.03).Conclusion: The present data suggest that the patient's motivation and the physician's treatment experience may be important for a better adherence to combination therapy for patients with chronic hepatitis C.
Inhibition of hepatic tumour necrosis factor‐α attenuates the anandamide‐induced vasoconstrictive response in cirrhotic rat livers
Authors: Yang Ying‐Ying , Lee Kuei‐Chuan , Huang Yi‐Tsau , Lee Fa‐Yauh , Chau Ga‐Yang , Loong Che‐Chuan , Lin Han‐Chieh , Lee Shou‐Dong 
Published: April 2009

Abstract Background: Increased anandamide, an endocannabinoid that interacts with both cannabinoid CB1 and CB2 receptors, can induce hepatic vasoconstrictive responses that contribute to the increased intrahepatic resistance (IHR) in cirrhotic rats. Chronic endotoxaemia and the subsequent release of tumour necrosis factor‐α (TNF‐α) are suggested to result in increased anandamide in cirrhotic livers. Thalidomide, which inhibited TNF‐α effectively, has been used clinically in states of chronic TNF‐α elevation with encouraging results. Aims: This study explores the possible effects of thalidomide on hepatic endocannabinoids and microcirculation of cirrhotic rats. Methods: Portal venous pressure (PVP), superior mesenteric arterial blood flow (SMA BF), hepatic TNF‐α, interleukin (IL‐6), protein expression of CB1 and CB2 receptor and thromboxane synthase (TXS) were measured in bile duct‐ligated (BDL) rats receiving 1‐month of vehicle (BDL‐V) or thalidomide (BDL‐thalido). The degree of hepatic fibrosis was also assessed. In the liver perfusion system, IHR and concentration–response curves of the portal perfusion pressure to anandamide were evaluated. Results: In BDL‐thalido rats, PVP, IHR and hepatic levels of TNF‐α and IL‐6, protein expression of CB1 receptors, TXS and hepatic fibrosis were lower than in BDL‐V rats. In BDL‐thalido rat livers, the attenuation of the vasoconstrictive response to anandamide was associated with an upregulation of the CB2 receptor and a downregulation of the CB1 receptor. Nevertheless, SMA BF was not different between BDL‐thalido and BDL‐V rats. Conclusions: Thalidomide decreased the PVP and IHR through the attenuation of anandamide‐induced constrictive response, decreasing the production of TNF‐α, IL‐6 and TXA2 in the liver and the suppression of hepatic fibrogenesis of rats with biliary cirrhosis of this study.
Variability in liver stiffness values from different intercostal spaces
Authors: Kim Seung Up , Kim Ja Kyung , Park Jun Yong , Ahn Sang Hoon , Lee Jung Min , Baatarkhuu Oidov , Choi Eun Hee , Han Kwang‐Hyub , Chon Chae Yoon , Kim Do Young 
Published: April 2009

Abstract Aim: To investigate the variability in liver stiffness measurement (LSM) values from the fifth, sixth and seventh intercostal space (ICS) and examine whether LSM better predicts significant fibrosis (F2–4) and cirrhosis when LSM is performed at the same site as liver biopsy (LB). Methods: This study enrolled 91 consecutive patients with hepatitis B virus (HBV)‐related chronic liver disease (CLD) who underwent both LB and LSM between September 2007 and January 2009. Results: The mean age of the patients was 45.4 years (66 men and 25 women). F1 fibrosis was noted in 12 patients (13.2%), F2 in 28 (30.7%), F3 in 15 (16.5%) and F4 in 36 (39.6%). The mean LSM values from the fifth, sixth and seventh ICS were 11.6, 11.1 and 10.9 kPa respectively. The mean LSM value from the same site as LB was 11.0 kPa. An interclass correlation analysis showed no significant difference in LSM values from the fifth, sixth and seventh ICS and the same site as LB. The area under the receiver operating characteristic curves of LSM values from the fifth, sixth and seventh ICS and the same site as LB for predicting significant fibrosis were 0.815, 0.838, 0.818 and 0.837, respectively, and those for cirrhosis were 0.919, 0.916, 0.907 and 0.913, respectively, with all overlapping confidence intervals. Conclusions: Any LSM value from the fifth, sixth or seventh ICS can predict significant fibrosis and cirrhosis with considerable accuracy without statistical differences regardless of correspondence with LB site in patients with HBV‐related CLD.
Students’ attitudes towards an on‐line orthodontic learning resource
Authors: Linjawi A. L. , Hamdan A. M. , Perryer D. G. , Walmsley A. D. , Hill K. B. 
Published: April 2009

AbstractAim:  The purpose of this study was to develop an online undergraduate orthodontic e‐course and assess its success as a learning resource from the students’ perspective.Methodology:  The orthodontic e‐course was composed of six main components; modules, photo gallery, clinical consultations, glossary, reading lists and resources. Four undergraduate orthodontic lectures were converted into a web‐based format using text, photographs, PowerPoint presentations and animations. The sample was comprised of sixty‐four third year undergraduate dental students at Birmingham Dental School, UK. Their average age was 20.7 years (age range: from 20–25 years). A questionnaire was developed to assess; course design, course delivery, course outcome and the potential use of the e‐course as a teaching method.Results:  There were no significant difference between genders (P < 0.05). Overall, student responded very positive to positive for course design, course delivery and course outcome. The orthodontic e‐course was still seen by most subjects (86%) as an adjunct and not a replacement of the traditional teaching methods. 34.4% of subjects felt that it should be as an optional supplement and 51.6% felt that it should be integrated with the undergraduate orthodontic curriculum. The significance of the program as a learning resource was reported to be the best aspect of the program.Conclusion:  Delivery of web‐based material in the undergraduate orthodontic curriculum was seen by students as a significant learning resource which supplements traditional learning methods.
Dentists’ ethical practical knowledge: a critical issue for dental education
Authors: Ardenghi Diego Machado 
Published: April 2009

AbstractDentists, just like teachers, when moving from school to the workplace (dental offices and classrooms respectively), may find it difficult to apply theories learned during formal education to the complexities of the workplace environment. These difficulties constitute a critical issue for dental education in the area of ethics. In teacher education, the knowledge teachers develop for dealing with the situations they encounter in the classroom is called teachers’ practical knowledge. In this study, I discuss the concept of teachers’ practical knowledge within the context of dentistry, focusing on the ethical dimensions of dentistry practice, arguing for a dentists’ ethical practical knowledge. In this sense, I articulate the similarities between teachers’ practical knowledge and its equivalent in dental education, suggesting alternatives for dental education that could foster the development of dentists’ ethical practical knowledge.