bluuebunny/crossref_metadata_2025 huggingface dataset:
Duodenal Ulcer Relapse Is Not Always Associated with Recurrence of H. pylori Infection: A Prospective Three‐Year Follow‐Up Study
Authors: Martino Gina , Paoletti Marco , Marcheggiano Adriana , D'ambra Giancarlo , Fave Gianfranco Delle , Annibale Bruno
Published: March 2003

Background. Long‐term data concerning the reappearance of Helicobacter pylori infection and duodenal ulcer (DU) recurrence after successful eradication are still few and conflicting. Inadequate histological assessment or use of indirect tests for the determination of H. pylori and bias in the selection of patients to be controlled can influence reported results. The aim of this study was to determine the rate of recurrence of H. pylori infection and ulcer relapse in a population of cured DU patients followed up for 3 years irrespective of their symptomatology.

Methods. Between 1992 and 1994, 126 patients with DU disease were treated with double or triple therapy. Patients using nonsteroidal antiinflammatory drugs or aspirin or receiving maintenance antisecretory therapy were excluded. H. pylori infection was assessed by three bioptic tests from both the antrum and the body (culture, urease, histopathological examination). After 2 months from cessation of treatment, DU had healed and H. pylori infection was cured in 102 of 126 patients (81%). These patients were endoscopically followed up after 1 and 3 years, respectively, and were advised to contact us at symptom recurrence. At 1 and 3 years, we studied 95 (93.2%) and 79 (77.4%) patients, respectively, of the 102 who were cured. The other patients were untraceable or refused endoscopy because they were asymptomatic.

Results. After 1 year, no patient had H. pylori recurrence, whereas three patients had a relapse of DU without evidence of infection. After 3 years, recurrence of H. pylori occurred in six patients (annual rate, 2.5%), DU relapsed in five H. pylori–positive patients (6.3%) and in two H. pylori–negative patients (annual rate, 1.9%). Fasting gastrin and acid secretion values studied in all relapsed patients were within the normal range except for one H. pylori–positive patient.

Conclusions. Recurrence of H. pylori infection is very low where treatment is effective, but a DU relapse, not related to acid hypersecretion, can occur in a small percentage of cured patients.
Colonization and Tissue Tropism of Helicobacter pylori and a Novel Urease‐Negative Helicobacter Species in ICR Mice Are Independent of Route of Exposure
Authors: McCathey Sonya N. , Shomer Nirah H. , Schrenzel Mark D. , Whary Mark T. , Taylor Nancy S. , Fox James G.
Published: March 2003

Background. In humans, Helicobacter pylori is known to colonize the stomach and to induce persistent gastritis; selected reports also suggest it causes extragastric disease, including hepatitis. H. pylori and a novel urease‐negative Helicobacter sp. induce gastritis and typhlocolitis, respectively, when inoculated orally into mice. Experimental typhlocolitis and hepatitis have been caused by intraperitoneal (IP) injection of H. hepaticus, H. bilis, and the novel Helicobacter spp. However, the route by which IP‐inoculated organisms localize to specific areas of the gastrointestinal system is unknown.

Materials and Methods. To determine whether Helicobacter spp. can be isolated from blood, can preferentially colonize specific tissues, and can cause pathological changes, we inoculated 6‐week‐old outbred mice orally or intraperitoneally with H. pylori or a novel Helicobacter sp.

Results. When these mice were inoculated by the IP route, H. pylori was cultured from lungs, spleen, liver, cecum, and stomach on day 1 after inoculation, from liver and stomach mucosa on day 3 after inoculation, and from the stomach on day 30 after inoculation, suggesting preferential colonization of the stomach. After inoculation by the IP route, the novel intestinal Helicobacter sp. was cultured from the blood, lungs, spleen, liver, kidneys, cecum, and feces but not from stomach mucosa on day 1 after inoculation. By day 30 after inoculation, the novel Helicobacter sp. was cultured from cecum and feces only, suggesting that it had preferentially colonized the lower bowel. By the IP route, the novel Helicobacter sp. induced hepatitis that persisted for 30 days after inoculation. Though mice inoculated intraperitoneally with H. pylori developed an acute hepatitis, the liver lesion began to resolve 30 days after inoculation. Mice inoculated orally with either H. pylori or the novel Helicobacter sp. did not have hepatitis on day 30 after inoculation but developed 100% colonization of stomach and cecum, respectively.

Conclusion. The isolation of H. pylori and the novel Helicobacter sp. from multiple tissues infers that a transient helicobacter bacteremia occurs when Helicobacter spp. are injected intraperitoneally, but organisms are cleared rapidly from nontarget tissues and preferentially colonize specific regions of the gastrointestinal tract.
Eradication ofH. pyloriwith Pantoprazole, Clarithromycin, and Metronidazole in Duodenal Ulcer Patients: A Head‐to‐Head Comparison Between Two Regimens of Different Duration
Authors: Dammann Hans‐Gerd , Fölsch Ulrich R. , Hahn Eckhart G. , Von Kleist Detlef‐Hasso , Klör Hans‐Ulrich , Kirchner Thomas , Strobel Sonja , Kist Manfred
Published: March 2003

Background.The study was conducted to compare the efficacy and tolerability of two pantoprazole‐based triple therapies of different length in the eradication ofH. pylori.

Methods.In this double‐blind, multicenter parallel group comparison,H. pylori‐positive patients were randomly assigned to either the PCM‐7 group (7 days of pantoprazole 40 mg bid, clarithromycin 500 mg bid, metronidazole 500 mg bid) or the PCM‐14 m group (modified 14 day therapy of the same regimen with metronidazole only given for 10 days due to labeling reasons).H. pyloristatus was determined by urease test, histology, culture, and13C‐urea breath test. Treatment outcome was assessed 6 weeks after intake of the last study medication.

Results.The following eradication rates were achieved: for PCM‐7 in the MITT population 83% (89/107), in the PP population 84% (81/97); for PCM‐14 m in MITT 87% (92/106), in PP 88% (91/104). Ulcer healing rates were: for PCM‐7 in MITT population 99% (106/107), in the PP population 99% (96/97); for PCM‐14 m in MITT 99% (105/106), in PP 99% (103/104). Gastrointestinal symptoms and gastritis scores decreased in both treatment groups. Equivalence of treatment regimens could be proven for all populations. In total, 64 patients reported adverse events. Five serious adverse events occurred, all unrelated to the study medication.

Conclusion.The two pantoprazole‐based triple therapies tested in this study are equally effective inH. pylorieradication, ulcer healing and relief from ulcer pain. It is concluded that 7 days of triple therapy are generally sufficient.
Analysis of iceA1 transcription in Helicobacter pylori
Authors: Donahue John P. , Peek Richard M. , Van Doorn Leen‐Jan , Thompson Stuart A. , Xu Qing , Blaser Martin J. , Miller Geraldine G.
Published: March 2003

Background. Transcription of the Helicobacter pylori iceA1 gene is induced following adherence of the bacterium to gastric epithelial cells in vitro, suggesting that this gene might be involved in H. pylori pathogenesis. Consequently, the current studies were undertaken to characterize iceA1 transcription and to define the structure of iceA1‐containing transcripts to evaluate the potential of this gene to encode functional proteins.

Materials and Methods. Northern blots and primer extension of RNA isolated from broth‐grown cultures of various H. pylori strains was done to analyze iceA1‐specific gene transcription. Reverse transcriptase (RT)‐PCR was used to determine the levels of iceA1 transcripts derived from readthrough transcription that was initiated upstream of iceA1 within the 5′‐flanking cysE gene.

Results. Three major transcripts were detected and each was initiated from a common promoter, designated PI. Two of these transcripts were comprised of iceA1 sequence, while a third transcript was dicistronic and included the downstream gene, hpyIM. In addition, 10‐fold lower levels of iceA1 transcripts were initiated upstream of PI, either within or immediately downstream of cysE.

Conclusions. The present analysis suggests that iceA1 does not encode a functional protein in the majority of H. pylori strains. However, transcription of hpyIM, which encodes a highly conserved DNA adenine methyltransferase, is linked to iceA1 transcription. Therefore, iceA1 may affect H. pylori virulence in vivo through transcriptional regulation of hpyIM expression levels, which may result in specific variations in DNA methylation patterns leading to alteration in the expression of genes involved in virulence or pathogenesis.
The Pathological Examinations of Gastric Mucosa in Patients with Helicobacter pylori–Positive and –Negative Pernicious Anemia
Authors: Sari Ramazan , Ozen Suleyman , Aydogdu Ismet , Yildirim Bulent , Sevinc Alper
Published: March 2003

Background. The basic histopathological finding in gastric mucosa is chronic atrophic gastritis in patients with pernicious anemia.

Materials and Methods. We evaluated the frequency of Helicobacter pylori and pathological examinations of gastric mucosa in pernicious anemia (n = 30) by endoscopical findings and biopsy. The results were compared with gastric mucosa specimens of patients with H. pylori–positive nonulcer dyspepsia (n = 36) and H. pylori–negative nonulcer dyspepsia (n = 21).

Results. H. pylori was diagnosed in 12 patients (40%) with pernicious anemia. Fundal biopsy examinations showed atrophic gastritis in 30 patients (100%), intestinal metaplasia in 13 patients (43.3%), lymphoid follicle in 15 patients (50%), and dysplasia in 6 patients (20%). Antral biopsy examinations showed atrophic gastritis in 8 patients (26.6%), intestinal metaplasia in 8 patients (26.6%), lymphoid follicle in 8 patients (26.6%), and dysplasia in 3 patients (10%). The frequency of fundal inflammation, atrophy, intestinal metaplasia, lymphoid follicle, and dysplasia and antral intestinal metaplasia and mild antral dysplasia were found to be higher in those in the pernicious anemia group than in the nonulcer dyspeptic patients. Antral inflammation, atrophy, and moderate and severe antral dysplasia were found to be higher in those in the nonulcer dyspeptic group.

Conclusions. Particularly, fundal precancerous lesions were found to be more frequent in patients with pernicious anemia independent of H. pylori.
Costs of Managing Helicobacter pylori‐Infected Ulcer Patients after Initial Therapy
Authors: Griffiths Robert I. , Rabeneck Linda , Guzman Gladys , Cromwell David M. , Strauss Michael J. , Robinson John W. , Winston Bradley , Li Theodore , Graham David Y.
Published: March 2003

Background.

The objective of this research was to evaluate the outcomes and costs of alternative approaches to managing patients previously treated for peptic ulcer disease and Helicobacter pylori infection.

Materials and Methods.

A decision‐analytic model was used to compare (1a) urease breath testing (UBT) for assessment of H. pylori status versus (1b) observation without further testing or treatment, among patients who were symptom‐free following initial antimicrobial and antisecretory therapy for endoscopically demonstrated ulcer and H. pylori infection; and (2a) UBT versus (2b) repeat endoscopy with H. pylori testing, and versus (2c) repeat antimicrobial and antisecretory therapy without further testing, among patients who remained symptomatic following initial therapy.

Results.

Among patients who were symptom free after initial therapy, 6.1% receiving UBT had symptomatic ulcer at one year, compared to 18.2% of those simply observed. The expected first‐year cost per symptom‐free patient following initial therapy was $591 for UBT compared to $480 for observation. Among patients with persistent symptoms after initial therapy, 21% receiving repeat therapy had symptomatic ulcer at one year, compared to 23.8% receiving repeat endoscopy, and 23.3% receiving UBT. Corresponding medical costs per patient were, respectively, $766, $1787 and $1122.

Conclusions.

The optimal approach to managing patients following initial treatment for ulcer and H. pylori infection depends on symptom status following initial therapy. For symptomatic patients, the preferred approach is to prescribe a repeat course of antimicrobial and antisecretory therapy. For patients without symptoms following initial therapy, UBT is the preferred approach because it is associated with a threefold lower risk of symptomatic ulcer at one year, although it costs an additional $110 per patient, compared with observation.
Correlation Between Helicobacter pylori Infection, Gastric Inflammation and Serum Homocysteine Concentration
Authors: Leung Wai K. , Ma P. K. , Choi Paul C. L. , Ching Jessica Y. L. , Ng Alex C. W. , Poon Peter , Woo K. S. , Sung Joseph J. Y.
Published: March 2003

Background.  Epidemiological studies have suggested a link between chronic Helicobacter pylori infection and ischemic heart disease but the underlying mechanism remains elusive. We hypothesized that H. pylori‐associated chronic gastritis causes impairment of absorption of vitamin cofactors that are essential in the metabolism of homocysteine and results in hyperhomocysteinemia.

Materials and Methods.  Forty‐nine dyspeptic patients were studied. H. pylori infection was defined by rapid urease test and histology. Fasting serum homocysteine level, which was measured by a validated commercial fluorescence polarization immunoassay, was correlated with H. pylori infection statuses and gastric histology. H. pylori‐infected patients were followed up for 24 weeks post eradication for changes in serum homocysteine concentration.

Results.  Univariate analyses showed that serum homocysteine level correlated with increasing age (p < .001), male sex (p = .003) and smoking habit (p = .025). There was no significant difference in serum homocysteine levels between H. pylori infected and uninfected subjects (median 10.5 vs. 10.2 µmol/l). After successful eradication of the bacterium, there was no significant reduction in homocysteine level. Moreover, there was no correlation between homocysteine level and gastric histology including H. pylori density, activity and inflammation scores, presence of atrophy or intestinal metaplasia.

Conclusions.  The postulated link between H. pylori infection and ischemic heart disease, if it actually exists, is unlikely to be mediated through hyper‐homocysteinemia.
Guidelines in the Management of Helicobacter pylori Infection in Japan
Authors: Asaka Masahiro , Satoh Kiichi , Sugano Kentaro , Sugiyama Toshiro , Takahashi Shin‐ichi , Fukuda Yoshihiro , Ota Hiroyoshi , Murakami Kazushige , Kimura Ken , Shimoyama Takashi
Published: March 2003

Background.

In preparation of the approval of Helicobacter pylori therapy by the Japanese national health system, the board of directors of the Japanese Society for Helicobacter Research decided to prepare guidelines on the diagnosis and treatment of H. pylori infection for physicians in routine medical practice.

Methods.

A guidelines preparation committee was formed and six meetings were held. Then, in December 1999, a consensus meeting was held in Kobe to obtain the opinions of general practitioners as well as experts from Europe, North America, and Asia.

Results.

Helicobacter pylori eradication therapy is recommended in gastric or duodenal ulcer patients. Helicobacter pylori eradication therapy is recommended or gastric mucosa associated lymphoid tissue (MALT) lymphoma but it should be done at specialist institutions. The significance of H. pylori eradication therapy is still under evaluation in patients with hyperplastic polyps, chronic atrophic gastritis, non‐ulcer dyspepsia and in patients after endoscopic mucosal resection of gastric cancer and after gastrectomy for gastric cancer. When diagnosing H. pylori infection, at least one of the tests requiring endoscopic biopsy (e.g. rapid urease test, histology, or culture) and tests not requiring biopsy (e.g. measurement of H. pylori antibody or urea breath test) should be used. Multiple tests are recommended to increase the accuracy. The drugs of first choice currently covered by the national health insurance system in Japan are: lansoprazole (30 mg) 1 capsule twice daily, amoxicillin (250 mg) 3 capsules twice daily, and clarithromycin (200 mg) 1–2 tablets twice daily. These three drugs should be administered after breakfast and dinner for 1 week.

Conclusion.

These guidelines are intended for utilization in routine medical practice after the Japanese national health system begins to cover the management of H. pylori infection.
Immune Response to a 26‐kDa Protein, Alkyl Hydroperoxide Reductase, in Helicobacter pylori‐Infected Mongolian Gerbil Model
Authors: Yan Jing , Kumagai Toshiko , Ohnishi Makoto , Ueno Ichiro , Ota Hiroyoshi
Published: March 2003

Background.

The host immune response is thought to play an important role in the outcome of Helico‐bacter pylori infection. The successful development of the H. pylori‐infected Mongolian gerbil model that mimics human disease has enabled study of the antibody response against H. pylori antigens.

Materials and Methods.

Serum samples from ulcer and carcinogenesis models of H. pylori‐infected gerbils were used to screen for H. pylori antigens that cause a humoral immune response in the infected hosts. H. pylori alkyl hydroperoxide reductase (AhpC) is one such antigen on which we report here. The tsaA gene encoding AhpC was amplified by PCR from H. pylori ATCC 43504 strain, cloned into pMALTM‐c2 expression vector and expressed in Escherichia coli. Maltose‐binding protein fusion protein (MBP‐AhpC) was purified by a MBP affinity column. Using purified recombinant AhpC protein as an antigen, the antibody response and changes of antibody levels against AhpC in the gerbil models were studied by Western blotting and ELISA.

Results.

Antibody against AhpC was negative in the early stages of infection, and became positive in the gerbils with the emergence of gastric diseases such as chronic active gastritis, gastric ulcer and gastric cancer. The antibody levels (ELISA) increased gradually over time and were higher in gerbils with gastric ulcer than that in gerbils without ulcers.

Conclusions.

Use of the gerbil model that mimics human H. pylori infection is likely to provide insights into the role of H. pylori‐specific antigens possibly related to the subsequent development of gastric diseases.
Effects of Selective Cyclooxygenase‐2 Inhibitor and Non‐Selective NSAIDs on Helicobacter pylori‐Induced Gastritis in Mongolian Gerbils
Authors: Bhang Choon Sang , Lee Hak Sung , Kim Sung Soo , Song Ho Jin , Sung Yong Jick , Kim Jin Il , Chung In Sik , Sun Hee Sik , Park Doo Ho , Lee Youn Soo
Published: March 2003

Background. It is still a point of controversy whether Helicobacter pylori‐infected patients are more likely to develop mucosal damage while taking NSADIs. Selective cyclooxygenase (COX‐2) inhibitors may be associated with less severe gastric mucosal damage than conventional NSAIDs, but this association is undefined in H. pylori‐induced gastritis. The aim of this study was to evaluate the effects of selective COX‐2 and nonselective NSAIDs on H. pylori‐induced gastritis.

Methods. After intragastric administration of indomethacin, NS‐398 or vehicle alone, once daily for 5 days in H. pylori‐infected and uninfected Mongolian gerbils, we evaluated gastric mucosal damage, inflammatory cell infiltration and prostaglandin E2 (PGE2) concentration. We investigated whether H. pylori infection induced the COX‐2 expression.

Results. In H. pylori‐uninfected groups, the indomethacin‐treated group showed the highest mucosal damage score and the lowest PGE2 concentration. There was no difference in mucosal damage scores and PGE2 concentration between NS‐398 and vehicle‐alone treated group. In H. pylori‐infected groups, there was no difference in mucosal damage scores, irrespective of the type of drugs administered. The indomethacin‐treated group showed the lowest PGE2 concentration, similar to that of the NS‐398 and vehicle‐alone treated groups, both without H. pylori infection. Gastric neutrophil and monocyte infiltration scores were higher in H. pylori‐infected groups than in uninfected groups. However, there was no difference in these scores according to the type of drugs administered, within H. pylori‐infected or uninfected groups. COX‐2 protein expression was observed in H. pylori‐infected Mongolian gerbils but not in uninfected ones.

Conclusions. Our animal study showed that H. pylori infection induced COX‐2 expression and increased prostaglandin concentration. Administration of NSAIDs decreased the prostaglandin concentration, but did not increase mucosal damage in H. pylori‐induced gastritis. Selective COX‐2 inhibitors, instead of conventional NSIADs, had no beneficial effect on preventing mucosal damage in H. pylori‐induced gastritis.
Enhanced Expression of Transcription Factor E2F in Helicobacter pylori‐infected Gastric Mucosa
Authors: Isomoto Hajime , Furusu Hisashi , Shin Masashi , Ohnita Ken , Miyazaki Masanobu , Omagari Katsuhisa , Mizuta Yohei , Murase Kunihiko , Inoue Ken‐ichiro , Murata Ikuo , Koji Takehiko , Kohno Shigeru
Published: March 2003

Objective. Helicobacter pylori is implicated in gastric carcinogenesis through increased gastric epithelial cell turnover. In fact, high proportions of proliferating and apoptotic epithelial cells are found in H. pylori‐infected gastric mucosa. E2F, a transcription factor, induces coordinated transactivation of a set of genes involved in cell cycle progression. The aim of this study was to investigate the expression of E2F in H. pylori‐infected gastric mucosa and examine the correlation between such expression and gastric epithelial cell proliferation and apoptosis.

Methods. Twenty‐five patients with H. pylori‐associated gastritis (HAG) and 13 control subjects negative for H. pylori were examined. E2F expression was studied in situ by Southwestern histochemistry, a method used to localize transcription factors. Labeled double‐stranded oligo‐DNA with specific consensus sequence for E2F binding sites was reacted with frozen sections from antral biopsy specimens obtained at endoscopy. Gastric epithelial cell proliferation was assessed by immunostaining of proliferating cell nuclear antigen (PCNA), while apoptosis was detected by terminal deoxynucleotidyl transferase‐mediated dUTP‐biotin nick end labeling (TUNEL). The percentages of epithelial cells with nuclear staining for PCNA and E2F were expressed as a positivity index (PI). The percentage of TUNEL‐positive epithelial cells was defined as apoptotic index.

Results. E2F was expressed in the nuclei of gastric epithelial cells within gastric pits. E2F PI in H. pylori‐infected gastric mucosa was significantly higher than that in noninfected. Expression of E2F correlated well with PCNA‐positive epithelial cells. We also demonstrated colocalization of PCNA with E2F expression in the same epithelial cells. Apoptotic index was also high in H. pylori‐infected mucosa, and correlated with E2F PI.

Conclusion. Our results demonstrated a significant increase in the expression of E2F in H. pylori‐infected mucosa, which correlated with both the percentages of PCNA‐ and TUNEL‐positive cells. Our results suggest that enhanced E2F expression in gastric mucosa may be involved in H. pylori‐related gastric carcinogenesis through accelerated cell turnover.
Accuracy of Office‐Based Immunoassays for the Diagnosis of Helicobacter pylori Infection in Children
Authors: Day Andrew S. , Sherman Philip M.
Published: March 2003

Background. Rapid non‐invasive diagnostic tests that can reliably document the presence or absence of Helicobacter pylori infection are urgently required. The aim of this study was to determine the accuracy of two immunoassays (Flex‐Sure and MedMira), developed for use outside the laboratory setting by practitioners, in the setting of a low prevalence of H. pylori infection.

Methods. Serum samples collected in four previous studies (n = 349) were employed to detect the presence of H. pylori‐specific immunoglobulin G, compared to previous results obtained using endoscopic biopsies, serology, flow cytometry, and urease breath testing. Serum samples included 52 obtained from adults (parents and grandparents of symptomatic children), 123 sera collected from children and adolescents undergoing diagnostic upper endoscopy for upper gastrointestinal tract symptoms, and 174 samples drawn from children in the primary care setting with or without recurrent abdominal pain.

Results. Overall, 16% of subjects were infected by the gastric pathogen. Both the specificity (%) and negative predictive value (%) of the two tests were high (FlexSure: 91 and 92; Medmira: 97 and 94, respectively). In adults, both tests also demonstrated high sensitivity (83% and 86%) and positive predictive values (79% and 83%, respectively). However, in children where the prevalence of infection was 12% (37 of 297 subjects), the sensitivity (59% and 71%) and positive predictive values (55% and 88%, respectively) of the immunoassays were lower.

Conclusions. These findings indicate that, in the setting of a low prevalence of H. pylori infection, the MedMira office‐based test provides satisfactory results and utility. However, the low positive–predictive value of the FlexSure kit may limit applicability of this test in children.
Improvement of Reflux Symptoms 3 Years After Cure of Helicobacter pylori Infection: A Case‐Controlled Study in the Japanese Population
Authors: Miwa Hiroto , Sugiyama Yuriko , Ohkusa Toshifumi , Kurosawa Akihiko , Hojo Mariko , Yokoyama Tetsuji , Hamada Tsutomu , Basyuda Hisashi , Sato Nobuhiro
Published: March 2003

Background. Development of reflux esophagitis is one of the adverse effects that cause concern in relation to curative treatment of Helicobacter pylori infection. However, recent studies present a rather negative association between curative treatment and development of reflux esophagitis or reflux symptoms. Therefore, this issue has remained controversial. Accordingly, we investigated the long‐term adverse effects of H. pylori eradication treatment in special reference to development of reflux symptoms.

Patients and Methods. We conducted a case controlled study by mailing structured questionnaires on past (before curative treatment or 3 years previously) and current status. A case was an endoscopically confirmed peptic ulcer patient with confirmed cure of the infection after eradication treatment 3 years previously and a control was one who had not undergone the eradication treatment during the same period. We studied 241 pairs who matched for age, gender, and type of ulcer disease (GU, DU or GDU). Of these pairs, 81.3% were male and the mean age was 52.6 ± 9.6 year (range 23–76).

Results. The rates of patients with improved reflux symptoms in the case and control groups were 65.4% and 30.4%, respectively, with the rate being significantly greater in the case group. On the contrary, the rates of those with worsened reflux symptoms were similar (5.1% and 7.6%). Regarding general events, the rate of patients with decreased frequency of hospital visits and of those who regularly used antiacid medications were significantly decreased in the case group. Furthermore, the case group experienced significantly fewer hospital admissions for various diseases in this 3‐year period. However, a significantly greater number of case group patients than control subjects gained weight.

Conclusion. Reflux symptoms as well as general well‐being were significantly improved after cure of H. pylori infection.
Epidemiology and diagnosis of Helicobacter pylori infection
Authors: Mitchell Hazel , Mégraud Francis
Published: March 2003

There have been no major breakthroughs in the field of epidemiology and diagnosis of Helicobacter pylori infection over the last year, thus for this reason, these two topics will be treated in the same chapter.

Information on the incidence of infection, as in the study of Malaty et al. are now being published from long‐term cohort follow‐ups. The route of transmission of H. pylori remains controversial, with circumstantial evidence for infection via exposure to animals, contaminated water supplies and oral reservoirs being reported.

The value of citric acid to improve urea breath test (UBT) results has been documented. A novel stool test has been released on the market and we are awaiting more information, while detection of antibodies in urine gave satisfactory results.

However, the most interesting data comes from the study of McColl et al. who clearly proved on a large sample and a 1‐year follow‐up that the ‘test and treat’ strategy using UBT, as proposed in the Maastricht Consensus Report, is definitely the method to use.
Self‐Care and Breast Cancer Recovery
Authors: Seegers Cathy , Walker B. Lee , Nail Lillian M. , Schwartz Anna , Mudgett Lorrie Larsen , Stephen Sharon
Published: March 2003

PURPOSE
: This study identified self‐care behaviors used by women during and after radiation therapy for early‐stage breast cancer.

DESCRIPTION OF STUDY
: Interviews with 23 women 7 months post‐radiation therapy for breast cancer were analyzed for descriptions of self‐care. The interviews were part of the final data collection in a longitudinal study investigating experiences post‐treatment.

RESULTS
: Self‐care behaviors reported most frequently were establishing a good support network, living life to the fullest despite illness, regulating feelings, managing stress, and taking responsibility for one's own health. Results suggest that breast cancer patients have many needs that continue to require attention post‐radiation therapy, making self‐care an important consideration throughout recovery.

CLINICAL IMPLICATIONS
: Quality of self‐care may make a significant difference to women after treatment for breast cancer. Healthcare providers can promote self‐care by encouraging patients to conserve energy, to engage in relationships, and to maintain a positive outlook and by suggesting activities that help patients cope, adapt, and manage symptoms during and after treatment.
Payment for cancer prevention. Community and government perspectives.
Authors: Gebbie KM
Published: March 2003

PURPOSE: The development of a stronger interest in cancer prevention and early detection programs has led to the opportunity for mechanisms to provide adequate financial support at the individual, practitioner, and community levels. This discussion draws on the experiences of public health systems and emerging models for personal care to describe a framework for consideration of prevention and early detection funding, and to discuss the prospects of funding. OVERVIEW: Some prevention and early detection services are financed appropriately through individual payment mechanisms and can be covered in indemnity and capitated insurance plans. Population‐based approaches to prevention do not fit this model, however, and need to be financed at the community level, through taxes or other shared financing schemes. CLINICAL IMPLICATIONS: Lack of public understanding of the differences between individual‐ and population‐based prevention makes resource development difficult. Practitioners interested in such approaches need to join with others in the community to gain support. Long‐term support of community efforts currently remains unclear. Although the actions identified are essential, they are not sufficient to support a comprehensive cancer prevention and detection program fully. The concerned clinician should become a part of the community‐wide effort. This may be done individually, through participation on a local board of health or a hospital‐based health promotion coalition. This also may be achieved through associations such as the local medical society or the local American Cancer Society.
An examination of nursing attitudes and pain management practices [see comments]
Authors: Dalton JA , Carlson J , Mann JD , Blau W , Bernard S , Youngblood R
Published: March 2003

PURPOSE: The purpose of this evaluation is to examine the relationship among nurses' pain management attitudes and pain management practices and to begin to explore the theoretical underpinnings that may influence this relationship. DESCRIPTION OF STUDY: A convenience sample of 29 female registered nurses working in hospice or home health settings participated in an educational program 1 day per week for 6 weeks. All participants were asked to complete the Cancer Pain Knowledge Inventory and Survey of Expectations and Pain Assessment Questionnaire 5 weeks before, immediately before, immediately after, 6 months after, and 12 months after the program. Seventeen participants completed all questionnaires at the 6‐month follow‐up; 16 participants completed all questionnaires at the 1‐year follow‐up. Personal beliefs about pain were evaluated in relation to the dimensions and treatment of pain. Intentions and expectations to perform specific activities were evaluated in relation to in‐depth assessments, equianalgesic conversions, demonstration of new ideas, and communication. RESULTS: Nurses' attitudes, beliefs, intentions, and expectations about pain and pain management influenced nurses' patient care and educational activities. Nurses who believed that patients should be pain free and nurses who focused on both the dimensions and treatment of pain implemented more pain management activities. In general, nurses who had high intentions and expectations performed more pain management activities. CLINICAL IMPLICATIONS: Although nurses reported change in attitude, and high expectancy for change, feelings of increased credibility, and increased motivation as advocates for new approaches to practice, nurses sometimes found it difficult to implement new practices because of constraints in time and collaborative efforts. To implement new knowledge and achieve individualized goals for change, nurses must be allowed adequate time to analyze the relationships between their beliefs about pain and the ways that they solve patients' pain problems. In addition, more support for multidisciplinary collaboration is needed.
A Review
Authors: Brown David W. , French Michael T. , Schweitzer Maurice E. , McGeary Kerry Anne , McCoy Clyde B. , Ullmann Steven G.
Published: March 2003

PURPOSE: The authors provide a review of the economic evaluation literature of breast cancer screening and identify important trends and gaps in the literature.

OVERVIEW: Healthcare resources are limited and economic evaluation plays a critical role in resource allocation, healthcare policy, and clinical decisions. Many economic evaluations of medical practice, however, are unreliable and do not use appropriate analytic techniques. Three important trends were observed. First, two economic evaluation methods are dominant. Second, a wide range of cost estimates exists across studies. Third, a lack of standardization exists across studies with regard to basic economic evaluation principles. These findings should be considered when conducting future research, analyzing economic evaluations of breast cancer screening, and developing clinical guidelines.

CLINICAL IMPLICATIONS: Concerns about cost containment in healthcare make it necessary for physicians and clinical administrators to take an active role in resource allocation decisions at the clinical level. For instance, the recent debate on the proper age to begin annual mammography screening involves both resource allocation and clinical issues. Thus, it is important for physicians and clinical administrators to be familiar with the economic evaluation literature of breast cancer screening, economic evaluation methodology, and the associated shortcomings of published estimates.
Patient and Caregiver Perceptions of Cancer Pain Control
Authors: Rushton Patricia , Brown Sherry
Published: March 2003

objectives: This study measured the perceptions of cancer patients and caregivers in Utah concerning knowledge about and adequacy of pharmacologic cancer pain control.

materials and methods: A descriptive survey was sent to a stratified random sample of adult cancer patients obtained from the Utah Tumor Registry. Questionnaires asked cancer patients and caregivers about their knowledge of pain control and about perceptions of the adequacy of pharmacologic cancer pain management.

results: The study had a 52% response rate (259 of 500) after two mailings. Eighty‐five percent (219 of 259) of the respondents stated that they had no cancer pain. With the first mailing, a “no pain” response was not offered as an option. When the researchers realized that this might be a possible response, a second mailing was sent, which may be the reason for the high response rate.

conclusions: Cancer literature indicates that much cancer pain is not effectively controlled. The majority of the respondents of this study reported no pain. Because this result is different than that reported in the literature, it may indicate that education of healthcare providers, patients, and families can improve cancer pain management and control. It may also indicate an inability of the study to obtain data from those patients having cancer pain. This study should be repeated with a focused population of advanced stage cancer patients with types of cancer typically producing high levels of cancer pain.
Age at Diagnosis and Quality of Life in Breast Cancer Survivors
Authors: Cimprich Bernadine , Ronis David L. , Martinez‐Ramos Gloria
Published: March 2003

purpose: The purpose of the study was to determine the relationship between life‐stage variables (ie, age at diagnosis and years of survival) and quality‐of‐life (QOL) outcomes in long‐term survivors of breast cancer.

description of study: In this cross‐sectional study, 105 long‐term survivors of breast cancer participated in a mailed survey assessing QOL. Participants were selected from a cancer center tumor registry using a stratified random‐sampling procedure that was based on age at diagnosis. The Quality of Life‐Cancer Survivors scale was used to assess QOL outcomes in the physical, psychological, social, and spiritual domains.

results: Long‐term survivors of breast cancer who had received diagnoses at an older age (> 65 years) showed significantly (P < .05) worse QOL outcomes in the physical domain, while those who had received diagnoses at a younger age (27–44 years) showed worse QOL outcomes in the social domain than other age groups. A nonlinear relationship was observed, with long‐term survivors who had received diagnoses in middle age (45–65 years) showing better QOL outcomes in the physical domain and in overall QOL. Age at diagnosis and years of survival were significant predictors of QOL outcomes.

clinical implications: These findings indicate that the life stage at diagnosis can help to predict long‐term QOL outcomes in breast cancer survivors. Educational strategies to help oncology professionals develop a better understanding of the impact of age at diagnosis may be important in developing tailored interventions that respond to the specific needs of breast cancer survivors at each life stage.
Family Perspectives of Ovarian Cancer
Authors: Ferrell Betty , Ervin Kate , Smith Stephany , Marek Thais , Melancon Cindy
Published: March 2003

purpose: This qualitative study explored quality of life (QOL) in family caregivers of ovarian cancer patients to better define their needs for support.

description of study: One thousand one hundred pieces of correspondence written by family caregivers of ovarian cancer patients were contributed to the City of Hope investigators by the founder and editor of Conversations!: The International Newsletter for Those Fighting Ovarian Cancer. The investigators analyzed meaningful comments in the letters using content analysis methods.

results: Comments by family caregivers reflected little concern for their own physical well‐being and, instead, focused on the psychological, social, and spiritual aspects of their experiences. Correspondence on the psychological effects of caregiving demonstrated poor QOL stemming from feelings of lack of control and helplessness. Social data showed that family caregivers lacked support, were given to feelings of isolation, and experienced considerable anxiety regarding the genetic nature of the disease. Spiritual well‐being was particularly important to caregivers, as they drew strength from their faith and were able to find positive meaning in their experiences.

clinical implications: The study findings revealed that caregivers require additional support from the healthcare community, especially to address disease‐specific needs in patients with ovarian cancer. The correspondence demonstrates a need in family caregivers to connect with others fighting the same disease. This study also identifies the need for support for at‐risk women, as well as a continuing need for palliative‐care services.
Survivorship Resources for Post‐Treatment Cancer Survivors
Authors: Tesauro Gina M. , Rowland Julia H. , Lustig Craig
Published: March 2003

purpose: The purpose of this project was to determine the scope of services and resources available to cancer survivors who have completed active treatment and their families at National Cancer Institute (NCI)‐designated comprehensive cancer centers.

description of study: Patient education program contacts from the 37 NCI‐designated comprehensive cancer centers participated in a telephone interview. Program contacts were asked to identify the types of medical and psychosocial services that their respective cancer center offered.

results: Telephone interviews were completed by patient education program contacts from all NCI‐designated comprehensive cancer centers for a total response rate of 100%. Services pertaining to lymphedema management were identified in 70% of cancer centers. Other common services identified specifically for post‐treatment cancer survivors at cancer centers were professionally led support groups (49% of cancer centers), long‐term medical care (38% of cancer centers), school re‐entry programs (19% of cancer centers), nutrition counseling (14% of cancer centers), and counseling addressing fertility and sexual concerns (14% of cancer centers).

clinical implications: Results from this project outline the range of services and resources that are provided to post‐treatment cancer survivors by NCI‐designated comprehensive cancer centers, and can be used to develop standards of care for future cancer control programs.
AmphiPax3/7, an amphioxus paired box gene: insights into chordate myogenesis, neurogenesis, and the possible evolutionary precursor of definitive vertebrate neural crest
Authors: Holland Linda Z. , Schubert Michael , Kozmik Zbynek , Holland Nicholas D.
Published: March 2003

SUMMARYAmphioxus probably has only a single gene (AmphiPax3/7 ) in thePax3/7subfamily. Like its vertebrate homologs (Pax3andPax7 ), amphioxusAmphiPax3/7is probably involved in specifying the axial musculature and muscularized notochord. During nervous system development,AmphiPax3/7is first expressed in bilateral anteroposterior stripes along the edges of the neural plate. This early neural expression may be comparable to the transcription ofPax3andPax7in some of the anterior neural crest cells of vertebrates. Previous studies by others and ourselves have demonstrated that several genes homologous to genetic markers for vertebrate neural crest are expressed along the neural plate–epidermis boundary in embryos of tunicates and amphioxus. Taken together, the early neural expression patterns ofAmphiPax3/7and other neural crest markers of amphioxus and tunicates suggest that cell populations that eventually gave rise to definitive vertebrate neural crest may have been present in ancestral invertebrate chordates. During later neurogenesis in amphioxus,AmphiPax3/7, like its vertebrate homologs, is expressed dorsally and dorsolaterally in the neural tube and may be involved in dorsoventral patterning. However, unlike its vertebrate homologs,AmphiPax3/7is expressed only at the anterior end of the central nervous system instead of along much of the neuraxis; this amphioxus pattern may represent the loss of a primitive chordate character.
The concept of developmental reprogramming and the quest for an inclusive theory of evolutionary mechanisms
Authors: Arthur Wallace
Published: March 2003

SUMMARY Evolutionary developmental biology has already made a major contribution to our understanding of evolutionary patterns, notably homology. However, while it has the potential to make an equally important contribution to our understanding of evolutionary mechanisms, and indeed to the integration of mechanism and pattern, it has not yet done so. This paper explores how this potential may be realized. In particular, I focus on the limitations of present‐day neo‐Darwinian theory, and indicate how a combination of the neo‐Darwinian and “evo‐devo” approaches provides a more inclusive view of evolutionary mechanisms with greater explanatory power. There is a particular focus on developmental reprogramming, which lies logically between mutation and selection, yet has been neglected in mainstream evolutionary theory. The inclusion of developmental reprogramming in the list of evolutionary mechanisms leads to a view that the direction of evolutionary change is determined by a combination of internal and external factors, rather than being controlled entirely by the environment.
Cranial neural crest cell migration in the Australian lungfish, Neoceratodus forsteri
Authors: Falck Pierre , Joss Jean , Olsson Lennart
Published: March 2003

SUMMARY A crucial role for the cranial neural crest in head development has been established for both actinopterygian fishes and tetrapods. It has been claimed, however, that the neural crest is unimportant for head development in the Australian lungfish (Neoceratodus forsteri  ), a member of the group (Dipnoi) which is commonly considered to be the living sister group of the tetrapods. In the present study, we used scanning electron microscopy to study cranial neural crest development in the Australian lungfish. Our results, contrary to those of Kemp, show that cranial neural crest cells do emerge and migrate in the Australian lungfish in the same way as in other vertebrates, forming mandibular, hyoid, and branchial streams. The major difference is in the timing of the onset of cranial neural crest migration. It is delayed in the Australian lungfish in comparison with their living sister group the Lissamphibia. Furthermore, the delay in timing between the emergence of the hyoid and branchial crest streams is very long, indicating a steeper anterior‐posterior gradient than in amphibians. We are now extending our work on lungfish head development to include experimental studies (ablation of selected streams of neural crest cells) and fate mapping (using fluoresent tracer dyes such as DiI) to document the normal fate as well as the role in head patterning of the cranial neural crest in the Australian lungfish.
Are entrenched characters developmentally constrained? Creating biramous limbs in an insect
Authors: Dworkin Ian M. , Tanda Soichi , Larsen Ellen
Published: March 2003

SUMMARYAre evolutionarily entrenched phenotypes highly constrained developmentally? We explored this question in the case of the uniramous appendages of fruit flies. We created bi‐ and polyramous antenna/leg combinations in four different genotypes. Each genotype consisted of two relevant mutations. We suggest that not all entrenched characters are strongly constrained by developmental processes and that there exists sufficient natural genetic variation to alter highly conserved phenotypes.