bluuebunny/crossref_metadata_2025 huggingface dataset:
Emerging Issues in Population Viability Analysis
Authors: Reed J. Michael , Mills L. Scott , Dunning John B. , Menges Eric S. , McKelvey Kevin S. , Frye Robert , Beissinger Steven R. , Anstett Marie‐Charlotte , Miller Philip
Published: March 2003

Abstract:Population viability analysis ( PVA) has become a commonly used tool in endangered species management. There is no single process that constitutes PVA, but all approaches have in common an assessment of a population's risk of extinction (or quasi extinction) or its projected population growth either under current conditions or expected from proposed management. As model sophistication increases, and software programs that facilitate PVA without the need for modeling expertise become more available, there is greater potential for the misuse of models and increased confusion over interpreting their results. Consequently, we discuss the practical use and limitations of PVA in conservation planning, and we discuss some emerging issues of PVA. We review extant issues that have become prominent in PVA, including spatially explicit modeling, sensitivity analysis, incorporating genetics into PVA, PVA in plants, and PVA software packages, but our coverage of emerging issues is not comprehensive. We conclude that PVA is a powerful tool in conservation biology for comparing alternative research plans and relative extinction risks among species, but we suggest caution in its use: (1) because PVA is a model, its validity depends on the appropriateness of the model's structure and data quality; (2) results should be presented with appropriate assessment of confidence; (3) model construction and results should be subject to external review, and (4) model structure, input, and results should be treated as hypotheses to be tested. We also suggest (5) restricting the definition of PVA to development of a formal quantitative model, (6) focusing more research on determining how pervasive density‐dependence feedback is across species, and (7) not using PVA to determine minimum population size or (8) the specific probability of reaching extinction. The most appropriate use of PVA may be for comparing the relative effects of potential management actions on population growth or persistence.
Spatial‐Accumulation Pattern and Extinction Rates of Mediterranean Flora as Related to Species Confinement to Habitats in Preserves and Larger Areas
Authors: Zurlini Giovanni , Grossi Luigi , Rossi Orazio
Published: March 2003

Abstract:Species‐area relationships (SARs) are still the main basis for all projections of extinction rates of species following habitat loss. To investigate spatial‐accumulation patterns of floristic species owing to the degree of species confinement to habitats, we considered 38 parks and reserves in Italy on a wide range of scales, covering about 70% of native flora and more than 21% of the land under legal protection. We used robust methods for multivariate outlier detection to derive the best regression model by checking accordance or lack of accordance with the SAR models even for those observations with no recorded species, which can occur when endemic species are rare. This method enabled us to demonstrate the arbitrariness of omitting observations without endemic species, because only a few such observations proved to be true outliers. As the degree of species confinement to habitat increased, the explained variance in species number and the slope value (z) increased significantly. The stronger the confinement of a species to favorable habitat, the more it was likely to be affected by habitat loss. For species within Italy, those found only within Italy had steeper species‐area slopes than those found more widely. When the analysis was extended to 17 larger areas of the Mediterranean region, a stability for the endemic spatial‐accumulation rate appeared across 15 to 47,000,000 ha. As area increases, the number of species increases, but the number of endemic species increases for more; therefore, a small preserve is expected to contain a large number of species even if it has few or no endemic species. The relatively few reserves we considered captured the country's general species richness far better than they did that of endemic species. We discuss the conservation implications of such results within the context of the national conservation program of the Map of Italian Nature, which is intended to fill the gaps in the existing reserve networks for preservation of species diversity.
Extinction and Spatial Structure in Simulation Models
Authors: Wiegand Kerstin , Henle Klaus , Sarre Stephen D.
Published: March 2003

Abstract: Aspects of within‐population spatial structure are often neglected in the modeling of population viability. To analyze the relevance of the spatial structure of single populations to population persistence, we compared the results of three models developed for the territorial, arboreal gecko Oedura reticulata: (1) a spatially structured model in which both low and high densities incur mortality costs due to increased movement, (2) a spatially structured model in which the Allee effect is removed, and (3) a spatially unstructured model in which there are no effects of density on mortality. Compared with nonspatial model populations, spatially structured populations exhibited reduced persistence. The Allee effect contributed only a small amount to the reduction in persistence. Increased mortality at high densities caused by difficulties in finding territories markedly reduced persistence in the spatially structured models compared with the density‐independent nonspatial model. We argue that the inclusion of elements of spatial structure may considerably influence the estimation of extinction risk in population viability analyses.
Correlation between Fitness and Genetic Diversity
Authors: Reed David H. , Frankham Richard
Published: March 2003

Abstract: Genetic diversity is one of the three forms of biodiversity recognized by the World Conservation Union ( IUCN ) as deserving conservation. The need to conserve genetic diversity within populations is based on two arguments: the necessity of genetic diversity for evolution to occur, and the expected relationship between heterozygosity and population fitness. Because loss of genetic diversity is related to inbreeding, and inbreeding reduces reproductive fitness, a correlation is expected between heterozygosity and population fitness. Long‐term effective population size, which determines rates of inbreeding, should also be correlated with fitness. However, other theoretical considerations and empirical observations suggest that the correlation between fitness and heterozygosity may be weak or nonexistent. We used all the data sets we could locate (34 ) to perform a meta‐analysis and resolve the issue. Data sets were included in the study, provided that fitness, or a component of fitness, was measured for three or more populations along with heterozygosity, heritability, and/or population size. The mean weighted correlation between measures of genetic diversity, at the population level, and population fitness was 0.4323. The correlation was highly significant and explained 19% of the variation in fitness. Our study strengthens concerns that the loss of heterozygosity has a deleterious effect on population fitness and supports the IUCN designation of genetic diversity as worthy of conservation.
How Much Information on Population Biology Is Needed to Manage Introduced Species?
Authors: Simberloff Daniel
Published: March 2003

Abstract: Study of the population biology of introduced species has elucidated many fundamental questions in ecology and evolution. Detailed population biological research is likely to aid in fine‐tuning control of widespread and/or long‐established invasions, and it may lead to novel control methods. It will also contribute to an overall understanding of the invasion process that may aid in the formulation of policy and help to focus attention on invasions that are especially prone to becoming problematic. But the importance of intensive population biological research in dealing with introduced species, especially those recently introduced, is often limited. In the worst instances, the absence of population biological data can be an excuse for inaction, when a prudent decision or quick and dirty operation might have excluded or eliminated an invader. The most effective way to deal with invasive introduced species, short of keeping them out, is to discover them early and attempt to eradicate or at least contain them before they spread. This approach has often been successful, but its success has usually relied on brute‐force chemical and mechanical techniques, not on population biological research.
An Early Labor Assessment Program: A Randomized, Controlled Trial
Authors: McNiven Patricia S. , Williams Jack I. , Hodnett Ellen , Kaufman Karyn , Hannah Mary E.
Published: March 2003

Background:

Approximately 31 percent of cesarean deliveries in the United States and Canada are performed for dystocia. The aim of this study was to determine the effectiveness of early labor assessment to reduce cesarean birth rates for low‐risk nulliparous women.

Methods:

Two hundred and nine low‐risk nulliparous women were randomly allocated to either the early labor assessment group or the direct admission to hospital group. Women in the early labor assessment group were evaluated and, if found to be in false or latent labor, were encouraged to go home or walk before admission to the labor unit. Those in the direct admission group were admitted to the labor unit without an assessment. Data were collected and analyzed about method of delivery, duration of labor, intrapartum interventions, and neonatal well‐being. Women completed an evaluation of their experience in the early postpartum period.

Results:

Significant decreases occurred in duration of labor, use of epidural analgesia for pain, and use of oxytocin to augment labor in the early labor assessment group. These women evaluated their labor and birth experience more positively than women in the direct admission group. No significant differences were found in the frequency of cesarean section or instrumental vaginal delivery for the two groups.

Conclusions:

Early labor assessment has the potential to reduce the number of women receiving oxytocin for augmentation, the rate of epidural analgesia for pain relief, and the duration of the active and second stages of labor, and to improve women's evaluations of their labor and birth experiences. (BIRTH 25:1, March 1998)
Maternal Perceptions of Labor with Fetal Monitoring by Pulse Oximetry in a Research Setting
Authors: Arikan Gürkan M. , Haeusler Martin C. H. , Deutsch Maria T. , Greimel Elfriede R. , Dorfer Martha
Published: March 2003

Objective:
Little research has evaluated maternal experience with fetal pulse oximety for fetal surveillance. The purpose of this study was to compare maternal perceptions of labor with intrapartal cardiotocography with or without fetal pulse oximetry in a research setting.
Methods:
One hundred women with vaginal, vertex deliveries and uncomplicated fetal outcomes were enrolled. The study group was a subset of 50 mothers who had participated in a pulse oximetry trial. The control group of 50 mothers was monitored by cardiotocography only. Both groups were matched for age, parity, weeks of gestation, epidural anesthesia use, and duration of labor. A global measure of maternal perception of labor was established by experience with labor, general attitude toward monitoring devices, satisfaction with monitoring, nursing and medical care, and anxiety, each of which was evaluated separately. The mothers in the study group were also interviewed about aspects related to the fetal pulse oximetry research setting, such as information, movement restriction, discomfort, care, privacy, and safety. The questionnaires were based on a standardized rating scale model, and the interviews were conducted two to four days after delivery. The results were analyzed by chi‐squared, paired t test, and ANOVA.Results: No significant differences were observed between the study and control participants in any parameter concerning the maternal perception of labor. Mothers' experiences with pulse oximetry as assessed by interview was overwhelmingly positive. Conclusions: Fetal monitoring by pulse oximetry in a research setting did not affect maternal perceptions of labor. Mothers' experiences with pulse oximetry were highly positive, suggesting that research in fetal pulse oximetry need not compromise maternal perceptions of labor. (BIRTH 25:3 September 1998)

This study received financial support from the Austrian Science Foundation (Grant 9344‐Med), Graz, Austria. 9344‐Med
Are Women Carrying “Basketballs” Really Having Boys? Testing Pregnancy Folklore
Authors: Perry Deborah F. , DiPietro Janet , Costigan Kathleen
Published: March 2003

Background:
Antenatal ascertainment of fetal sex is a common feature of modern pregnancies. Women who opt not to learn fetal sex typically employ a variety of methods to forecast it. This study investigated the validity of prevalent folklore used to identify fetal sex before birth.
Method:
One hundred four pregnant women, who did not know the sex of the fetus, were administered a questionnaire to explore their perceptions of fetal sex and the basis for these predictions.
Results:
Fetal sex was not systematically related to the shape of the woman's abdomen, prevalence of morning sickness, or comparisons with previous pregnancies. However, women who had more than twelve years of education correctly predicted fetal sex greater than chance (71% correct), in contrast to less educated women (43% correct). Contrary to expectations, women whose forecasts were based on psychological criteria (i.e., dreams or feelings) were more likely to be correct than those employing prevalent folklore criteria (i.e., the way a woman was carrying the pregnancy).
Conclusions:
In general, women were not good predictors of fetal sex. The mechanisms that promote maternal accuracy in predicting fetal sex for highly educated women are unknown. It is reasonable to expect that maternal perceptions of fetal sex contribute to the process of fetal attachment.
The Relationship of Maternal Personality Characteristics to Birth Outcomes and Infant Development
Authors: Schatz David , Harder David , Schatz Michael , Harden Kathleen , Chilingar Linda , Fox David , Hoffman Clement
Published: March 2003

Background:
Previous studies reported an association between maternal psychological factors and adverse pregnancy outcomes. The objective of this study was to evaluate the relationships between maternal personality characteristics, as determined by the Minnesota Multiphasic Personality Inventory (MMPI), and infant birth outcomes and development. Method:The inventory was administered during pregnancy to 638 pregnant women enrolled in a staff model health maintenance organization. MMPI validity as well as clinical and research scales were evaluated in relationship to infant birth outcomes (low birthweight, preterm birth) and 15‐month‐old infant development as assessed by the Bayley Scales of Infant Development. Results:Mothers of low birthweight infants scored significantly lower on the hypochondriasis scale, a relationship which was no longer significant after controlling for ethnicity. No other relationships were observed between infant birth outcomes and maternal MMPI scale scores. A higher infant Mental Developmental Index (MDI) was related to higher maternal masculinity‐femininity and ego‐strength scale scores and lower lie and hypochondriasis scale scores. Only the relationship between infant MDI and maternal masculinity‐femininity scale score remained significant after controlling for ethnicity and socioeconomic index (β= 0.104, p =0.036). Conclusions:Maternal personality characteristics, as determined by the MMPI, did not appear to be significantly related to the occurrence of preterm birth or low birthweight in this healthy, general population. Maternal personality characteristics reflected in the MMPI masculinity‐femininity scale appeared to be related to infant mental development, above and beyond the effects of socioeconomic status and ethnicity.
Resident Physicians' Knowledge of Breastfeeding and Infant Growth
Authors: Guise Jeanne‐Marie , Freed Gary
Published: March 2003

Background:
It is well documented that breastfed infants grow differently from formula‐fed infants. The purpose of this study was to assess resident physicians' knowledge of breastfeeding and infant growth. Methods:A cross‐sectional, self‐administered survey was administered to family medicine and pediatric resident physicians from three large, hospital‐based public and private programs in North Carolina. Results:One hundred and seven (46%) of 235 residents completed the study, representing 55 percent of family medicine residents and 39 percent of pediatric residents. Ninety‐nine percent of participants reported frequently or always plotting infant growth at well‐child visits. None reported plotting breastfed babies on a chart specific to breastfeeding. Only 5 percent of participants knew that breastfed infants grew at a slower velocity than formula‐fed infants after 4 months of age. This knowledge was not significantly related to specialty, year of training, or gender; it was significantly related to breastfeeding experience (p < 0.04). Of the residents who did not have personal experience with breastfeeding, 99 percent answered incorrectly compared with 88 percent of those who had some personal experience in breastfeeding. Conclusions:In this sample of family medicine and pediatric residents, almost all were unaware that breastfed infants grow at slower rates after 4 months of age. Since the frequency of breastfeeding is increasing in the United States, it is important that physicians be able to monitor the growth of breastfed infants accurately and provide expert counseling for breastfeeding mothers.
Breastfeeding Peer Support: Maternal and Volunteer Perceptions from a Randomized Controlled Trial
Authors: Dennis Cindy‐Lee
Published: March 2003

ABSTRACT: Background: Several studies have demonstrated the positive effects of peer support on various breastfeeding outcomes, but no study has assessed women's and peer volunteers’ views on, or the nature and intensity of, the supportive intervention. The objective of this study was to describe maternal and peer volunteer perceptions of their experience while participating in a breastfeeding peer support trial.

Methods: A randomized controlled trial was conducted to evaluate the effect of telephone‐based peer (mother‐to‐mother) support on breastfeeding duration. Two hundred and fifty‐six primiparous breastfeeding women were randomly allocated to receive either conventional care or conventional care plus peer support. Three primary outcome measures were peer volunteer activity logs, maternal perceptions of peer support, and evaluations of the peer volunteer experience.

Results: Questionnaires were completed by 98.5 percent (n=130) of the mothers in the peer support group. Mothers reported their peer volunteers were available when difficulties were experienced, increased their confidence, decreased their concerns, and assisted them in reaching their breastfeeding goals. These supportive interactions resulted in 81.5 percent of mothers (n=106) being satisfied with their peer support experience and suggesting that every new mother should be offered this intervention. Similarly, all the peer volunteers interviewed (n=30) viewed their experience positively. They suggested some intervention modifications as follows: ensure that mothers enrolled in the program want peer support; provide peer volunteers with ongoing educational sessions and opportunities to ‘‘socialize'’ with other volunteers; and disseminate the results of peer support efforts.

Conclusions: Both mothers and peer volunteers perceived their intervention experiences positively. Whereas maternal satisfaction was related to the number and duration of peer volunteer contacts, peer volunteers enjoyed their training session and the opportunity to assist mothers for a variety of reasons. Specific intervention modifications should be implemented to enhance peer volunteer satisfaction and retention. (BIRTH 29:3 September 2002)
Decreased Prevalence of Helicobacter pylori Infection in Gastroesophageal Reflux Disease
Authors: Varanasi Ravikant V. , Fantry George T. , Wilson Keith T.
Published: March 2003

Background. An increased incidence of reflux esophagitis has been reported after eradication of H. pylori in patients with duodenal ulcer. To determine if H. pylori is associated with lower rates of esophagitis, we studied the prevalence of H. pylori infection in patients with and without reflux esophagitis and a subgroup of patients with concomitant peptic ulcer disease.

Methods. Patients who underwent esophagogastroduodenoscopy and had diagnostic testing for H. pylori over a 30‐month period were studied. H. pylori infection was determined by rapid urease testing, gastric histopathology, or serology. Reflux esophagitis was determined by endoscopic and/or histologic criteria.

Results. Of 514 patients, 39.5% had H. pylori infection and 22.2% had reflux esophagitis. The prevalence of H. pylori infection in patients with reflux esophagitis was 30.7%, compared with 42.0% in patients without esophagitis (p = 0.039). The odds ratio for esophagitis risk with H. pylori infection was 0.61 (95% CI, 0.39–0.95). Neither patient age nor gender affected H. pylori prevalence. In patients with duodenal ulcer, H. pylori was present in 36.4% of patients with esophagitis and in 69.2% of patients without esophagitis (p = 0.018). The odds ratio for esophagitis with H. pylori infection in these patients was 0.25 (95% CI, 0.09–0.73).

Conclusions. Our study demonstrates that H. pylori infection is significantly less prevalent in patients with reflux esophagitis and may protect against its development. In duodenal ulcer patients, this effect was more dramatic. Further study is required to confirm these findings and elucidate mechanisms underlying possible beneficial effects of H. pylori.
Miconazole Gel Increases the Cure Rate of Helicobacter pylori Infection When Added to Lansoprazole and Amoxicillin in a Randomized Trial
Authors: Ikezawa Kazuto , Kashimura Hiromasa , Mahmudul Hassan , Nakahara Akira , Yanaka Akinori , Matsuzaki Yasushi , Mutoh Hiroshi , Tanaka Naomi
Published: March 2003

Background. Miconazole is an antimycotic agent with bacteriocidal activity against Helicobacter pylori in vitro. Its role in the clinical eradication of H. pylori has not been studied. The objective of this study was to investigate the efficacy and side effect profile of miconazole for the treatment of H. pylori.

Materials and Methods. We studied 65 patients with gastritis or peptic ulcer disease in whom H. pylori infection was confirmed by a rapid urease test and microbiologic assessment. In vitro miconazole sensitivity was assessed for the H. pylori strains isolated from the enrolled patients. All patients were randomized to receive either dual therapy consisting of lansoprazole 30 mg daily and amoxicillin 500 mg three times a day for 14 days (LA, n = 33) or triple therapy using the LA regimen plus miconazole gel 100 mg three times a day for 14 days (LAM, n = 32). At least 8 weeks after the treatment, successful therapy was validated by the histological and microbiologic assessment. Adverse effects and drug adherence were monitored by direct questioning.

Results. The minimum inhibitory concentrations of miconazole ranged from 3.13 to 6.25 mg/L. H. pylori was eradicated in 16 of 33 patients (48%, 95% CI = 31% to 67%) after LA therapy, and 24 of 32 patients (75%, 95% CI = 59% to 91%) after LAM therapy (p < .03). There was no significant difference in the occurrence of adverse events between the two groups.

Conclusion. The addition of miconazole gel to the LA regimen significantly improved the cure rate of H. pylori without an increase in adverse effects.
Experimental Infection in Cats with a cagA+ Human Isolate of Helicobacter pylori
Authors: Perkins S.E. , Fox J.G. , Marini R.P. , Shen Z. , Dangler C.A. , Ge Z.
Published: March 2003

Background.

Helicobacter pylori has been cultured from the inflamed gastric mucosa of naturally and experimentally‐infected cats. The lesions in the H. pylori‐infected cat stomach mimic many of the features seen in human stomachs infected with H. pylori. This study sought to determine whether H. pylori‐negative, specific pathogen‐free cats with normal gastric mucosa were susceptible to colonization with a human cagA+ strain of H. pylori, and whether gastritis developed after infections.

Methods.

Four H. pylori‐negative cats treated with cimetidine were orally dosed 3 times at 2‐day intervals with 3 ml (1.5 × 108 CFU/ml) of H. pylori .

Results.

All experimentally‐infected cats became persistently colonized as determined by H. pylori isolation from gastric tissue by culture at 12 weeks, and all 4 cats were found positive by PCR during serial gastric biopsies and necropsy at 15 weeks postinoculation. The 2 control cats did not have H. pylori isolated, nor was gastric tissue positive by PCR. The H. pylori isolated from the 4 experimentally‐infected cats had RFLP patterns specific for the flaA gene identical to those of the inoculating strain. All 4 H. pylori‐infected cats had multifocal gastritis, consisting of lymphoid aggregates plus multiple large lymphoid nodules. In the control cats, one cat had a few focal lymphocytic aggregates in the body submucosa, whereas the second cat had normal gastric mucosa.

Conclusion.

Human cagA+H. pylori readily colonized the cat stomach and produced a persistent gastritis. The findings demonstrate the utility of the cat to study H. pylori induced pathogenesis.
Accuracy of Four Commercially Available Serologic Tests, Including Two Office‐based Tests and a Commercially Available 13C Urea Breath Test, for Diagnosis of Helicobacter pylori
Authors: Cohen Hartley , Rose Steven , Lewin David N. , Retama Betty , Naritoku Wesley , Johnson Cindy , Bautista Lorraine , Crowe Helen , Pronovost Allan
Published: March 2003

Background.

Diagnosis of H. pylori infection may be made by endoscopic (invasive) tests, or by nonendoscopic (noninvasive) tests. Our aim was to evaluate recently available nonendoscopic tests, including two office‐based serologic tests and a commercially available 13C urea breath test.

Methods.

Gastric biopsy specimens (for culture and stain) from 178 patients (mean age 46 ± 13.3 years, 79 men and 99 women), none of whom had received anti‐H. pylori therapy, were tested for H. pylori infection. These tests were compared against two commercial serum IgG antibody immunoassays (Biowhittaker’s Pyloristat, and Quidel), 2 office‐based serum qualitative IgG antibody tests (FlexSure HP, and QuickVue One‐Step), the Meretek 13C urea breath test, and the CLOtest (a biopsy urease test).

Results.

The breath test (n = 147) had the best accuracy (96%) of the noninvasive tests studied. The serologic tests had similar accuracy to one another (84%–90%). The major drawback of the serologic tests was suboptimal specificity (75%–87%). Diagnosis of H. pylori based on the two office‐based tests were not significantly different compared to the quantitative IgG antibody tests. The CLOtest had an accuracy of 97%.

Conclusions.

The Meretek 13C urea breath test is an excellent test, but is considerably more expensive than serologic tests. The FlexSure HP and the QuickVue One‐Step office‐based qualitative IgG serologic antibody tests gave similar results to laboratory based quantitative antibody tests, and are acceptable for initial diagnosis of H. pylori infection. The advantages of the office‐based tests are low cost, simplicity, and immediacy of results.
CagA and VacA: Virulence Factors of Helicobacter pylori in Thai patients with Gastroduodenal Diseases
Authors: Mahachai Varocha , Tangkijvanich Pisit , Wannachai Natnipa , Sumpathanukul Piched , Kullavanijaya Pinit
Published: March 2003

Background. The aim of this study was to assess the seroprevalence of cytotoxin‐associated gene A (cagA) and vacuolating cytotoxin gene A (vacA) of Helicobacter pylori in selected Thai populations with specific gastroduodenal diseases.

Materials and Methods. The immunoblot assay was used to detect serum antibodies against CagA and VacA obtained from the following patients: 87 cases of nonulcer dyspepsia (NUD), 61 cases of duodenal ulcer (DU), 49 cases of gastric ulcer (GU), and 10 cases of gastric cancer (GC).

Results. Serum antibodies to CagA were detected in 75.4% of all patients (70.1% of NUD, 78.7% of DU, 77.6% of GU, and 90% of GC). Although the prevalence of CagA seropositivity in GC patients was higher than in the other three groups, the difference was not statistically significant (p > .05).

Conclusions. The high seroprevalence of the CagA‐positive H. pylori strain in patients with peptic ulcer, GC, and NUD indicates that this strain is common in Thai patients with gastroduodenal diseases. Furthermore, phenotypic classification of H. pylori into type 1 (CagA‐positive, VacA‐positive) and type 2 (CagA‐negative, VacA‐negative) is not a useful marker for screening patients with severe forms of gastroduodenal diseases.
Influence of Oral Helicobacter pylori on the Success of Eradication Therapy Against Gastric Helicobacter pylori
Authors: Miyabayashi Hideharu , Furihata Kenichi , Shimizu Toshiki , Ueno Ichirou , Akamatsu Taiji
Published: March 2003

Background. The goal of this study was to see whether Helicobacter pylori (H. pylori) in the oral cavity might adversely affect the outcome of eradication therapy for gastric H. pylori.

Materials and Methods. Forty‐seven patients (36 males, 11 females) with gastric H. pylori infection were enrolled in this study. Gastric H. pylori infection was confirmed by both immunohistological staining with anti‐H. pylori antibody and bacterial culture of biopsy specimens. The therapeutic regimen consisted of 30 mg/day lansoprazole, 750 mg/day metronidazole, and 400 mg/day clarithromycin administered for 2 weeks. A fragment of the H. pylori urease gene was amplified by nested PCR for DNA extracted from saliva and dental plaque from the same patients. We examined the correlation between the gastric eradication success rate and the prevalence of H. pylori in the oral cavity as determined by PCR before and after the eradication therapy.

Results. The eradication success rate was significantly lower in the oral H. pylori‐positive cases (12/23, 52.1%) than in the negative cases (22/24, 91.6%) at 4 weeks after the therapy (p = .0028). Two years later, only 16 of the 23 (69.5%) oral H. pylori‐positive cases were disease‐free, as compared to 23 of the 24 (95.8%) oral H. pylori‐negative cases (p = .018).

Conclusions. H. pylori in the oral cavity affected the outcome of eradication therapy and was associated with a recurrence of gastric infection. We recommend that oral H. pylori should be examined by nested PCR and, if positive, should be considered a causal factor in refractory or recurrent cases.
Helicobacter pylori Adhesins: Review and Perspectives
Authors: Evans Doyle J. , Evans Dolores G.
Published: March 2003

It is highly unlikely that chronic infection with H. pylori could occur in the absence of adhesin–host cell interactions. Also, there is no evidence that any of the serious outcomes of H. pylori infection such as gastric and duodenal ulcers, gastric cancer or mucosa‐associated lymphoid tissue (MALT) lymphoma could occur without prior colonization of the gastric epithelium mediated by H. pylori adhesins. H. pylori is highly adaptable, as evidenced by the fact that it can occupy a single host for decades. An important facet of this adaptability is its ability to physically interact with various types of host cells and also with host mucins and extracellular matrix proteins using a number of different adhesins displaying a variety of unique receptor specificities. Thus it is highly unlikely that any one particular H. pylori adhesin will ever be proven responsible for a particular outcome such as duodenal ulcer, MALT lymphoma, or adenocarcinoma. Also, while the search for additional H. pylori adhesins should and certainly will continue, we suggest that the scope of this effort should be expanded to include investigations into the patterns of expression and interaction between individual outer membrane proteins. Which of the numerous H. pylori outer membrane proteins (OMPs) actually function as adhesins (i.e., have receptor‐binding sites) and which OMPs are simply necessary for optimal display of the adhesive OMPs? There are many other important questions about H. pylori adhesins waiting to be answered. For example, which adhesins are responsible for loose adherence to host cells and which adhesins are responsible for intimate, or membrane‐to‐membrane, adherence, and do these adhesins normally work in concert or in a sequential fashion? Also, is a specific type of adhesin necessary for type IV protein translocation into host cells and, if so, is adhesin expression coregulated with the effector protein export?
Curing Helicobacter pylori Infection in Patients with Duodenal Ulcer Does Not Provoke Gastroesophageal Reflux Disease
Authors: Befrits Ragnar , Sjöstedt Svante , Ödman Bengt , Sörngård Heléne , Lindberg Greger
Published: March 2003

Background. It has been suggested that the incidence of gastroesophageal reflux disease (GERD) increases after successful eradication of Helicobacter pylori infection. We present data on development of GERD from a controlled study of H. pylori eradication in 165 duodenal ulcer patients.

Methods. Patients (mean age, 55 years; 102 men; current smokers; n = 74) were randomly assigned 2 : 1 to receive omeprazole, 40 mg twice daily, in combination with either amoxicillin, 750 mg twice daily, or placebo. Endoscopy and dyspeptic symptoms, including heartburn, were assessed at inclusion and at 6, 12, and 24 months after treatment. In addition, symptoms were assessed at 18 months. Patients with erosive esophagitis or reflux symptoms requiring treatment at inclusion were not included in the study.

Results. Fifty‐one of 145 (35%) evaluable patients developed heartburn, and 13 of 145 (9%) developed esophagitis during follow‐up. The life‐table analysis of the cumulated risk of developing heartburn showed that patients whose H. pylori infection was eradicated had a significantly lower risk for developing heartburn than those with persistent H. pylori infection. The groups did not show any difference in cumulative risk of developing esophagitis.

Conclusion. Our data show that successful eradication of H. pylori infection does not increase the incidence of GERD in duodenal ulcer patients.
Challenges to Therapy in the Future
Authors: O’Morain Colm , Montague Sean
Published: March 2003

Quadruple therapy (with a proton pump inhibitor (PPI), metronidazole, tetracycline and bismuth) is generally reserved for second‐line treatment; however, studies using this regimen for 7 days have found it to be effective even in metronidazole‐resistant strains. Resistance is an ongoing problem with antimicrobial therapy but considerable progress has now been made into understanding the underlying genetic mechanisms of this process. Metronidazole resistance in Europe is usually in the range of 20–30% of strains but may be as high as 70% in some countries. One genetic mechanism involved is thought to be a mutation of the rdxA gene. Macrolide resistance appears to be on the increase in Europe, varying from 1% in some countries to 13% in others. The genetic mechanism involved has been shown to be a point mutation of a ribosomal RNA. Amoxicillin resistance is an emerging problem that has an adverse effect on eradication rates in clinical practice. Resistance has been shown to be caused by the absence of one of the four binding proteins in the cell wall. Few novel antibiotics have been developed for use in eradication therapy, although rifabutin, secnidazole and furazolidone have shown some success as part of combination therapy. Alternative therapies that have been tested include mucosal protective agents which have been used in place of a PPI in some eradication regimens with some success, and the somatostatin analog, octreotide, that has been used as part of quadruple therapy in place of a PPI and produced eradication rates of approximately 88%. The ultimate challenge is still to develop a safe and effective vaccine against Helicobacter pylori. Current and future research will also focus on identifying genetic targets for therapy, adhesion molecule analogs to prevent binding of the bacterium, and urease inhibitors.

The current triple therapy treatment options available for the eradication of Helicobacter pylori infection are over 90% effective in susceptible organisms and there are very few medical conditions to which we can offer such efficacious treatment. Unfortunately, the recommendations made at consensus conferences are not always put into practice and physicians in primary care may be unaware of the true efficacy of eradication therapy. Treatment is very simple: three drugs, twice a day for 1 week. The main focus for both primary care physicians and gastroenterologists should be to reinforce the need for patient compliance, otherwise we will see an increase in antibiotic resistance. Patients should be prewarned that they may experience some mild side effects and should be encouraged to complete the course of treatment. The real challenge for the future will be the management of patients who do not respond to first‐line treatment. This paper will focus on potential problems with therapy, such as antibiotic resistance, and possible future solutions, such as novel antibiotics and vaccines.
Beneficial Effect of Helicobacter pylori Eradication in Dermatologic Diseases
Authors: Shiotani Akiko , Okada Kazuhisa , Yanaoka Kimihiko , Itoh Hidekazu , Nishioka Shingo , Sakurane Mikihisa , Matsunaka Masahiro
Published: March 2003

Background.

A relationship between skin diseases, particularly rosacea and chronic urticaria, and H. pylori infection has been suggested.

Methods.

We preformed a prospective evaluation of the effect of H. pylori eradication in patients with a variety of chronic skin diseases. Patients were followed monthly for at least one year after cure of the infection. The effect of therapy was scored using a three point scale: complete remission (> 90% improvement), partial remission (50–90% improvement) or no improvement (< 50 improvement). The relationship between response and anti‐H. pylori Ig G and E to specific H. pylori antigens was analyzed by Western blot analysis.

Results.

Eighty‐eight H. pylori‐infected patients with skin disease were enrolled. Treatment was successful in 73% of patients with chronic urticaria as 23% (6 of 26) had complete and 50% had partial remission. Sixty‐two percent (18 of 29) with pruritus cutaneus had partial remission as well as 30% with prurigo chronica multiformis had complete remission. Western blotting was done on 24 patients with skin disease and a 44K H. pylori antigen was detected by Ig E analysis in 100% (5 of 5) patients with complete remission compared to 23% (3 of 13) in those without skin disease.

Conclusions.

These results suggest it may be prudent to test patients with chronic urticaria, prurigo chronica multiformis, pruritus cutaneus, and eczema nummulare for H. pylori infection and to eradicate the infection in those whose test is positive.
Additive Effect of Pronase on the Efficacy of Eradication Therapy Against Helicobacter pylori
Authors: Gotoh Akira , Akamatsu Taiji , Shimizu Toshiki , Shimodaira Kazuhisa , Kaneko Taimei , Kiyosawa Kendo , Ishida Kimitaka , Ikeno Tatsuo , Sugiyama Atsushi , Kawakami Yoshiyuki , Ota Hiroyoshi , Katsuyama Tsutomu
Published: March 2003

Background. Helicobacter pylori (H. pylori) colonizes not only the surface of the surface mucous cells but also the surface mucous gel layer (SMGL). Thus, we examined the possible value of pronase, a mucolytic agent, as a potential eradication therapy.

Materials and Methods. One hundred and thirty‐five patients were randomly assigned to two treatment groups. Sixty‐eight patients received 30 mg of lansoprazole once daily, 500 mg of amoxicillin and 250 mg of metronidazole thrice daily for 2 weeks (LAM group), while the other 67 patients received the same dosage of those agents plus 18,000 tyrosine units of pronase thrice daily for 2 weeks (LAMP group). Eradication was assessed 4–6 weeks after treatment by immunohistochemical tests and cultures. We also determined the in vitro activity of pronase against H. pylori, and evaluated the synergistic effects between pronase and the other three drugs. To investigate the effect of pronase on the structure of the SMGL, surgically removed stomachs obtained from patients who had taken pronase were examined histopathologically.

Results. The cure rates for H. pylori infection in the LAMP group were significantly higher than those in the LAM group (intention to treat analysis: 94.0 vs. 76.5%, p = .0041). Pronase exhibited no antibacterial activity against H. pylori., and no in vitro synergistic effects were observed. In the patients who took pronase before surgery, the SMGL was thinner than in the patients who did not take pronase, and the structure of the SMGL was markedly disrupted.

Conclusions. Pronase has an additive effect in curing H. pylori infection. Pronase has no apparent in vitro activity against H. pylori, but may improve the local delivery of antibiotics by virtue of its removal and disruption of the SMGL.
The Role of the Ferric Uptake Regulator (Fur) in Regulation of Helicobacter pylori Iron Uptake
Authors: Van Vliet Arnoud H. M. , Stoof Jeroen , Vlasblom Ronald , Wainwright Stuart A. , Hughes Nicola J. , Kelly David J. , Bereswill Stefan , Bijlsma Jetta J. E. , Hoogenboezem Theo , Vandenbroucke‐Grauls Christina M. J. E. , Kist Manfred , Kuipers Ernst J. , Kusters Johannes G.
Published: March 2003

Background. Availability of the essential nutrient iron is thought to vary greatly in the gastric mucosa, and thus the human gastric pathogen Helicobacter pylori requires regulatory responses to these environmental changes. Bacterial iron‐responsive regulation is often mediated by Ferric Uptake Regulator (Fur) homologs, and in this study we have determined the role of H. pylori Fur in regulation of H. pylori iron uptake.

Methods. Wild‐type H. pylori and fur mutant derivatives were compared after growth in iron‐restricted and iron‐replete conditions. Iron‐uptake was measured using 55Fe‐labeled iron, whereas gene expression was monitored at the transcriptional level using Northern hybridization and lacZ reporter gene fusions.

Results. Iron‐uptake and total cellular iron content were approximately five‐fold increased in the fur mutant compared with the wild‐type strain, which indicated that in the fur mutant iron‐uptake is not repressed by excess iron. A comprehensive screening of all H. pylori genes encoding putative iron‐uptake proteins indicated that some of these H. pylori genes are constitutively expressed, while others are iron‐ and Fur‐regulated.

Conclusions. Iron uptake in H. pylori is in part differently regulated compared with other bacteria, since in H. pylori some iron‐uptake systems are constitutively expressed. However, other iron uptake systems of H. pylori display the iron‐ and Fur‐mediated repression that is common in bacteria. Taken together, this Fur‐mediated modulation of iron‐uptake capacity may be a specific adaptation to the conditions in the human stomach, where iron starvation and iron overload can be encountered in relatively short time intervals.
Helicobacter pylori Strain and the Pattern of Gastritis Among First‐Degree Relatives of Patients with Gastric Carcinoma
Authors: Li Li , Genta Robert M. , Go Mae F. , Gutierrez Oscar , Kim Jong G. , Graham David Y.
Published: March 2003

Background. Relatives of gastric cancer patients have an increased risk of gastric cancer, possibly related to genetically‐related strains of Helicobacter pylori or a common environment.

Methods. The pattern of gastritis and H. pylori from gastric cancer patients and their first‐degree relatives were compared using detailed DNA fingerprints and vacA, cagA, and iceA genotyping.

Results. Sixteen index cases from Korea, the US, or Colombia and their 38 first‐degree relatives (brothers, sisters, sons and daughters) were studied. No definite, or consistent, relationship between the pattern of gastritis and the relatedness of the H. pylori strain was observed (i.e. relatives could have an identical or a totally different pattern of gastritis regardless if they were infected with identical or highly similar organisms). For example, three elderly siblings of an index case with atrophic pangastritis had identical H. pylori isolates and environments in childhood and yet two had antral predominant nonatrophic gastritis, which is typically associated with duodenal ulcer instead of gastric cancer.

Conclusions. The results of this study are not consistent with the hypothesis that specific virulence factors or similar H. pylori strains correlate with a specific histologic pattern or outcome even among those sharing the same environment in childhood.
Current Surgical Options in the Control of Cancer Pain
Authors: Cullinane Carey A. , Chu David Z.J. , Mamelak Adam N.
Published: March 2003

purpose: Pain syndromes resulting from recurrent or metastatic cancer require careful evaluation to determine the cause of the pain and the appropriate and judicious use of antitumor treatment. The choice of therapy must integrate the type of pain, its function, the overall disease burden of the patient, and psychological aspects of the cancer. As a general rule, opioid analgesics are the mainstay of treatment in patients with cancer‐related pain. When pharmacologic pain control is insufficient or is associated with intolerable side effects, the surgical management of pain can be considered.

overview: In this article, we review the options, indications, and side effects of the interventional and surgical methods available for the treatment of cancer‐related pain.

clinical implications: Planning surgical treatment for cancer‐related pain after a patient's lack of response to therapy with opioid analgesics requires an understanding of sensory innervation as well as a realistic expectation of survival, anesthetic risk, or possibility of incomplete pain relief. As such, surgical interventions must be tailored to the individual patient. Clinicians should keep in mind the surgical alternatives for the effective control of pain when it becomes apparent that medical therapy is ineffective.