bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sympathetic autoregulation in peripheral vascular disease
Authors: Delis K T , Lennox A F , Nicolaides A N , Wolfe J H 
Published: March 2003

Abstract

Background
Lower limb venous pressure increases on dependency, stimulating a local sympathetic axon reflex which triggers precapillary and arteriolar vasoconstriction. The resulting decrease in arterial calf inflow, known as the venoarteriolar response (VAR), is impaired in critical leg ischaemia. The aim of the study was to evaluate the VAR in symptomatic non-critical leg ischaemia and after restoration of leg perfusion following successful revascularization.

Methods
The study included 30 normal subjects, 30 patients with stable intermittent claudication and 30 patients with severe ischaemia who had undergone successful infrainguinal revascularization. In all patients the foot skin blood flow (flux) in the horizontal (HBF) and sitting (SBF) positions was measured using laser Doppler fluxmetry. The VAR was calculated as (HBF − SBF)/HBF × 100 per cent. The pressure that elicited the reflex (pVAR) was evaluated in the horizontal position.

Results
The median VAR was significantly lower in patients with stable claudication than in normal subjects or patients following successful revascularization (29·1 versus 59·5 and 63·9 per cent respectively; P &lt; 0·0001). Similar results were obtained for the pVAR (22 versus 45 and 40 mmHg respectively; P &lt; 0·001). There was no difference, however, in either the VAR or pVAR between normal individuals and patients following a successful bypass.

Conclusion
Patients with claudication had a significant impairment of orthostatic sympathetic autoregulation. After successful revascularization, and in spite of the extensive disease in the receiving circulation, this autoregulation returned to normal.
Prognostic factors after oesophagectomy and extended lymphadenectomy for squamous oesophageal cancer
Authors: Osugi H , Takemura M , Takada N , Hirohashi K , Kinoshita H , Higashino M 
Published: March 2003

Abstract

Background
The prognosis of patients without nodal metastasis of oesophageal cancer is generally good, but recurrence develops in some cases.

Methods
Data on 88 consecutive patients with squamous oesophageal cancer who underwent three-field lymph node dissection from 1986 to September 1998 and who had no evidence of nodal disease were reviewed retrospectively. Disease status was based on histological examination of the section of each node with the largest surface area, stained with haematoxylin and eosin.

Results
The 3- and 5-year survival rates of patients without lymph node metastasis were 85 and 81 per cent respectively, better than in patients with metastasis. Twelve patients died from recurrence. Recurrence was haematogenous in nine patients and locoregional in three. Survival was worse in men, for patients with lesions located in the upper thoracic oesophagus, and in those with lymphatic or blood vessel invasion. Only the presence of lymphatic invasion correlated with survival on multivariate analysis (P = 0·04).

Conclusion
Although survival was generally good in patients without nodal metastasis from oesophageal cancer following three-field lymph node dissection, patients with lymphatic invasion remained at risk for haematogenous dissemination.
Persistent popliteal fossa reflux following saphenopopliteal disconnection
Authors: Rashid H I , Ajeel A , Tyrrell M R 
Published: March 2003

AbstractBackgroundThis was a retrospective assessment of the technical adequacy of saphenopopliteal disconnection (SPD).MethodsPatients scheduled for SPD underwent preoperative colour-coded duplex imaging to localize the saphenopopliteal junction (SPJ). Operations were conducted with the patients under general anaesthesia in the prone position with planned full popliteal fossa exposure. Patients were reimaged 6 weeks after operation.ResultsSome 69 patients had surgery over 4 years; complete data were available for 59 (27 men and 32 women, median age 55 (range 27–78) years). There were eight staged bilateral procedures. Postoperative duplex scans identified 23 (39 per cent) with ideal results (incompetent SPJ successfully disconnected), 12 (20 per cent) with satisfactory results (incompetent SPJ disconnected successfully but persisting venous reflux in superficial veins), eight duplex failures (14 per cent) (previously identified incompetent SPJ persisted but was competent after operation) and 13 surgical failures (22 per cent) (incompetent SPJ completely missed during surgery). There were three major postoperative complications (5 per cent) (two deep vein thromboses and one popliteal vein injury) and one patient suffered a sural nerve palsy.ConclusionDespite preoperative duplex localization of the SPJ, SPD proved an unreliable technique in this series.
Influence of implantation interval on the long-term biocompatibility of surgical mesh
Authors: Klosterhalfen B , Junge K , Hermanns B , Klinge U 
Published: March 2003

Abstract

Background
The aim was to study the long-term tissue response to polypropylene mesh.

Methods
This was a retrieval study that investigated 76 polypropylene meshes with a median implantation interval of 18 (range 2–180) months. Mesh was explanted following hernia recurrence, infection or pain. The median implantation interval was 20 (range 4–180) months in the recurrence group, 30 (range 5–48) months in the pain group and 10 (range 2–56) months in the infection group (P &lt; 0·05, infection versus pain or recurrence). The inflammatory response was determined by immunohistochemistry of macrophages (CD68), polymorphonuclear granulocytes (CD15) and T and B lymphocytes (CD3 and CD20). The cell turnover within the interface mesh fibre–recipient tissue was measured by TUNEL for apoptosis or DNA strand breaks, Ki67 for cell proliferation and heat-shock protein (HSP) 70 for cell stress.

Results
With the exception of HSP-70, levels of all variables decreased over time. Sex, age, type of previous operation or location of the mesh did not have a significant influence.

Conclusion
Long-term incorporated polypropylene mesh in humans has a more favourable tissue response with increasing implantation interval.
Multiple sectioning and immunohistochemical staining of sentinel nodes in patients with breast cancer
Authors: Motomura K , Komoike Y , Inaji H , Hasegawa Y , Kasugai T , Noguchi S , Koyama H 
Published: March 2003

Abstract

Background
The aim of the present study was to investigate whether focused analysis of sentinel nodes is more useful than routine haematoxylin and eosin examination of axillary lymph nodes obtained by axillary lymph node dissection.

Methods
One hundred and fifty-two patients with breast cancer with clinically negative axillary nodes underwent successful sentinel node biopsy using a combination of dye and radioisotope, followed immediately by standard level I and II axillary lymph node dissection. Multiple sectioning, with haematoxylin and eosin and immunohistochemical analysis of sentinel nodes using cytokeratin antibody, was compared with single section and haematoxylin and eosin analysis of sentinel and non-sentinel nodes (routine examination).

Results
A mean of 1·9 (range 1–12) sentinel nodes and 11·2 (range 4–24) non-sentinel nodes were excised per patient. Metastases were detected in 44 patients (29 per cent) by single section and haematoxylin and eosin analysis of sentinel and non-sentinel nodes. An additional five patients (3 per cent) with metastases were detected by multiple sectioning and haematoxylin and eosin analysis of sentinel nodes. A further 20 patients (13 per cent) with metastases were identified by multiple sectioning and immunohistochemical analysis of sentinel nodes. Both haematoxylin and eosin and immunohistochemical analysis of sentinel nodes missed one patient with node metastases, which led to a false-negative rate of 1 per cent.

Conclusion
Multiple sectioning and immunohistochemical staining of sentinel nodes identified 16 per cent more patients with positive axillary lymph nodes than routine haematoxylin and eosin examination.
Microemulsion cyclosporin inhibits vascular remodelling and attenuates associated changes in profibrotic gene expression in an experimental model of allograft vasculopathy
Authors: Murphy G J , Bicknell G R , Nicholson M L 
Published: March 2003

AbstractBackgroundChronic allograft dysfunction (CAD), the leading cause of solid organ transplant failure, is characterized by histological evidence of extracellular matrix (ECM) accumulation (fibrosis). The aim of this study was to characterize the changes in fibrosis-associated gene expression in an experimental model of CAD and to measure the effect of the immunosuppressant cyclosporin on these changes.MethodsLewis recipients of F344 rat thoracic to abdominal transplants were administered cyclosporin or no treatment. Vascular remodelling and ECM accumulation (picrosirius red) were measured using computerized histomorphometry. Fibrosis-associated gene expression was studied by semiquantitative reverse transcription–polymerase chain reaction.ResultsCyclosporin inhibited medial ECM accumulation and vascular remodelling in allografts. This was associated with an attenuation of the graft inflammatory infiltrate and a reduction in intragraft matrix metalloproteinase (MMP) 2 and MMP-9 messenger RNA (mRNA) levels. There was a significant negative correlation between neoadventitial ECM density and MMP-9 expression, as well as with vessel circumference. Neoadventitial ECM density was significantly higher in the cyclosporin-treated group than in animals with untreated allografts, as were mRNA levels of collagen 3 and tissue inhibitor of metalloproteinase 1.ConclusionThe alloimmune injury itself may contribute directly to vascular remodelling and fibrosis in allograft vasculopathy. Cyclosporin attenuated this component of the pathophysiology of CAD effectively.
Perineural invasion has a negative impact on survival of patients with gallbladder carcinoma
Authors: Yamaguchi R , Nagino M , Oda K , Kamiya J , Uesaka K , Nimura Y 
Published: March 2003

Abstract

Background
The clinical significance of perineural invasion of gallbladder carcinoma remains unclear. The aim of this study was to elucidate the incidence and mode of perineural invasion of gallbladder carcinoma and clarify its prognostic significance.

Methods
A clinicopathological study was conducted on 68 patients who underwent attempted curative resection for gallbladder carcinoma. According to the pathological tumour node metastasis (pTNM) classification of the Union Internacional Contra la Cancrum, there were five (7 per cent), nine (13 per cent), 20 (29 per cent) and 34 (50 per cent) patients with pT1, pT2, pT3 and pT4 disease respectively. Twenty patients (29 per cent) had pM1 disease, including involved para-aortic nodes, liver metastases and localized dissemination.

Results
The overall incidence of perineural invasion was 71 per cent (48 of 68 patients). Forty-four (96 per cent) of 46 patients with extrahepatic bile duct invasion had perineural invasion. Although several histological factors were associated with perineural invasion, multivariate analysis demonstrated that extrahepatic bile duct invasion was the only significant factor correlated with perineural invasion (odds ratio 99·0, P &lt; 0·001). The perineural invasion index, defined as the ratio of the number of involved nerves to the total number of nerves examined, was significantly higher at the centre than in the proximal and distal parts of the tumour in the 46 patients with extrahepatic bile duct invasion (P &lt; 0·001). The 5-year survival rate for patients with perineural invasion was significantly lower than that for patients with no invasion (7 versus 72 per cent; P &lt; 0·001). Cox proportional hazard analysis identified perineural invasion (relative risk (RR) 5·3, P &lt; 0·001) and lymph node metastasis (RR 2·5, P = 0·008) as significant independent prognostic factors.

Conclusion
Perineural invasion is common in advanced gallbladder carcinoma and has a significant negative impact on patient survival.
Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands
Authors: Kapiteijn E , Putter H , van de Velde C J H 
Published: March 2003

Abstract

Background
Local control and survival following surgical treatment of rectal cancer have been improved by the introduction of total mesorectal excision (TME). The aim of this study was to determine the nationwide impact of the introduction and training of TME on recurrence and survival in rectal cancer.

Methods
Short- and long-term outcomes of a recently published trial of rectal cancer surgery (TME trial) were compared with results from an older trial (cancer recurrence and blood transfusion (CRAB) trial), in which conventional surgery was performed without quality control. Only patients who were operated on with curative intent and who did not receive neoadjuvant radiotherapy were studied. Differences in clinicopathological characteristics were corrected for by multivariate analysis. To ensure valid comparisons, only events that occurred within 2 years of operation were analysed with regard to long-term outcome.

Results
In the univariate analysis, a higher clinical anastomotic leak rate was found in patients following low anterior resection in the TME trial (P = 0·046), but this association was not significant in the multivariate analysis. The local recurrence rate decreased from 16 per cent in the CRAB trial to 9 per cent in the TME trial, and type of operation (conventional (CRAB trial) versus TME (TME trial)) was an independent predictor of local recurrence (P = 0·002). Type of operation was also an independent predictor of overall survival (P = 0·019); there was a higher survival rate in the TME trial.

Conclusion
The introduction and training of TME has led to improved long-term outcome of patients with rectal cancer in the Netherlands.
Pelvic exenteration for advanced colorectal cancer with reconstruction of urinary and sphincter functions
Authors: Koda K , Tobe T , Takiguchi N , Oda K , Ito H , Miyazaki M 
Published: March 2003

Abstract

Background
Total pelvic exenteration (TPE) for the treatment of advanced colorectal cancer usually involves a double stoma for faecal and urinary excretion, which reduces patient quality of life. In this study, a stomaless reconstruction method for patients normally requiring TPE was evaluated.

Methods
Five patients underwent stomaless TPE. After removal of the tumour with an adequate surgical margin, the urethra was transected at the urogenital diaphragm and the rectum at the anal canal. An ileal neobladder was constructed and coloanal anastomosis was performed. The major omentum was used to construct a septum between the anastomoses. A transgastric ileus tube was used as an intestinal stent to prevent ileus.

Results
All patients were alive 12–39 months after operation. Faecal continence was preserved in four patients whose diverting colostomies were closed. All five patients were able to void urine spontaneously, with daytime continence. All but one, in whom cancer recurred, were mobile in the community.

Conclusion
Stomaless TPE may be considered for locally advanced colorectal cancers that invade the genitourinary organs, provided that neither the anal canal nor the urogenital diaphragm is affected.
Karyotypic aberrations of chromosomes 16 and 17 are related to survival in patients with breast cancer
Authors: Hislop R G , Pratt N , Stocks S C , Steel C M , Sales M , Goudie D , Robertson A , Thompson A M 
Published: March 2003

Abstract

Background
Breast cancer has a high incidence and associated mortality rate, yet little is known of the sequence of genetic events that underlie the clinical course.

Methods
The study was a comparative genomic hybridization analysis of 40 primary breast cancers with survival data at a mean of 8·4 years.

Results
The mean number of aberrations was 9·0, with a mean of 5·5 gains and 3·5 deletions per tumour. The most common aberrations were: gain of 1q (27 of 40), 8q (19 of 40) and 17q (13 of 40), and deletion of 17p (12 of 40) and 8p (11 of 40). These results are consistent with a distinctive pattern of large-scale (karyotypic) genetic change in primary breast cancer.

Conclusion
The novel findings of this study were that only women who were disease-free had loss of 16q (E-cadherin) in association with a gain of 16p, and 17p13 (p53) loss combined with 17q12 (HER2) amplification was found only in the cancers of women who developed recurrent disease. The karyotypic changes seen in primary breast cancer seem to be associated with outcome and point to the underlying genetic events.
Estimation of directional division frequencies in vascular cambium and in marginal meristematic cells of plants
Authors: Barlow P. W. , Brain P. , Powers S. J. 
Published: March 2003

Abstract.Using simple arithmetical formulae, it is shown that, when the meristematic initial cells of a growing plant organ are arranged in a ring, the cellular dimensions predict the relative frequencies of anticlinal and periclinal divisions which these cells undergo. The pattern of cell file branching which appears during the course of development, and which is predicted by this mathematical model, is validated using data pertaining to the numbers and dimensions of initial cells within the secondary vascular cambium of hybrid aspen trees. Data pertaining to a second, simpler set of initial cells which comprises the outer cellular ring of the thallus of the alga Coleochaete orbicularis, and from which all the radial cell files of the circular disc‐like thallus are descended, have also been used for model validation. Combining the mathematical approach to division frequencies with data of actual cell sizes permits inferences about the course of the increase of the number of cell files (generated by the anticlinal divisions) and the number of cells within each file (generated by the periclinal divisions) during the earlier stages of secondary tissue or thallus development, and also about how they will develop at future stages. The question whether or not cell division patterns conform to the geometry of the system in which the cells are embedded is also discussed.
Radiation‐induced oral mucositis in mice: strain differences
Authors: Dörr W. , Spekl K. , Martin M. 
Published: March 2003

Abstract. The present study was initiated to investigate strain differences in oral mucosal radiosensitivity in mice with regard to induction of clinically manifest ulceration. Mouse ventral tongue epithelium was used as an established animal model for radiobiological studies of radiation‐induced mucositis. Mice from two different strains, C3H/Neu (n = 40) from the Dresden colony, and B6D2F1 (n = 50) from the Harlan/Winkelmann UK colony were subjected to irradiation of tongue mucosa. Graded single doses were applied to a 3 × 3 mm2 test field in the centre of the lower tongue with 25 kV X‐rays in order to generate full dose‐effect curves for acute mucosal ulceration, as a clinically relevant reaction. For both groups, dose‐effect curves were computed by logit analysis; comparison of the curves was by maximum‐likelihood χ2 test. In addition, the time course of ulceration, i.e. latent time and individual ulcer duration, was analysed. In both mouse strains, a well‐defined dose effect was observed. The ED50 values, i.e. the doses at which ulceration is expected in 50% of the animals irradiated, and their standard deviation σ, calculated by logit analysis, can be used to describe radiosensitivity. The ED50 was 11.0 ± 3.4 Gy (95% confidence interval (7.2; 15.4), P for dose dependence: 0.014) and 13.4 ± 3.6 Gy (95% confidence interval (10.6; 16.1), P for dose dependence: 0.0002) in C3H and BDF1 mice, respectively. Hence, oral mucosa in BDF1 mice was found to be marginally more radioresistant (P = 0.1). The latent time to ulceration, i.e. the time between irradiation and first diagnosis of ulcer, was 11.6 ± 0.2 days (mean ± SEM, n = 18) in C3H mice and 5.6 ± 0.1 days (n = 27) in BDF1 mice (P = 0.0001). Both were independent of dose (PC3H = 0.94, PBDF1 = 0.33) and hence were calculated for all responding animals of the respective strain. Ulcer duration was 2.8 ± 0.2 days and 2.4 ± 0.1 days in C3H and B6 mice, respectively, and was also independent of dose (PC3H = 0.25, PBDF1 = 0.99), but was dependent on the mouse strain (P = 0.036). In conclusion, no statistically significant difference in oral mucosal radiosensitivity was observed between the mouse strains. This, however, may be attributed to the small number of animals used per dose group. The time course data, with a shorter latency and ulcer duration in BDF1 mice, are in good accordance with the higher proliferation rates reported for oral mucosa in this mouse strain.
Simulation of cell proliferation in mouse oral epithelium, and the action of epidermal growth factor: evidence for a high degree of synchronization of the stem cells
Authors: Appleton D. R. , Thomson P. J. , Donaghey C. E. , Potten C. S. , McGurk M. 
Published: March 2003

Abstract. Computer simulation has been carried out to help to determine the cell‐proliferative mechanisms underlying data gathered from a double‐labelling experiment on the dorsal tongue of the mouse. Good fits to the data have been obtained by assuming that there is a high degree of synchrony in the stem cells, which have a 24‐h cell cycle time, and that daughters of these cells undergo two further divisions, with mean cell cycle times of 48 h, before differentiating. This results in one‐seventh of proliferative cells being stem cells, which ties in well with the concept of epidermal proliferative units. There is no need to assume that S‐phase duration changes diurnally. The administration of epidermal growth factor seems to increase the degree of synchrony. In such systems, the influx to S‐phase and the efflux from it have very sudden short peaks, which it is impossible to observe unless observations are taken very frequently. There are therefore implications for the designs of experiments that attempt to study diurnal rhythms or the effect of factors that disturb the normal proliferative pattern of cells.
Transcending the fissure in risk theory: critical realism and child welfare
Authors: Houston Stan 
Published: March 2003

ABSTRACTWithin risk theory a key fissure has emerged. On the one hand, objectivist theories continue to treat risk as a measurable entity, while on the other, subjectivist accounts approach risk as a socially constructed phenomenon. Arguably, we need to transcend this false opposition and harmonize important insights from both approaches. Building on an earlier paper in this journal, the author tries to achieve this synthesis by applying Bhaskar's critical realist perspective to this contested area. The reconciliation of objectivism and subjectivism within critical realism, it is argued, redirects our attention to the deep‐seated causes of harm or the underlying mechanisms that, when activated, give rise to situations involving risk. The paper concludes by reviewing the implications of these ideas for child and family social work. It is here that connections are made with attachment theory and the recent interest in childhood resilience.