bluuebunny/crossref_metadata_2025_split huggingface dataset:
Different presentation of hepatitis B‐related hepatocellular carcinoma in a cohort of 1863 young and old patients — implications for screening
Authors: Lam C.‐M. , Chan A. O. O. , Ho P. , Ng I. O.‐L. , Lo C. M. , Liu C. L. , Poon R. T. P. , Fan S. T. 
Published: March 2004

SummaryAim : To compare the clinico‐pathological features of hepatitis B virus‐related hepatocellular carcinoma in young and old patients.Methods : The clinico‐pathological characteristics of hepatitis B virus‐related hepatocellular carcinoma were compared in 1863 consecutive patients (121 patients, ≤40 years; 1742 patients, > 40 years) seen at a single institution over the last 13 years.Results : Young patients presented more often with pain (P < 0.0001), hepatomegaly (P = 0.01) and ruptured hepatocellular carcinoma (P = 0.02), whereas old patients presented with ankle oedema (P = 0.001), ascites (P = 0.002) and by routine screening (P = 0.035). Liver function, Child–Pugh grading and indocyanine green test were better preserved in young patients. They also had a higher α‐foetoprotein concentration (P = 0.001), larger tumour size (P = 0.001) and more frequent metastasis (P = 0.008), but a similar surgical resection rate (33.6% vs. 28%), to old patients. There was no difference between the two groups in the overall post‐resection survival rate, but there was a shorter survival in young patients with unresectable disease (3.6 months vs. 4.6 months, P = 0.004).Conclusion : Young patients with hepatocellular carcinoma often show a later presentation, but a higher resectability rate and similar survival rates, than old patients. The screening programme should include young hepatitis B virus carriers, even in the absence of cirrhosis.
Living with an elephant: Growing up with parental substance misuse
Authors: Kroll Brynna 
Published: March 2004

ABSTRACTAlthough parental substance misuse is now a focus of concern in child welfare practice, we know little about what it is really like for children who grow up in families where adult drug and/or alcohol use is an issue. Set against a backdrop of research links between parental substance misuse and child maltreatment, this article examines a number of studies that focus on the experiences of children and young people in this context. Emerging themes are identified which provide insight into the world of children for whom a substance is, effectively, a family member –‘the elephant in the living room’– and the implications for practice, particularly in relation to children's visibility, disclosure and confidentiality, are considered. It is argued that a focus on the ‘elephant’ often leads to children remaining ‘invisible’ to those whose role it is to ensure their welfare.
Patterns of injury in patients with radiographic occult fracture of neck of femur as determined by magnetic resonance imaging
Authors: Galloway Howard R , Meikle Grant R , Despois Mervyn 
Published: March 2004

SummaryThe purpose of the present study was to review retrospectively our experience with MRI in patients over the age of 50 who present to the emergency department with inability to weight bear following a fall and whose initial radiographs were normal. The study was designed to establish the incidence and pattern of bone and soft tissue injuries in these patients and to determine whether MRI could provide predictive information regarding length of hospital stay. The present study demonstrated the practicality of a protocol using MRI to obtain rapid definitive diagnosis in patients with occult fractures of the pelvic ring and neck of femur. The present study also suggests that significant prognostic information with regard to length of hospital stay can be obtained from an early MRI scan.
Intensity‐modulated radiotherapy: Examples of its utility in head and neck cancer
Authors: Porceddu Sandro , Hope Geoff , Wills Julie , Cramb Jim , Rischin Danny , Corry June , Peters Lester 
Published: March 2004

SUMMARYIntensity‐modulated radiotherapy (IMRT) has been available at Peter MaCallum Cancer Centre (PMCC) since November 2000. The present report illustrates two cases of our early experience with IMRT. Case 1 is a 66‐year‐old man with a T1N2M0 nasopharyngeal carcinoma treated with chemo‐radiotherapy using parotid‐sparing IMRT. Fourteen months following treatment he remains in complete remission, with salivary function assessed using a xerostomia‐specific quality of life questionnaire, having returned to near pretreatment levels by 12 months. Case 2 is a 70‐year‐old man with a T4N0M0 base of tongue squamous cell carcinoma treated with chemo‐radiotherapy after refusing radical surgery. He had received subtotal nodal irradiation to 36 Gy in 1994 for Hodgkins disease stage IIA. A radical dose was still achievable despite previous irradiation without exceeding unacceptable spinal cord dose with IMRT. He remains in complete remission 14 months from his initial presentation without evidence of neurological toxicity. Intensity‐modulated radiotherapy allows sparing of critical normal structures in the head and neck without compromising dose to the tumour. It is, therefore, desirable for several clinical applications and essential in some, if unacceptable compromises are not to be made.
Abdominal cerebrospinal fluid pseudocyst
Authors: Pathi Ramon , Sage Michael , Slavotinek John , Hanieh Ahmad 
Published: March 2004

SUMMARYA case of an abdominal cerebrospinal fluid (CSF) pseudocyst in a patient with a ventriculoperitoneal shunt is reported to illustrate this known but rare complication. In the setting of a VP shunt, the frequency of abdominal CSF pseudocyst formation is approximately 3.2%, often being precipitated by a recent inflammatory or infective process or recent surgery. Larger pseudocysts tend to be sterile, whereas smaller pseudocysts are more often infected. Ultrasound and CT each have characteristic findings.
Focal nodular hyperplasia in a child with hemihypertrophy and multiple cutaneous vascular malformations
Authors: Al‐Attar M , Verma R , Shannon RS , McKeever PA , Rickett A 
Published: March 2004

SUMMARYA case of focal nodular hyperplasia of the liver occurring in a 9‐year‐old girl with musculoskeletal hemihypertrophy and multiple cutaneous capillary haemangiomata is described. The child presented because of limb length discrepancy and was found to have a large mass in the liver. Imaging showed a mass of similar characteristics to normal liver tissue. Prominent vascular supply to the liver was also seen. We present this case to emphasize the important diagnosis of focal nodular hyperplasia, which may occur in syndromic form in children with typical cutaneous and skeletal manifestations.
Primary nasal lymphoma, NK/T‐cell type: Report of two cases with similar presentation but different outcome
Authors: Loong Susan , Soong Yoke Lim , Tham Ivan , Lee Khai Mun 
Published: March 2004

SUMMARYTwo cases of natural killer (NK)/T‐cell primary nasal lymphoma with similar clinical presentations are reported, for comparison and contrast, to highlight the clinical issues and challenges posed by this unusual disease, its aggressiveness being matched only by its rarity. Presenting as a lesion in the nasal cavity with histological features of malignant lymphoma, primary nasal lymphoma is an uncommon extranodal lymphoma, which poses problems in both diagnosis and management. In people of oriental descent, the common cell subtype is NK/T‐cell. Although it is generally thought that combination treatment with chemotherapy and radiation is the best management for early stage non‐Hodgkin's lymphoma (NHL), there is still debate as to whether combined therapy is optimal treatment for this particular subtype of NHL, given that it responds less well to conventional chemotherapy. Herein we report two patients to illustrate these controversies.
Parotid gland as an initial site of metastasis
Authors: Borg Martin F 
Published: March 2004

SUMMARYThe parotid gland is an uncommon site of metastasis from carcinomas arising outside the head and neck region. Involvement of the parotid gland as an initial site of metastasis or presentation is rare. The present case report is the first, to our knowledge, to describe the management and outcome of an elderly man whose first presentation of an asymptomatic squamous cell carcinoma of the lung was that of a rapidly growing fungating left parotid mass.
The Politics of Service Delivery Reform
Authors: Batley Richard 
Published: March 2004

AbstractThis article identifies the leaders, the supporters and the resisters of public service reform. It adopts a principal–agent framework, comparing reality with an ‘ideal’ situation in which citizens are the principals over political policy‐makers as their agents, and policy‐makers are the principals over public service officials as their agents. Reform in most developing countries is complicated by an additional set of external actors — international financial institutions and donors. In practice, international agencies and core government officials usually act as the ‘principals’ in the determination of reforms. The analysis identifies the interests involved in reform, indicating how the balance between them is affected by institutional and sectoral factors. Organizational reforms, particularly in the social sectors, present greater difficulties than first generation economic policy reforms.
India's Middle Classes and the Environment
Authors: Mawdsley Emma 
Published: March 2004

AbstractThe focus of most analyses of environmental struggles and discourses in colonial and postcolonial India is on rural and forest areas, and on subalterns versus elites. Recently, however, there has been increased interest in urban environmental issues, and, to some extent, in India's (variously defined)‘middle classes’. This article reviews a range of literatures — environmental, social‐cultural and political — in order to draw out themes and arguments concerning the relationships between India's middle classes and the complex meanings and materialities of the environment. Three issues are explored in detail: civic indifference and the public sphere; environmental activism; and Hinduism and ecological thinking. The article emphasizes the importance of recognizing diversity and dynamism within the middle classes in relation to the environment. It argues the need to develop situated understandings of what constitutes ‘the environment’ amongst different middle class groups; and underlines the ways in which environmental issues reflect and are often emblematic of wider social and political debates.
Second degree price discrimination and natural monopoly
Authors: Weichenrieder Alfons J. 
Published: March 2004

AbstractThis paper considers the efficiency of a contestable natural monopoly if consumers are heterogeneous and the monopolist can differentiate prices imperfectly. The paper shows that a “no‐distortion‐at‐the‐top” result, which is standard in models with restricted entry, may also appear in a contestable market. Depending on cost and demand structures, first best efficiency can also be a sustainable equilibrium. However, due to the existence of a continuum of equilibria, first best efficiency is not guaranteed. Most notably, even a stable “distortion‐at‐the‐top” result is possible.
Quasi‐geometric discounting: A closed‐form solution under the exponential utility function
Authors: Maliar Lilia , Maliar Serguei 
Published: March 2004

AbstractThis paper studies a discrete‐time utility maximization problem of an infinitely‐lived quasi‐geometric consumer whose labour income is subject to uninsurable idiosyncratic productivity shocks. We restrict attention to a first‐order Markov recursive solution. We show that under the assumption of the exponential utility function, the problem of the quasi‐geometric consumer admits a closed‐form solution.
An overview of positive pressure ventilation
Authors: Vassilev Elena , McMichael Maureen 
Published: March 2004

AbstractObjective:  The purpose of this article is to give the reader a brief overview of the indications for positive pressure ventilation (PPV).Data sources:  Current human and veterinary literature.Summary: There are numerous indications for PPV in veterinary medicine. These include both pulmonary parenchymal disease and diseases that affect ventilation. When choosing PPV, a clinician must have a comprehensive understanding of the different ventilation mode options available and the physiologic effects of ventilation on the patient.Conclusions: PPV is becoming more widely used in veterinary medicine and is improving the survival of animals with hypoxemic and hypercapnic respiratory failure.
The LspB Protein Is Involved in the Secretion of the LspA1 and LspA2 Proteins byHaemophilus ducreyi
Authors: Ward Christine K. , Mock Jason R. , Hansen Eric J. 
Published: March 2004

ABSTRACTThe LspA1 and LspA2 proteins ofHaemophilus ducreyi35000 are two very large macromolecules that can be detected in concentrated culture supernatant fluid. Both of these proteins exhibit homology with the N-terminal region of theBordetella pertussisfilamentous hemagglutinin (FHA), which is involved in secretion of the latter macromolecule. ThelspA2open reading frame is flanked upstream by a gene,lspB, that encodes a predicted protein with homology to theB. pertussisFhaC outer membrane protein that is involved in secretion of FHA across the outer membrane. TheH. ducreyi lspBgene encodes a protein with a predicted molecular mass of 66,573 Da. Reverse transcription-PCR analysis suggested that thelspBgene was transcribed together with thelspA2gene on a single mRNA transcript. PolyclonalH. ducreyiLspB antiserum reacted with a 64-kDa antigen present in the Sarkosyl-insoluble cell envelope fraction ofH. ducreyi35000, which indicated that the LspB protein is likely an outer membrane protein. Concentrated culture supernatant fluids fromH. ducreyi lspBandlspA1 lspBmutants did not contain detectable LspA1 and detectable LspA2, respectively. However, complementation of thelspBmutant with the wild-typelspBgene on a plasmid restored LspB protein expression and resulted in release of detectable amounts of the LspA1 protein into culture supernatant fluid. When evaluated in the temperature-dependent rabbit model of infection, thelspBmutant was attenuated in the ability to cause lesions and was never recovered in a viable form from lesions. These results indicated that theH. ducreyiLspB protein is involved in secretion of the LspA1 and LspA2 proteins across the outer membrane.
GNA33 of
Neisseria meningitidis
Is a Lipoprotein Required for Cell Separation, Membrane Architecture, and Virulence
Authors: Adu-Bobie Jeannette , Lupetti Pietro , Brunelli Brunella , Granoff Dan , Norais Nathalie , Ferrari Germano , Grandi Guido , Rappuoli Rino , Pizza Mariagrazia 
Published: March 2004

ABSTRACT

GNA33 is a membrane-bound lipoprotein with murein hydrolase activity that is present in all
Neisseria
species and well conserved in different meningococcal isolates. The protein shows 33% identity to a lytic transglycolase (MltA) from
Escherichia coli
and has been shown to be involved in the degradation of both insoluble murein sacculi and unsubstituted glycan strands. To study the function of the gene and its role in pathogenesis and virulence, a knockout mutant of a
Neisseria meningitidis
serogroup B strain was generated. The mutant exhibited retarded growth in vitro. Transmission electron microscopy revealed that the mutant grows in clusters which are connected by a continuous outer membrane, suggesting a failure in the separation of daughter cells. Moreover, sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis of culture supernatant revealed that the mutant releases several proteins in the medium. The five most abundant proteins, identified by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry analysis, belong to the outer membrane protein family. Finally, the mutant showed an attenuated phenotype, since it was not able to cause bacteremia in the infant rat model. We conclude that GNA33 is a highly conserved lipoprotein which plays an important role in peptidoglycan metabolism, cell separation, membrane architecture, and virulence.
Aeromonas
Flagella (Polar and Lateral) Are Enterocyte Adhesins That Contribute to Biofilm Formation on Surfaces
Authors: Kirov Sylvia M. , Castrisios Marika , Shaw Jonathan G. 
Published: March 2004

ABSTRACT

Aeromonas
spp. (gram-negative, aquatic bacteria which include enteropathogenic strains) have two distinct flagellar systems, namely a polar flagellum for swimming in liquid and multiple lateral flagella for swarming over surfaces. Only ∼60% of mesophilic strains can produce lateral flagella. To evaluate flagellar contributions to
Aeromonas
intestinal colonization, we compared polar and lateral flagellar mutant strains of a diarrheal isolate of
Aeromonas caviae
for the ability to adhere to the intestinal cell lines Henle 407 and Caco-2, which have the characteristic features of human intestinal enterocytes. Strains lacking polar flagella were virtually nonadherent to these cell lines, while loss of the lateral flagellum decreased adherence by ∼60% in comparison to the wild-type level. Motility mutants (unable to swim or swarm in agar assays) had adhesion levels of ∼50% of wild-type values, irrespective of their flagellar expression. Flagellar mutant strains were also evaluated for the ability to form biofilms in a borosilicate glass tube model which was optimized for
Aeromonas
spp. (broth inoculum, with a 16- to 20-h incubation at 37°C). All flagellar mutants showed a decreased ability to form biofilms (at least 30% lower than the wild type). For the chemotactic motility mutant
cheA
, biofilm formation decreased >80% from the wild-type level. The complementation of flagellar phenotypes (polar flagellar mutants) restored biofilms to wild-type levels. We concluded that both flagellar types are enterocyte adhesins and need to be fully functional for optimal biofilm formation.
Salivary Secretory Leukocyte Protease Inhibitor and Oral Candidiasis in Human Immunodeficiency Virus Type 1-Infected Persons
Authors: Chattopadhyay Amit , Gray Laurie R. , Patton Lauren L. , Caplan Daniel J. , Slade Gary D. , Tien Hsaio-Chuan , Shugars Diane C. 
Published: March 2004

ABSTRACT

Oropharyngeal candidiasis, typically caused by
Candida albicans
, is the most common oral disease associated with human immunodeficiency virus type 1 (HIV-1) infection. Secretory leukocyte protease inhibitor (SLPI), a 12-kDa antiprotease, suppresses the growth of
C. albicans
in vitro. To determine whether the mucosal protein plays a role in protecting oral tissues against fungal infection, we conducted a cross-sectional study investigating the oral and systemic health and salivary SLPI levels in 91 dentate HIV-1-infected adults receiving medical care in the southeastern United States. Participants with a self-reported history of clinical oropharyngeal candidiasis during the previous 2 years constituted the test group (
n
= 52), while the comparison group (
n
= 39) had no oropharyngeal candidiasis during that period. Data collected from medical records, oral examination, and SLPI enzyme-linked immunosorbent assay quantitation of whole saliva were analyzed by
t
test, analysis of variance, linear regression, and unconditional logistic regression. The test group had a significantly higher mean salivary SLPI level than the comparison group (1.9 μg/ml versus 1.1 μg/ml,
P
< 0.05). Linear regression modeling identified CD4 cell count and history of oropharyngeal candidiasis as key predictors of salivary SLPI and revealed a significant interaction (
P
< 0.05) between immunosuppression (CD4 cell count below 200 cells/μl) and positive history of oropharyngeal candidiasis in predicting salivary SLPI level. By logistic regression modeling, a salivary SLPI level exceeding 2.1 μg/ml, low CD4 count, antiretroviral monotherapy, and smoking were key predictors of oropharyngeal candidiasis. These data support a key role for SLPI in the oral mucosal defense against
C. albicans
. The antimicrobial mucosal protein may serve as an indicator of previous oropharyngeal candidiasis infection among immunosuppressed persons.
An Abundance of
Escherichia coli
Is Harbored by the Mucosa- Associated Bacterial Flora of Interleukin-2-Deficient Mice
Authors: Schuppler M. , Lötzsch K. , Waidmann M. , Autenrieth I. B. 
Published: March 2004

ABSTRACT

Mice deficient in interleukin-2 are well suited for use as an animal model for inflammatory bowel disease. Raised under specific-pathogen-free conditions, interleukin-2-deficient mice develop an inflammatory bowel disease resembling ulcerative colitis in humans. The finding that colitis was attenuated when the mice were kept under germfree conditions implies that the resident intestinal flora is involved in the pathogenesis of colitis. The present study addresses the composition of the mucosa-associated bacterial flora in colon samples from interleukin-2-deficient mice that developed colitis. This was investigated by comparative 16S ribosomal DNA (rDNA) sequence analysis and fluorescence in situ hybridization using rRNA-targeted fluorescent probes to quantify the bacterial populations of the mucosa-associated flora. The investigations revealed distinct differences in the bacterial composition of the mucosa-associated flora between interleukin-2-deficient mice and healthy controls. Fluorescence in situ hybridization identified up to 10% of the mucosa-associated flora in interleukin-2-deficient mice as
Escherichia coli
, whereas no
E. coli
was detected in the mucosa from healthy wild-type mice. This finding was consistent with the results from comparative 16S rDNA analysis. About one-third of the clones analyzed from 16S rDNA libraries of interleukin-2-deficient mice represented
Enterobacteriaceae
, whereas none of the clones analyzed from the healthy controls harbored 16S rDNA from
Enterobacteriaceae
. The abundance of
E. coli
in the colonic mucosa of interleukin-2-deficient mice strongly suggests a participation in the pathogenesis of colitis in the interleukin-2-deficient mouse model for inflammatory bowel disease.
Mycobacterium tuberculosisLipomannan Induces Apoptosis and Interleukin-12 Production in Macrophages
Authors: Dao D. N. , Kremer L. , Guérardel Y. , Molano A. , Jacobs W. R. , Porcelli S. A. , Briken V. 
Published: March 2004

ABSTRACTThe mycobacterial cell wall component lipoarabinomannan (LAM) has been described as a virulence factor ofMycobacterium tuberculosis, and modification of the terminal arabinan residues of this compound with mannose caps (producing mannosyl-capped LAM [ManLAM]) inM. tuberculosisor with phosphoinositol caps (producing phosphoinositol-capped LAM [PILAM]) inMycobacterium smegmatishas been implicated in various functions associated with these lipoglycans. A structure-function analysis was performed by using LAMs and their biosynthetic precursor lipomannans (LMs) isolated from different mycobacterial species on the basis of their capacity to induce the production of interleukin-12 (IL-12) and/or apoptosis of macrophage cell lines. Independent of the mycobacterial species, ManLAMs did not induce IL-12 gene expression or apoptosis of macrophages, whereas PILAMs induced IL-12 secretion and apoptosis. Interestingly, uncapped LAM purified fromMycobacterium chelonaedid not induce IL-12 secretion or apoptosis. Furthermore, LMs, independent of their mycobacterial origins, were potent inducers of IL-12 and apoptosis. The precursor of LM, phosphatidyl-myo-inositol dimannoside, had no activity, suggesting that the mannan core of LM was required for the activity of LM. The specific interaction of LM with Toll-like receptor 2 (TLR-2) but not with TLR-4 suggested that these responses were mediated via the TLR-2 signaling pathway. Our experiments revealed an important immunostimulatory activity of the biosynthetic LAM precursor LM. The ratio of LAM to LM in the cell wall of mycobacteria may be an important determinant of virulence, and enzymes that modify LM could provide targets for development of antituberculosis drugs and for derivation of attenuated strains ofM. tuberculosis.