bluuebunny/crossref_metadata_2025 huggingface dataset:
Syntactic variation in West African English
Authors: BAMIRO EDMUND O.
Published: February 2007

ABSTRACT: The major focus of this paper is a description of syntactic variation in West African English with examples from West African English literature. The following categories of syntactic variation in West African English are identified and described: subjectless sentences, deletion of the ‐ly morpheme in manner adjuncts, omission of function words, reduplication, formation of interrogatives without changing the position of subject and auxiliary items, tag questions, the use of the progressive aspect with mental processes, non‐distinctive use of reciprocal pronouns, substitution of prepositions in idiomatic usage, and focus constructions. The fact that many of the syntactic features of West African English are also found in other varieties of non‐native Englishes around the world indicates that, contrary to the speculation of some scholars, the new Englishes have acquired some stable linguistic characteristics and that their usage cuts across various educational and socio‐economic strata in countries where English is used as an institutionalized second language. However, more comparative studies need to be done to uncover additional facts about the mutual linguistic relationships among the new Englishes.
World Englishes: To Teach or Not to Teach?
Authors: BROWN KIMBERLEY
Published: February 2007

ABSTRACT: As the status of English as a world language changes, and as the number of users of English grows, it is important to move beyond the traditional limits of language pedagogy and the assumption that all learners of English desire to speak British, American, Canadian, Australian, or New Zealand English. Just as it is necessary to move beyond methods in our language education programs, it is necessary to move beyond what Kachru 1988 terms ‘Inner Circle’ varieties of English as the only varieties to be explored in pedagogical settings. At the present time, little information about the roles and functions of English as a world language is presented in many TESOL preparatory programs (Vavrus, 1991), and little information in provided in three of the most popular methodology texts (Brown, 1993). It is the intention of this paper to identify the primary reasons a world Englishes perspective should be infused into the TESOL preparatory curriculum, to discuss the status of current research in world Englishes, to examine what a world Englishes perspective can contribute to language pedagogy, and to provide a bibliography of resources for teacher educators who wish to build such a perspective into their courses.
‘What do you do with a ball in soccer?’– medium, mode, and pluricentricity in succer reporting1
Authors: LEITNER GERHARD , HESSELMANN MARKUS
Published: February 2007

ABSTRACT:Variation studies on Englishes are slowly shifting towards the investigation of contextual parameters as avenues of pluricentric development. The role of media languages, in particular across media types and outlets, is often overlooked. This paper combines contextual parameters with media language studies. The focus is on only one segment: the sports domain, in the print and broadcast media in British, Indian and Ghanaian English. Exploiting ICE's design and text retrieval features and adding Ghanaian samples, we assembled a small‐scale special purpose corpus of reporting/commenting texts. We looked at the link between the sports register and the reported (= media) version, descriptions of actions and their spatio‐temporal coordinates, linguistic creativity, mode, and variety‐specific features. Our findings confirm that media are a considerable differentiating factor. The reporting of completed or of ongoing events turns out to result in quite distinct discourses. The press reconstructs a past event at a higher level of abstraction and evaluation than broadcast media's moment‐by‐moment commenting mode. Mode and pluricentricity were not found to be strong independent variables.
Changing lexical features in Puerto Rican English
Authors: NASH ROSE , FAYER JOAN M.
Published: February 2007

ABSTRACT: In order to understand what happens when languages are in contact in a community, it is necessary to observe that community's acceptance or rejection of the changes that are occurring. Lexicon is the logical area for this analysis since of all the components of language, it changes the fastest. The present study of language contact in Puerto Rico found that the degree of acceptance of lexical change in English due to contact is dependent not only on the type of lexical deviance from established norms but also on the speakers’ self‐evaluation of language dominance. Four types of lexical deviance arising from languge contact were identified: deceptive cognates, false cognates, accidentally similar cognates and accidentally created cognates. Of these, deceptive cognates had the highest percentage of acceptance. The findings indicate that the lexical characteristics of this new contact variety of English, Puerto Rican English, are determined by the particular type of lexical deviance interacting with the linguistic self‐evaluation of the speakers.
Code‐switching and universal constraints: evidence from Farsi/English
Authors: MAHOOTIAN SHAHRZAD
Published: February 2007

ABSTRACT: Structural constraints on codeswitching have been the focus of much research and debate. While some researchers claim to have discovered universal constraints on codeswitching (Belazi et al., 1994; Di Sciullo el al., 1986; Joshi, 1985; Myers‐Scotton, 1993; Sankoff and Poplack, 1981), others deny the possibility of constraints motivated solely by syntactic considerations (Bokamba, 1989; Clyne, 1987). In a significant departure from both of these schools of thought, this paper presents a syntactic account of codeswitching which relies only on general principles of phrase structure and rejects constraints specific to codeswitching. This model is shown to account for intrasentential switches between typologically different languages such as Farsi and English, including within word switches and switches between modifiers and nouns.
The Veterans Health Administration: An American Success Story?
Authors: OLIVER ADAM
Published: February 2007

The Veterans Health Administration (VHA) provides health care for U.S. military veterans. By the early 1990s, the VHA had a reputation for delivering limited, poor‐quality care, which led to health care reforms. By 2000, the VHA had substantially improved in terms of numerous indicators of process quality, and some evidence shows that its overall performance now exceeds that of the rest of U.S. health care. Recently, however, the VHA has started to become a victim of its own success, with increased demands on the system raising concerns from some that access is becoming overly restricted and from others that its annual budget appropriations are becoming excessive. Nonetheless, the apparent turnaround in the VHA's performance offers encouragement that health care that is both financed and provided by the public sector can be an effective organizational form.
SA HealthPlus: A Controlled Trial of a Statewide Application of a Generic Model of Chronic Illness Care
Authors: BATTERSBY MALCOLM , HARVEY PETER , MILLS P. DAVID , KALUCY ELIZABETH , POLS R.G. , FRITH PETER A. , McDONALD PETER , ESTERMAN ADRIAN , TSOURTOS GEORGE , DONATO RONALD , PEARCE RODNEY , McGOWAN CHRISTOPHER
Published: February 2007

SA HealthPlus, one of nine national Australian coordinated care trials, addressed chronic illness care by testing whether coordinated care would improve health outcomes at the cost of usual care. SA HealthPlus compared a generic model of coordinated care for 3,115 intervention patients with the usual care for 1,488 controls. Service coordinators and the behavioral and care‐planning approach were new. The health status (SF‐36) in six of eight projects improved, and those patients who had been hospitalized in the year immediately preceding the trial were the most likely to save on costs. A mid‐trial review found that health benefits from coordinated care depended more on patients' self‐management than the severity of their illness, a factor leading to the Flinders Model of Self‐Management Support.
Rethinking Prevention in Primary Care: Applying the Chronic Care Model to Address Health Risk Behaviors
Authors: HUNG DOROTHY Y. , RUNDALL THOMAS G. , TALLIA ALFRED F. , COHEN DEBORAH J. , HALPIN HELEN ANN , CRABTREE BENJAMIN F.
Published: February 2007

This study examines the Chronic Care Model (CCM) as a framework for preventing health risk behaviors such as tobacco use, risky drinking, unhealthy dietary patterns, and physical inactivity. Data were obtained from primary care practices participating in a national health promotion initiative sponsored by the Robert Wood Johnson Foundation. Practices owned by a hospital health system and exhibiting a culture of quality improvement were more likely to offer recommended services such as health risk assessment, behavioral counseling, and referral to community‐based programs. Practices that had a multispecialty physician staff and staff dieticians, decision support in the form of point‐of‐care reminders and clinical staff meetings, and clinical information systems such as electronic medical records were also more likely to offer recommended services. Adaptation of the CCM for preventive purposes may offer a useful framework for addressing important health risk behaviors.
Planning and Studying Improvement in Patient Care: The Use of Theoretical Perspectives
Authors: GROL RICHARD P.T.M. , BOSCH MARIJE C. , HULSCHER MARLIES E.J.L. , ECCLES MARTIN P. , WENSING MICHEL
Published: February 2007

A consistent finding in articles on quality improvement in health care is that change is difficult to achieve. According to the research literature, the majority of interventions are targeted at health care professionals. But success in achieving change may be influenced by factors other than those relating to individual professionals, and theories may help explain whether change is possible. This article argues for a more systematic use of theories in planning and evaluating quality‐improvement interventions in clinical practice. It demonstrates how different theories can be used to generate testable hypotheses regarding factors that influence the implementation of change, and it shows how different theoretical assumptions lead to different quality‐improvement strategies.
Treatment of Helicobacter pylori Infection: A Review of the World Literature
Authors: van Der Hulst René W.M. , Keller Josbert J. , Rauws Erik A.J. , Tytgat Guido N.J.
Published: February 2007

Background.None of the currently used anti‐Helicobacter pylori drug regimens cures the infection 100%, and cure results still vary considerably. The present article reviews the effectiveness of currently used antimicrobial regimens, aimed to cure H. pylori infection.

Methods.Data collection started from the beginning of the anti‐H. pylori‐therapy era until May 1995. No attempt at formal metanalysis has been made, because many studies have been published only in abstract form. Attempts were made to exclude duplicates of studies by comparison to previously reported ones; the authors of suspected duplicates were contacted. After amalgamation of the number of included patients and the number of successfully treated patients, the mean values of eradication rates and the 95% confidence intervals were calculated.

Results.A total of 237 treatment arms were analyzed. Bismuth triple therapy continues to reach high eradication rates worldwide (78–89%). Side effects leading to diminished patient compliance and the marked decline of eradication efficacy in cases of metronidazole resistance are considered to be the major drawbacks of this therapy. Proton pump inhibitor (PPI) dual therapy is better tolerated with fewer side effects than is bismuth triple therapy. The mean eradication rates vary from 55 to 75%, and the extremes lie between 24 and 93%. PPI triple therapies have been shown to be very effective against H. pylori (eradication rates, 80–89%). Quadruple therapy leads to a mean eradication rate of 96%.

Conclusion.Based on efficacy, PPI triple or bismuth triple therapy are recommended as first‐line treatment for H. pylori infection. Quadruple therapy could serve as second‐line treatment for eradication of initial failures and in case of metronidazole resistance.
An Increase in Helicobacter pylori Strains Resistant to Metronidazole: A Five‐Year Study
Authors: Ling Thomas K.W. , Cheng Augustine F.B. , Sung Joseph J.Y. , Yiu Phyllis Y.L. , Chung Sydney S.C.
Published: February 2007

Background.Metronidazole is one of the most commonly used antimicrobial agents for the treatment of Helicobacter pylori infection. Resistance to metronidazole has been reported worldwide but with a wide range of prevalence. We started using the classical triple therapy (bismuth, tetracycline, and metronidazole) for H. pylori infection in 1991 but recently have experienced a decline in its efficacy in curing the infection. Thus our aim was to investigate in a single center the prevalence of metronidazole‐resistant H. pylori over a period of 5 years.

Materials and Methods.A total of 1,015 different H. pylori strains collected over a period of 5 years were tested for sensitivity against metronidazole, ampicillin, tetracycline, and imipenem. Antibiotic sensitivity was tested by the disk diffusion and agar dilution methods. To elucidate further the possible relationship between these metronidazole‐resistant strains, genomic DNA digestion by the Hae III endonuclease and ribotyping were undertaken in a selected group of isolates.

Results.In 1991, 29 of 132 (22.0%) tested strains of H. pylori were found to be resistant to metronidazole. Since our initiation at that time of a triple therapy of bismuth, metronidazole, and tetracycline, the prevalence of metronidazole‐resistant strains rose rapidly to 73.2% in 1995. All H. pylori isolates were sensitive to ampicillin, tetracycline, and imipenem. A high degree of genomic heterogeneity was found among these isolates. Thus it is unlikely that the resistant strains of H. pylori were originated from a single clone.

Conclusions.This study shows a rapid increase in metronidazole‐resistant H. pylori with the use of an anti‐Helicobacter regimen that contains metronidazole. We anticipate that the efficacy of metronidazole‐containing anti‐Helicobacter regimens will decline with the rapid rise in resistant strains of H. pylori.
The Influence of Helicobacter pylori Status on Circulating Levels of the Coagulation Factors Fibrinogen, von Willebrand Factor, Factor VII, and Factor VIII
Authors: Carter Angela M. , Moayyedi Paul , Catto Andrew , Heppell Richar M. , Axon Anthony T. R. , Grant Peter J.
Published: February 2007

Background.
Helicobacter pylori (H. pylori) infection has been associated with an increased risk of developing ischemic heart disease (IHD). It has been suggested that a persisting low‐grade acute phase response results from the chronic inflammation caused by H. pylori infection, which may give rise to increased circulating levels of certain coagulation factors.

Materials and Methods.One hundred three (53 male) nonconsecutive, randomly selected white subjects with symptoms of dyspepsia were recruited for study from an outpatient endoscopy clinic at Leeds General Infirmary. The presence of H. pylori was determined by histological and microbiological investigation, a rapid urease test, and a 13carbon urea breath test (13C‐UBT). Fibrinogen was measured by the Clauss method, factor VIII:C (FVIII:C) and factor VII:C (FVII:C) were measured by clotting rate assays, and the von Willebrand factor (vWF) was determined by an enzyme‐linked immunosorbent assay.

Results.No difference was found in levels of coagulation factors according to H. pylori status. Multiple regression models were used to account for the effect of covariates and H. pylori status on levels of FVII:C, FVIII:C, vWF, and fibrinogen, and again H. pylori status was not a significant determinant of levels of any of these coagulation factors. No difference occurred in full blood count, platelet count, white cell count, or plasma viscosity in individuals who were H. pylori‐positive compared with those who were negative.

Conclusions.
H. pylori infection is not associated with increased circulating levels of fibrinogen, FVII:C, vWF.Ag, or FVIII:C or hemorrheology in this patient group.
Is Antrum or Corpus the Best Site for Culture of Helicobacter pylori?
Authors: Yousfi Mahmoud M. , Reddy Rita , Osato Michael S. , Graham David Y.
Published: February 2007

BackgroundIsolating Helicobacter pylori on culture media and performing antibiotic susceptibility testing is potentially the most useful tool for guiding antibiotic therapy, especially when antimicrobial resistance is suspected. The aim of this study was to determine whether the yield of H. pylori culture was related to the site from which the gastric specimen was obtained either before or after therapy.

Methods.Gastric mucosal biopsies from the antrum and the corpus of the stomach were cultured. H. pylori status was determined by histological assessment using the Genta stain.

Results.Fifty‐two patients with documented H. pylori infection were studied: Twenty‐three were tested before antibiotic therapy and 29 after therapy had failed. In 47 patients (90%), both antral and corpus culture specimens were positive. In 5 patients (10%), only one site was positive, with three false‐negative antral and two false negative corpus cultures. The overall sensitivity of culture in detecting H. pylori infection was 95% (95% confidence interval = 89–98%) and was not significantly different for the antrum or corpus, either before or after therapy.

Conclusion.Culture of gastric biopsies from either the antrum or the corpus has an excellent diagnostic yield even in patients who failed antimicrobial therapy.
Different Expression of Helicobacter pylori Gastritis in Children: Evidence for a Specific Pediatric Disease?
Authors: Meining Alexander , Behrens Richard , Lehn Norbert , Bayerdörffer Ekkehard , Stolte Manfred
Published: February 2007

BackgroundInfection with Helicobacter pylori causes active chronic gastritis. Once the infection is acquired, gastritis will persist for almost the rest of one's life. To date, very few data are available on H. pylori gastritis in relation to age. Therefore, we attempted to inestigate whether H. pylori gastritis in children exhibits features different from H. pylori gastritis in adults of two different age groups.

Materials and Methods.Fifty consecutive children with a median age of 11 years (range, 3–18 years) were compared with two groups of 50 adult patients, one group with a median age of 43 (range, 19–56 years) and another group with a median age of 70 years (range, 59–86 years). All patients had H. pylori gastritis unrelated to active peptic ulcer disease. Two biopsy specimens were taken from the antrum and two from the corpus, and the following gastritis parameters were evaluated: degree and activity of gastritis, H. pylori colonization, replacement of foveolar epithelium by regenerative epithelium, mucous depletion, presence of atrophic gastritis with intestinal metaplasia, and presence of lymphoid follicles.

Results.Degree and activity of gastritis, extent of H. pylori colonization, degree of replacement by regenerative epithelium, extent of mucous depletion, degree of atrophic gastritis with intestinal metaplasia, and the presence of lymphoid follicles in the antrum, as well as the presence of lymphoid follicles in the corpus differed significantly (chi‐square test: p < .05). All these differences—except the once frequent occurrence of atrophic gastritis with intestinal metaplasia in adults—were attributable to a higher expression of these gastritis parameters in children.

Conclusions.We conclude that H. pylori gastritis, particularly in the antrum, is more severely expressed in childhood. One reason for this might be a child‐specific immune response to an infection with H. pylori. Alternatively, infection may represent a pediatric disease characterized by a nonatrophic, highly expressed form of gastritis, which changes its appearance once the host becomes adapted over time.
Eradication of Helicobacter pylori Using One‐week Triple Therapies Combining Omeprazole with Two Antimicrobials: The MACH I Study
Authors: Lind Tore , van Zanten Sander Veldhuyzen , Unge Peter , Spiller Robin , Bayerdörffer Ekkehard , O'Morain Colm , Bardhan Karna Dev , Bradette Marc , Chiba Naoki , Wrangstadh Michael , Cederberg Christer , Idström Jan‐Peter
Published: February 2007

Background.Eradication of Helicobacter pylori provides potential cure in the majority of patients with peptic ulcer disease, and eradication rates of more than 90% have been reported, using omeprazole in combination with two antimicrobials. The choice of antimicrobials, dose regimen and duration of treatment have varied between studies, however, and an optimal treatment still has to be established.

Materials and Methods.We conducted an international, randomized, double‐blind, placebo‐controlled study involving more than 100 patients in each of six treatment groups in 43 hospital gastrointestinal units in Canada, Germany, Ireland, Sweden, and the United Kingdom. Patients (n=787) with proved duodenal ulcer disease were randomized to treatment twice daily for 1 week with omeprazole, 20 mg (O), plus either placebo (P) or combinations of two of the following anti‐microbials: amoxicillin, 1 gm (A), clarithromycin, 250 or 500 mg (C250, C500), or metronidazole, 400 mg (M). Eradication of H. pylori was evaluated by 13C‐UBT, performed before and 4 weeks after treatment cessation.

Results.The eradication rates for the all‐patients‐treated analysis were 96%. OAC500; 95%, OMC250; 90%, OMC500; 84%, OAC250; 79%, OAM; and 1%, OP. OAC500 and OMC250 achieved eradication rates with lower 95% confidence interval limits exceeding 90%. All regimens were well‐tolerated, 96% of patients complied with their dose regimen, and 2.3% of the patients discontinued treatment owing to adverse events.

Conclusions.Omeprazole triple therapies given twice daily for 1 week produce high eradication rates, are well‐tolerated, and are associated with high patient compliance. The two most effective therapies were those combining omeprazole, 20 mg, with either amoxicillin, 1 gm, plus clarithromycin, 500 mg, or metronidazole, 400 mg, plus clarithromycin, 250 mg, all given twice daily.
Gastric Juice Polymerase Chain Reaction: An Alternative to Histology in the Diagnosis of Helicobacter pylori Infection
Authors: Basso Daniela , Navaglia Filippo , Cassaro Maura , Scrigner Marina , Toma Andrea , Bo Nadia Dal , Mario Francesco Di , Rugge Massimo , Plebani Mario
Published: February 2007

Background.Infection from Helicobacter pylori plays a role in several gastroduodenal diseases. The recent availability of molecular techniques, particularly the polymerase chain reaction (PCR), allows us to detect small amounts of this bacterium. The aims of this study were to compare PCR and histological findings and to ascertain the clinical usefulness of H. pylori PCR identification in different biological samples.

Materials and Methods.We studied 94 consecutive patients. Saliva, gastric juice, and four antral and four body biopsies were obtained from each patients. H. pylori was evaluated histologically in two antral and two body biopsies (Giemsa or Warthin‐Starry stain). After extraction, DNA was submitted for PCR amplification using the two primers HPU1 and HPU2, which amplified a 411‐bp product from the urease gene A.

Results.Forty‐nine patients were H. pylori‐positive at histological workup. The sensitivity of PCR was 92% for gastric juice, 73% for antral biopsies, 61% for body biopsies, and 13% for saliva. Of the 45 H. pylori‐negative patients at histological assessment, 7 (16%) had positive findings on PCR, mainly when gastric juice was examined.

Conclusions.These results indicate that PCR is as sensitive as histological assessment. We suggest that PCR H. pylori detection in gastric juice is a sensitive method for diagnosing this infection.
Helicobacter pylori Infection, Gastritis, and the Temperature of Choice for Hot Drinks
Authors: Graham David Y. , Abou‐Sleiman Joseph , El‐Zimaity Hala M. T. , Badr Adnan , Graham David P. , Malaty Hoda M.
Published: February 2007

Background.The role of the temperature of the diet as a potential etiological factor for gastritis or peptic ulcer disease has been postulated since the beginning of the century. Animal studies have demonstrated damage to gastric mucosa caused by hot water at 60 to 80°C. In the pre‐Helicobacter pylori era it was reported that the majority of ulcer patients preferred hot drinks. It also was reported that the temperature of choice for drinks increased with severity of histological grade of gastritis. We evaluated the association between the preferred temperature of hot drinks and the presence of H. pylori infection.

Methods. We tested the temperature of choice for hot drinking liquids among 12 H. pylori‐negative and 43 H. pylori‐positive volunteers. We also compared the effect of H. pylori therapy on hot drink temperature preference and, in 32 individuals, whether there was a relation between temperature and the degree of gastric atrophy.

Results.There was no difference in the preferred temperature for hot drinks between those volunteers with and without H. pylori infection (63.4°± 6°C compared to 61.3°± 7°C, respectively) (mean ± 1 SD, p=.3) There was no change in preferred temperature after successful therapy of the H. pylori infection compared to unsuccessful H. pylori therapy, nor was there a correlation between the preferred temperature and the presence, absence, or degree of gastric atrophy (r2 < 0.001).

Conclusion. The temperature of preference for hot drinks was not influenced by H. pylori infection or by the presence of atrophic gastritis.
Identification of a 23S rRNA Gene Mutation in Clarithromycin‐Resistant Helicobacter pylori
Authors: Stone Gregory G. , Shortridge Dee , Flamm Robert K. , Versalovic James , Beyer Jill , Idler Ken , Zulawinski Laura , Tanaka S. Ken
Published: February 2007

BackgroundTransition mutations (A‐G) at residue 2143, cognate to position 2058 in the Escherichia coli 23S rRNA gene, have been shown to confer resistance to macrolides in Helicobacter pylori. This study reports the finding that transversion mutations (A‐C) can occur at 2143 as well.

Materials and Methods.Three clarithromycin‐resistant H. pylori isolated from three different patients after treatment with clarithromycin were analyzed for point mutations by cycle sequencing of a 163‐bp amplified region surrounding residue 2143 within the conserved loop of the 23S rRNA gene.

Results.Nucelotide sequence comparisons of a 163‐bp amplified product revealed that A‐C transversion mutations occurred at position 2143. H. pylori isolated from the patients prior to treatment were susceptible to clarithromycin and displayed no polymorphism at 2143.

Conclusion.This is the first report to show that A‐C transversion mutations at position 2143 can confer resistance to clarithromycin in H. pylori and further support the role that mutations at position 2143 play in conferring macrolide resistance in H. pylori.
Double‐Blind, Multicenter Evaluation of Lansoprazole and Amoxicillin Dual Therapy for the Cure of Helicobacter pylori Infection
Authors: Harford William , Lanza Frank , Arora Ajit , Graham David , Haber Marian , Weissfeld Alice , Rose Pamela , Siepman Nancy
Published: February 2007

BackgroundTreatment with amoxicillin plus omeprazole results in disappointing cure rates of Helicobacter pylori infection. The minimal inhibitory concentration of lansoprazole for H. pylori in vitro is lower than that for omeprazole, prompting interest in treatment with amoxicillin plus lansoprazole.

Materials and Methods.
H. pylori‐infected patients with endoscopically documented duodenal ulcer either currently or within the past year were randomized to 14 days of (1) lansoprazole, 30 mg bid, plus amoxicillin, 1 gm tid; (2) lansoprazole, 30 mg tid, plus amoxicillin, 1 gm tid; (3) lansoprazole, 30 mg tid alone; or (4) amoxicillin, 1 gm tid alone. Endoscopy was done at enrollment and at 4 to 6 weeks after completion of treatment or for recurrent symptoms. H. pylori status was assessed by culture and histology. Ulcer prevalence was evaluated at follow‐up endoscopy.

Results.Two hundred sixty‐two patients met enrollment criteria and were treated. By per‐protocol analysis, H. pylori infection was cured in 57% of those treated with lansoprazole twice daily plus amoxicillin and in 67% of those treated with lansoprazole three times daily plus amoxicillin, compared with 0% treated with lansoprazole alone or amoxicillin alone (p < .001 for dual therapy versus either monotherapy). Amoxicillin resistance was not observed. At follow‐up endoscopy, ulcer prevalence was 17% in patients treated with lansoprazole twice daily plus amoxicillin, 23% in those treated with lansoprazole three times daily plus amoxicillin, 33% in those treated with lansoprazole alone, and 35% in those treated with amoxicillin alone (p= .024; lansoprazole twice daily plus amoxicillin versus amoxicillin alone).

Conclusions.Treatment with amoxicillin plus lansoprazole, 30 mg tid, led to cure of H. pylori infection in 67% of patients with active or recently healed duodenal ulcer.
Decrease in Gastric Permeability to Sucrose Following Cure of Helicobacter pylori Infection
Authors: Goodgame Richard W. , Malaty Hoda M. , El‐Zimaity Hala M.T. , Graham David Y.
Published: February 2007

Background.

Gastric sucrose permeability is a noninvasive marker that reliably increases in association with gastrointestinal injury due to use of nonsteroidal antiinflammatory drugs. Despite the effect of Helicobacter pylori infection on the gastric mucosa, in a previous study we were unable to demonstrate that H. pylori infection was associated with abnormal gastric sucrose permeability. Our goal in this study was to explore further whether H. pylori infection changed gastric permeability; therefore, we evaluated the effect of treatment of H. pylori infection on gastric permeability to sucrose and the relation of sucrose permeability to density of polymorphonuclear leukocytes.

Materials and Methods.

Five hundred milliliters of a solution containing 100 gm of sucrose was ingested by the subject at bedtime. Overnight urine was collected and assayed for sucrose by high‐performance liquid chromatography. Sucrose permeability was assessed both before and approximately 4 weeks after anti–H. pylori therapy.

Results.

Seventeen asymptomatic H. pylori–infected volunteers participated; 8 were cured. Sucrose permeability was in the range commonly found in normal controls both before and after anti–H. pylori therapy (mean excretion, 76.3 mg; range, 13–171 mg). Gastric sucrose permeability correlated with the density of polymorphonulcear cell infiltration of the mucosa. Cure of the H. pylori infection was associated with a small but significant decrease in sucrose permeability (98.8 ± 18 mg to 51.7 ± 9.8 mg (p = .01). Sucrose permeability was greater in those with a high density of mucosal polymorphonuclear cells compared to those with lower scores (119.5 ± 4 vs 71.4 ± 13 for those with scores ≥ 5 compared to scores ≤ 4;p = .023). Failed therapy resulted in an increase in the mucosal density of polymorphonuclear infiltration and sucrose permeability (56.4 ± 13 mg–99.7 ± 19 mg pretreatment vs posttreatment, respectively;p = .031).

Conclusion.

H. pylori gastritis causes a small but measurable increase in gastric permeability to sucrose that may reflect epithelial transmigration of neutrophils.
Atrophic Body Gastritis: Distinct Features Associated with Helicobacter pylori Infection
Authors: Annibale Bruno , Marignani Massimo , Azzoni Cinzia , D’ambra Giancarlo , Caruana Pietro , D’adda Tiziana , Fave Gianfranco Delle , Bordi Cesare
Published: February 2007

Background.

Usually, atrophic body gastritis has been considered an autoimmune disease characterized by the presence of parietal cell antibodies. Previous investigations into the role of Helicobacter pylori infection have obtained conflicting results. The aim of this study was to investigate the prevalence and role of H. pylori in a prospectively investigated population of patients with corpus‐predominant atrophic gastritis.

Patients and Methods.

A consecutive series of 67 newly diagnosed cases of atrophic body gastritis was derived from a screening of 326 patients with unexplained anemia or dyspepsia. Criteria for diagnosis were fasting hypergastrinemia, pentagastrin‐resistant achlorhydria, and histological confirmation of body atrophy. In all 67 patients, H. pylori infection was evaluated independently by histological assay and urease test. The gastritis status of both the fundic and antral mucosa were graded according to the Sydney system. Parietal cell and intrinsic factor antibodies also were determined.

Results.

Active H. pylori infection was present in 26.8% of our patients and allowed us to identify a patient’s subpopulation with a significantly smaller degree of body mucosa damage as shown by functional parameters (gastrin, gastric acid secretion, pepsinogen I) and histological assessment. In this subpopulation, a higher prevalence of gastric cancer familial history was found. Presence of parietal cell antibodies showed a similar prevalence in H. pylori–positive and H. pylori–negative patients (61.1% vs. 69.4%) and was not associated with significant functional and histological differences. Cure of infection determined an evident improvement of corporal atrophy as well as a reduction of hypergastrinemia.

Conclusion.

Active H. pylori infection, a potential cause of oxyntic gland atrophy, is found in one‐fourth of patients with newly diagnosed atrophic body gastritis.
Frozen‐Section Biopsy in Perendoscopic Diagnosis of Helicobacter pylori
Authors: Salmenkylä Sinikka , Hyvärinen Hannu , Halonen Kaija , Sipponen Pentti
Published: February 2007

Background.

Our goal was to investigate how reliably Helicobacter pylori infection can be diagnosed from gastric biopsy specimens by frozen‐section technique.

Patients and Methods.

The series consisted of 105 consecutive outpatients who underwent diagnostic upper gastrointestinal endoscopy for abdominal complaints at Jorvi Hospital (Espoo, Finland) during the beginning of 1996. Endoscopic biopsies from antrum and corpus were taken for both frozen‐section and traditional histology, the latter serving as reference (control) material. In the frozen‐section technique, the biopsy specimens were transferred immediately to the pathology laboratory, were prefixed for 30 sec in 10% neutral formalin, were frozen in liquid nitrogen, and were cut into sections with a cryostat. The sections were stained for 10 minutes with 1% toluidine blue. The control biopsy specimens were fixed overnight in 10% neutral formalin and embedded in paraffin, and the sections were stained with the modified Giemsa method.

Results.

In the diagnosis of H. pylori infection, both the sensitivity and the specificity of the frozen‐section technique were 98% compared to the findings in the reference series. One false‐negative result occurred among 41 positive cases, and one case erroneously was classified positive among 64 cases that were negative for H. pylori in the ordinary histology. The frozen‐section technique slightly underestimated the degree of colonization of the gastric mucosa by H. pylori, compared to the findings in the reference material. In the diagnosis of gastritis (chronic inflammation of any degree), the sensitivity and specificity of frozen sections were 92% and 95%, respectively. In the frozen‐section technique, the report of the pathologist of the presence or absence of H. pylori gastritis in biopsy specimens could be given to the gastroenterologist by telephone in approximately 20 minutes.

Conclusions.

The frozen‐section technique is a reliable and rapid method for the diagnosis of H. pylori and provides possibilities for perendoscopic diagnosis of the infection in the hospitals where the frozen‐section service is available.
Failed Treatment of Helicobacter pylori Infection Associated with Resistance to Clarithromycin
Authors: Tompkins David Stewart , Perkin Jill , Smith Carole
Published: February 2007

Background.

Resistance of Helicobacter pylori to clarithromycin is uncommon. Initial studies have suggested that primary resistance has a significant adverse effect on bacteriological cure rates and acquired resistance develops frequently with failure of treatment following regimens containing clarithromycin.

Materials and Methods.

H. pylori isolates were obtained from patients with duodenal ulcer treated with clarithromycin and omeprazole and examined for susceptibility to clarithromycin using the E‐test method. A 13C urea breath test was used to confirm infection with H. pylori and successful treatment.

Results.

H. pylori infection was successfully treated in 101 patients, all with susceptible isolates, and persisted in 30 patients of whom 4 had resistant isolates. Of 16 patients with bacteriological cure failure who had susceptible isolates pretreatment, 11 (68.8%) had resistant isolates post‐treatment.

Conclusions.

This study confirms previous reports that acquired resistance of H. pylori to clarithromycin develops frequently (68.8–96%) in individuals with failed dual therapy regimens. Primary resistance, although uncommon (3%), was 100% predictive of treatment failure with the regimen used in this study. Effective treatment of H. pylori infection should help to prevent the development of resistance to clarithromycin.
Monoclonal Antibodies against Helicobacter pylori Cross‐React with Human Tissue
Authors: Ko Gyung Hyuck , Park Heung Bae , Shin Myoung Keun , Park Cheol Keun , Lee Jeong Hee , O Youn Hee Shang , Cho Myung Je , Lee Woo Kon , Rhee Kwang Ho
Published: February 2007

Background.

H. pylori is a causative agent of chronic gastritis. However, the pathogenic mechanism by which H. pylori induces chronic inflammation and epithelial injuries in the gastric and duodenal mucosa is not well known. Investigators have recently reported that some monoclonal antibodies against H. pylori cross‐react with the gastric epithelial cells. So, there exists the possibility that the autoimmune mechanism may be involved in the pathogenesis of chronic gastritis caused by H. pylori. The purpose of his study is to investigate whether the antibodies against H. pylori react with human tissues or not, using a large panel of monoclonal antibodies.

Materials and Methods.

Two hundred and fourteen monoclonal antibodies against H. pylori were produced. An immunohistochemical staining of human tissues, including H. pylori‐infected gastric mucosa, was performed using the antibodies.

Results.

Of 214 monoclonal antibodies, 71 antibodies reacted with H. pylori in the gastric mucosa. Of 71 antibodies, 25 antibodies also reacted with gastric epithelial cells, 11 antibodies reacted with ductal cells of the salivary gland, 11 antibodies reacted with renal tubular cells, and 8 antibodies reacted with duodenal epithelial cells. The antibodies which showed cross‐reactivity with gastric epithelial cells included those against urease, flagella, lipopolysaccharide, and heat shock protein of H. pylori.

Conclusions.

It is believed that the autoimmune reaction might be involved in the pathogenesis of chronic gastritis due to H. pylori infection, and that the autoimmune reaction induced by H. pylori infection might also be involved in the pathogenesis of various diseases in other organs.
A Retrospective, Comparative Study on the Frequency of Abuse in Migraine and Chronic Daily Headache
Authors: Lee Peterlin B. , Ward Thomas , Lidicker Jeffrey , Levin Morris
Published: February 2007

Objective.—To assess and contrast the relative frequency of a past history of physical and/or sexual abuse in patients with chronic daily headache (CDH) versus migraine.

Background.—A number of risk factors have been identified as risk factors for chronification of headache disorders. Limited data exist regarding the influence of physical and/or sexual abuse on primary headache disorders.

Methods.—This was a retrospective chart review of 183 consecutive new headache patients seen from December 2004 through August 2005 at an outpatient tertiary‐care center. Patients were included in the study if they had chronic daily headache (with criteria for medication over‐use headache or chronic migraine), or migraine with or without aura. A history of physical and/or sexual abuse was systematically asked of all headache patients at their first visit in the clinic. This information was then transferred to a semi‐standardized form and the relative frequency of abuse in both groups contrasted.

Results.—Of the 161 patients included in the study, 90.1% were female with a mean age of 36.4 ± 12.0. A total of 59.0% of the patients were diagnosed with CDH and 41.0% were diagnosed with migraine. Overall, 34.8% of all patients, 40.0% of CDH patients, and 27.3% of migraine patients had a history of physical and/or sexual abuse. The relative frequency of a history of physical and/or sexual abuse was higher in the CDH group as compared to the migraine group (P= .048).

Conclusion.—The relative frequency of abuse is higher in CDH sufferers than migraineurs, suggesting that physical and sexual abuse may be risk factors for chronification.
Cutaneous Allodynia in Transformed Migraine Patients
Authors: Cooke Lara , Eliasziw Michael , Becker Werner J.
Published: February 2007

Background.—There is growing evidence that central sensitization plays a role in migraine pathogenesis, and that cutaneous allodynia is its clinical correlate. In headache research, allodynia has largely been studied in episodic migraine. The purpose of this investigation was to determine whether cutaneous allodynia occurs in transformed migraine, using individuals without headaches as controls.

Methods.—Fifteen patients with a diagnosis of transformed migraine and 15 control subjects with no history of headaches were included. All subjects were females between 18 and 50. Similar to the methods of Burstein et al, Von Frey hairs (VFH) were sequentially applied to territories supplied by divisions of the trigeminal nerve, cervical paraspinal muscles, trapezius muscles, ventral forearm, and lower leg to determine a pain threshold. As a milder stimulus, a cotton swab was stroked in the same locations. Each trial was repeated 3 times on 2 occasions. Group comparisons were made using the Student's t‐test.

Results.—Mean pain thresholds were lower among migraine patients than control subjects across all test areas. The thresholds were statistically significantly lower in migraine patients than in control subjects for the 1st division of the trigeminal nerve (34.0 g versus 115.8 g, P= .035) and for the 2nd division (23.5 g versus 97.6 g, P= .039). Six patients found a cotton swab‐stroke painful, compared to zero control subjects. Using a quantitative definition of allodynia, 75% of patients had allodynia to mechanical stimuli.

Conclusions.—This study is the first to demonstrate allodynia in transformed migraine patients using a headache‐free control population and supports the hypothesis that central sensitization plays a role in the evolution of transformed migraine.
Effects of Autogenic Training on Nitroglycerin‐Induced Headaches
Authors: Juhasz Gabriella , Zsombok Terezia , Gonda Xenia , Nagyne Nora , Modosne Edit , Bagdy Gyorgy
Published: February 2007

Objectives.—To investigate the prophylactic and acute effects of autogenic training (AT) during a nitroglycerin‐induced migraine attack.

Methods.—Thirty female migraineurs (without aura) and 11 controls participated in the study. Of these, 11 migraineurs and 5 controls practiced AT regularly for at least 6 months prior to and during the sublingual nitroglycerin test. Headache intensity and characteristics were recorded with a standardized method. During the nitroglycerin challenge, blood was collected for plasma cortisol determination and blood pressure and pulse rate were recorded.

Results.—As a long‐term preventive treatment, AT significantly decreased the mean headache frequency and intensity (P= .001) compared to the pretreatment period in the migraineurs who regularly practiced AT (n = 11). During the nitroglycerin challenge, AT successfully attenuated the nitroglycerin‐induced acute decrease in blood pressure and pulse rate (P= .013; n = 16 AT subjects vs n = 25 non‐AT subjects). However, it was not effective in preventing immediate headache (P= .71), did not decrease the frequency of acute migraine attacks (P= .79), and could not alleviate acute migraine pain (P= .78; n = 16 AT subjects vs n = 25 non‐AT subjects). Plasma cortisol concentration significantly increased (P= .003) during the acute migraine attack (n = 22), and migraine intensity correlated with plasma cortisol elevations (P < .001; n = 41) and showed a tendency of negative correlation with morning plasma cortisol concentration (P= .08; n = 41). However, AT did not alter plasma cortisol responses (P= .99; n = 16 AT subjects vs n = 25 non‐AT subjects).

Conclusion.—(1) The long‐term AT therapy proved to be a significantly effective preventive intervention in migraine sufferers. We hypothesized that this long‐term effect of AT is based on modulation of the pain anticipation system, which is strongly correlated with function of the anterior cingulate cortex. (2) We demonstrated that AT could not alter the nitroglycerin‐induced acute migraine attacks, which are directly related to the dysfunctional brainstem activation according to previous studies. (3) Our results suggested that there are multiple, complex relationships between cortisol responses and migraine pain, which are possibly mediated by the brain serotonergic system. (4) In addition, our results provide further evidence that nitroglycerin‐induced vasodilatation is not directly connected to either immediate headache or delayed migraine attack.
French General Practitioners' Management of Children's Migraine Headaches
Authors: Cuvellier Jean‐Christophe , Fily Antoine , Joriot Sylvie , Cuisset Jean‐Marie , Vallée Louis
Published: February 2007

Objectives.—This study sought to examine the treatment of children with migraine headaches in a prospective sample of children referred to a tertiary center for headaches.

Background.—Despite the wide diffusion of guidelines for headache management in children, their application in general practice is far from optimal.

Methods.—This prospective study analyzed previous headache treatment by general practitioners in 151 consecutive children (F/M: 0.82; mean age 10.4 ± 3.2 years) referred for migraines to the Lille University Hospital Neuropediatric department between October 1, 2003, and November 30, 2005. The physician completed a questionnaire according to the parents' responses to questions about previous advice about life‐style adjustments (diet, exercise, and sleep hygiene) and abortive and prophylactic treatment. Questions about abortive treatment covered ergot derivatives, triptans, and 3 aspects of ibuprofen use—appropriate dose (ie, more than 7.5 mg/kg), recommendation to administer the drug early in attacks, and warnings about drug abuse. Under the topic of prophylactic treatment, we asked about information from general practitioners about preventive therapy and advice to keep a headache diary.

Results.—Fewer than 15% of patients had received advice about life‐style adjustments. Only 30.3% had received ibuprofen at a correct dose (more than 7.5 mg/kg); only 26.5% were told to use it early during the headache; and only 9.1% were warned about drug abuse. Ergot derivatives were prescribed to 4.6% of children and triptans to 9.1%. Families of 17.9% reported that the general practitioners gave them information about prophylactic treatment. Only 8.0% were advised to keep a headache diary.

Conclusion.—This study shows the need to increase the role and the involvement of family doctors in the management of primary headache in children in general, and of pediatric migraine in particular.