bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying a Linked Reserve System Using a Regional Landscape Approach: the Florida Ecological Network
Authors: Hoctor Thomas S. , Carr Margaret H. , Zwick Paul D.
Published: March 2003

Abstract: We completed an analysis of potential ecological connectivity to identify areas with priority conservation significance and landscape linkages as part of a state of Florida program called Greenways. This is the latest step in the state's design and protection of a reserve system based on an aggressive land acquisition program. We used geographic information systems software (Arc‐Info) to develop a decision support model that uses land‐use data and information on significant ecological areas—including important habitats for target species, priority ecological communities, wetlands, roadless areas, floodplains, and important aquatic systems—to identify larger areas of ecological priority and potential ecological linkages. The result of this process, the Florida Ecological Network, includes approximately half the state's area, with over half of this network already in conservation lands or public‐domain water. This network could provide a linked statewide reserve system containing most of each major ecological community and most known occurrences of rare species. Although the ecological network represents significant progress toward a more integrated approach to biodiversity conservation in Florida, further analysis is needed to (1) ensure that the needs of wide‐ranging species, such as the Florida panther (  Puma concolor coryi) and Florida black bear (  Ursus americanus floridanus), are addressed; (2) identify other biodiversity elements not well represented; and (3) designate a system of cores and buffers that will address management issues. Reserve design is an iterative process, and future plans need to address new information, including the results of the Florida GAP analysis project and ongoing habitat loss.
Incorporating Habitat Mapping into Practical Koala Conservation on Private Lands
Authors: Lunney Daniel , Matthews Alison , Moon Chris , Ferrier Simon
Published: March 2003

Abstract: Identifying and conserving faunal habitat on private lands has been conducted largely on a site‐by‐site basis as development proposals arise. We sought to map koala habitat at a scale suitable for use by a local planning authority so that habitat remnants could be protected and managed while remaining in private ownership. At this scale, the level of detail and accuracy needed by local planners required a new approach to mapping koala habitat. Two independent techniques, community and field surveys, were employed. We mailed a survey to every household in Coffs Harbour shire. Respondents told of 3309 koala sightings. We conducted a field survey, a plot‐based scat (  fecal pellet) search, to determine which vegetation types and tree species were preferred by koalas. We surveyed 119 sites, which contained 42 different vegetation types. Of these, 37 (31%) had been used by koalas. The outcomes of the community and field surveys were combined to produce a distribution map of koala habitat. The most striking outcome has been the use of our results by the local government authority, Coffs Harbour City Council: planners have incorporated the koala habitat map into their local environmental plan. Our procedure offers a rigorous, repeatable, and publicly accessible method for identifying and mapping important habitat for the purposes of land‐use planning, an essential procedure for conserving habitat outside the reserve system.
Improving Habitat Models and Their Utility in Koala Conservation
Authors: Cork Steven J. , Hume Ian D. , Foley William J.
Published: March 2003

Abstract: Models of what makes good koala habitat are a key to developing effective conservation policy and practices. Koala habitat models are based on (1) ecological studies of high‐density koala populations in limited areas, (2) physiological studies of koala nutrition and characteristics of food plants, and (3) surveys of koala geographic distribution and biophysical features of forests and woodlands. The role of models in koala conservation varies because legislators, decisionmakers, land managers, and citizens have different expectations and uses for models. Although current habitat models address many of these needs, overall they lack sufficient certainty and authority to resolve disputes and develop policy. Unpublished and inadequately peer‐reviewed data and models add to misinterpretation and argument. Improvements are needed in the decision‐making process to increase the constructive involvement of all interest groups and to focus on the koala conservation problem, thereby reducing use of the popular media and courts of law to achieve objectives.
Modeling and Predicting Species Occurrence Using Broad‐Scale Environmental Variables: an Example with Butterflies of the Great Basin
Authors: Fleishman Erica , Nally Ralph Mac , Fay John P. , Murphy Dennis D.
Published: March 2003

Abstract:If occurrence of individual species can be modeled as a function of easily quantified environmental variables (e.g., derived from a geographic information system [GIS]) and the predictions of these models are demonstrably successful, then the scientific foundation for management planning will be strengthened. We used Bayesian logistic regression to develop predictive models for resident butterflies in the central Great Basin of western North America. Species inventory data and values for 14 environmental variables from 49 locations (segments of canyons) in the Toquima Range ( Nevada, U.S.A.) were used to build the models. Squares of the environmental variables were also used to accommodate possibly nonmonotonic responses. We obtained statistically significant models for 36 of 56 (64%) resident species of butterflies. The models explained 8–72% of the deviance in occurrence of those species. Each of the independent variables was significant in at least one model, and squared versions of five variables contributed to models. Elevation was included in more than half of the models. Models included one to four variables; only one variable was significant in about half the models. We conducted preliminary tests of two of our models by using an existing set of data on the occurrence of butterflies in the neighboring Toiyabe Range. We compared conventional logistic classification with posterior probability distributions derived from Bayesian modeling. For the latter, we restricted our predictions to locations with a high ( 70%) probability of predicted presence or absence. We will perform further tests after conducting inventories at new locations in the Toquima Range and nearby Shoshone Mountains, for which we have computed environmental variables by using remotely acquired topographic data, digital‐terrain and microclimatic models, and GIS computation.
Genetic Effects of Multiple Generations of Supportive Breeding
Authors: Wang Jinliang , Ryman Nils
Published: March 2003

Abstract: The practice of supporting weak wild populations by capturing a fraction of the wild individuals, bringing them into captivity for reproduction, and releasing their offspring into the natural habitat to mix with wild ones is called supportive breeding and has been widely applied in the fields of conservation biology and fish and wildlife management. This procedure is intended to increase population size without introducing exogenous genes into the managed population. Previous work examining the genetic effects of a single generation of supportive breeding has shown that although a successful program increases the census population size, it may reduce the genetically effective population size and thereby induce excessive inbreeding and loss of genetic variation. We expand and generalize previous analyses of supportive breeding and consider the effects of multiple generations of supportive breeding on rates of inbreeding and genetic drift. We derived recurrence equations for the inbreeding coefficient and coancestry, and thereby equations for inbreeding and variance effective sizes, under three models for selecting captive breeders: at random, preferentially among those born in captivity, and preferentially among those born in the wild. Numerical examples indicate that supportive breeding, when carried out successfully over multiple generations, may increase not only the census but also the effective size of the supported population as a whole. If supportive breeding does not result in a substantial and continuous increase of the census size of the breeding population, however, it might be genetically harmful because of elevated rates of inbreeding and genetic drift.
A Molecular Genetic Assessment of Mating‐System Variation in a Naturally Bird‐Pollinated Shrub: Contributions from Birds and Introduced Honeybees
Authors: England Phillip R. , Beynon Fiona , Ayre David J. , Whelan Robert J.
Published: March 2003

Abstract:Introductions of European honeybees have occurred globally, potentially affecting the natural pollination ecology of many plants. Introduced honeybees are now the most frequent visitors to the inflorescences of the self‐compatible, bird‐pollinated Australian shrubGrevillea macleayanaand may therefore be expected to have altered the mating system. To examine the degree to which birds continue to play a role in determining the mating system ofG. macleayanain this disturbed system, we compared outcrossing rates in open‐pollinated inflorescences with inflorescences from which birds had been selectively excluded. Outcrossing rates were estimated from the microsatellite genotypes of over 100 seeds per population in three populations. Outcrossing rates ( t) in open‐pollinated seeds were surprisingly low (0.062–0.225) and did not vary significantly among the three populations. Nevertheless, outcrossing was significantly lower when birds were excluded (data pooled from all populations). Two lines of evidence suggest that there are temporal fluctuations in outcrossing rate and hence that birds usually have a major effect on the mating system ofG. macleayana. First, at one site,twas substantially lower than estimates from an earlier study (0.06 in 1995 cf. 0.85 in 1990). Second, fixation indices based on seeds were high in all populations (  >0.68), whereas values for the established plants ( parental generation) were much lower in two of the three populations (0.06–0.32). Our findings suggest that honeybee activity is so high that the contribution of birds to pollination inG. macleayanais sometimes relatively trivial.
Evaluating the Effectiveness of Predator Control: the Non‐Native Red Fox as a Case Study
Authors: Harding Elaine K. , Doak Daniel F. , Albertson Joy D.
Published: March 2003

Abstract: Non‐native vertebrate predators pose a severe threat to many native species, and a variety of management programs are aimed at reducing predator effects. We sought to assess the effects of predator‐control programs by analyzing changes in prey and predator populations based on data commonly collected in these programs. We examined data from a predator‐control program that primarily targets the introduced red fox ( Vulpes vulpes regalis) in central California. Red foxes negatively affect populations of native waterbirds, particularly the endangered California Clapper Rail ( Rallus longirostris obsoletus). Using a combination of matrix population modeling, simple difference equations, and statistical analysis, we analyzed data on removed predators and monitored prey populations. Past control efforts succeeded in depressing fox numbers in local areas over 3‐month intervals, and there was a significant, positive relationship between the growth rate of local Clapper Rail populations and the successful trapping of red foxes in the preceding year. By modeling the effect of different fox‐removal rates, we found that a stable or declining population could be achieved by removing a minimum of 50% of the adults and 25% of the juveniles. Under trapping rates of 50–70%, the proportion of the fox population composed of immigrants averaged 20–52%. In contrast to the current management approach, elasticity analyses suggested that changes in adult survival rates had relatively little effect on long‐term population growth. Overall, our approach indicated that predator control was effective in the short term, but for longer‐term success it may be necessary to redirect efforts to control juvenile and immigrant foxes. Our analytical approach is potentially useful for evaluating current control programs aimed at reducing the effects of predators on native species.
Rural Development and Sustainable Wildlife Use in Peru
Authors: Bodmer Richard E. , Lozano Etersit Pezo
Published: March 2003

Abstract:Tropical conservation has seen a convergence between conservation projects and rural development, with both approaches promoting participation of local people in sustainable resource use. But there is a discord between rural development and sustainable use of wildlife. Implementing more sustainable use of wildlife usually means decreased economic benefits for rural people, especially over the short term. In contrast, rural‐development projects are often mandated to generate income for rural people over the short term. We examined this dilemma through an integrated economic and harvest analysis of the costs associated with converting unsustainable hunting to more sustainable hunting in the Peruvian Amazon. Our analysis suggests that a change in hunting practice would have significant economic costs for rural people and would result in a 36% decrease in the economic benefits they derive from wildlife hunting. In contrast, converting unsustainable hunting to more sustainable hunting would have little effect on meat markets in the urban center of Iquitos, Peru, with markets losing only 3.6% of their economic value. There would be no economic costs for the international pelt trade. If rural‐development projects absorb the short‐term economic costs, they can help people convert unsustainable wildlife use to more sustainable use and assist rural people in realizing the long‐term benefits of more sustainable hunting. But many rural‐development projects would need to change their mandate for short‐term income generation to incorporate the realities of sustainability.
Effects of Variation on Harvest Limits for Nontimber Forest Species in Mexico
Authors: Ticktin Tamara , Nantel Patrick , Ramirez Fernando , Johns Timothy
Published: March 2003

Abstract: Successful conservation of nontimber products and their rainforest habitats requires the identification of optimal harvest regimes, the accurate estimation of maximum harvest limits, and the implementation of those limits by local harvesters. We used a combination of participatory research techniques and demographic modeling to determine maximum sustainable harvest rates of the bromeliad Aechmea magdalenae in the buffer zone of the Los Tuxtlas Biosphere Reserve in Mexico. We examined the effects of three types of variation on maximum harvest rates: variation between forest types, between harvest regimes, and over time. We also tested the accuracy of estimating maximum harvest limits using matrix‐model projections of unharvested populations. Maximum harvest rates of ramets from secondary forest populations were much higher than from primary‐forest populations. Likewise, variation in local harvest regimes had a large effect on maximum harvest rates. Populations concurrently harvested for leaves and ramets had higher maximum sustainable levels of ramet harvest than those harvested for ramets only. Simulations using harvested and unharvested populations yielded significantly different estimates of maximum sustainable harvest limits, indicating that methods for calculating maximum harvest limits that assume linear responses to harvest may lead to erroneous conclusions. Active participation in the research process enabled local harvesters to accept as valid the harvest limits determined in this study, to switch to using a more sustainable harvest regime, and to pass a local law prohibiting the destruction of their remaining primary forest because of its potential as A. magdalenae habitat.
A Transdisciplinary Approach to Conservation Land Acquisition
Authors: Czech Brian
Published: March 2003

Abstract: Land acquisition is one of the keys to biodiversity conservation, and it is a transdisciplinary endeavor requiring consideration of natural and social phenomena. I integrated principles of conservation biology, ecological economics, and political science to outline an approach to conservation land acquisition in the United States. American political economy, especially, has profound implications for conservation land acquisition, yet these implications have been largely neglected by public land conservation agencies. I derived three general recommendations for the conservation of biodiversity via land acquisition: (1) relatively inexpensive lands in relatively intact ecosystems should be prioritized for acquisition, (2) fee‐title acquisition should be favored over easement acquisition, and (3) low‐lying coastal properties should receive lower priority. These recommendations contribute to an ecologically macroeconomic approach to conservation land acquisition, and each will become more appropriate as the sizes of the U.S. and global economies increase. Ultimately, however, the conservation of biodiversity will require a new political economy predicated on sustainability rather than growth.
Enlisting Taxonomists to Survey Poorly Known Taxa for Biodiversity Conservation: a Lichen Case Study
Authors: Hunter Malcolm L. , Webb Sara L.
Published: March 2003

Abstract:A comprehensive approach to conserving endangered species requires data on the geographic distribution, habitat, and abundance of species from a wide array of taxa, including invertebrates, lichens, bryophytes, and other poorly known groups. Such information can also contribute to ecosystem‐based conservation efforts. Unstructured surveys by taxonomists can identify species that appear to be rare, but such surveys are inadequate for most conservation purposes. We describe simple approaches for systematically gathering and analyzing more–useful data: using time‐ and area‐constrained searches, recording abundances, listing common as well as rare species, using “control” areas, and characterizing the environmental context of each survey site. The particular methods described are for lichen surveys, but they are directly applicable to bryophyte surveys, and the general principles are relevant to all species surveys designed to inform conservation efforts.
What Contributes to Breastfeeding Success After Childbirth in a Maternity Ward in Finland?
Authors: Tarkka Marja‐Terttu , Paunonen Marita , Laippala Pekka
Published: March 2003

Background:
The study objective was to gain information about factors that contribute to the successful establishment of breastfeeding in first‐time mothers while they are still in the maternity hospital. The study was part of a wider longitudinal project that examined the development of first‐time mothers into motherhood during eight months after the birth.
Methods:
Data were collected by a questionnaire distributed between January and May 1995. The sample comprised 326 first‐time mothers, who completed the questionnaires on about the fifth day after childbirth. A polychotomic logistic regression analysis was applied.
Results:
Mothers who had a positive experience of breastfeeding in the maternity ward and who began lactating 2 to 3 days postpartum coped better with breastfeeding than those whose experience was less positive and who lactated later. Moreover, the greater the emotional (affect) and concrete (aid) support received by the mother from members of her support network, the better she coped with breastfeeding. By contrast, those mothers who were upset while in the maternity ward coped less well with breastfeeding.
Conclusions:
Establishing successful breastfeeding in first‐time mothers requires the professional guidance and support of the maternity staff and paying attention to the person closest to the new mother, who in this study was the spouse or father of the child. (BIRTH 25:3 September 1998)
Changes in Cesarean Delivery in an Italian University Hospital, 1982–1996: A Comparison with the National Trend
Authors: Zanetta Gerardo , Tampieri Antonio , Currado Isa , Regalia Anita , Nespoli Antonella , Fei Francesca , Colombo Carla , Bottino Salvatore
Published: March 2003

Background:
The cesarean delivery rate in Italy rose dramatically from the mid‐1970s to 1996, accounting for 22.4 percent of all deliveries in the last national survey. The aim of this study was to analyze the results of the clinical practice of a new staff in the Department of Obstetrics and Gynecology of a university hospital, with particular focus on the application of common protocols. The rates of cesarean sections and perinatal mortality were chosen as parameters for good clinical practice and were compared with national data.
Methods:
A new staff assumed the obstetric management at the hospital in 1982. Standardized protocols were implemented for all major indications for cesarean delivery (repeat cesarean section, dystocia, breech presentation, fetal distress).
Results:
The rate of cesarean deliveries decreased from 26.4 to 12 percent and remained stable during the past decade. Other operative modalities were used for approximately 1.5 percent of deliveries. The perinatal mortality decreased to 0.5 percent in 1994. To confirm whether or not staff followed common protocols, a review of three years (1994–1996) showed a fairly stable frequency of cesarean sections on different days and nights during the week, confirming the homogeneity of obstetric management.
Conclusions:
Our data showed that, irrespective of the local situation and of the risks of litigation, a significant reduction of cesarean sections can be achieved in a tertiary care center without detrimental effects on newborns, especially in a teaching hospital where residents are trained. Despite national trends suggesting the contrary, some women may choose to deliver in an obstetrics department with better care and fewer operative procedures than in hospitals with higher cesarean delivery rates.
Differences in the Valuation of Birth Outcomes Among Pregnant Women, Mothers, and Obstetricians
Authors: Vandenbussche Frank P.H.A. , De Jong‐Potjer Lieke C. , Stiggelbout Anne M. , Le Cessie Saskia , Keirse Marc J.N.C.
Published: March 2003

Background:
Decisions are usually based on the perceived merits of alternative approaches. This process can be quantified by combining the probabilities of expected outcomes with their desirability. We studied differences in the valuation of birth outcomes among pregnant women, mothers, and obstetricians, and assessed how these would affect a particular obstetric decision.
Methods:
In a study conducted at Leiden Hospital, Leiden, The Netherlands, 12 obstetricians, 15 pregnant women, and 15 mothers participated in a standard reference gamble to determine the value of 12 different outcomes: 3 types of birth combined with 4 states of infant outcome. These were then applied to an obstetric decision tree based on the Dublin trial of intermittent auscultation versus electronic intrapartum fetal heart rate monitoring.
Results:
Contrary to obstetricians, women valued permanent neurologic handicap significantly higher than neonatal death (
p < 0.01). Women expressed no overriding preferences for the type of birth, whereas obstetricians were clearly antipathetic to cesarean section. Within‐group consistency was significantly higher for pregnant women and mothers than for obstetricians (
p < 0.0001). However, application of the measured values to the obstetric decision tree merely led to marginal changes in overall expected value of the decision alternatives.
Conclusions:
Values attached to birth processes and outcomes differ significantly between (expectant) mothers and doctors. These differences should be recognized and respected in obstetric decision making.
Position for Newborn Sleep: Associations with Parents' Perceptions of Their Nursery Experience
Authors: Colson Eve R. , Bergman David M. , Shapiro Eugene , Leventhal John H.
Published: March 2003

Background:
In the United States, sudden infant death syndrome is the leading cause of death among infants between the ages of 1 and 12 months. Although its etiology is unclear, infants who sleep in the prone or side positions are at increased risk. The objective of this study was to examine the association between the perceptions of inner city parents about teaching and modeling during the postpartum period of infant sleeping position, and their choice of sleeping position for their infants.
Methods:
A convenience sample of parents of 100 healthy infants who came for the 2‐week well‐child visit at an urban primary care center were invited to complete a questionnaire and to report on the position in which infants were placed for sleep.
Results:
Forty‐two percent of parents reported that they usually placed their infants in the supine position for sleep; 26 percent placed their infants to sleep in the prone position at least some of the time. Parents who reported being told by a doctor or a nurse to have their infants sleep in the supine position were more likely to choose that position. Similarly, those who reported seeing their infants placed to sleep exclusively in the supine position in the hospital were also more likely usually to choose that position. Parents who reported that they both were told by a doctor or a nurse to put their infants to sleep in the supine position and reported seeing their infants exclusively placed that way in the nursery were the most likely usually to choose that position for their infants to sleep.
Conclusions:
Perceptions by parents of instructions from a doctor or a nurse of the position in which the infants were placed in the nursery were associated with the position parents reported placing their infants to sleep at home. Efforts to promote the supine sleeping position in the inner‐city setting should address both practices and education provided to parents in the nursery during the postpartum hospital stay and should be sufficiently powerful to align their perceptions of the postpartum experience with current American Academy of Pediatrics recommendations.
Erb's Palsy Causation: A Historical Perspective
Authors: Sandmire Herbert F. , DeMott Robert K.
Published: March 2003

A better understanding of the forces involved when brachial plexus injury occurs has evolved over the past 10 to15 years. A particular challenge was that all of the useful information had to be derived indirectly by identifying associations—a challenge that was met by individual researchers who made significant observations that, in turn, stimulated others to search for additional findings. Gradually the pieces of the puzzle began to form the picture. The significant steps in this journey were first, the recognition of the substantial number of injuries occurring without concurrent shoulder dystocia; second, the finding that a much greater frequency of injury is associated with an ultrashort second stage of labor; third, the observations that the injury rate is independent of the experience of the birth attendant; fourth, the recognition of the substantial numbers of injuries occurring in the posterior arm; and fifth, the anecdotal experience of countless delivery attendants, who relate that the forces applied in the injured cases were perceived to be no stronger than those applied when no injury occurred. We present a historical review for each step in this journey. We reviewed all articles published on this subject in Obstetrics and Gynecology and the American Journal of Obstetrics and Gynecology and some European journals. The period for review primarily covered articles published since 1980. Several textbooks on obstetrics and child neurology were also reviewed. (BIRTH 29:1 March 2002)
Serologic Detection of CagA Positive Helicobacter pylori Infection in a Northern Italian Population: Its Association with Peptic Ulcer Disease
Authors: Orsini Barbara , Ciancio Giuseppe , Surrenti Elisabetta , Macrí Giuseppe , Biagini Maria Rosa , Milani Stefano , Surrenti Calogero
Published: March 2003

Background.

About 60–70% of Helicobacter pylori strains possess cagA (cytotoxin associated gene A) gene and express its product CagA, a highly immunogenic 128–140kD protein. Patients infected with CagA positive strains develop serum IgG anti‐CagA. A serologic response to CagA has been detected in Helicobacter pylori infected patients with peptic ulcer more frequently than in those with gastritis alone. It is unclear whether this finding is consistent in different geographical populations. We investigated the relationship between anti‐CagA seropositivity and peptic ulcer disease in a Northern Italian population.

Materials and Methods.

We studied 135 H. pylori infected patients: 65 with duodenal ulcer (DU), 28 with gastric ulcer (GU) and 42 with non ulcer dyspepsia (NUD). Sera from these patients were assayed by EIA (enzyme immunoassay) for anti‐CagA IgG.

Results.

A high prevalence of anti‐CagA was found associated with DU (86.1%) and GU (96.4%), while NUD patients showed anti‐CagA seropositivity of 52.4% (Odd ratio, 5.66; 95% confidence interval, 2.23 to 14.32;p~<~.001, DU vs. NUD; Odd ratio, 24.5; 95% confidence interval, 3.05 to 197.6;p~=~.003, GU vs. NUD). DU patients showed anti‐CagA seropositivity titer (1.15 (0.61 OD, mean (SD) higher than that of NUD patients (0.78 (0.60 OD, mean (SD) (p~<~.05).

Conclusions.

These data demonstrate in a Northern Italian population that anti‐CagA seropositivity is strongly associated with peptic ulcer disease and suggest that CagA might play an important role in ulcer pathogenesis.
Amoxicillin/Metronidazole/Omeprazole/Clarithromycin: A New, Short Quadruple Therapy for Helicobacter pylori Eradication
Authors: Treiber G. , Ammon S. , Schneider E. , Klotz U.
Published: March 2003

Background.

Triple therapy regimens including two antibiotics plus acid suppression have become the new standard therapy in Helicobacter pylori eradication because of success rates of about 90%. However, these regimens are still costly, duration is about one week or less, and side‐effects are not negligible. We therefore evaluated a new quadruple therapy, because theoretically a shorter duration of treatment may result in reduced costs, fewer side‐effects, and possibly in a lower potential for antibiotic resistances.

Methods.

Controlled, prospective pilot study including H. pylori‐positive patients with gastric or duodenal ulcers or erosive gastritis, treated after failure of dual therapy (proton‐pump‐inhibitors or ranitidine plus amoxicillin) or for the first time. They were assigned to a one week triple standard therapy, consisting of metronidazole 400~mg bid~ + omeprazole 20~mg bid ~+ clarithromycin 250~mg bid, or a newly created quadruple‐regimen, which adds amoxicillin (1~g bid) to the above triple regimen. Each of the four drugs was given for 5~days. H. pylori status was checked by 13C urea breath test before and after four weeks of therapy.

Results.

A total of 71 patients were treated by quadruple therapy, and 42 patients were treated by triple therapy. The eradication rate of H. pylori for patients under quadruple treatment, without vs. with previous dual therapy, were 96% vs. 92% (42/44 vs. 22/24) by per protocol and 91% vs. 88% (42/46 vs. 22/25) by intention to treat analysis (comparisons not significant). No major side‐effects were reported.

Conclusions.

~Five‐day quadruple therapy (with omeprazole, metronidazole, clarithromycin and amoxicillin) represents an effective and safe new regimen for H. pylori eradication.
Ranitidine Bismuth Citrate Plus Clarithromycin: A Dual Therapy Regimen for Patients with Duodenal Ulcer
Authors: Lanza Frank L. , Sontag Stephen J. , Ciociola Arthur A. , Sykes Deborah L. , Heath Amy , McSorley David J.
Published: March 2003

Background.

The combination of ranitidine bismuth citrate (RBC) and clarithromycin (CLR) was compared with each treatment alone for the eradication of H. pylori and healing of duodenal ulcers in patients infected with H. pylori.

Methods.

This two‐phase, randomized, double‐blind, placebo‐controlled, multicenter study evaluated 203 patients with an active duodenal ulcer treated with either (1) RBC 400 mg BID for 4 weeks plus CLR 500 mg TID for the first 2 weeks; (2) RBC 400 mg BID for 4 weeks plus placebo TID for the first 2 weeks; (3) placebo BID for 4 weeks plus CLR 500 mg TID for the first 2 weeks; or (4) placebo BID for 4 weeks plus placebo TID for the first 2 weeks. Patients with healed ulcers after treatment entered a 24‐week observation phase for the assessment of H. pylori and ulcer relapse.

Results.

Four‐week ulcer healing rates were higher with RBC + CLR (71%) and RBC alone (66%) compared with placebo (15%;p < 0.05) and CLR alone (49%). H. pylori eradication rates were significantly higher with RBC + CLR (86%) compared with RBC alone (0%, p < .001) or CLR alone (24%, p < .001). Ulcer recurrence rates after 6 months were lower in patients eradicated of H. pylori infection (17%) compared with patients who remained infected (43%). All treatments were well tolerated.

Conclusions.

Ranitidine bismuth citrate plus clarithromycin is a simple, convenient, and well‐tolerated dual therapy regimen that is effective in eradicating H. pylori and healing duodenal ulcers in patients infected with H. pylori. The eradication of H. pylori in patients with healed ulcers significantly reduces the rate of ulcer relapse.
The Role of Endoscopic Findings for the Diagnosis of Helicobacter pylori Infection: Evaluation in a Country with High Prevalence of Atrophic Gastritis
Authors: Mihara Mitsuhiro , Haruma Ken , Kamada Tomoari , Komoto Kunihiko , Yoshihara Masaharu , Sumii Koji , Kajiyama Goro
Published: March 2003

Background.

This study examines endoscopic findings in the diagnosis of Helicobacter pylori (H. pylori) in the Japanese population.

Materials and Methods.

The endoscopic findings (including gastric fold findings and degree of atrophy by the Kimura‐Takemoto classification system), histologic severity of inflammation, and glandular atrophy were assessed according to the Sydney system in 642 patients (419 men; 223 women; mean age 43.5 years, range 13–86). H. pylori infection was evaluated by Giemsa staining and serum IgG antibodies.

Results.

391 of 642 patients (60.9%) were diagnosed as having endoscopic gastritis. Of the 391 patients with endoscopic gastritis, 318 (82.6%) had histologic gastritis and 310 (79.3%) had H. pylori infection. Of the 251 patients with endoscopically normal stomachs, 43 (17.1%) had histologic gastritis and 32 (12.7%) had H. pylori infection. Atrophic gastritis was the most prevalent finding (56.3%) among those with endoscopic gastritis. The prevalence of H. pylori infection in patients with atrophic gastritis (92.7%) and rugal hyperplastic gastritis (92.3%) was significantly higher than in those with other types of gastritis or with a normal stomach (12.7%). A markedly high prevalence of H. pylori infection was found in subjects with tortuosity, hyperrugosity, and/or hyporugosity of the gastric folds.

Conclusions.

The accurate endoscopic assessment of gastritis according to the Sydney system along with gastric fold findings and the endoscopically identified extent of gastric atrophy are valuable indicators for determining H. pylori infection and histologic gastritis in the Japanese population.
Combined Activity of Azithromycin and Lansoprazole Against Helicobacter pylori
Authors: Trautmann Matthias , Riediger Christine , Möricke Angelika , Vogt Konstanze , Bohr Ulrich , Glasbrenner Bernhard
Published: March 2003

Background. Due to its unique pharmacokinetic properties, azithromycin may be an attractive combination partner for H. pylori eradication regimens. However, up to 15% of clinical isolates are primarily resistant to azithromycin as well as to other macrolide antibiotics. Combination therapy with lansoprazole, a proton pump inhibitor known to have intrinsic antibacterial activity against H. pylori, may be useful to counteract such resistance. We therefore evaluated the combined effects of azithromycin and lansoprazole in vitro.

Materials and Methods. Minimal inhibitory concentrations (MICs) of azithromycin and lansoprazole alone and in combination were determined for 106 clinical H. pylori isolates by means of an agar dilution technique. Killing kinetics of seven isolates were also studied in fluid medium.

Results. MIC values for 50 and 90% of the isolates (MIC50, MIC90) were 0.19 and 0.5 mg/l for azithromycin, and 44.5 and 104 mg/l for lansoprazole. Nine strains (8.5%) had an MIC of azithromycin ≥ 16 mg/l and were regarded as resistant. An additive interaction between the two drugs was found in 72 (68%), and indifferent effects in 24 strains (23%). Three of 9 azithromycin‐resistant strains regained sensitivity in the presence of lansoprazole. In fluid culture, synergism between the two drugs occurred in 6 out of 7 strains tested.

Conclusion. In the majority of strains, lansoprazole and azithromycin interacted in an additive or synergistic manner depending on the test method employed. Addition of lansoprazole restored in vitro sensitivity to azithromycin in 3 out of 9 azithromycin‐resistant strains. Such effects may enhance the elimination of H. pylori during clinical eradication therapy.
Randomized Placebo‐Controlled Trial of Helicobacter pylori Eradication for Iron‐Deficiency Anemia in Preadolescent Children and Adolescents
Authors: Choe Yon Ho , Kim Soon Ki , Son Byong Kwan , Lee Don Haeng , Hong Yun Chul , Pai Soo Hwan
Published: March 2003

Background. A few cases relating H. pylori infection to iron‐deficiency anemia have been described recently. We investigated the role of H. pylori infection in iron‐deficiency anemia in preadolescent children and adolescents.

Patients and Methods. We conducted a double‐blind, placebo‐controlled therapeutic trial in 43 subjects (mean age, 15.4 years) with iron‐deficiency anemia. Endoscopy was performed, and biopsy specimens were examined by urease test and histological analysis. Twenty‐two of 25 H. pylori–positive patients were assigned randomly to three groups. Group A patients were given oral ferrous sulfate and a 2‐week course of bismuth subcitrate, amoxicillin, and metronidazole. Group B patients were given placebo for iron and a 2‐week course of triple therapy. Group C patients were given oral ferrous sulfate and a 2‐week course of placebo. Iron status was reassessed 4 weeks and 8 weeks after the 2‐week regimen ended.

Results. Of the 43 subjects with iron‐deficiency anemia, 25 (58.1%) had H. pylori in the antrum. Group A and B subjects, who received eradication therapy, showed a significant increase in hemoglobin level as compared with group C subjects at 8 weeks after therapy (p = .0086).

Conclusions. Treatment of H. pylori infection was associated with more rapid response to oral iron therapy as compared with the use of iron therapy alone. Such treatment also led to enhanced iron absorption even in those subjects who did not receive oral iron therapy.
Prevalence of CagA, VacA Antibodies in Symptomatic and Asymptomatic Children with Helicobacter pylori Infection
Authors: Elitsur Yoram , Neace Cheryl , Werthammer Matthew C. , Triest William E.
Published: March 2003

Background. Limited data are available on the prevalence of CagA and VacA Helicobacter pylori antibodies in children. The aim of this study was to investigate the antibody prevalence to the H. pylori virulence factors CagA and VacA in symptomatic and asymptomatic children with H. pylori infection and to correlate these antibodies with the severity of gastric inflammation or density of H. pylori organisms in the gastric mucosa.

Materials and Methods. Twenty‐three symptomatic children and 132 asymptomatic children with positive H. pylori serology participated in this study. Anti–H. pylori IgG antibody and CagA or VacA H. pylori antibodies were measured by enzyme immunoassay (HM‐CAP; sensitivity and specificity> 90%) and Western immunoblot (Helicoblot 2.0) methods, respectively. Gastric inflammation and H. pylori density were graded histologically using the revised Sydney criteria.

Results. The prevalence of CagA and VacA antibodies were 69% and 35% in symptomatic children and 54% and 52% in asymptomatic children, respectively. Multiple regression analysis showed a correlation between CagA antibody and the severity of gastritis but no correlation with other histological features, including the number of neutrophils or lymphoid follicles. Neither antibody correlated with the degree of bacterial density in the gastric mucosa.

Conclusion. CagA and VacA H. pylori antibodies are common in the pediatric population. The combined CagA/VacA antibodies correlated weakly with the degree of mucosal inflammation.
Pretreatment Antimicrobial Susceptibilities of Paired Gastric Helicobacter pylori Isolates: Antrum Versus Corpus
Authors: Ikezawa Kazuto , Kashimura Hiromasa , Kojima Maki , Aikawa Tatsuya , Nakahara Akira , Mutoh Hiroshi , Tanaka Naomi
Published: March 2003

Background. Antimicrobial susceptibility testing of Helicobacter pylori isolates is the most useful tool for guiding specific therapy, especially when primary resistance is suspected. However, the most informative gastric biopsy site for detection of resistant H. pylori isolates is uncertain. We sought to determine whether susceptibilities to commonly used antimicrobials (amoxicillin, clarithromycin, minocycline, and metronidazole) were related to biopsy site.

Methods. H. pylori isolates were obtained from patients who had duodenal ulcer and had not received any therapy directed against H. pylori. Agar‐dilution minimum inhibitory concentrations of each antimicrobial were compared between paired H. pylori isolates from the antrum and the proximal corpus.

Results. Differences in minimum inhibitory concentrations exceeding twofold were observed within the pairs of H. pylori isolates in 5 of the 40 patients tested. In three patients with clarithromycin‐resistant isolates and two with metronidazole‐resistant isolates, both antral and corporeal specimens revealed resistance. However, no patient had pairs of isolates categorized as resistant at one site and sensitive at the other.

Conclusions. While we found that an individual may have a mixed H. pylori infection with respect to differing antimicrobial susceptibility in different parts of the stomach, a single biopsy specimen from either the antrum or the corpus should provide reliable detection of H. pylori isolates with primary resistance.
Comparative Treatment of Helicobacter pylori–Positive Duodenal Ulcer Using Pantoprazole at Low and High Doses Versus Omeprazole in Triple Therapy
Authors: Catalano Filippo , Branciforte Giuseppe , Catanzaro Roberto , Bentivegna Carmelo , Cipolla Rosanna , Nuciforo Giuseppe , Brogna Alfio
Published: March 2003

Background. Helicobacter pylori eradication has become the standard treatment for peptic ulcer disease. H. pylori–eradicating triple therapy with omeprazole plus two antibiotics has been used until recently; however, the efficacy of pantoprazole and antibiotics for H. pylori eradication has not been researched thoroughly until now. The aim of this randomized clinical trial was to verify the efficacy of triple oral therapy comparing the effects of pantoprazole using two different doses versus omeprazole twice daily in H. pylori eradication, in ulcer healing and relapses, and in gastritis improvement.

Materials and Methods. We enrolled 243 patients with H. pylori–positive duodenal ulcer and randomized them into three treatment groups: 84 patients (group Ome40) were assigned to receive omeprazole, 20 mg twice daily, plus amoxicillin, 1 gm twice daily, and clarithromycin, 500 mg twice daily for 10 days; 79 patients (group Pan40) were treated with pantoprazole, 40 mg daily, plus amoxicillin and clarithromycin at the same doses as those of group Ome40; and 80 patients (group Pan80) were treated with pantoprazole, 40 mg twice daily, plus amoxicillin and clarithromycin at the same doses as those of group Ome40.

Results. Ulcer healing was observed in 81 of 84 patients (96.4%) in group Ome40; in 66 of 79 patients (83.5%) in group Pan40; and in 77 of 80 patients (96.2%) in group Pan80. H. pylori was eradicated in 79 of 84 patients (94%) in group Ome40; in 63 of 79 patients (79.7%) in group Pan40; and in 75 of 80 patients (93.7%) in group Pan80.

Conclusions. We found that 10‐day triple therapy with amoxicillin, clarithromycin, and either pantoprazole, 80 mg daily, or omeprazole, 40 mg daily, is highly effective in ulcer healing and is very well tolerated, achieving the 90% cure recommended for an ideal first‐line anti–H. pylori positive duodenal ulcer treatment regimen.
13C‐Urea Breath Test and Gastric Mucosal Colonization by Helicobacter pylori in Children: Quantitative Relation and Usefulness for Diagnosis of Infection
Authors: Vincent Pascal , Michaud Laurent , De Lasalle Elisabeth Martin , Benon Benoît , Turck Dominique , Gottrand Frédéric
Published: March 2003

Objective. Because in children Helicobacter pylori colonization could differ as compared to that in adults, gastric metabolism of urea and the reliability of the breath test must be evaluated. The aim of this study was to quantify the relationship between breath test and colonization.

Methodology. We studied data from 50 endoscopies performed in 39 children and adolescents (20 girls, 19 boys, aged 3–18 years); 28 were infected with H. pylori. Biopsies were analyzed for histological and microbiological diagnosis of infection and for quantitative antral culture of H. pylori. A 13C urea breath test was performed on the same day as that of endoscopy (
n = 33) or delayed between 2 and 90 days (
n = 17).

Results. Using a cut‐off value of 3 δ‰, sensitivity was 96.5%, and specificity was 91.5%. The three children showing discrepancies between breath test and biopsy results had a δ‰ value close to the cut‐off. For the 26 cases with a positive culture, we noted a significant correlation (r = 0.63; p < .001) that was not affected by the delay between breath test and gastroscopy.

Conclusion. This quantitative relation between bacterial density and δ‰ permits increasing the reliability of the test by interpreting carefully those results that approach the cut‐off value.
Factors Affecting the Validity of the 13C‐Urea Breath Test for In Vivo Determination of Helicobacter pylori Infection Status in a Mouse Model
Authors: Hammond Paul D. , Stutzenberger Fred J. , Butler Ross N. , Read Leanna C. , Davidson Geoffrey P.
Published: March 2003

Background. The mouse model using a human isolate of Helicobacter pylori is being widely accepted as an economical means of studying gastric infection. A noninvasive monitoring method would be useful for repeated testing to establish the time course of infection and the efficacy of treatments. In this study, we describe factors that affect interpretation of 13C urea breath test results for the assessment of H. pylori infection status in this model.

Materials and Methods. Female C57Bl/6 mice that underwent gavage with H. pylori or saline were breath‐tested using 50 μg of 13C urea at intervals up to 2 months after inoculation. The generation of 13CO2 (excess δ13CO2) by infected mice was compared to that of uninfected controls. The effects of diet, fasting, and coprophagy on the reliability of the 13C urea breath test were quantitated.

Results. Both commercial and synthetic mouse diets exhibited marked in vitro urease activity. A minimum fasting time of 13 hours prior to breath testing significantly reduced this dietary contribution to excess δ13CO2 values. The coprophagic tendency of the mice caused spuriously high excess δ13CO2 counts in the breath of both control and H. pylori–infected mice.

Conclusions. Although the dietary contribution to spuriously high values of excess δ13CO2 in mice breath‐tested for H. pylori infection was reduced by fasting, the high nonspecific urease activity generated by coprophagy severely limited the reliability of the urea breath test in the assessment of H. pylori infection status.