bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of 24 h continuous hypothermic perfusion on heart preservation by assessment of oxidative stress
Authors: Fitton Torin P , Wei Chiming , Lin Ruxian , Bethea Brian T , Barreiro Christopher J , Amado Luciano , Gage Fred , Hare Joshua , Baumgartner William A , Conte John V 
Published: June 2004

Abstract:  Introduction:  Despite investigating numerous solutions, additives, and techniques over the last two decades, extending donor heart preservation beyond 4–6 h has not been achieved. Hypothermic heart preservation (HP) induces oxidative stress (OS) with reactive oxygen species (ROS) production, causing DNA cleavage and impairing repair. Quantification of cardiomyocyte concentrations of DNA damage by‐products (8‐oxoG) and mismatch repair enzymes (MYH, OGG‐1, MSH2) reflects the severity of OS. If increased repair enzyme production is insufficient to repair injury, cell death occurs and functional outcomes are impacted. We investigated continuous hypothermic perfusion (CHP), a new form of HP, and the mechanism of injury associated with hypothermic storage, by assessing functional outcome and OS after allotransplantation of canine hearts.Methods:  Fourteen canine hearts were harvested using standard techniques after baseline echocardiograms and haemodynamic parameters were obtained. The hearts were implanted after 24 h CHP (n = 10) or 4 h static preservation (SP; n = 4). After weaning from cardiopulmonary bypass (CPB), recipients were kept alive for 6 h. Repeat echocardiograms and haemodynamic parameters were obtained. Quantification of MYH, OGG‐1, and MSH2 concentrations were performed on biopsies using immunohistochemistry and Western blot analysis.Results:  Twelve out of 14 hearts (8/10 CHP; 4/4 SP) were successfully weaned on moderate inotropic support. Post‐implant echocardiogram, completed in 6/10 CHP and 2/4 SP hearts, demonstrated hyperdynamic function and normal wall motion. The expression and activity of DNA repair enzymes was identical between normal baseline and CHP hearts.Conclusion:  CHP reduces OS associated with prolonged hypothermic preservation and may allow longer preservation periods without compromising function. CHP offers several potential advantages: (1) resuscitation of non‐beating heart donor organs, (2) time for HLA tissue typing, (3) facilitate interventions improving graft function, and (4) increased organ sharing.
ABO blood group influences a candidate's likelihood of receiving an HLA zero antigen mismatch kidney
Authors: Bryan Christopher F , Cherikh Wida S , Cheng Yulin , Aeder Mark I , Muruve Nicolas A , Nelson Paul W , Shield Charles F , Warady Bradley A , Winklhofer Franz T 
Published: June 2004

Abstract:  National sharing of HLA zero‐mismatched kidneys has improved long‐term graft survival. The distribution of those HLA‐matched kidneys by ABO blood group, however, has not been examined.Utilizing the UNOS/OPTN (United Network for Organ Sharing/Organ Procurement Transplantation Network) database, we analysed 112 971 kidney waiting list registrations added during 6/3/95–31/12/00, and 8162 HLA zero‐mismatched (0 mm) primary kidney transplants in the USA during 1/1/88–31/3/02. We also analyzed A isoagglutinin titer histories for 87 blood group B end stage renal disease (ESRD) patients for whom at least 1 yr of testing was done. Blood group A patients received 40.1% of the HLA‐0 mm kidneys while having a 26.5% representation on the national waiting list. Blood group B patients comprised 17.4% of the waiting list, but received only 10.4% of the HLA‐0 mm kidneys. Most (89.6%) blood group B patients awaiting kidney transplantation have low levels of A isoagglutinins, making them eligible to receive a blood group A2 kidney transplant. The national HLA‐0 mm kidney allocation sharing system's imbalance by ABO blood group could be partially resolved in the future by allocating HLA‐0 mm blood group A2 kidneys to B patients.
Update on the immunology, diagnosis and management of systemic lupus erythematosus
Authors: Reeves G. E. M. 
Published: June 2004

Abstract Lupus occurs with a prevalence of 2−9 in 10 000 people, targeting female and indigenous populations in particular. Lupus and related systemic autoimmune syndromes (scleroderma, Sjögren's syndrome, rheumatoid arthritis and polymyositis) result from a similar set of genetically and environmentally modulated immune disturbances, and the diagnostic and management approach to these conditions is broadly comparable. Evanescent , vague symptoms, restrictive diagnostic criteria and low diagnostic suspicion might have resulted in the under‐diagnosis of these problems in the past, imposing considerable burdens on sufferers and the community. Serological screening should be employed cautiously and wisely, given the rapidly occurring changes in methodology, which have lowered their specificity. Close liaison with the immunology laboratories performing these tests is therefore advisable. Clinicians should emphasize the improving prognosis of lupus and related conditions as a result of earlier disease detection, improved educational support systems and refined medical therapies. (Intern Med J 2004: 34: 338−347)
Holter monitoring in the diagnosis of stroke mechanism
Authors: Shafqat S. , Kelly P. J. , Furie K. L. 
Published: June 2004

Abstract Background: Atrial fibrillation (AF), an important and treatable cause of ischaemic stroke, can occur as a sustained or a paroxysmal arrhythmia. Continuous cardiac rhythm monitoring (Holter monitoring) is often performed in stroke patients to identify paroxysmal AF, which is an indication for warfarin anti­coagulation in this patient population.Aim: The aim of this study was to assess the clinical utility of Holter monitoring in detecting occult AF in patients with possible cardioembolic stroke.Methods: The medical records of ischaemic stroke patients consecutively hospitalized at a single academic centre during a one‐year period were reviewed. Data regarding patient demographics, stroke characteristics, electrocardiography and echocardiography results and duration and findings of Holter monitoring were abstracted. The primary outcome was yield of newly diagnosed AF on Holter monitoring.Results: Of 465 consecutive patients admitted with a diagnosis of new ischaemic stroke, 210 underwent Holter monitoring. The mean duration of monitoring was 22.8 ± 4.0 h. Previously undiscovered AF was ­identified in five cases (2.4%), all of which represented non‐rheumatic AF. In three cases, the Holter test was negative despite AF documented on an admission electro­cardiogram.Conclusions: Holter monitoring can identify occult ­paroxysmal AF, assisting targeted secondary prevention in patients with new ischaemic stroke. However, the standard 24‐h duration of monitoring probably under­estimates the prevalence of paroxysmal AF in this population. Prospective studies are indicated to evaluate the value of longer monitoring periods in stroke popu­lations. (Intern Med J 2004; 34: 305−309)
Primary immunodeficiency diseases in adulthood
Authors: Riminton D. S. , Limaye S. 
Published: June 2004

Abstract Occasionally, patients present with clinical episodes of infectious disease that seem to fall beyond the scope of normal immunocompetence. Examples include infections that are unusually persistent, recurrent or resistant to treatment, or those involving unexpected dissemination of disease or atypical pathogens. Recent cellular and molecular advances in immunology help to inform the investigation and management of these cases and provide opportunities for family surveillance and disease prevention. More than 100 separate primary (inherited) immunodeficiency disease (PID) states have now been defined, each with a range of syndromic manifestations. Many of these are rare diseases of childhood, but some, either in atypical or attenuated forms, emerge for the first time in adulthood. We outline a diagnostic approach to five groups of PID presenting in adulthood and describe the recently launched web‐based PID Register of Australia and New Zealand − a new mechanism for improving knowledge and service delivery to Australasian patients and their clinical carers. (Intern Med J 2004; 34: 348−354)
Vaccination for asthma exacerbations
Authors: Bardin P. G. 
Published: June 2004

Abstract Most asthma exacerbations are caused by common cold virus infections, predominantly rhinovirus infections. Full protection against repeat infections with the same rhinovirus serotype is given by serum neutralizing antibody, but cross‐reactive antibody developed against other serotypes could yield partial protection and result in attenuated cold and airway symptoms. It is proposed that vaccine‐mediated induction of cross‐reactive antibody might not prevent rhinovirus infections but might reduce severe asthma symptoms and exacerbations. (Intern Med J 2004; 34: 358−360)
Ethics as process and practice
Authors: Frank A. W. 
Published: June 2004

Abstract The noun form of ethics suggests something substantive; this substance is located in both offices of institutionalized experts and a body of canonical solutions to recognizable troubles. The present article recommends thinking of ethics not as substance but as a process of lives and decisions affecting each other over time. No single decision stands alone and no single patient can be considered as a stand‐alone entity. Examples include how people struggle with choices they should not have to make, how decisions at one time are affected by earlier decisions that are not considered within the purview of ethics, and how to deal with conflicts of legitimate interests. When institutional ethics becomes a prescribed activity, the goal of being ethical is easily forgotten. (Intern Med J 2004; 34: 355−357)
Impact of early screening for reflux in siblings on the detection of renal damage
Authors: Houle Anne‐Marie , Cheikhelard Alaa , Barrieras Diego , Rivest Marie‐Christine , Gaudreault Valérie 
Published: June 2004

OBJECTIVETo assess the impact of screening siblings after detecting significant vesico‐ureteric reflux (VUR) and renal scarring, as such screening might identify patients with VUR before urinary tract infections develop, but might also detect clinically insignificant VUR.PATIENTS AND METHODSWe used a previously reported screening protocol to assess the clinical characteristics of patients, including the incidence of renal scarring, and their siblings, and compared the results. In all, 123 children were screened and 44 (36%) had VUR on voiding cystography. The median (range) age at screening was 9 (1–90) months.RESULTSThe grades of VUR detected were < III in 61% and ≥ III in 39%; VUR was bilateral in 48%. In all, 37 siblings with VUR were assessed by ultrasonography; 70% were normal, including 12 (32%) children with VUR of grade ≥ III. When used, renal scintigraphy was normal in 74% of siblings, vs 18% of index patients. However, when screened after 2 years old, siblings had twice the risk of already having renal damage on renal scintigraphy (P = 0.04).CONCLUSIONEarly screening (≤ 2 years) appears to be more protective for avoiding renal damage than screening older patients. Thus we propose early screening in asymptomatic siblings to detect VUR before it becomes clinically significant.
Use of the holmium:YAG laser for ureterolithotripsy in children
Authors: Dogan Hasan S. , Tekgul Serdar , Akdogan Bulent , Keskin Mehmet S. , Sahin Ahmet 
Published: June 2004

OBJECTIVETo review our experience with rigid ureteroscopy and holmium:YAG laser for treating ureteric calculi in children.PATIENTS AND METHODSThe study included 35 children who were treated with rigid ureteroscopy for ureteric calculi between November 1997 and June 2003 (15 boys and 20 girls; mean age 6.2 years, range 1–14). The mean (range) stone size was 8 (4–15) mm and the duration of anaesthesia 46.6 (15–90) min. The stone was in the distal third of the ureter in 33 children and in the proximal third in two. We used a 7.5/8/10 F rigid ureteroscopes with routine dilatation of the ureteric orifice. For lower ureteric stones, lithotripsy was carried out with holmium:YAG laser in 29 cases, a pneumatic impactor in two and forceps extraction in two. Both stones in the proximal ureter were pushed back into the collecting system. All the ureters were stented using JJ stents in 31 and ureteric catheters in four cases. The mean postoperative follow‐up was 12 (2–30) months.RESULTSExcluding the two stones pushed back, the stone‐free rate after a one‐stage procedure was 82% (27/33). With repeated procedures in the six (ESWL in two) remaining cases the success rate was 97% (32/33). The ureter was perforated in two patients within the first five in the series. There was no pyelonephritis or gross haematuria after surgery.CONCLUSIONUreteroscopy and lithotripsy using the holmium:YAG laser is effective and safe for treating ureteric stones in children, in experienced hands. The results would be even better using smaller and flexible ureteroscopes.
The role of the rhabdosphincter in female rat voiding
Authors: Streng Tomi , Santti Risto , Andersson Karl‐Erik , Talo Antti 
Published: June 2004

OBJECTIVESTo obtain information on the mechanisms of female rat micturition using a model in which pressure was measured in the bladder and distal part of the urethra corresponding to the location of the rhabdosphincter, providing information on the role of the sphincter in opening and closing the urethral lumen.MATERIALS AND METHODSA micturition reflex was induced in adult anaesthetized (chloral hydrate and urethane) female rats by filling the bladder with saline. Bladder pressure (BP), urethral pressure (UP), electromyography (EMG) of the middle part of the rhabdosphincter, and urinary flow rate in the distal urethra were simultaneously recorded.RESULTSThere were four phases of the micturition contraction, the second characterized by intraluminal pressure high‐frequency oscillations (IPHFOs) of BP. When a non‐oscillatory micturition contraction started, the BP increased and exceeded UP for the rest of the micturition contraction. Even though the BP increased during this first phase, the urethral lumen stayed closed. Its opening was indicated by a simultaneous decrease in BP and increase of UP as the fluid flowed from the bladder to the urethra. When the rhabdosphincter closed, as indicated by an EMG‐burst of the muscle, the UP declined, bladder pressure increased and the flow ceased. Because of momentary contractions of the rhabdosphincter, the UP and urine flow rate had the same periodicity as the IPHFOs of BP.CONCLUSIONSThe simultaneous recording of the BP, UP, EMG of the rhabdosphincter and urinary flow rate showed the sequence of events during micturition. The rhabdosphincter acts as an ‘on‐off’ switch, causing interruptions in the urinary flow rate.
Interleukin‐2 blocks the antitumour activity caused by depletion of CD25+ cells in a murine renal adenocarcinoma model
Authors: Takeuchi Takumi , Konno‐Takahashi Naoko , Kasuya Yutaka , Ogushi Tetsuo , Nishimatsu Hiroaki , Kitamura Tadaichi 
Published: June 2004

OBJECTIVETo test the effectiveness of antimouse CD25 monoclonal antibody (mAb) against murine renal adenocarcinoma (RENCA) cells, as immunoregulatory/suppressor cells are known to be involved in tumour development in vivo, but the functions of these cells are not yet clear, and eliminating naive CD25 (interleukin‐2 receptor α)‐positive T cells elicits potent immune responses to syngeneic tumours in vivo.MATERIALS AND METHODSAliquots of 1 × 104 or 1 × 105 RENCA cells were implanted into the subcapsule of the left kidney of syngeneic male Balb/c mice. Mice were injected with 125 µg of antimouse CD25 mAb to deplete CD25+ cells before RENCA implantation. Then 104 units of recombinant human interleukin‐2 (rhIL‐2) were subcutaneously injected twice daily for 7 days. Fourteen or 25 days later the tumour size was determined by laparotomy, and cells sorted using two‐colour flow cytometry.RESULTSDepletion of naive CD25+ cells with anti‐CD25 mAb and rhIL‐2 administration effectively induced anti‐RENCA tumour activity in Balb/c hosts. However, co‐administration of anti‐CD25 mAb and rhIL‐2 abrogated this significant suppression of RENCA tumour growth. RENCA implantation reduced the proportion of CD4+ cells among splenocytes, whereas anti‐CD25 mAb treatment increased it. The proportion of CD25+CD8+ cells among splenocytes and that of CD25+ cells among CD8+ cells were markedly reduced by co‐administration of anti‐CD25 mAb and rhIL‐2 with RENCA implantation. Both CD4+ and CD8+ cells were stained around the remnant microscopic RENCA tumour after anti‐CD25 mAb treatment.CONCLUSIONEither depletion of naive CD25+ cells or rhIL‐2 administration suppressed RENCA tumour growth in murine hosts. However, co‐administration of anti‐CD25 mAb and rhIL‐2 abrogated this significant suppression of RENCA tumour growth.
Vaginal construction using sigmoid colon in children and young adults
Authors: Rajimwale Ashok , Furness Peter D. , Brant William O. , Koyle Martin A. 
Published: June 2004

Authors from Denver describe their experience in neovaginal construction using sigmoid colon in young adults. They outline potential difficulties, particularly with patients having an android pelvis, but feel that the isolated sigmoid neovagina construction is widely applicable and can be used at any age. However, they point out that the long‐term satisfaction for intercourse needs long‐term evaluation.The impact of early screening for reflux in siblings of those with VUR is evaluated by authors from Montreal. They found that screening at an early stage (<2 years) was more protective against renal damage than screening at a later stage. They suggested that the optimal way to proceed was early screening in asymptomatic siblings to detect VUR before it becomes clinically significant.OBJECTIVETo evaluate the age at which patients who required vaginal replacement (an uncommon procedure in children) were diagnosed, and the cause of their anomaly, and to relate these variables to the surgical outcome.PATIENTS AND METHODSPatients who had vaginal replacement at the author's institution between 1990 and 2002 were reviewed retrospectively. Depending on the age at reconstructive surgery, patients were divided into pre‐ and postpubertal groups.RESULTSA neovagina was constructed in 23 patients during the study period; sigmoid colon was used in 20 but not in two patients with cloacal exstrophy and in one with Mayer‐Rokitansky‐Kuster–Hauser syndrome (MRKHS). These cases were excluded from the analysis of outcomes and complications. Group 1 comprised patients diagnosed and treated before puberty and group 2 those diagnosed and/or treated afterward. In group 1 the presenting diagnoses included androgen insensitivity syndrome (AIS) in six patients, MRKHS in two, cloacal exstrophy in two, vaginal tumour in one, Müllerian duct renal aplasia cervicothoracic somite dysplasia, vertebral abnormalities, anal atresia, cardiac anomalies, tracheo‐oesophageal fistula, and/or oesophageal atresia, renal abnormalities and limb defects syndromes in one each. In group 2 the presenting diagnoses included MRKHS in seven, AIS in two, and congenital adrenal hyperplasia in one. Complications included superficial wound infection (two patients), recurrent introital stenosis, and blind loop mucocele, complete stenosis of perineal neovaginal opening (one each) and dyspareunia in three. Neither age nor pelvic habitus (android vs gynaecoid) influenced the outcome, and the cosmetic results were excellent in all the patients.CONCLUSIONIsolated sigmoid neovaginal construction appears to be applicable to many diagnoses and in patients at any age. Although an android pelvis can present technical challenges, in this experience it was not associated with a greater complication rate. The long‐term satisfaction with the sigmoid neovagina for intercourse, especially in those constructed before puberty, still requires long‐term evaluation.
Laparoscopic radical prostatectomy: current status
Authors: Hasan Waleed A. , Gill Inderbir S. 
Published: June 2004

The role of laparoscopic radical prostatectomy is reviewed by authors from the Cleveland clinic. They discuss not only its history and development but also its current status in the management of prostate cancer. Bladder cancer is reviewed comprehensively by authors from Miami and Iowa; not only TCC but also the rather uncommon small cell neoplasm.Finally, authors from London assess the use of tissue microarrays in the validation of markers which may have diagnostic, prognostic and therapeutic significance in urological oncology.
Matched‐cohort analysis of patients with prostate cancer followed with observation or treated with three‐dimensional conformal radiation therapy
Authors: Kramer Noel M. , Horwitz Eric M. , Uzzo Robert G. , Hanlon Alexandra L. , Hanks Gerald E. 
Published: June 2004

OBJECTIVESTo compare the outcome of similar patients with prostate cancer treated by either observation or three‐dimensional conformal radiation therapy (3‐DCRT).PATIENTS AND METHODSThe study included 69 patients with nonmetastatic prostate cancer who were observed only; the indications included indolent disease, significant medical comorbidities and refusal of treatment. Of these, 62 patients had palpable T1–T2a and seven T2b–T3a disease, a median Gleason score of 6 and a median initial prostate‐specific antigen (PSA) level of 5.3 ng/mL. A matched‐cohort analysis of 69 patients, based on palpation T category, Gleason score and initial PSA, was used to compare the outcome between the observation and 3‐DCRT groups. The median radiation dose for latter was 72 Gy.RESULTSThe median follow‐up for the observed patients was 49 months. The 5‐ and 8‐year actuarial rates of freedom from distant metastases were 100% and 93%, respectively, and the actuarial overall survival rates 94% and 73%, respectively. Seven observed patients had local disease progression on physical examination. Four patients who initially were observed received radiation therapy later for a rising PSA and/or local disease progression. For the 69 matched 3‐DCRT patients, the overall 5‐year rate for no biochemically evident disease was 74%. The respective 5‐ and 8‐year actuarial rates of freedom from distant metastases were 95% and 95%, and actuarial overall survival rates 95% and 75%. There were no significant differences in distant metastasis and overall survival rates between the groups, and no deaths from prostate cancer in either group.CONCLUSIONSObservation is a reasonable alternative to treatment in selected patients. During the 5‐year follow‐up the progression rates were relatively low, and there was no difference in distant metastasis or overall survival between the groups. As the follow‐up was short a longer follow‐up is needed to determine whether the outcome of those patients who chose observation will remain comparable to that in those undergoing immediate 3‐DCRT.