bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of systemic factors on pre-existing intimal hyperplasia and their effect on the outcome of infrainguinal arterial reconstruction with vein
Authors: Beattie D K , Sian M , Greenhalgh R M , Davies A H 
Published: July 2002

Abstract

Background
The association between raised levels of homocysteine, fibrinogen and lipoprotein (a), and the presence of pre-existing intimal hyperplasia (IH) in vein has not been assessed. The positive association between such hyperplasia and graft failure following infrainguinal arterial reconstruction, and between lipoprotein (a) and graft failure, is disputed. The influence of homocysteine on outcome has not been investigated prospectively.

Methods
Fifty-seven patients (63 grafts) undergoing infrainguinal arterial reconstruction with saphenous vein were studied. Homocysteine, fibrinogen and lipoprotein (a) levels were measured, and a vein biopsy was taken at operation. Patients underwent graft surveillance and outcome at 12 months was determined.

Results
Fifty-seven per cent of patients had hyperhomocysteinaemia. Patients with pre-existing IH had significantly higher homocysteine levels. There was no association between homocysteine and outcome, or between fibrinogen and pre-existing IH or outcome. Lipoprotein (a) levels were significantly lower in patients with pre-existing disease, and were lower, but not significantly, in those whose grafts failed. The correlation between pre-existing IH and vein graft failure was highly significant.

Conclusion
Hyperhomocysteinaemia is associated with peripheral vascular disease and the development of pre-existing IH in vein, which itself is associated with vein graft failure.
Putting your heart into walking further
Authors: Nawaz S , Wilkinson C H , Walker R D , Pockley A G , Wood R F M 
Published: July 2002

Abstract

Background
Leg exercise training improves maximum walking distance (MWD) in claudicants, but it also causes neutrophil activation and may, as a consequence, elicit damage to the coronary circulation. It was hypothesized that symptomatic improvements induced by exercise programmes result from systemic cardiovascular effects rather than localized changes in the lower limb. The aim of this study was to develop an upper body training programme that would enhance cardiovascular fitness while avoiding potentially damaging inflammatory responses.

Methods
Sixty-three stable claudicants were recruited; all underwent arm and leg ergometry exercise assessments. Peripheral blood was obtained before and 1 h after exercise. The intensity (median channel of fluorescence; MCF) of neutrophil CD11b expression (as a measure of neutrophil activation) was determined using whole blood flow cytometry. Patients were randomized to an arm (n = 24) or leg (n = 24) training programme structured to achieve identical heart rate changes. Training involved two supervised sessions per week for 6 weeks. Controls undertook no exercise (n = 15). The MWD was determined at the beginning and end of training.

Results
Arm exercise had no effect on neutrophil expression of CD11b, whereas expression was significantly increased by leg exercise (Table). Arm and leg training increased the maximum work rate from 75 to 100 W (P = 0·004; Wilcoxon test) and there was a concomitant decrease in the submaximal heart rate (arm group 150 to 131 beats min−1; leg group 155 to 136 beats min−1; P = 0·002). These cardiovascular changes were accompanied by an increased MWD (Table). There were no changes in the control group.

Conclusion
Upper body training can increase walking distance in claudicants without neutrophil activation and maximizing cardiovascular fitness appears to be the key to improving symptoms in these patients.
Use of superficial femoral/popliteal veins for suprainguinal arterial reconstruction in the presence of infection
Authors: Gibbons C P , Ferguson C J , Edwards K , Osman H Y 
Published: July 2002

Abstract

Background
Mycotic aneurysms and graft infection in the aortoiliac region provide formidable technical challenges and carry a high morbidity and mortality rate with either of the standard techniques of in situ antibiotic-bonded prosthetic reconstruction or extra-anatomical bypass. This study investigated the use of autologous superficial femoral/popliteal vein (SFPV) for arterial reconstruction in ten patients with arterial or graft infections of the aortoiliac region.

Methods
Two patients with mycotic aortic aneurysms and four with aortic graft infections underwent aortoiliac replacement with SFPV after thorough debridement and/or excision of infected graft material. Three infected femorofemoral grafts were replaced in situ with reversed SFPV and an infected axillofemoral graft was converted to an iliofemoral reversed SFPV graft. All patients received appropriate antibiotic therapy and were followed by regular postoperative duplex imaging. Preoperative femoral vein duplex imaging was performed in eight of ten patients to confirm suitability as a graft.

Results
Nine of the ten patients survived with a functioning graft and without limb loss or evidence of infection at 3–30 months. One patient died from myocardial infarction after operation. Two patients had minor swelling of one leg. Three patients required angioplasty of anastomotic stenoses detected by duplex surveillance at 6 weeks.

Conclusion
SFPV is an excellent conduit for aortic or iliac reconstruction in the presence of infection. Duplex imaging is useful to confirm the suitability of deep veins for use as a graft and for postoperative surveillance.
Larval debridement therapy: a cost-effective alternative to hydrogel in necrotic venous ulcers: a randomized trial
Authors: Wayman J , Walker A , Sowinski A , Walker M A 
Published: July 2002

Abstract

Background
Evidence for the effectiveness of larval debridement therapy (LDT) in necrotic wounds has hitherto been the anecdotal results of enthusiasts. The aim of this study was to compare the cost and effectiveness of LDT with standard hydrogel treatment of necrotic venous ulcers.

Methods
Patients with sloughy venous ulcers were randomized to either standard hydrogel dressings (Intrasite gel) (group 1) or LDT (group 2). All patients were reviewed every 72 h until effective debridement had occurred, for a maximum of 1 month. The outcome measure used for effectiveness was whether or not desloughing occurred and time to deslough. The measures of cost were the cost of nursing time, dressing costs, and costs of larvae and hydrogel required to achieve healing in 1 month's treatment.

Results
Twelve patients were randomized. Ulcers in all patients receiving LDT (group 2) desloughed within two applications of larva therapy. All of these patients were treated subsequently with four-layer bandaging and all healed within 4 months. Ulcers in only two patients in group 1 desloughed completely within 1 month. One of the patients in whom hydrogel had failed at 1 month was changed to LDT and the ulcer desloughed with one application. Taking into account the cost of a vial of larvae (£58), the overall median cost of treatment in group 1 was greater than that in group 2 (£136·23 (range 63·89–319·30) versus £78·64 (range 73·49–£92·36)).

Conclusion
LDT is more effective and significantly less expensive than hydrogel in the debridement of sloughy venous ulcers. While a larger randomized controlled study should be performed to confirm these observations, LDT appears to be a cost-effective alternative to hydrogel.
Carotid artery plaque instability is associated with expression of matrix metalloproteinases 2 and 12
Authors: Senaratne J W B , Hands L J , Collin J , Morris P J , Green F R 
Published: July 2002

Abstract

Background
There has been considerable interest in the role of matrix metalloproteinases (MMPs) in atherosclerotic plaque rupture and the possible use of MMP inhibitors in stabilization of plaques. Collagenolytic MMPs, athough important in causing plaque instability, may not be a feasible target, as interfering with collagen turnover in tightly stenosed lesions may induce occlusion. This study investigated the expression of elastinolytic MMP-2, MMP-9 and MMP-12 in carotid plaques in relation to plaque stability.

Methods
Plaques removed at surgery were examined immediately and classified as unstable (plaques with ulceration, rupture, thrombosis; n = 34) or stable (plaques with or without calcification without the above complications; n = 26). MMP expression was studied by immunohistochemistry (after saponin permeabilization) and computed image analysis of whole plaques to obtain percentage staining.

Results
Expression of all three MMPs was significantly higher in unstable plaques.
In a logistic regression model, only MMP-2 (P = 0·04) and MMP-12 (P = 0·0018) expression was shown to be significantly greater in unstable plaques.

Conclusion
Although MMP-2, MMP-9 and MMP-12 are all expressed in higher amounts in unstable plaques, MMP-12 was shown to be the most significantly associated with plaque instability, followed by MMP-2. These findings may be useful in directing efforts to develop specific inhibitors, particularly to MMP-12 which has elastin and not collagen as its main substrate.
Initial management of cerebrovascular disease by general practitioners
Authors: Gibbs R G J , Todd J C , Newson R , Greenhalgh R M , Davies A H 
Published: July 2002

Abstract

Background
The aim of this study was to determine the primary management of patients presenting with a new diagnosis of transient ischaemic attack (TIA) or stroke by general practitioners and to establish whether practice was uniform across the UK, and to determine whether initial management influenced the performance of carotid endarterectomy (CEA) across the health regions of the UK.

Methods
Information on regional reporting of new cases of TIA and stroke between 1992 and 1996 was obtained from the General Practice Research Database, a database of six million patients from 450 practices. Analysis of data from the primary care database and routine data sources was undertaken. Main outcome measures were incidence of TIA and stroke, rates of referral for specialist opinion, prescription of antiplatelet agents and rates of CEA.

Results
There were twofold differences (P &lt; 0·00005, χ2 test) in the incidence of cerebrovascular disease between Regional Health Authorities (RHAs) between the years 1992 and 1996 and also for each year. Mean stroke incidence per annum was 143 per 100 000 and TIA incidence 183 per 100 000. Yorkshire had the highest incidence at 170 (stroke) and 206 (TIA) per 100 000 of the population compared with 95 and 98 per 100 000 for Oxford. Some 37 per cent of new patients with stroke and 19 per cent of patients with TIA were referred for specialist opinion following initial diagnosis. These rates did not change over time. There was no positive correlation between disease incidence and referral rate; Yorkshire referred the least (14 per cent) and Oxford the most (26 per cent). The majority of referrals for TIA were made to general medicine (39 per cent); 6 per cent of patients were referred directly for surgical opinion. Mean prescription rate of antiplatelet medication over the time period was 17 per cent for patients with stroke and 35 per cent for those with TIA. Mean CEA rate for English RHAs for the time interval was 15·5 per 100 000. There was a positive correlation between the incidence of disease and rate of CEA, with the regions with the highest incidence of disease tending to perform the most CEAs.

Conclusion
The incidence of cerebrovascular disease varies significantly across health regions in the UK. There was no correlation between the regional incidence of disease and the number of patients referred for specialist opinion, but CEA rates were generally correlated with the regional difference in incidence of disease. The low referral rate may be a factor in the perceived underperformance of CEA in the UK and the low usage of antiplatelet medication is surprising.
Smoking and disease recurrence after operation for Crohn's disease
Authors: Yamamoto T , Keighley M R B 
Published: July 2002

Abstract

Background
There is increasing speculation about the role of smoking in the pathogenesis of inflammatory bowel diseases. The purpose of this study is to review the impact of smoking on disease recurrence after operation for Crohn's disease.

Methods
A Medline-based literature review (1966–1999) was carried out; ten studies examined the relationship between smoking and disease recurrence after operation.

Results
Approximately half of the patients were smokers at the time of operation. In most studies smoking significantly increased the risk of postoperative disease recurrence. Smokers had an approximately twofold increased risk of recurrence compared with non-smokers and the effect of smoking was dose dependent. The increased risk of recurrence among smokers was more prominent in women than in men, and a longer duration of smoking increased the risk of recurrence. Ex-smokers had a similar recurrence rate to non-smokers and giving up smoking soon after operation was associated with a lower probability of recurrence.

Conclusion
Smoking significantly increases the risk of recurrence of disease after operation for Crohn's disease, especially in women and heavy smokers. Encouraging patients to stop smoking is an important part of the management of Crohn's disease.
Pattern of recurrence following radical oesophagectomy with two-field lymphadenectomy
Authors: Dresner S M , Griffin S M 
Published: July 2002

Abstract

Background
Despite increasingly radical surgery for oesophageal cancer, many patients continue to develop recurrent disease. The aim of this study was to evaluate the pattern of failure following attempted curative oesophagectomy with two-field lymphadenectomy for adenocarcinoma and squamous cell carcinoma of the middle and lower third of the oesophagus.

Methods
A total of 176 consecutive patients discharged from hospital following R0 resection between 1 April 1990 and 31 December 1999 were followed for evidence of recurrence over a mean interval of 26 months.

Results
Adenocarcinoma was the predominant histological subtype (n = 113) compared with squamous cell carcinoma (n = 63). Sex and age distribution were similar for both histological subtypes (M: F ratio 2·5: 1, median age 64 (range 40–77) years). Overall 2- and 5-year survival rates were 54 and 31 per cent respectively. Some 85 patients (48 per cent) developed proven recurrence, of whom five are alive and 80 dead. The median time to recurrence was 11·7 (range 1·5–67) months, with a median survival thereafter of only 2·7 (0–25·9) months. The pattern of recurrence was locoregional in 27 per cent (mediastinal 21 per cent and cervical 6 per cent) and distant in 18 per cent (liver 6 per cent, bone 6 per cent, cerebral 2 per cent, peritoneal 2 per cent, lung 1 per cent, skin 1 per cent). There was no difference in the overall pattern of dissemination or timing of recurrence for either histological subtype. Over 50 per cent of all recurrences occurred within 12 months of surgery, with local, regional and distant recurrence occurring at a median of 11·9 (range 1.8–52), 11·0 (range 5–67) and 11·0 (1·5–58) months respectively.

Conclusion
The low incidence of cervical recurrence suggests that a more extensive ‘three-field’ lymphadenectomy is unlikely to improve survival rates. Better staging modalities are needed to identify patients who will have recurrence within 12 months of operation, so that they may be either entered into trials of multimodality treatment or offered non-surgical palliation.
British Journal of Surgery prize-winning paper, presented to the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, London, UK, September 1999
Applied issues with predators and predation: editor’s introduction
Authors: Ormerod S. J. 
Published: July 2002

Summary

The effects of predation are among the most pervasive in ecology. As parasitoids, parasites, grazers or top carnivores, predators have large influences on the distribution, density, dynamics and evolved traits of other organisms. Effects scale‐up to influence community attributes such as species coexistence and ecosystems processes such as production or trophic cascades.
Increasingly, however, some of the largest predation issues fall clearly within the scope of applied ecology. They include instances where, due to their ecological attributes and trophic position: (i) predators are valuable to nature conservation, as biocontrol agents, as natural enemies, or as grazers used in rangeland or ecosystem management; (ii) natural or introduced predators are viewed negatively due to effects on conservation, agriculture, forestry, hunting or disease transmission; (iii) predators are affected by human activities such as resource exploitation, or from exposure to factors such as biomagnified pollutants and disturbance; (iv) predators are controversial because different groups view them as either desirable or undesirable.
In all these cases, ecologists have a pivotal rôle in facilitating appropriate management. For valued predators, this involves developing sufficient ecological understanding to optimize habitat, increase prey abundance or to reinforce, establish or reintroduce desirable species. For predators considered undesirable, management can involve direct control. In other cases, predation and its consequences can be mitigated by deterrent, exclusion, supplementary feeding, habitat management to favour prey, predator swamping, or by compensating losses financially. These latter strategies are often used where predators are themselves considered too valuable to remove or control.
This collection of seven papers illustrates many of these themes by examining contrasting aspects of the applied ecology of Eurasian lynx; by further probing the interaction between predatory birds and red grouse; by exploring the effects of weather on biocontrol; and by illustrating effects on plant species where grazing or seed predation play a dominant rôle.
A key lesson from these and other recent papers in the Journal of Applied Ecology is that the successful management of predators depends invariably on understanding adequately the exact ecological context in which predator–prey interactions take place and in which problems arise. With predator‐related issues growing rather than diminishing, ecologists will need sufficient resources to maintain current research if they are to provide the understanding required to offer and evaluate sound management.
Cameleon calcium indicator reports cytoplasmic calcium dynamics in Arabidopsis guard cells
Authors: Allen Gethyn J. , Kwak June M. , Chu Sarah P. , Llopis Juan , Tsien Roger Y. , Harper Jeffrey F. , Schroeder Julian I. 
Published: July 2002

SummaryCytoplasmic free calcium ([Ca2+]cyt) acts as a stimulus‐induced second messenger in plant cells and multiple signal transduction pathways regulate [Ca2+]cyt in stomatal guard cells. Measuring [Ca2+]cyt in guard cells has previously required loading of calcium‐sensitive dyes using invasive and technically difficult micro‐injection techniques. To circumvent these problems, we have constitutively expressed the pH‐independent, green florescent protein‐based calcium indicator yellow cameleon 2.1 in Arabidopsis thaliana (Miyawaki et al. 1999; Proc. Natl. Acad. Sci. USA 96, 2135–2140). This yellow cameleon calcium indicator was expressed in guard cells and accumulated predominantly in the cytoplasm. Fluorescence ratio imaging of yellow cameleon 2.1 allowed time‐dependent measurements of [Ca2+]cyt in Arabidopsis guard cells. Application of extracellular calcium or the hormone abscisic acid (ABA) induced repetitive [Ca2+]cyt transients in guard cells. [Ca2+]cyt changes could be semi‐quantitatively determined following correction of the calibration procedure for chloroplast autofluorescence. Extracellular calcium induced repetitive [Ca2+]cyt transients with peak values of up to approximately 1.5 μM, whereas ABA‐induced [Ca2+]cyt transients had peak values up to approximately 0.6 μM. These values are similar to stimulus‐induced [Ca2+]cyt changes previously reported in plant cells using ratiometric dyes or aequorin. In some guard cells perfused with low extracellular KCl concentrations, spontaneous calcium transients were observed. As yellow cameleon 2.1 was expressed in all guard cells, [Ca2+]cyt was measured independently in the two guard cells of single stomates for the first time. ABA‐induced, calcium‐induced or spontaneous [Ca2+]cyt increases were not necessarily synchronized in the two guard cells. Overall, these data demonstrate that that GFP‐based cameleon calcium indicators are suitable to measure [Ca2+]cyt changes in guard cells and enable the pattern of [Ca2+]cyt dynamics to be measured with a high level of reproducibility in Arabidopsis cells. This technical advance in combination with cell biological and molecular genetic approaches will become an invaluable tool in the dissection of plant cell signal transduction pathways.
The Nature of Psychiatric Classification: Issues Beyond ICD-10 and DSM-IV
Authors: Jablensky Assen 
Published: July 2002

Objective: The aim of this paper is to provide an overview of the methodological underpinnings of current classification systems in psychiatry, their impact on clinical and social practices, and likely scenarios for future development, as an introduction to a series of related articles in this issue. Method: The method involved a selective literature review. Results: The role and significance of psychiatric classifications is placed in a broader social and cultural context; the ‘goodness of fit’ between ICD-10 and DSMIV on one hand, and clinical reality on the other hand, is examined; the nature of psy chiatric classification, compared to biological classifications, is discussed; and questions related to the impact of advances in neuroscience and genetics on psychiatric classification are raised for further discussion. Conclusions: The introduction of explicit diagnostic criteria and rule-based classification, a major step for psychiatry, took place concurrently with the ascent to dominance of a biomedical paradigm and the synergistic effects of social and economic forces. This creates certain risks of conceptual closure of clinical psychiatry if phenomenology, intersubjectivity and the inherent historicism of key concepts about mental illness are ignored in practice, education and research.