bluuebunny/crossref_metadata_2025 huggingface dataset:
Lethal and Sublethal Effects of UV‐B/pH Synergism on Common Frog Embryos
Authors: Pahkala Maarit , Räsänen Katja , Laurila Anssi , Johanson Ulf , Björn Lars Olof , Merilä Juha
Published: March 2003

Abstract:Although the negative effects of ultraviolet‐B ( UV‐B) radiation on the development of many amphibian species have been demonstrated, some species—such as the common frog (   Rana temporaria)—seem to be tolerant of UV‐B radiation. The amount of UV‐B radiation received is likely to vary among populations of the same species, but little is known about geographic variation in UV‐B tolerance. Similarly, although UV‐B radiation can have synergistic effects with other stressors, no studies have focused on geographic variation of these effects on amphibians. We investigated the synergistic effects of UV‐B radiation and low pH on hatchability and early development ofR. temporariaembryos in a factorial laboratory experiment with animals originating from southern and northern Sweden. Newly fertilized eggs were exposed to three different UV‐B treatments (no UV‐B [control], 1.254 k/J/m 2[normal] and 1.584 k/J/m 2[26% enhanced]) and two pH treatments (4.5 [low] and 7.6 [neutral]). Ultraviolet‐B radiation in combination with low pH lead to markedly (approximately 50%) reduced survival rates and increased (approximately 30%) frequency of developmental anomalies in the northern but not in the southern population. The UV‐B‐ exposed embryos hatched at smaller size in the southern population, whereas low pH reduced hatchling size in both populations. In both populations and pH treatments, embryos in the normal UV‐B treatment developed significantly faster than embryos in the enhanced or control UV‐B treatments. No interaction between pH and UV‐B on developmental rates or hatchling size was detected. The results demonstrate—contrary to earlier belief—thatR. temporariaembryos are not insensitive to increased levels of UV‐B radiation. The lethal effects of UV‐B radiation may, however, become manifested only in combination with other stressors, such as low pH, and the effects of this synergism may differ among different populations of the same species.
Performance of Greater Sage‐Grouse Models for Conservation Assessment in the Interior Columbia Basin, U.S.A.
Authors: Wisdom Michael J. , Wales Barbara C. , Rowland Mary M. , Raphael Martin G. , Holthausen Richard S. , Rich Terrell D. , Saab Victoria A.
Published: March 2003

Abstract: Valid modeling of habitats and populations of Greater Sage‐Grouse ( Centrocercus urophasianus) is a critical management need because of increasing concern about population viability. Consequently, we evaluated the performance of two models designed to assess landscape conditions for Greater Sage‐Grouse across 13.6 million ha of sagebrush steppe in the interior Columbia Basin and adjacent portions of the Great Basin of the western United States (referred to as the basin). The first model, the environmental index model, predicted conditions at the scale of the subwatershed (mean size of approximately 7800 ha) based on inputs of habitat density, habitat quality, and effects of human disturbance. Predictions ranged on a continuous scale from 0 for lowest environmental index to 2 for optimal environmental index. The second model, the population outcome model, predicted the composite, range‐wide conditions for sage grouse based on the contribution of environmental index values from all subwatersheds and measures of range extent and connectivity. Population outcomes were expressed as five classes (A through E) that represented a gradient from continuous, well‐distributed populations (outcome A) to sparse, highly isolated populations with a high likelihood of extirpation (outcome E). To evaluate performance, we predicted environmental index values and population outcome classes in areas currently occupied by sage grouse versus areas where extirpation has occurred. Our a priori expectations were that models should predict substantially worse environmental conditions (  lower environmental index) and a substantially higher probability of extirpation (  lower population outcome class) in extirpated areas. Results for both models met these expectations. For example, a population outcome of class E was predicted for extirpated areas, as opposed to class C for occupied areas. These results suggest that our models provided reliable landscape predictions for the conditions tested. This finding is important for conservation planning in the basin, where the models were used to evaluate management of federal lands for sage grouse.
An Analysis of Late‐Seral Forest Connectivity in Western Oregon, U.S.A.
Authors: Richards William H. , Wallin David O. , Schumaker Nathan H.
Published: March 2003

Abstract: Habitat loss and fragmentation due to timber harvest in western Oregon has put wildlife species reliant on late‐seral forest under demographic pressure as available habitat shrinks and local populations become isolated. Few studies have examined the effects of habitat removal and fragmentation on the ability of wildlife to disperse over large areas. We used a spatially explicit population model to examine the effects of landscape patterns on the dispersal success of territorial wildlife species with different dispersal capabilities and home‐range sizes. Simulations of dispersal were conducted on 8.3 million ha of forested landscape in western Oregon, based on forest conditions derived from satellite imagery. We compared dispersal success for baseline conditions of land cover with two alternative landscape patterns: late‐seral forest habitat systematically converted to a younger forest class based on (1) public ownership and (2) the Northwest Forest Plan reserve system. Dispersal success increased with larger dispersal distances and with smaller home ranges (  p < 0.01). Results indicate that the reserve system will not maintain habitat connectivity throughout the landscape for species with relatively short dispersal distances. Patches showing the greatest decrease in dispersal activity following the systematic removal of late‐seral forest habitat were identified as important areas of connectivity.
Intravenous Therapy for Women in Labor: Implementation of a Practice Change
Authors: Tourangeau Ann , Carter Norma , Tansil Nicole , McLean Alice , Downer Valerie
Published: March 2003

Background: Intravenous therapy for women in labor has been routinely administered in many North American hospitals since the 1950s. The purpose of this study was to evaluate a change in intravenous therapy practice. Methods: The evaluation study, using a posttest, quasi‐experimental design, examined the responses of women in labor and nurses to a questionnaire. Proxy prestudy cohort data were used for comparison of some patient outcomes. The convenience sample comprised 219 women admitted to the labor and delivery unit of a community hospital in Toronto, Ontario, between August and October 1997. Results: Under the new intravenous therapy protocol, 26 percent of the women in labor did not receive intravenous therapy compared with 100 percent under the old protocol. The primary reasons for therapy were to enable administration of prescribed medication and bolus intravenous administration associated with epidural anesthesia. At the first after‐delivery void, 61 percent of study women—65 percent of those who received intravenous therapy and 50 percent of those who received no intravenous therapy—tested negative for ketonuria. All 119 comments from nurses indicated comfort with their judgments related to the initiation of intravenous therapy. Conclusions: The change in the intravenous therapy protocol was supported by the study findings. Nurses should increase patient education about drinking and eating adequately throughout labor if appropriate, and resuming adequate fluid and food intake as quickly as possible after childbirth.
Women's Request For a Cesarean Section: A Critique of the Literature
Authors: Gamble Jenny A , Creedy Debra K
Published: March 2003

Background:
The consistently high cesarean section rate in most developed Western countries has been attributed in part to maternal request. This controversial view demands critical analysis. This paper provides a critique of published research relating to women's request for cesarean delivery.
Method:
A search of the major databases was undertaken using the search term “cesarean section” with “maternal request,”“decision‐making,”“patient‐participation,”“decision‐making‐patient,”“patient‐satisfaction,”“patient‐preference,” and “maternal‐choice.” Ten research articles examining women's preferred mode of birth were retrieved, nine of which focused on women's preference for cesarean delivery.
Results:
The methodology of some studies may result in overreporting women's request for a cesarean delivery. The role of the woman's caregiver in the generation, collection, and entry of data, and the occurrence of post hoc rationalization, recall bias, and women's tendency to be less critical of their care immediately after birth are possible areas of concern. Due consideration is rarely given to the influence of obstetric risk for women who may be requesting a cesarean section or to the information women used in making their decision. Women's perceptions of their involvement in decision‐making regarding cesarean section are used to draw conclusions regarding women's request.
Conclusions:
Few women request a cesarean section in the absence of current or previous obstetric complications. The focus on women's request for cesarean section may divert attention away from physician‐led influences on the continuing high cesarean section rates.
Perinatal Depression: A Randomized Controlled Trial of an Antenatal Education Intervention for Primiparas
Authors: Hayes Barbara A , Muller Reinhold , Bradley Benjamin S
Published: March 2003

Background:
Depression can be an unexpected and distressing companion for a woman during the major life transition of becoming a mother for the first time. Researchers now demonstrate that approximately 50 percent of women will experience perinatal distress. Therefore, the etiology and management of perinatal depression is essential for a quality care of childbearing women. The objectives of this study were to develop an education intervention tailored to the information needs of primiparous women about perinatal depression, to deliver this intervention antenatally, and to conduct a randomized controlled trial to determine the effect of the antenatal education intervention in the reduction of postnatal depression.
Method:
A prospective, randomized controlled trial of the education intervention (n= 206) was conducted at three sites in Australia. The outcome of changes in mood state was measured by the Profile of Mood States questionnaire once antenatally (12–28 wk), and twice postnatally (8–12 and 16–24 wk); social support and demographic data were also collected. The education package was administered to the intervention group at the antenatal assessment of mood.Results:A significant and steady reduction in scores (overall and on the subscales) was observed over time for both groups that showed significant improvement in symptoms of depression. No difference was detected when comparing the intervention group with the control group. Additional multivariate regression analyses revealed no relevant influence of social support or demographic variables.Conclusions:Women in both the study and control groups were more depressed antenatally than postnatally. The finding that the education intervention made no difference challenges the two strongly held tenets of health education in childbearing women—that depression can be reduced through education and that antenatal education interventions can endure into the postnatal period.
Does Bathing Newborns Remove Potentially Harmful Pathogens from the Skin?
Authors: Medves Jennifer M. , O'Brien Beverley
Published: March 2003

Background: Newborn infants are routinely bathed after birth partly to reduce the possibility of transmitting potential pathogens to others. The extent to which a mild soap reduces the quantity and type of microbes found on the skin through normal colonization has not been reported. The objective of the study was to compare colonization rates between infants bathed in soap and water and infants bathed in plain water. Method: One hundred and forty infants were randomly assigned to one group bathed in a mild pH neutral soap and water or to another group bathed in water alone. Microbiology swabs were taken on three occasions (before the first bath, 1 hour after the bath, and 24 hours after birth) from two sites (anterior fontanelle and umbilical area). Results: No difference occurred between groups on type or quantity of organisms found at each time period. Skin colonization is a function of time, and the quantity of organisms identified increased over time (Friedman A

2= 111.379, df = 5, p < 0.001). Conclusions: Bathing with mild soap as opposed to bathing in water alone has minimal effect on skin bacterial colonization. Skin colonization increased over time. The findings did not support the efficacy of bathing with soap and water to reduce skin colonization of bacterial pathogens. Although the incidence of potential pathogens colonizing the skin during the first day of life is low and unlikely to pose a risk to healthy newborns, health care professionals may wish to wear gloves until the infant has been bathed.
Postdischarge Surveillance After Cesarean Section
Authors: Creedy Debra K. , Noy Denise L.
Published: March 2003

Background:
Cesarean section is a major surgical procedure with a relatively short hospital stay. A significant rate of surgical site infection after this procedure is missed by standard inpatient surveillance. This study aimed to evaluate a method of postdischarge surveillance and compare results with the incidence of infection before discharge.
Method:
A postdischarge survey was sent on day 30 to 277 women who had delivered by cesarean section during the 12‐month study period. A follow‐up telephone interview was conducted if the questionnaire had not been returned within 2 weeks, if a diagnosis of infection could not be clearly determined from the participant's responses, or to confirm the diagnosis of infection. If follow‐up was not completed, a chart audit was undertaken.
Results:
A total response rate of 89 percent (247/277) was obtained, and 28 women with a surgical site infection were identified from the survey. Telephone follow‐up and chart review of patients with possible infection and of nonresponders identified 32 percent more postdischarge infections (14/42). The overall infection rate was 17 percent compared with 2.8 percent at discharge.
Conclusions:
Postdischarge surveillance is necessary to determine accurate surgical site infection rates after cesarean section, increase awareness of caregivers about infection control problems, and indicate the need for appropriate follow‐up care. Women undergoing a cesarean delivery should be informed of the risk of postdischarge infection and educated about the signs and symptoms of infection.
Acupuncture To Treat Nausea and Vomiting in Early Pregnancy: A Randomized Controlled Trial
Authors: Smith Caroline , Crowther Caroline , Beilby Justin
Published: March 2003

Background: Nausea and vomiting in early pregnancy are troublesome symptoms for some women. We undertook a single blind randomized controlled trial to determine whether acupuncture reduced nausea, dry retching, and vomiting, and improved the health status of women in pregnancy. Methods: The trial was undertaken at a maternity teaching hospital in Adelaide, Australia, where 593 women less than 14 weeks' pregnant with symptoms of nausea or vomiting were randomized into 4 groups: traditional acupuncture, pericardium 6 (p6) acupuncture, sham acupuncture, or no acupuncture (control). Treatment was administered weekly for 4 weeks. The primary outcomes were nausea, dry retching, vomiting, and health status. Comparisons were made between groups over 4 consecutive weeks. Results: Women receiving traditional acupuncture reported less nausea (p < 0.01) throughout the trial and less dry retching (p < 0.01) from the second week compared with women in the no acupuncture control group. Women who received p6 acupuncture (p < 0.05) reported less nausea from the second week of the trial, and less dry retching (p < 0.001) from the third week compared with women in the no acupuncture control group. Women in the sham acupuncture group (p < 0.01) reported less nausea and dry retching (p < 0.001) from the third week compared with women in the no acupuncture group. No differences in vomiting were found among the groups at any time. Conclusion: Acupuncture is an effective treatment for women who experience nausea and dry retching in early pregnancy. A time‐related placebo effect was found for some women. (BIRTH 29:1 March 2002)
RFLP and RAPD Analysis of In Vivo Genetic Interactions Between Strains of Helicobacter pylori
Authors: Danon Stephen J. , Luria Brian J. , Mankoski Raymond E. , Eaton Kathryn A.
Published: March 2003

Background.

The nature of the in vivo interactions between co‐colonizing strains of Helicobacter pylori has not been well studied. This study was designed to investigate the in vivo interaction between strains of H. pylori using restriction fragment length polymorphism analysis (RFLP) and random amplified polymorphic DNA fingerprinting (RAPD) analysis.

Materials and Methods.

Mice were orally inoculated with either a single strain or a mixture of strains, and killed at various time intervals up to 12 months after inoculation.

Results.

Inoculum and recovered bacteria were identified by RAPD and RFLP. After 12 months of colonization, bacteria recovered from mice given a single strain were identical to the inoculum. In contrast, bacteria recovered from mice given a mixture of strains developed minor but consistent differences in their RAPD patterns. This variation occurred in spite of the fact that only single strains were recovered from mice given a mixture of strains.

Conclusion.

These findings support the development of genetic heterogeneity of H. pylori during long‐term colonization either by genetic drift or by in vivo recombination. Such genomic modification in vivo could explain the naturally occurring heterogeneity of H. pylori.
Helicobacter pylori (H. pylori) in Gastric Mucosa of Children with Abdominal Complaints: Immunohistochemistry Detects Antigen‐Reactive Corpus Mucosa Cells
Authors: Vorobjova Tamara , Maaroos Heidi‐Ingrid , Rägo Tiina , Zimmermann Arthur , Uibo Raivo
Published: March 2003

Background.

Previous morphological and serological studies of gastric Helicobacter pylori (H. pylori) colonization among Estonian children with abdominal complaints, as well as among populations of schoolchildren, have shown a high prevalence of H. pylori (49–60%). Based on published data concerning the high specificity and sensitivity of immunohistochemical detection of H. pylori, we examined the prevalence of H. pylori in gastric biopsy specimens of Estonian children by different localization and morphological type of gastritis comparing Giemsa staining with immunohistochemistry.

Material and Methods.

Formalin‐fixed biopsies (107 antral, 108 corpus mucosa) of 112 children (41 boys, 71 girls, age range 1–16~years, median age 12~years) with abdominal complaints were stained with hematoxylin & eosin and Giemsa stains, as well as examined using the peroxidase antiperoxidase (PAP) method with polyclonal antibodies to H. pylori.

Results.

Gastritis of any degree and localization was found in 84/112 (75%) children. Using Giemsa staining H. pylori were detected in 83/112 (74%) of all children, and by use of the PAP method in 55/112 (49%) (p~=~.001). Concordance of the results of immunohistochemical and Giemsa methods in antrum biopsies was 70%, in corpus biopsies 73%. In 12 out of 108 (11%) corpus mucosa specimens a positive staining with anti‐H. pylori IgG was localized in the cytoplasma of corpus mucosal cells in the neck part of the glands.

Conclusions.

The prevalence of H. pylori was higher when employing the Giemsa stain in comparison with immunohistochemistry. Antibody reactivity of cells in the neck part of the corpus glands may either be due to cross‐reactivity of anti‐H. pylori IgG with epithelial cell epitopes, or to internalization of H. pylori by these cells, suggesting a pathogenic role of neck cells in an anti‐H. pylori immune response.
Cure of H. pylori Infection Using a 7‐Day Triple Therapy Combining Pantoprazole with Two Antibiotics
Authors: Adamek Romuald J. , Pfaffenbach Boris , Szymanski Christian
Published: March 2003

Background.

Acid pump inhibitors combined with antimicrobials cure gastritis and peptic ulcer disease but a standard therapy has not yet been established. We therefore investigated a triple therapy with pantoprazole.

Methods.

The aim of this open‐label monocenter trial, involving 30 intention‐to‐treat patients with peptic ulcer disease or functional dyspepsia, was to assess the H. pylori cure rate after a 7‐day triple therapy with pantoprazole (40 mg bid) plus metronidazole (500 mg bid) and amoxicillin (1 g bid). The H. pylori status was assessed by rapid urease test, histological examination and culture at the initial examination and by histological examination and culture at the study end 4 weeks after ending all therapy.

Results.

At the end of the trial H. pylori was eradicated in 21 of 27 per protocol patients (78%; 95% CI 58–91%) and in 21 of 30 patients included in the trial (70%; 95% CI 51–85%). In 15 of 16 per protocol patients with metronidazole‐sensitive strain (94%; 95% CI 70–100%) the infection was cured, but in contrast eradication was accomplished in only one of 3 patients with a metronidazole‐resistant H. pylori strain. Post‐treatment resistance to metronidazole was observed in 6 cases, although 4 of them had had H. pylori strains sensitive to metronidazole at the initial visit. The gastritis had clearly been improved, and the activity of gastritis had completely disappeared 4 weeks after treatment. Seven adverse events were observed in 7 patients, the intensity of which was moderate in 6 cases.

Conclusions.

This short‐term triple therapy with pantoprazole, amoxicillin and metronidazole provides an effective regimen especially in patients with metronidazole‐sensitive strain.
Lansoprazole Quadruple Therapy Is Effective in Curing Helicobacter pylori Infection
Authors: Korman Melvyn G. , Bolin Terry D. , Nicholson Fiona B. , Engelman Jeffrey L.
Published: March 2003

Background.

Quadruple therapy using omeprazole combined with classic bismuth triple therapy has been advocated as optimal therapy for the cure of Helicobacter pylori (H. pylori) infection. We investigated the efficacy of substituting lansoprazole for omeprazole in proton pump quadruple therapy.

Materials and Methods.

In a prospective open study, 219 consecutive patients, with either peptic ulcer disease or biopsy‐proven H. pylori‐associated gastritis, received seven days of lansoprazole, bismuth, tetracycline and metronidazole after three days of lansoprazole pretreatment. Cure of infection was judged by 14C urea breath test at six weeks after completion of therapy.

Results.

On an intention to treat basis, 198 of the 219 patients (90%) were confirmed to be cured of H. pylori infection. Compliance was excellent and minimal side effects reported.

Conclusion.

Lansoprazole‐based quadruple therapy achieves a very high cure rate in an unselected population of either peptic ulcer patients or those with H. pylori‐associated gastritis. Recommended regimens should achieve at least 90% cure of infection. Lansoprazole quadruple therapy is effective and compares favorably with other H. pylori treatment regimens.
Gastric Ulcer Formation after the Hanshin‐Awaji Earthquake: A Case Study of Helicobacter pylori Infection and Stress‐Induced Gastric Ulcers
Authors: Matsushima Yumi , Aoyama Nobuo , Fukuda Haruhiko , Kinoshita Yoshikazu , Todo Akio , Himeno Seiichi , Fujimoto Sotaro , Kasuga Masato , Nakase Hiroshi , Chiba Tsutomu
Published: March 2003

Background. Both Helicobacter pylori (H. pylori) infection and various stresses are known to induce peptic ulcer disease of the upper gastrointestinal tract. However, the pathogenetic relationship between the two factors has not yet been clarified. We conducted a case‐control study to examine whether H. pylori infection played a role in the development of gastric ulcer (GU) induced by life‐event stresses that were experienced after the Hanshin‐Awaji earthquake.

Materials and Methods. Serum samples from patients in the devastated area who developed GUs during the 2 months following the Hanshin‐Awaji earthquake and those from GU patients in the same area during the corresponding period of the previous year, and from gender‐, age‐ and institute‐matched ulcer‐free controls were tested for the presence of the H. pylori IgG antibody.

Results. A significant association between H. pylori infection and the development of GU in uninjured patients was observed in all sets [matched odds ratio (OR) = 3.23, 95% confidence interval: 1.95–5.35]. Moreover, the prevalence of H. pylori infection in patients who developed GUs after the earthquake was not different from that for GU patients in the previous year. In contrast, there was no association between H. pylori infection and the development of GU in the physically injured patients after the earthquake.

Conclusions. H. pylori infection may play an important role in the development of GUs that are induced by emotional life‐event stresses.
Seroprevalence of Helicobacter pylori and Length of Stay in a Nursing Home
Authors: Regev Arie , Fraser Gerald M. , Braun Marius , Maoz Eran , Leibovici Lenard , Niv Yaron
Published: March 2003

Background. Helicobacter pylori infection appears to be contracted mainly in childhood, and it is associated with disadvantaged socioeconomic conditions, overcrowding, and living in institutions. In this study we determined the seroprevalence of H. pylori among elderly patients (age ≥ 70 years) admitted to a major medical center in Israel, and studied the relationship between seroprevalence of H. pylori and the duration of stay in a nursing home prior to the admission.

Patients and Methods. Whole blood from 182 consecutive patients hospitalized at the Rabin Medical Center was tested for the presence of anti‐H. pylori IgG using Helisal Rapid Blood Test kit (Cortecs Diagnostics). Multivariate logistic regression analysis was used to study the relation between H. pylori seropositivity and possible predictive factors such as age, gender and duration of stay in a nursing home.

Results. Of the 182 patients included in the study, 80 (44%) were living in nursing homes (NH) and 102 (56%) were living in their own homes (H) prior to admission. Subjects that stayed in nursing homes for more than 15 months were significantly more likely to be seropositive than subjects with a shorter duration of stay (84% and 63% respectively, p = 0.03). Using a multivariate logistic regression analysis on both the NH group and the whole group, seropositivity was found to be significantly associated with duration of stay in a nursing home ( p = 0.03 and p = 0.01 respectively). Seropositivity was not associated with age in either group.

Conclusions. Living in a nursing home is associated with increased risk for H. pylori infection in the elderly. There is a strong correlation between the duration of stay in a nursing home and the prevalence of H. pylori infection.
Antigenic Mimicry Between Helicobacter pylori and Gastric Mucosa: Failure to Implicate Heat‐Shock Protein Hsp60 Using Immunoelectron Microscopy
Authors: Taylor Diane E. , Fedorak Richard N. , Sherburne Richard
Published: March 2003

Background. Helicobacter pylori infection induces autoantibodies that cross‐react with human gastric mucosa from infected individuals. Candidates for the antigens responsible for molecular mimicry causing autoreactivity include the heat‐shock protein HspB (Hsp60, sometimes called Hsp54) or Lewis x and Lewis y carbohydrate antigens.

Objective. Our goal was to investigate the involvement of HspB (Hsp60) in autoreactivity between H. pylori and gastric biopsy tissue.

Materials and Methods. Immunoelectron microscopy was used to study cross‐reactivity among biopsy tissues from a patient with gastritis, gastric ulcer, and duodenal ulcer and his own serum as well as reactivity with serum raised against HspB from H. pylori and monoclonal antibodies against Lewis antigens.

Results. The patient serum reacted with gastric mucosa, and the antibodies involved were predominantly IgG. Antibody raised to H. pylori HspB (Hsp60) reacted only with H. pylori cells but not with gastric mucosal tissue. In contrast, monoclonal antibodies specific for Lewis x and Lewis y antigens reacted with both H. pylori and human gastric epithelial tissue.

Conclusions. Hsp60 (Hsp54) is unlikely to be involved in autoreactivity seen in individuals infected with H. pylori. In contrast, we could not rule out the role of Lewis x and Lewis y carbohydrate antigens, expressed as a component of H. pylori lipopolysaccharides, in molecular mimicry and autoantibody production.
Clinical and Pathological Importance of cagA‐Positive Helicobacter pylori Strains in Children with Abdominal Complaints
Authors: Korzon Maria , Sikorska‐Wiśniewska Graz·yna , Jankowski Zbigniew , Kur Józef , Banach Piotr
Published: March 2003

Background. The aim of this study was to assess the correlation between the prevalence of Helicobacter pylori strains possessing cytotoxin‐associated gene A (cagA) in children and the intensity of clinical complaints and morphological changes of the gastric mucosa.

Materials and Methods. A group of 80 children with gastrointestinal complaints was included in this study. Pathologists examined mucosal biopsy specimens from these patients. The urease test and multiplex polymerase chain reaction (MPCR) were used to identify H. pylori strains.

Results. In the group of children infected with cagA‐positive H. pylori strains, fourth‐degree gastritis was more frequent than in the group with cagA‐negative H. pylori colonization. In histopathological assessment, infection with cagA‐positive H. pylori was associated also with higher grades of inflammatory intensity and activity.

Conclusions. Marked inflammation of the antral mucosa was significantly more frequent in children infected with cagA‐positive H. pylori than in those infected with cagA‐negative H. pylori, as assessed endoscopically and histopathologically. No specific symptoms for cagA‐positive and cagA‐negative H. pylori infection were observed.
Different Helicobacter pylori Strains Colonize the Antral and Duodenal Mucosa of Duodenal Ulcer Patients
Authors: Thoreson Ann‐Catrin E. , Hosseini Nosrat , Svennerholm Ann‐Mari , Bölin Ingrid
Published: March 2003

Background. We have investigated the possibility that the same patients may be colonized by Helicobacter pylori strains of different genotypes or phenotypes in the antrum as compared to in the duodenum. The strains were typed for DNA fingerprints, different lipopolysaccharides (LPS), and Lewis antigen expression on the O–side chains of LPS.

Materials and Methods. Polymerase chain reaction (PCR) amplifications using primer sequences (i.e., the Enterobacterial Repetitive Intergenic Consensus [ERIC]) and randomly amplified polymorphic DNA (RAPD) elements were performed to asses chromosomal DNA diversity between H. pylori strains. The expression of different LPS types and Lewis antigens in the various H. pylori isolates were determined by whole bacterial enzyme‐linked immunosorbent assays using monoclonal antibodies.

Results. Duodenal ulcer patients had different H. pylori genotypes in the duodenum as compared to in the antrum as shown by ERIC‐PCR (44%) and by RAPD‐PCR (75%). Different DNA patterns were found among the strains that were isolated from various regions of the duodenum in 4 of 16 patients (25%) as shown by ERIC‐PCR and in 8 of 16 patients (50%) as shown by RAPD‐PCR. Sixty‐three percent of the duodenal ulcer patients had H. pylori strains with a different Lewis antigen phenotype in the duodenum as compared to in the antrum, and 3 of 16 patients (19%) had strains with different Lewis antigens expressed by strains from different duodenal biopsies from the same patient.

Conclusion. The results suggest that a mixed population of different H. pylori strains with marked variation, both genotypically and phenotypically, colonize the same patient.
Characterization of a Culture Method to Recover Helicobacter pylori from the Feces of Infected Patients
Authors: Dore Maria P. , Osato Michael S. , Malaty Hoda M. , Graham David Y.
Published: March 2003

Background. Helicobacter pylori is difficult to culture from stool. Multiple efforts from multiple laboratories have been unsuccessful, and the optimal conditions to recover H. pylori from stool are still not known. Recovery of H. pylori from feces of infected individuals is important for the performance of molecular epidemiological investigations, especially in children, where their symptoms do not warrant endoscopy to recover the organism.

Methods. Fresh fecal specimens (noncathartic) were obtained from 19 known H. pylori–infected patients and were processed to recover the organism. Fresh fecal specimens (noncathartic) were also obtained from three known H. pylori–negative individuals (controls) to determine whether H. pylori could be isolated from stools seeded with known concentrations of the organism. Treatment of the fecal suspensions with cholestyramine, a basic anion exchange resin that binds bile acids, was used in an attempt to enhance recovery of H. pylori by sequestering bile acids that are inhibitory to H. pylori growth. H. pylori was identified based on colony morphology, cell morphology, Gram's stain, biochemical reactions, and polymerase chain reaction for two H. pylori genes.

Results. Among 19 patients, H. pylori was cultured at least once from 3 and three times from 2 (5 of 19). Feces that were seeded with H. pylori and obtained from three H. pylori–negative volunteer controls yielded positive recovery in all instances.

Conclusion. We have confirmed that it is possible to culture H. pylori from human stool, but the procedure for optimal recovery has still not been defined.
Is Sudden Infant Death Syndrome Associated with Helicobacter pylori Infection in Children?
Authors: Elitsur Yoram , Btriest William , Sabet Zia , Neace Cheryl , Jiang Chuancang , Thomas Eapen
Published: March 2003

Helicobacter pylori infection has recently been implicated in the pathogenesis of sudden infant death syndrome (SIDS). We investigated this association. Twenty‐five pairs of gastric and tracheal tissue specimens obtained from autopsies of 25 children with previous diagnoses of SIDS were available for this study. The presence of H. pylori organisms was evaluated by three different methods: histology (hematoxylin‐eosin or Giemsa staining), immunohistochemistry, and nested polymerase chain reaction technique. We were unable to confirm the presence of H. pylori organisms by the first two methods. H. pylori DNA was identified by nested polymerase chain reaction in six different tissue specimens (stomach, 4; trachea, 2). In no case was H. pylori DNA detected in both tissues. We concluded that H. pylori infection is most likely not associated with SIDS.
Helicobacter pylori in School Children From the Western Province of Sri Lanka
Authors: Fernando Neluka , Perera Nelun , Vaira Dino , Holton John
Published: March 2003

Background.  Little is known about the prevalence of Helicobacter pylori in Sri Lanka and nothing is known about its prevalence in children. Therefore the prevalence of H. pylori in a group of school children in Sri Lanka was determined.

Materials and Methods.  The presence of H. pylori colonisation was determined by detection of faecal antigen and salivary antibody (IgG) by enzyme immuno assay, in 184 children aged between 5 and 19 years, in the Western Province‐Colombo district of Sri Lanka.

Results.  Overall, only 12/184 (6.5%) had detectable H. pylori antigen in their stools and were considered infected with H. pylori, while 51/184 (27.7%) had H. pylori IgG in saliva. H. pylori salivary IgG declined with age while H. pylori antigen detection increased with age. H. pylori infection, as determined by salivary antibody (66%), was greater in children living in overcrowded conditions, although this was not statistically significant.

Conclusion.  The prevalence of H. pylori among school children in Sri Lanka was 6.5% by detection of faecal antigen and 27.7% by detection of salivary antibody, respectively. Initial infection with H. pylori appeared to occur in early childhood whilst active disease began in late childhood. Overcrowding appears to facilitate the transmission of the organism. Overall the prevalence of H. pylori was low in Sri Lanka compared with other countries in South‐east Asia.
The Relationship Between Consumption of Antimicrobial Agents and the Prevalence of Primary Helicobacter pylori Resistance
Authors: Perez Aldana L. , Kato M. , Nakagawa S. , Kawarasaki M. , Nagasako T. , Mizushima T. , Oda H. , Kodaira J. , Shimizu Y. , Komatsu Y. , Zheng R. , Takeda H. , Sugiyama T. , Asaka M.
Published: March 2003

Background. Primary and acquired resistance to the antimicrobial agents is a primary reason for the failure of Helicobacter pylori eradication therapies. We assessed the primary antibiotic resistance rates of H. pylori to three different antibiotics and its relationship due to the annual antibiotic consumption in Japan during the period prior to approval of anti‐H. pylori therapy in Japan.

Materials and Methods. Antibiotic susceptibility was tested using the agar dilution method for clarithromycin, amoxicillin and metronidazole. Isolates were considered resistant when the MIC value was > 8 mg/l for metronidazole, > 1 mg/l for clarithromycin and < 0.5 mg/l for amoxicillin.

Results. Helicobacter pylori isolates were obtained from 593 Japanese patients from 1995 to 2000. Primary resistance of H. pylori to clarithromycin, metronidazole and amoxicillin was found in 11%, 9% and 0.3% strains, respectively. The proportion with clarithromycin resistance significantly increased from 7% in 1997–98 to 15.2% in 1999–2000 (p = .003). During the same period the metronidazole resistance rate also increased from 6.6% in 1997–98 to 12% in 1999–2000 (p = .02). The prevalence of clarithromycin and metronidazole was related to the annual consumption of these antimicrobial agents.

Conclusion. Resistance rates for both clarithromycin and metronidazole appear to reflect the annual consumption of these agents. The high rate of clarithromycin resistance in Japan suggests that the effectiveness of clarithromycin‐based therapies may be compromised in the near future.
Preventive Effects of Cladosiphon Fucoidan Against Helicobacter pylori Infection in Mongolian gerbils
Authors: Shibata Hideyuki , Iimuro Masaki , Uchiya Naoaki , Kawamori Toshihiko , Nagaoka Masato , Ueyama Sadao , Hashimoto Shusuke , Yokokura Teruo , Sugimura Takashi , Wakabayashi Keiji
Published: March 2003

Background. Recently, the acquisition by Helicobacter pylori of resistance to antibiotics has become a serious problem. Therefore, nonantibiotic substances are required to diminish H. pylori‐induced gastric lesions. In the present study, the effects of Cladosiphon fucoidan were examined in terms of H. pylori attachment to porcine gastric mucin in vitro and Helicobacter pylori‐induced gastritis in vivo.

Methods. The inhibitory effect of Cladosiphon fucoidan and other polysaccharides on H. pylori attachment to porcine gastric mucin was assayed in vitro with mucin‐coated microtiter plates. The effect of Cladosiphon fucoidan on H. pylori‐induced gastritis was examined in vivo using Mongolian gerbils. H. pylori‐inoculated gerbils were given fucoidan in drinking water. Six weeks after H. pylori‐inoculation, gerbils were sacrificed for macroscopic and microscopic examination of gastric lesions and counting of viable H. pylori in the gastric mucosa.

Results. Cladosiphon fucoidan inhibited the H. pylori attachment to porcine gastric mucin at pH 2.0 and 4.0. Two other sulfated polysaccharides, Fucus fucoidan and dextran sulfate sodium, also inhibited the attachment but only at pH 2.0. Inhibitory effects of these three sulfated polysaccharides were not observed at pH 7.2 and nonsulfated polysaccharides, such as mannan and dextran, exerted no influence at any pH. In the in vivo experiment, the H. pylori‐induced gastritis and the prevalence of H. pylori infected animals were markedly reduced by fucoidan in a dose‐dependent manner, at doses of 0.05 and 0.5% in the drinking water.

Conclusion. Cladosiphon fucoidan may deserve particular attention as a safe agent that can prevent H. pylori infection and reduce the risk of associated gastric cancer.
Genomics of Helicobacter pylori
Authors: Thompson Lucinda J. , De Reuse Hilde
Published: March 2003

During this review period, we have definitely entered into the genomic era. The Helicobacter pylori studies reported here illustrate the use of most of the technologies currently available to globally interrogate the genome of a pathogen. Global analysis of the gene content of H. pylori strains gives insight into the extent of its genetic diversity and its in vivo evolution. Our understanding of the particularities of H. pylori as a gastric pathogen colonizing a unique niche has been improved by studies aimed at: (i) the identification of H. pylori‐specific genes; (ii) the establishment of correlations between the presence of one or a group of genes (or proteins) with clinical outcome; and (iii) the analysis of global regulatory circuits or responses to the extracellular signals. The response of host cells to H. pylori infection will be developed in the chapter ‘H. pylori and gastric malignancies’ by Sepulveda and Coehlo. Despite our knowledge of the H. pylori genome, the function of about one third of its total proteins is still unknown. Functional genomics are straightforward approaches for the identification of new gene functions or metabolic pathways as well as for the understanding of cellular processes and the detection of new virulence factors. In silico studies combined with experimental work will undoubtedly continue to develop. To date, the expansion of proteomics with refinements in mass spectrometry technology has illustrated that through immunoproteomics and comparative studies, relevant novel antigens can be identified. Genomics not only provides invaluable information on H. pylori but also opens new perspectives for diagnostic or therapeutic applications.
An Integrated Psychosocial‐ Spiritual Model for Cancer Pain Management
Authors: Otis‐Green Shirley , Sherman Rhonda , Perez Martin , Baird Reverend Pamela
Published: March 2003

purpose: Cancer pain is known to be a multidimensional and complex experience that can cause severe suffering and can lessen quality of life. The psychosocial and spiritual aspects of cancer pain play an important role in this phenomenon. This article describes a multidisciplinary model for cancer pain management that focuses on the psychosocial and spiritual aspects of cancer pain and the needs of patients.

description of program: This multidisciplinary model has been organized to provide the most effective pain management to a variety of patients within a comprehensive cancer center. Our model includes multiple oncology mental health professionals, including psychologists, social workers, spiritual care providers, and psychiatrists. Each discipline provides a unique assessment and an evaluation of the needs of patients with cancer pain and their support system that is integrated into a comprehensive treatment plan. Regular collaboration occurs between disciplines to ensure that the patients receive optimal pain management.

clinical implications: This model provides a framework from which treatment interventions can be implemented. The emphasis on consistent collaboration between disciplines is a vital component in providing effective cancer pain management. This multidisciplinary psychosocial‐spiritual model can be replicated, modified, or both, to become standard practice in other comprehensive cancer centers.
Options in the Treatment of Chemotherapy‐Induced Emesis
Authors: Pendergrass Kelly B.
Published: March 2003

PURPOSE: The incidence and duration of chemotherapy‐induced emesis,pathophysiology of the emetic response, and antiemetic treatment of options are reviewed.

OVERVIEW: Nausea and vomiting are among the most common and debilitating side effects of cancer chemotherapy. If not controlled, these side effects may interfere with the delivery of potentially life‐saving treatment. Acute, delayed, and anticipatory nausea and vomiting may be prevented by appropriate antiemetic therapy. Drug selection is based on the emetogenicity of the patient's cancer treatment and potency of the antiemetic agent. Efficacy and safety of the antiemetic regimen are often improved by combining agents with different mechanisms of action.

CLINICAL IMPLICATIONS: By preventing and controlling chemotherapy‐induced emesis, clinicians may improve cancer patients' functional status and quality of life significantly. Improved tolerability may lead to greater patient acceptance of chemotherapy and prevent premature withdrawal from or cessation of treatment. Controlling chemotherapy‐induced emesis also helps to decrease the direct and indirect costs of managing cancer.
Family Reports of Cancer Pain, Pain Relief, and Prescription Access
Authors: Bucher Julia A. , Trostle Georgia Brown , Moore Michelle
Published: March 2003

purpose
: The authors 1) describe family caregiver reports of degree of pain, pain relief, and prescription access in persons with advanced cancer during the last 4 weeks of life and 2) test for differences according to geographic location and care setting.

description of study
: A randomized, stratified sample of 375 caregivers was produced from a list of all state residents who died of cancer in 1994. Written informed consent was received from 170 family caregivers (46%) who were then interviewed by telephone. Caregiver responses regarding pain intensity, pain relief, prescription access, and care setting were analyzed.

results
: Eighty‐six percent (n = 147) of caregivers reported that pain was a problem, and 61% (n = 103) recalled a great deal to quite a bit of pain compared with 25% (n = 44) who recalled some or little pain. The mean degree of pain was 2.23 (SD ± 1.32) on a scale of 1 (a great deal) to 5 (no pain). Of 140 caregivers reporting pain relief data, 46% (n = 64) reported that interventions either stopped the pain or that pain became much better, whereas 54% (n = 76) reported that interventions made the pain a little better, had no effect, or made it worse. The overall mean of pain relief was 2.62 (SD ± .87) on a scale of 1 (usually stopped the pain) to 5 (made it worse). Greater degrees of pain were associated with reports of less pain relief (r = −19; P = .02). No differences in pain or pain relief were found across county type or patient care setting. Caregivers in the institution‐only group (n = 18) recalled lower degrees of pain and the home‐only group (n = 61) reported the most pain relief. Many in this latter group were served by hospice and home health nurses, and only 4% of the entire sample were served by physicians alone. Notably, 12% (n = 21) of the sample reported problems filling prescriptions. Of these, half had difficulty obtaining medicine because it was “not available.” A total of 48 problems with prescription access were found that were distributed evenly across county types and patient care settings.

clinical implications
: Findings suggest that caregiver reports about the degree of pain or the effectiveness of pain interventions do not vary by residence or care setting at the end of life. Pain relief is moderate at best. Health professionals in all patient care settings should routinely address the issue of obtaining and paying for prescriptions, and local cancer pain task forces should be formed to advocate for better pain relief. An additional solution is to equip families with problem‐solving skills specific to cancer pain.