bluuebunny/crossref_metadata_2025 huggingface dataset:
Levofloxacin‐Containing Triple Therapy to Eradicate the Persistent H. pylori after a Failed Conventional Triple Therapy
Authors: Cheng Hsiu‐Chi , Chang Wei‐Lun , Chen Wei‐Ying , Yang Hsiao‐Bai , Wu Jiunn‐Jong , Sheu Bor‐Shyang
Published: July 2007

Objective:  To identify the optimal dosage of levofloxacin to eradicate persistent Helicobacter pylori when triple therapy with amoxicillin, clarithromycin, and omeprazole fails.

Methods:  We investigated 124 patients whose triple therapy including clarithromycin had failed. Clarithromycin resistance was indirectly assessed by the 13C‐urea breath test, with a post‐treatment value cut‐off point at 15. All patients were randomly divided into two groups, to receive 1‐week amoxicillin 1 g and lansoprazole 30 mg twice daily, plus either levofloxacin 500 mg once (ALL‐500 group) or twice daily (ALL‐1000 group). Six weeks later, the 13C‐urea breath test was repeated to assess whether H. pylori was eradicated.

Results:  Intention‐to‐treat (ITT) and per‐protocol (PP) analysis showed no difference in H. pylori eradication rates in both the ALL‐500 and ALL‐1000 groups (ITT: 79% vs. 80.6%, p > .05; PP: 86% vs. 87.5%, p > .05). For both groups, the per‐protocol H. pylori eradication rates were also similarly high between patients with a post‐treatment value of 13C‐urea breath test ≤ 15 and those with a value > 15 (ALL‐500: 85% vs. 86.5%, p > .05; ALL‐1000: 88.9% vs. 86.8%, p > .05).

Conclusion:  One‐week levofloxacin 500 mg daily‐based triple therapy is effective for eradicating the persistent H. pylori after a failed triple therapy with amoxicillin, clarithromycin, and omeprazole.
Evidence that the Degree and Duration of Acid Suppression are Related to Helicobacter pylori Eradication by Triple Therapy
Authors: Sugimoto Mitsushige , Furuta Takahisa , Shirai Naohito , Kodaira Chise , Nishino Masafumi , Ikuma Mutsuhiro , Ishizaki Takashi , Hishida Akira
Published: July 2007

Backgrounds and aims:  Eradication rates of Helicobacter pylori by a proton pump inhibitor‐based triple therapy depend on CYP2C19 genotype status. We investigated whether gastric acid inhibition during an eradication therapy would influence the eradication rates attained by the triple therapy.

Methods:  Thirty‐two patients with H. pylori infection underwent the first‐line triple therapy with lansoprazole 30 mg, amoxicillin 750 mg, and clarithromycin 400 mg b.i.d. for 1 week. In all 32 patients, the 24‐hour intragastric pH monitoring was performed on day 6 during the treatment period.

Results:  The intention‐to‐treat‐based eradication rate by the first‐line therapy was 75.0% (24/32, 95%CI: 56.60–88.54%). In patients with successful eradication, the median 24‐hour pH was 6.4 (range; 5.0–7.6), which was significantly higher than that in patients without eradication [5.2 (2.2–6.2), p = .0131]. The median percentage time of pH < 4.0 during 24‐hour postdose in patients with eradication [0.5% (0.0–31.6%)] was significantly shorter than that in patients without eradication [26.7% (6.0–72.2%), p = .0017]. These parameters for acid inhibition significantly differed among the different CYP2C19 genotype groups. When the percentage time of pH < 4.0 and 24‐hour pH were attained < 10% and > 6.0, respectively, during the eradication treatment, the majority of patients could eradicate H. pylori infection, irrespective of the bacterial susceptibility to clarithromycin.

Conclusions:  The sustained intragastric pH > 4.0 for a longer postdose time appears to be required for a successful eradication of H. pylori with lansoprazole and acid‐labile antibiotics.
Improved In vitro Model Systems for Gastrointestinal Infection by Choice of Cell Line, pH, Microaerobic Conditions, and Optimization of Culture Conditions
Authors: Lindén Sara K. , Driessen Kim M. , McGuckin Michael A.
Published: July 2007

Background:  Commonly used in vitro infection cultures do not mimic the human gastrointestinal tract with regard to pH and microaerobic conditions. Furthermore, despite the importance of mucin–Helicobacter interactions, the cell lines used have not been selected for appropriate mucin expression. To make in vitro studies more applicable to human disease, we have developed coculture methods taking these factors into account.

Materials and methods:  Nine human gastrointestinal epithelial cell lines (MKN1, MKN7, MKN28, MKN45, KATO3, HFE145, PCAA/C11 Caco‐2, and LS513) were investigated. Expression and glycosylation of mucins (MUC1, 2, 3, 4, 5AC, 5B, 6, 12, 13, and 16) were determined by immunohistochemistry. We analyzed the effect of microaerobic conditions and acidic pH on cell proliferation, viability, and apoptosis.

Results:  Microaerobic culture, which is more physiological for the bacteria, did not adversely affect mammalian cell viability, proliferation, or induce apoptosis The cell lines varied in mucin expression, with MKN7 and MKN45 being most similar to gastric mucosa and Caco‐2 and LS513 to intestinal mucosa, although none exactly matched normal mucosa. However, changes in culture conditions did not cause major changes in the mucin expression within cell lines.

Conclusions:  Culture conditions mimicking the natural environment and allowing the bacterial cells to thrive had no effect on cell viability or apoptosis, and very little influence on mucin expression of human gastrointestinal cells. Thus, it is feasible, using the simple methods we present here, to substantially improve bacterial–mammalian cell in vitro coculture studies to make them more reflective of human infection.
Reversal of Migraine Symptoms by Helicobacter pylori Eradication Therapy in Patients with Hepatitis‐B‐Related Liver Cirrhosis
Authors: Hong Liu , Zhao Yunping , Han Ying , Guo Wei , Wang Jun , Li Xiaohua , Han Yu , Fan Daiming
Published: July 2007

Helicobacter pylori infection might be associated with vascular diseases, such as primary Raynaud phenomenon and coronary heart diseases. The possible mechanism might be due to H. pylori antigens causing intermittent vasospasm of arterioles, which also played roles in the development of liver cirrhosis. Migraine, a functional vascular disease, was observed in many patients with cirrhosis in the clinic. This study aimed to assess the effects of H. pylori eradication on migraine symptoms in patients with hepatitis‐B‐virus‐related cirrhosis. The results clearly showed that the intensity, duration, and frequency of attacks of migraine were significantly reduced in all the patients in whom H. pylori has been eradicated. Thus, the study pushed further insight into the mechanisms of migraine pathogenesis.
Atrophic Gastritis, Helicobacter pylori, and Colorectal Cancer Risk: A Case‐Control Study
Authors: Machida‐Montani Ai , Sasazuki Shizuka , Inoue Manami , Natsukawa Syusuke , Shaura Kozo , Koizumi Yoichi , Kasuga Yoshio , Hanaoka Tomoyuki , Tsugane Shoichiro
Published: July 2007

Background:  Helicobacter pylori is a major risk factor for atrophic gastritis and gastric cancer. Various extragastric manifestations of H. pylori infection have also recently been suggested. However, the correlation between H. pylori and colorectal cancer (CRC) is controversial. The aim of this study was to examine the correlation between H. pylori, serum gastrin level, and atrophic gastritis with CRC.

Materials and methods:  Subjects were patients with CRC; controls were participants of a health check‐up program that was conducted between October 1998 and March 2002 at four hospitals in Nagano Prefecture. For 121 newly diagnosed CRC cases, two controls matched by age (within 3 years), gender, and residence were randomly selected from the program participants. We conducted questionnaires and obtained blood samples from the cases and their controls. Consequently, the CRC cancer pairs consisted of 113 cases and 226 controls.

Results:  Neither H. pylori infection nor gastrin level nor atrophic gastritis showed any association with a risk for CRC. However, serologically determined atrophic gastritis demonstrated significant elevation in odds ratios (ORs) for rectal cancer (OR = 3.15, 95% confidence interval; 1.19–8.35).

Conclusions:  Gastric conditions such as chronic H. pylori infection and atrophic gastritis are unlikely to increase the risk for CRC, although atrophic gastritis may increase the risk of rectal cancer.
Immunochromatographic Monoclonal Test for Detection of Helicobacter pylori Antigen in Stool is Useful in Children from High‐Prevalence Developing Country
Authors: Nares‐Cisneros Jesús , Jaramillo‐Rodríguez Yolanda , Martínez‐Ordaz Verónica Araceli , Velasco‐Rodríguez Victor Manuel , Madero Agustín , Mena‐Arias Gilberto , Manriquez‐Covarrubias Luis
Published: July 2007

Background:  Tests to detect Helicobacter pylori antigens in feces for diagnosis of infection in children demonstrate controversial results. One novel and fast monoclonal test improves diagnostic accuracy in adults, but clinical evidence of its usefulness at pediatric age is insufficient to date. The objective of this work was to evaluate the diagnostic accuracy of this test in a sample of Mexican children.

Methods:  We conduced a transversal study in 150 selected children with digestive symptoms suggestive of organic disease in whom a clinical history was conducted in addition to a fast monoclonal test (ImmunoCardSTAT® HpSA, Meridian Diagnostics) performed by immunchromatography. Patients were submitted to endoscopy and histopathologic study.

Results:  Of the 150 children (mean age 7.8 ± 4.7 years), 107 (71.3%) were positive for the test, and presence of H. pylori was confirmed histologically in 109 (72.7%) children, with sensitivity of 96.3% (95% CI = 95.8–96.8), specificity of 95.1% (95% CI = 93.9–96.4), and accuracy of 96.0% (95% CI, –95.6 to –96.3); pretest probability was 0.73, while post‐test probability was 0.98. Infection rate and test accuracy increased with age.

Conclusions:  This test is useful for detecting H. pylori infection in children of all ages, and is a good alternative for screening studies in developing countries with elevated prevalence due to its being fast, noninvasive, inexpensive, and easy to carry out.
Efficacy and Safety of Saccharomyces boulardii in the 14‐day Triple Anti‐Helicobacter pylori Therapy: A Prospective Randomized Placebo‐Controlled Double‐Blind Study
Authors: Cindoruk Mehmet , Erkan Gulbanu , Karakan Tarkan , Dursun Ayse , Unal Selahattin
Published: July 2007

Background:  Recent studies indicate a potential role of Saccharomyces boulardii in the prevention of Helicobacter pylori treatment‐related side‐effects and also in improvement of eradication rate. Our aim is to investigate the efficacy and safety of S. boulardii in the prevention of side‐effects related to H. pylori eradication. The secondary aim of the study was to define the effect of S. boulardii on the eradication success of anti‐H. pylori therapy.

Materials and methods:  One hundred and twenty‐four patients with H. pylori infection (male/female: 44/80, mean age: 48 ± 14.25 year) receiving 14 days of triple therapy (clarithromycin 500 mg b.i.d., amoxicillin 1000 mg b.i.d., and lansoprazole 30 mg b.i.d.) were randomly assigned to S. boulardii or placebo. Dyspeptic symptoms were recorded by using modified Glasgow Dyspepsia Questionnaire (GDQ). Side‐effect profile and tolerability were assessed using a symptom‐based questionnaire. H. pylori status was rechecked after 6 weeks after completion of eradication therapy.

Results:  H. pylori eradication rate, although higher in the treatment group, was statistically similar in treatment and control groups: 71% (44/62) versus 59.7% (37/62), respectively (p > .05). Nine (14.5%) patients in the treatment group and 19 (30.6%) patients in the placebo group experienced diarrhea (p < .05). Epigastric discomfort was more frequent in the control group [9 (14.5%) versus 27 (43.5%), respectively (p < .01)]. Diffuse abdominal pain, abdominal gas, taste disturbance, urticaria, nausea symptoms were similar in both groups. GDQ scores after treatment were significantly better for treatment group (mean ± SD, range: 1.38 ± 1.25 (0–5) vs. 2.22 ± 1.44 (0–6), respectively; p < .01).

Conclusion:  S. boulardii improved anti‐H. pylori antibiotherapy‐associated diarrhea, epigastric discomfort, and treatment tolerability. In addition, S. boulardii supplement decreased post‐treatment dyspepsia symptoms independent of H. pylori status. However, S. boulardii had no significant affect on the rate of H. pylori eradication.
A Report Card to Grade Helicobacter pylori Therapy
Authors: Graham David Y. , Lu Hong , Yamaoka Yoshio
Published: July 2007

Helicobacter pylori causes a serious bacterial infectious disease, and the expectations of therapy should reflect this fact. Increasing antibiotic resistance, especially to clarithromycin, has significantly undermined the effectiveness of legacy triple therapy consisting of a proton pump inhibitor, clarithromycin, and amoxicillin. Current cure rates are consistently below 80% intention‐to‐treat, the accepted threshold separating acceptable from unacceptable treatment results. Grading clinical studies into effectiveness categories using prespecified criteria would allow clinicians to objectively identify and compare regimens. We offer a therapy report card similar to that used to grade the performance of school children. The intention‐to‐treat cure rate categories are: F or unacceptable ( 80%), D or poor (81–84%), C or fair (85–89%), B or good (90–95%), and A or excellent (95–100%). The category of “excellent” is based on the cure rates expected with other prevalent bacterial infectious diseases. We propose that only therapies that score “excellent” (grade = A) should be prescribed. Regimens scoring as B or “good” can be used if “excellent” results are not obtainable. In most regions legacy triple therapy should be abandoned as unacceptable. Quadruple therapy and sequential therapy are reasonable alternatives for initial therapy.
Should Hypertension Guidelines Be Changed for Hypertensive Patients With the Metabolic Syndrome?
Authors: Segura Julian , Banegas Jose Ramon , García‐Donaire Jose Antonio , Rodríguez‐Artalejo Fernando , de la Cruz Juan Jose , Praga Manuel , Ruilope Luis Miguel
Published: July 2007

The authors analyzed the impact of present guidelines for hypertension management on cardiovascular (CV) risk factors in hypertensive patients with and without the metabolic syndrome (MS). Results in 549 nondiabetic hypertensive patients with a mean follow‐up of 3.8±1.2 years on usual recommended care were reviewed. At baseline, 231 (42.1%) patients had MS and, per the definition, showed significantly higher values of traditional CV risk factors than non‐MS patients. At the end of follow‐up, blood pressure levels were similar in both groups; the lipid profile tended to improve in MS patients. Eighteen MS patients (7.8%) and 7 non‐MS patients (2.2%) developed diabetes (P<.001). Prevalence of microalbuminuria was reduced in both groups, but it remained significantly higher in MS patients. Usual care of hypertensive patients achieved similar blood pressure and low‐density lipoprotein cholesterol goals, both in MS and non‐MS patients. Global CV risk, however, remained higher in MS patients, as suggested by a 3‐fold higher incidence of new‐onset diabetes (absolute increase of 5.6%) and a 2‐fold increase in microalbuminuria.
Masked Hypertension in Diabetes Mellitus: A Potential Risk
Authors: Eguchi Kazuo , Ishikawa Joji , Hoshide Satoshi , Pickering Thomas G. , Shimada Kazuyuki , Kario Kazuomi
Published: July 2007

The prevalence and clinical significance of masked hypertension (MHT) in diabetics have infrequently been described. The authors assessed the association of MHT (defined using a clinic blood pressure [BP] <140/90 mm Hg and daytime ambulatory BP ≥135/85 mm Hg) with microvascular and macrovascular end organ damage in 81 clinically normotensive Japanese diabetic persons. The prevalence of silent cerebral infarcts (SCIs), increased left ventricular mass, and albuminuria were evaluated. Of 81 patients, 38 (46.9%) were classified as having MHT and showed significantly more SCIs (mean ± SE: 2.5±0.5 vs 1.1±0.2; P=.017), and more albuminuria (39% vs 16%; P=.025), but no increase in left ventricular mass index, than the normotensive persons in office and on ambulatory BP monitoring group. The prevalence of MHT in this diabetic population was high (47%). Diabetic patients with MHT showed evidence of brain and kidney damage. Hence, out‐of‐office monitoring of BP may be indicated in diabetics whose BP is normal in the clinic.
Why Physicians Who Treat Hypertension Should Know More About Air Pollution
Authors: Brook Robert D.
Published: July 2007

Exposure to ambient levels of particulate matter (PM) air pollution increases the risk of a host of cardiovascular diseases and events. One potential mechanism explaining this association is that acute exposure to PM at high concentrations is capable of raising blood pressure within hours to days. Epidemiologic studies confirm that even commonly encountered levels of airborne pollutants can result in a prohypertensive response in humans. Several biologic pathways may be involved, including autonomic nervous system imbalance and arterial vascular dysfunction/vasoconstriction due to systemic oxidative stress/inflammation triggered by PM inhalation. The clinical importance of this vasopressor response and its relative role in promoting cardiovascular events associated with PM remain unclear. Because air pollution exposure is ubiquitous throughout the world, however, all health care providers and especially those who treat hypertension should be aware of this emerging and important biologic relationship.
Linking deformation, migmatite formation and zircon U–Pb geochronology in polymetamorphic orthogneisses, Sveconorwegian Province, Sweden
Authors: MÖLLER C. , ANDERSSON J. , LUNDQVIST I. , HELLSTRÖM F.
Published: July 2007

Absolute ages of migmatization in the polymetamorphic, parautochthonous basement of the Sveconorwegian Province, Sweden, have been determined using U–Pb ion probe analysis of zircon domains that formed in leucosome of migmatitic orthogneisses. Migmatite zircon was formed by recrystallization whereas dissolution–reprecipitation and neocrystallization were subordinate. The recrystallized migmatite zircon was identified by comparison of zircon in mesosomes and leucosomes. It is backscatter electron‐bright, U‐rich (800–4400 ppm) with low Th/U‐ratios (generally 0.01–0.1), unzoned or ‘oscillatory ghost zoned’, and occurs as up to 100 μm‐thick rims with transitional contacts to cores of protolith zircon. Protolith ages of 1686 ± 12 and 1668 ± 11 Ma were obtained from moderately resorbed, igneous zircon crystals (generally Th/U = 0.5–1.5, U < 300 ppm) in mesosomes; protolith zircon is also present as resorbed cores in the leucosomes. Linkage of folding, synchronous migmatization and formation of recrystallized zircon rims allowed direct dating of south‐vergent folding at 976 ± 7 Ma. At a second locality, similar recrystallized zircon rims in leucosome date pre‐Sveconorwegian migmatization at 1425 ± 7 Ma; an upper age bracket of 1394 ± 12 Ma for two overprinting phases of deformation (upright folding along gently SSW‐plunging axes and stretching in ESE) was set by zircon in a folded metagranitic dyke. Lower age brackets for these events were set at 952 ± 7 and 946 ± 8 Ma by zircon in two crosscutting and undeformed granite–pegmatite dykes. Together with previously published data the present results demonstrate: (i) Tectonometamorphic reworking during the Hallandian orogenesis at 1.44–1.42 Ga, resulting in migmatization and formation of a coarse gneissic layering. (ii) Sveconorwegian continent–continent collision at 0.98–0.96 Ga, involving (a) emplacement of an eclogite unit, (b) regional high‐pressure granulite facies metamorphism, (c) southvergent folding, subhorizontal, east–west stretching and migmatization, all of which caused overprint or transposition of older Mesoproterozoic and Sveconorwegian structures. The Sveconorwegian migmatization and folding took place during or shortly after the emplacement of Sveconorwegian eclogite and is interpreted as a result of north–south shortening, synchronous with east–west extension and unroofing during late stages of the continent–continent collision.
Editorial: Poor Outcomes for Fast Transporters on PD: The Rise and Fall of a Clinical Concern
Authors: Chung Sung Hee , Heimbürger Olof , Lindholm Bengt
Published: July 2007

A rapid peritoneal solute transport rate (PSTR), generally termed a “high” PSTR, may in fact be associated with low small solute transport due to the low ultrafiltration rates with which it is associated; the term “fast” PSTR has, therefore, been proposed as a more accurate descriptive term. During the 1990s several studies showed that fast PSTR was associated with high mortality—presumably because it may lead to fluid overload, nutritional and metabolic alterations but also because it may be associated with other risk factors such as cardiovascular disease, other comorbid diseases, and inflammation. However, the consensus of today is that a fast PSTR is not as critical for patient survival as previously thought but that the prognosis depend on the type of fast PSTR: Type 1—an early inherent type which is associated with increased mortality mainly because it is associated with comorbidity and inflammation; these patients would have a poor prognosis also if they were treated by hemodialysis. Type 2—an early inherent type with a large peritoneal surface area; and Type 3—a late acquired type with peritoneal membrane changes which develop with time on peritoneal dialysis (PD); these two types have a good prognosis provided that fluid balance is controlled using automated peritoneal dialysis (APD) and icodextrin‐based PD solution. Thus, with the increased use of APD and icodextrin, the prognosis of fast transporters now looks less bleak. Perhaps, it will be possible in the future to even demonstrate improved survival in the Type 2 and Type 3 fast transporters using APD and icodextrin. In addition, there is hope that the new PD solutions may prevent the development of fast PSTR as well as have a favorable impact on its complications.
Vancomycin Use in Patients Requiring Hemodialysis: A Literature Review
Authors: Pallotta Katie E. , Manley Harold J.
Published: July 2007

Vancomycin, a glycopeptide antibiotic, has remained a popular antimicrobial agent throughout the past five decades, and is often included in empiric antibiotic regimens. With gram‐positive coverage, it has found a niche in the treatment of methicillin‐resistant Staphylococcus aureus. Although vancomycin has been in existence for many years, questions remain regarding its use. New technologies and practice pattern changes have occurred over the years that altered vancomycin dosing in hemodialysis (HD) patients. Examples of these changes include increased resistance of many organisms, development of high flux HD filters, and reprocessing practices. This review provides a summary of the several concerns that exist in the dosing of vancomycin in HD patients today, and provides a summary table of intradialytic dosing regimens.
Loop Diuretic Therapy, Thiamine Balance, and Heart Failure
Authors: Sica Domenic A.
Published: July 2007

Thiamine, or vitamin B1, is a water‐soluble B complex vitamin that was first discovered in 1910 in the process of exploring how rice bran cured patients of beriberi. Thiamine is not synthesized in humans, therefore its availability for necessary cellular processes hinges on its continual ingestion. The amount of thiamine one needs to ingest to maintain balance is disease state‐dependent or medication‐dependent. Severe chronic thiamine deficiency can have significant neurologic and cardiac effects, the latter is reflected in a particular type of heart failure called wet beriberi. This form of heart failure clearly benefits from thiamine supplementation. It is unclear, however, whether thiamine supplementation offers any benefit in other forms of heart failure. Despite this, it is not unreasonable for heart failure patients to routinely ingest a thiamine‐containing multivitamin; patients using diuretics have an increased urinary excretion of thiamine and thus are at a higher risk for developing thiamine deficiency. The role of thiamine in heart failure, however, remains arguable.
The Roles of Selenium and Mercury in the Pathogenesis of Viral Cardiomyopathy
Authors: Cooper Leslie T. , Rader Valerie , Ralston Nicholas V. C.
Published: July 2007

Research on the pathogenesis of nonischemic dilated cardiomyopathy (DCM) has largely been focused on the role of viral pathogens and altered immunity. Trace elements have only rarely been considered; however, clinical observations that trace elements influence cardiovascular disease have been made in populations with extreme dietary deficiency or occupational exposure. Recently, animal models of DCM have been used to explore interactions among trace elements, viral pathogens, and the immune system. Discovery of interactions of trace elements with causes for DCM has heightened awareness of potential contributions of environmental variables to DCM pathogenesis. This article reviews the present knowledge regarding trace elements, in particular selenium and mercury, in the pathogenesis of viral and immune‐mediated DCM. Based on recent studies, the authors propose a novel paradigm for the pathogenesis of viral DCM that incorporates trace element imbalance and its interactions with the cellular physiology of viral‐induced cardiomyocyte dysfunction.
Prevalence and Determinants of Cognitive Impairment in Chronic Heart Failure Patients
Authors: Debette Stéphanie , Bauters Christophe , Leys Didier , Lamblin Nicolas , Pasquier Florence , Groote Pascal de
Published: July 2007

Cognitive impairment has seldom been investigated in patients with chronic heart failure (CHF). The authors' aim was to assess the prevalence and determinants of cognitive impairment in patients hospitalized for CHF decompensation. The authors prospectively performed the Folstein Mini‐Mental State Examination (MMSE) and completed a standardized questionnaire for cerebrovascular accidents (CVA) and transient ischemic attacks (TIA) in patients hospitalized for CHF decompensation during a 3‐month period. A total of 83 patients were studied: 15 had a history of CVA or TIA, 51 (61%) had an MMSE score ≤28 (or ≤26 if schooling ≤8 years), and 26 (31%) had an MMSE score <24. Factors associated with an MMSE score <24 were atrial fibrillation/flutter (odds ratio [OR], 8.1; 95% confidence interval [CI], 1.9–34.6), New York Heart Association functional class IV (OR, 4.1; CI, 1.0–16.4), and schooling >8 years (OR, 0.2; CI, 0.0–0.8). Adjusting for history of CVA or TIA or excluding patients with a history of CVA or TIA did not affect the findings. Cognitive impairment is frequent in patients hospitalized for CHF decompensation whether or not they have a past history of CVA or TIA. The severity of cognitive impairment parallels that of CHF. The question of whether this cognitive impairment decreases adherence to treatment and contributes to a worse outcome in CHF patients should be explored.
Left Ventricular End‐Diastolic Pressure and Risk of Subsequent Heart Failure in Patients Following an Acute Myocardial Infarction
Authors: Mielniczuk Lisa M. , Lamas Gervasio A. , Flaker Greg C. , Mitchell Gary , Smith Sidney C. , Gersh Bernard J. , Solomon Scott D. , Moyé Lemuel A. , Rouleau Jean L. , Rutherford John D. , Pfeffer Marc A.
Published: July 2007

Left ventricular end‐diastolic pressure (LVEDP) is an important measure of ventricular performance and may identify patients at increased risk for developing late clinical symptoms of heart failure (HF). The primary outcome in this analysis of 744 patients from the Survival and Ventricular Enlargement (SAVE) trial was the development of death or HF over a mean time of 36 months. The mean LVEDP for all patients was 23±9 mm Hg, and 75% of participants (n=558) had an LVEDP >15 mm Hg. Patients with an LVEDP >30 mm Hg (n=187) had the highest risk of death or HF (unadjusted hazard ratio, 1.40; 95% confidence interval [CI], 1.00–1.97) when compared with the other 2 cohorts combined (n=603). After adjustment for other known predictors of cardiac risk, LVEDP no longer remained significant (adjusted hazard ratio, 1.12; 95% CI, 0.77–1.65). Elevated LVEDP is common following myocardial infarction; however, it is not an independent predictor of subsequent HF risk. The variability in LVEDP is not fully explained by infarct size and atherosclerotic burden.
Altered Left Ventricular Diastolic Performance in Oncologic Patients Treated With Epirubicin
Authors: Radulescu Dan , Pripon Sorin , Parv Andreea , Duncea Caius , Ciuleanu Tudor E. , Radulescu Letitia I.
Published: July 2007

Anthracyclines confer an increased risk of cardiotoxicity. The authors evaluated left ventricular (LV) performance in patients treated with epirubicin. Sixty‐eight patients with malignancies (study group), treated with epirubicin ≤450 mg/m2, and a matched control group of 68 cancer patients who had not started chemotherapy were evaluated by Doppler echocardiography. The authors assessed LV diastolic function by measuring the transmitral flow: the maximal velocity of the E and A waves, the Emax/Amax ratio, the pressure half time of E wave (PHT), and the isovolumic relaxation time (IVRT). Global LV ejection fraction (LVEF) was estimated to determine the systolic performance. The authors documented alterations of the LV diastolic performance in the study group by finding a significant decrease in Emax, whereas Amax was significantly increased. Prolonged PHT and IVRT were also certified in the epirubicin‐treated group compared with controls. No significant variation in LVEF between the 2 groups was detected.
Age‐Related Gender Differences in Reporting Ictal Fear: Analysis of Case Histories and Review of the Literature
Authors: Chiesa Valentina , Gardella Elena , Tassi Laura , Canger Raffaele , Lo Russo Giorgio , Piazzini Ada , Turner Katherine , Canevini Maria Paola
Published: July 2007

Summary

To determine if there are age or gender‐related differences in reporting fear as a symptom of epileptic seizure, all clinical charts of patients evaluated at the “C. Munari – Epilepsy Surgery Center” of Milan from 1990 to June 2005 were analyzed, looking for patients with ictal fear. Among the 2,530 clinical charts examined (1,330 male and 1,200 female), 265 patients were found with ictal fear (100 men, 165 women). The gender difference in reporting ictal fear was not so marked in the pediatric age group (98 girls, 74 boys), whereas in adult patients the difference was significant (158 women, 83 men). Interestingly, more men than women (14:3) had ictal fear during childhood that disappeared during adulthood. The literature review confirmed that ictal fear is significantly more common in women, though there is no gender difference in the pediatric age group.
Neuromagnetic Localization of Spike Sources in Perilesional, Contralateral Mirror, and Ipsilateral Remote Areas in Patients with Cavernoma
Authors: Jin Kazutaka , Nakasato Nobukazu , Shamoto Hiroshi , Kanno Akitake , Itoyama Yasuto , Tominaga Teiji
Published: July 2007

Summary

Purpose: To assess neuromagnetic spike localization as an indication for extended lesionectomy of cavernoma.

Methods: Electroencephalography (EEG) and magnetoencephalography (MEG) was simultaneously recorded in 17 patients (8 men, mean age 29.7 years) with single cavernoma. The location of the equivalent current dipole (ECD) of the interictal spikes was correlated with the lesion shown by magnetic resonance imaging.

Results: Preoperative ECD localization was classified into four types: perilesional, adjacent to the cavernoma only (n = 6); mirror, adjacent to the lesion and at the contralateral homologous site (n = 5); remote, mainly at a remote site in the ipsilateral hemisphere (n = 3); and no spikes (n = 3). The spikes were detected by only MEG in two of five “mirror” and all three “remote” patients. In the mirror group, contralateral spikes were synchronized with the ipsilateral spikes, or also occurred independently. Two “perilesional” and two “mirror” patients became seizure‐free and spike‐free after extended lesionectomy. In contrast, the other two “mirror” patients had residual seizures and spikes after pure lesionectomy.

Conclusion: The detectability of mirror and remote spikes was higher by MEG than by EEG, whereas the detectability of perilesional spikes was similar by MEG and EEG. Therefore, the use of both EEG and MEG will provide the maximum information about spike distribution and propagation. Residual seizures and spikes after pure lesionectomy, but not after extended lesionectomy, in the “mirror” patients suggest the importance of resection of the perilesional irritable zone. Extended resection of the irritable cortex surrounding cavernoma is recommended for better seizure control, particularly in “mirror” patients.
Interictal Psychoses in Comparison with Schizophrenia—A Prospective Study
Authors: Tadokoro Yukari , Oshima Tomohiro , Kanemoto Kousuke
Published: July 2007

Summary

Purpose: To prospectively investigate the incidence of interictal psychoses of epilepsy patients, and make a comparison between those with interictal psychoses and patients with schizophrenia in respect to their responses to antipsychotic drugs, as well as psychotic states.

Methods: We undertook a two‐part prospective investigation. In Part I, the psychotic episodes of 619 epilepsy patients were investigated, while 182 patients with psychotic syndromes were followed in Part II, of whom 59 were diagnosed with schizophrenia and 13 with epilepsy with interictal psychoses. The Positive and Negative Syndrome Scale was used for efficacy assessment.

Results: The average annual incidence of interictal psychosis was 0.42% during the 56‐month study period. A significant difference was found between patients with schizophrenia and epilepsy patients with interictal psychoses in respect to results on the negative subscale of the PANSS at the initial examination (mean scores of 18.1 and 13.2, respectively, p = 0.004). The response rates one year later for these groups were 27.1% and 53.8%, respectively, which showed a trend of better response to the antipsychotic medication by the epilepsy group (p = 0.098). Initial and maximum doses of antipsychotic drugs used for epilepsy patients with interictal psychoses were significantly lower than those used for patients with schizophrenia (p = 0.008 and p = 0.006, respectively).

Conclusions: Schizophrenia and epileptic psychosis showed different symptom profiles. On average, epilepsy patients with interictal psychoses achieved higher remission rates with lower doses of antipsychotic drugs as compared to patients with schizophrenia in the present 1‐year follow‐up study.
DESCRIPTION OF A NEW GENUS OF PFIESTERIA‐LIKE DINOFLAGELLATE, LUCIELLA GEN. NOV. (DINOPHYCEAE), INCLUDING TWO NEW SPECIES: LUCIELLA MASANENSIS SP. NOV. AND LUCIELLA ATLANTIS SP. NOV.1
Authors: Mason Patrice L. , Litaker R. Wayne , Jeong Hae Jin , Ha Jeong Hyun , Reece Kimberly S. , Stokes Nancy A. , Park Jae Yeon , Steidinger Karen A. , Vandersea Mark W. , Kibler Steve , Tester Patricia A. , Vogelbein Wolfgang K.
Published: July 2007

A new genus of Pfiesteria‐like heterotrophic dinoflagellate, Luciella gen. nov., and two new species, Luciella masanensis sp. nov. and Luciella atlantis sp. nov., are described. These species commonly occur with other small (<20 μm) heterotrophic and mixotrophic dinoflagellates in estuaries from Florida to Maryland and the southern coast of Korea, suggesting a possible global distribution. An SEM analysis indicates that members of the genus Luciella have the enhanced Kofoidian plate formula of Po, cp, X, 4′, 2a, 6″, 6c, PC, 5+s, 5‴, 0p, and 2″″. The two four‐sided anterior intercalary plates are diamond shaped. The genus Luciella differs from the other genera in the Pfiesteriaceae by a least one plate in the plate tabulation and in the configuration of the two anterior intercalary plates. An SSU rDNA phylogenetic analysis confirmed the genus as monophyletic and distinct from the other genera in the Pfiesteriaceae. The morphology of Luciella masanensis closely resembles Pfiesteria piscicida Steid. et J. M. Burkh. and other Pfiesteria‐like dinoflagellates in size and shape, making it easily misidentified using LM. Luciella atlantis, in contrast, has a more distinctive morphology. It can be distinguished from L. masanensis and other Pfiesteria‐like organisms by a larger cell size, a more conical‐shaped epitheca and hypotheca, larger rhombic‐shaped intercalary plates, and an asymmetrical hypotheca. The genus Luciella is assigned to the order Peridiniales and the family Pfiesteriaceae based on plate tabulation, plate pattern, general morphology, and phylogenetic analysis.
CHARACTERIZATION AND COMPARISON OF PROKARYOTIC EPIPHYTES ASSOCIATED WITH THREE EAST AFRICAN SEAGRASSES1
Authors: Uku Jacqueline , Björk Mats , Bergman Birgitta , Díez Beatriz
Published: July 2007

Prokaryotic epiphytes on leaves of three seagrass species, Thalassodendron ciliatum, Thalassia hemprichii, and Cymodocea rotundata, from two Kenyan coastal sites, Nyali (a high‐nutrient site) and Vipingo (a low‐nutrient site), were characterized genetically and morphologically. Denaturing gradient gel electrophoresis (DGGE) and clone libraries of PCR‐amplified 16S rRNA gene fragments were used to study prokaryotes associated with these seagrasses. In general, the epiphytic coverage was greater in the high‐nutrient site, while the microbial diversity was linked to seagrass species rather than the study sites. Cytophaga–Flavobacteria–Bacteroides (CFB) were associated with T. ciliatum and T. hemprichii mainly in the nutrient‐poor site, while α‐, β‐, and γ‐proteobacteria were associated with all three species at the two study sites. Some bacteria phylotypes were closely related to sequences of microorganisms previously recovered from wastewaters or other contaminated sources, indicating the influx of land‐based wastes into these coastal lagoon ecosystems. The abundance of potential nitrogen (N2)‐fixing cyanobacteria on C.  rotundata, particularly in the low‐nutrient site, suggested that this association may have been acquired to meet N demands. Unicellular cyanobacteria were dominant and associated with C. rotundata and T. hemprichii (with those on T. hemprichii being closely related to cyanobacterial symbiotic species), while T. ciliatum was almost devoid of cyanobacterial associations at the same site (Nyali), which suggests specificity in the cyanobacteria–seagrass associations. The abundance of prokaryotic epiphytes was considered to be linked to water depth and tidal exposure.
PHOTOSYNTHETIC CHARACTERIZATION OF DEVELOPING AND MATURE AKINETES OF APHANIZOMENON OVALISPORUM (CYANOPROKARYOTA)1
Authors: Sukenik Assaf , Beardall John , Hadas Ora
Published: July 2007

Akinetes, differentiated resting cells produced by many species of filamentous, heterocystous cyanobacteria, enable the organism to survive adverse conditions, such as cold winters and dry seasons, and to maintain germination capabilities until the onset of suitable conditions for vegetative growth. Mature akinetes maintain a limited level of metabolic activities, including photosynthesis. In the present study, we have characterized changes in the photosynthetic apparatus of vegetative cells and akinetes of the cyanobacterium Aphanizomenon ovalisporum Forti (Nostocales) during their development and maturation. Photosynthetic variable fluorescence was measured by microscope‐PAM (pulse‐amplitude‐modulated) fluorometry, and the fundamental composition of the photosynthetic apparatus was evaluated by fluorescence and immunological techniques. Vegetative cells and akinetes from samples of Aphanizomenon trichomes from akinete‐induced cultures at various ages demonstrated a gradual reduction, with age, in the maximal photosynthetic quantum yield in both cell types. However, the maximal quantum yield of akinetes declined slightly faster than that of their adjacent vegetative cells. Mature akinetes isolated from 6‐ to 8‐week‐old akinete‐induced cultures maintained only residual photosynthetic activity, as indicated by very low values of maximal photosynthetic quantum yields. Based on 77 K fluorescence emission data and immunodetection of PSI and PSII polypeptides, we concluded that the ratio of PSI to PSII reaction centers in mature akinetes is slightly higher than the ratio estimated for exponentially grown vegetative cells. Furthermore, the cellular abundance of these protein complexes substantially increased in akinetes relative to exponentially grown vegetative cells, presumably due to considerable increase in the biovolume of akinetes.
A COMPARISON OF PHOTORESPONSE AMONG TEN DIFFERENT KARENIA BREVIS (DINOPHYCEAE) ISOLATES1
Authors: Schaeffer Blake A. , Kamykowski Daniel , McKay Laurie , Sinclair Geoff , Milligan Edward J.
Published: July 2007

Many laboratories have solely used the Wilson isolate to physiologically characterize the harmful algal bloom (HAB) dinoflagellate Karenia brevis (C. C. Davis) G. Hansen et Moestrup. However, analysis of one isolate may lead to misinterpretations when extrapolating measurements to field populations. In this study, pulse‐amplitude‐modulated chlorophyll fluorometer (PAM‐FL) relative electron transport rate (ETR), Fv/Fm, and chl were compared with traditional techniques, such as 14C photosynthesis versus irradiance (P–E) curves, DCMU [3‐(3′,4′‐dichlorophenyl)‐1,1‐dimethyl urea] Fv/Fm, and extracted chl. The DCMU and PAM‐FL values of Fv/Fm (r2 = 0.51) and chl (r2 = 0.58) were in good agreement. There was no correlation between 14C and PAM‐FL α, Pmax, and β parameters because PAM‐FL ETR was only a relative measurement. The PAM‐FL techniques were then used to investigate P–E curves, quantum yield of PSII (Fv/Fm), and chl from 10 K. brevis isolates to determine whether one or all isolates would better represent the species. Comparisons were made with a radial photosynthetron, which allowed for controlled conditions of light and temperature. Isolate α, Pmax, and β varied between 0.097 and 0.204 μmol e− · m−2 · s−1 · (μmol quanta · m−2 · s−1)−1, 80.41 and 241 μmol e− · m−2 · s−1, and 0.005 and 0.160 μmol e− · m−2 · s−1 · (μmol quanta · m−2 · s−1)−1, respectively. Either carbon limitation and/or bacterial negative feedback were implicated as the cause of the P–E parameter variability. Furthermore, these results directly contradicted some literature suggestions that K. brevis is a low‐light‐adapted dinoflagellate. Results showed that K. brevis was more than capable of utilizing and surviving in light conditions that may be present on cloudless days off Florida.
Acoustic Startle at Baseline and During Acute Alcohol Withdrawal in Replicate Mouse Lines Selectively Bred for High or Low Al cohol Preference
Authors: Chester Julia A. , Barrenha Gustavo D.
Published: July 2007

Background: Previous data in both rat and mouse genetic models suggest that there is a genetic relationship between acute alcohol withdrawal responses and innate alcohol drinking behavior. The purpose of the present study was to examine whether acute alcohol withdrawal responses, as measured by acoustic startle and prepulse inhibition (PPI) of acoustic startle, may be genetically related to innate differences in alcohol preference in 2 mouse lines selectively bred for high (HAP1 and HAP2) or low (LAP1 and LAP2) alcohol preference. Line differences in startle responses at baseline, prior to alcohol or saline treatment, were also measured.

Methods: Alcohol‐naive, male and female HAP1 (n = 35) and LAP1 (n = 32) and HAP2 (n = 43) and LAP2 (n = 40) mice were tested under baseline conditions and during withdrawal from a single injection of 4.0 g/kg alcohol or equal volume of saline at 4, 8, and 12 hours post‐injection.

Results: On most trial types, baseline startle responses and PPI were greater in both HAP lines than in both LAP lines, and startle responses were greater in males than in females. During acute alcohol withdrawal, both male LAP lines, and LAP1 females, showed reduced startle responses at the 4‐hour time point during acute alcohol withdrawal. In contrast, both HAP1 males and females showed a trend toward enhanced startle at 4 hours in withdrawal. No clear differences in PPI during withdrawal were evident.

Conclusions: These findings indicate good evidence for a genetic relationship between greater baseline acoustic startle responses and PPI and high alcohol preference. Modest support for a genetic correlation between low alcohol preference and reduced startle responses at 4 hours in withdrawal was found in male mice. The suppression in acoustic startle during acute alcohol withdrawal in male LAP lines but not in male HAP lines suggests that a genetic propensity toward low alcohol preference may be related to greater sensitivity to alcohol as measured by acoustic startle responses during acute alcohol withdrawal.
An Outreach Program Improved Osteoporosis Management After a Fracture
Authors: Feldstein Adrianne C. , Vollmer William M. , Smith David H. , Petrik Amanda , Schneider Jennifer , Glauber Harry , Herson Michael
Published: July 2007

This longitudinal retrospective cohort study evaluated implementation of an intervention to improve management of osteoporosis after a fracture in a nonprofit group‐model health maintenance organization (HMO) in the U.S. Pacific Northwest with 480,000 members and electronic medical record data. Participants were female HMO members aged 67 and older who sustained a qualifying clinical fracture(s) and who had not received a bone mineral density (BMD) measurement or osteoporosis treatment in the 12 months before the fracture (N=3,588). Phase 1 included outreach to clinicians and patients; Phase 2 added clinician and staff incentives. Primary outcome was “osteoporosis management”—receipt of a BMD measurement or osteoporosis medication in the 6 months after an index fracture. Before the intervention, 13.4% (95% confidence interval (CI)=12.0–14.8%) of patients had received osteoporosis management, and the time trend was not significant. Postintervention, the probability of osteoporosis management increased on average 3.1% (95% CI=2.6–3.5%) every 2 months throughout both study phases without a significant added improvement in Phase 2. Improvement varied according to clinic and was less likely for patients with dementia. Overall, the probability of osteoporosis management increased from the baseline level of 13.4% to 44.0% (95% CI=40.0–48.0%) by the end of the study period (20 months post‐intervention). The study found that an outreach program to primary care providers and patients improved the management of osteoporosis after a fracture. If widely implemented, this intervention could substantially improve the secondary prevention of osteoporosis. More‐individualized interventions may be necessary for high‐risk subgroups.
Specific Learning Disabilities and the Portuguese Educational System
Authors: de Miranda Correia Luís , Martins Ana Paula Loução
Published: July 2007

Although the Portuguese educational system advocates the accommodation of all students in regular schools, it has not adopted a coherent discourse that would contribute to meeting effectively the needs of students with specific learning disabilities (SLD). As such, the successive reorganizations of special education have resulted in uninformed decisions that have caused the education of students with SLD in Portugal to be, in many instances, detrimental to their academic and social growth. We describe the reality of SLD in Portugal, considering four main topics: (1) the establishment of the SLD concept, (2) the birth of a Portuguese definition of SLD, (3) the context of educational policy, and (4) the provision for students with SLD.