bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of music on preprocedure anxiety in Hong Kong Chinese day patients
Authors: Lee David , Henderson Amanda , Shum David
Published: December 2004

Aims and objectives.  To identify the effect of music on preprocedure anxiety levels of Hong Kong Chinese patients undergoing day procedures in a local community based hospital.

Design.  Pre and post‐test quasi experimental design with non‐random assignment.

Method.  A total of 113 participants were assigned to the control group or intervention group depending on the day of their procedure. Participants’ anxiety levels were measured objectively by comparing their vital signs and subjectively by the Spielberger State Trait Anxiety Scale. Participants’ physiological parameters (blood pressure, pulse and respiration) and State Trait Anxiety Scale were measured at two time periods. The control group undertook the usual relaxing activities provided in the waiting room compared with the intervention group who listened to music of their own choice in reclining chairs while waiting for the procedure.

Results.  The physiological parameters for both the control and intervention groups dropped significantly during the waiting period, however, only the intervention group had a significant reduction in reported anxiety levels.

Conclusions.  These results suggest that providing self‐selected music to day procedure patients in the preprocedure period assists in the reduction of physiological parameters and anxiety, yet, a relaxing environment can assist in the reduction of physiological parameters.

Relevance to clinical practice.  The administration of self‐selected music to day procedure patients in the preprocedure period can be effective in the reduction of physiological parameters and anxiety.
Small bowel bacterial overgrowth and rice malabsorption in healthy and physically disabled older adults
Authors: Mitsui T. , Kagami H. , Kinomoto H. , Ito A. , Kondo T. , Shimaoka K.
Published: December 2004

Aim  To determine whether there are differences in small bowel bacterial overgrowth (SBBO) and rice digestion between healthy and disabled older adults and to estimate the influence of physical activity on these nutritional statuses.

Method  Fifteen disabled adults who commute to a day‐care centre and 11 healthy older adults participated in this study. SBBO and rice absorption were judged using a breath hydrogen test. Physical activity was estimated using a pedometer.

Results  The average number of steps taken per day by the disabled was 1056 ± 243, which was statistically lower than that of the healthy, 6904 ± 782 (P < 0.001). No SBBO‐positive subject was seen in the healthy group, whereas five (33.3%) of 15 disabled older adults were SBBO‐positive. After ingesting glucose solution, the ▵H2 of disabled subjects was higher than that of the healthy subjects (7.6 ± 2.7 versus 0.5 ± 0.3 p.p.m., P < 0.05). Rice malabsorption was seen in one (9.1%) of 11 in the healthy and two (14.3%) of 14 in the disabled groups, which was not statistically significant.

Conclusions  Disabled older people who have a physically inactive lifestyle are at risk of SBBO, probably because of a reduction in their intestinal motility. SBBO has no influence on absorption of rice, and some older adults, independent of physical condition, can not absorb rice adequately.
Validation of a short questionnaire to qualitatively assess the intake of total fat, saturated, monounsaturated, polyunsaturated fatty acids, and cholesterol
Authors: Rohrmann S. , Klein G.
Published: December 2004

Background  To validate a self‐administered 20‐item short questionnaire (SQ) for classifying individuals according to their intake of total fat, saturated (SFA), monounsaturated (MUFA), and polyunsaturated fatty acids (PUFA), as well as cholesterol.

Methods  The SQ was sent to a randomly selected subsample of 300 participants of the European Prospective Investigation into Cancer and Nutrition (EPIC) in Heidelberg. The SQ was sent back by 244 participants (52.5% women, 47.5% men). Intake of total fat, SFA, MUFA, PUFA, and cholesterol was calculated from a 148‐item food frequency questionnaire (FFQ). The intake was compared with the scores computed from the SQ.

Results  Spearman's correlation coefficient between the intake estimated from the FFQ and the score from the SQ ranged from r = 0.29 (PUFA) to r = 0.56 (cholesterol). When the participants were assigned to quartiles of intake according to both methods 29–42% were classified into the same quartile, 1–7% of the participants were grossly misclassified.

Conclusions  The SQ demonstrated a good validity with respect to SFA and cholesterol and an acceptable validity with respect to total fat and MUFA, while the results are less good for PUFA. The SQ can be used to classify persons according to their intake into categories of intake.
The dietitians challenge: the implementation of nutritional advice for people with diabetes*
Authors:   Nutrition Sub‐Committee of the Diabetes Care Advisory Committee of Diabetes UK
Published: December 2004

The evidence base for current nutritional recommendations has been extensively reviewed on behalf of the European Association for the Study of Diabetes (EASD) 1998 and the American Diabetes Association (ADA) 2002. The nutrition Sub‐Committee of Diabetes UK is in general agreement with those recommendations. This paper provides consensus‐based recommendations that emphasize the practical implementation of nutritional advice for people with diabetes, and describe the provision of dietetic services required to provide the information. Important changes from previous Diabetes UK (previously British Diabetic Association Diabet. Med.9, 189) recommendations include greater flexibility in the proportions of energy derived from carbohydrate and monounsaturated fat, further liberalization in the consumption of sucrose, more active promotion of foods with a low glycaemic index, and greater emphasis on the provision of nutritional advice in the context of wider lifestyle changes, particularly physical activity. Monounsaturated fats are now promoted as the main source of dietary fat because of their lower susceptibility to lipid peroxidation – and consequent lower atherogenic potential. Consumption of sucrose for patients who are not overweight can be increased up to 10% of daily energy derived from carbohydrate provided that this is eaten in the context of a healthy diet and distributed throughout the day. The role of the dietitian is outlined in facilitating lifestyle changes and evidence is presented for the effectiveness of advice provided by trained dietitians. The increasing evidence for the importance of good metabolic control and the growing requirement for measures to prevent Type 2 diabetes in an increasingly obese population will require major expansion of dietetic services if the standards in National Service Frameworks are to be successfully implemented at local level.
Pericardiocentesis guided by 2‐D echocardiography: the method of choice for treatment of pericardial effusion
Authors: Lindenberger M. , Kjellberg M. , Karlsson E. , Wranne B.
Published: December 2004

Abstract.  Lindenberger M, Kjellberg M, Karlsson E, Wranne B (Linköping University, Linköping, Sweden). Pericardiocentesis guided by 2‐D echocardiography: the method of choice for treatment of pericardial effusion. J Intern Med 2003; 253: 411–417.

Background.  Percutaneous pericardiocentesis guided by 2‐D echocardiography has been used at Linköping Heart Centre since 1983.

Aim.  To evaluate our experience of this method including a follow‐up and also to determine the aetiology of pericardial effusion.

Methods.  A retrospective study including 120 of 252 consecutive patients punctured.

Results.  The two most common aetiologies were cardiac surgery (77% valve surgery), followed by malignant disease. The postsurgical effusions became clinically important a median of 12 days after surgery (range 0–56 days). The median survival in the group with malignant disease was 89 days (30‐day survival 87%, 1‐year survival 10%). Indwelling catheter was used in 93% of the patients. There was no mortality but one patient needed a second pericardiocentesis after an accidental puncture of the right ventricle. Nine patients had rhythm aberrations. Recurring effusion that needed puncture was seen in 8%.

Conclusion.  Pericardiocentesis guided by 2‐D echocardiography is a safe and efficient method to treat pericardial effusion and also valuable as palliative treatment for patients with malignant aetiology of the effusion.
The hypothalamus–pituitary function after pituitary stereotactic radiosurgery: evaluation of growth hormone deficiency
Authors: Degerblad M. , Brismar K. , Rähn T. , Thorén M.
Published: December 2004

Abstract.  Degerblad M, Brismar K, Rähn T, Thorén M (Karolinska Hospital, Stockholm, Sweden). The hypothalamus–pituitary function after pituitary stereotactic radiosurgery: evaluation of growth hormone deficiency. J Intern Med 2003; 253: 454–462.

Objectives.  Radiation therapy to the pituitary gland means a considerable risk of developing hypopituitarism. The aim of the study was to investigate the growth hormone releasing hormone (GHRH)–growth hormone (GH)–insulin‐like growth factor‐I (IGF‐I) axis after treatment with stereotactic radiosurgery to the pituitary because of Cushing's disease.

Setting.  Inpatient ward in university clinic.

Subjects.  Eleven adult patients (eight women, three men), 20–65 years of age were studied 2.5–11.3 years after stereotactic radiosurgery (isocentre dose 50–100 Gy lesion−1) and compared with healthy controls.

Main outcome measures.  Spontaneous GH secretion was evaluated as 12‐h night GH profiles. Stimulated GH responses were evaluated in seven of 11 patients using arginine–insulin and GHRH tests. Serum IGF‐I levels were measured in fasting serum morning samples.

Results.  All patients except one displayed blunted nocturnal GH profiles. After arginine–insulin challenge, six of seven patients displayed low GH release. GH response was higher after GHRH injection compared with both the response to arginine–insulin and to the maximum GH levels in the nocturnal profiles. Seven patients had an IGF‐I standard deviation score (SDS) within the normal range for age. Serum IGF‐I values were correlated to mean GH values in the 12‐h night profile (r = 0.67, P < 0.05) and both these variables were negatively correlated to time elapse since last radiation treatment (r = −0.64, P < 0.05 and r = −0.78, P < 0.05, respectively).

Conclusions.  Our patients with Cushing's disease evaluated several years after stereotactic radiosurgery as the primary and only treatment, demonstrated severely blunted spontaneous GH secretion and GH response to arginine–insulin. A disturbed regulation at the hypothalamic level was suggested as mechanism for this. Noteworthy is that serum IGF‐I values correlated to the mean values of the 12‐h GH profile.
Septal alcohol ablation and Heyde's syndrome revisited
Authors: Riis Hansen P. , Hassager C.
Published: December 2004

Abstract. Riis Hansen P, Hassager C (Gentofte University Hospital, Hellerup, Denmark). Septal alcohol ablation and Heyde's syndrome revisited. (Case Report). J Intern Med 2003; 253: 490–491.

We describe a 57‐year‐old male with hypertrophic obstructive cardiomyopathy and occult blood loss. Septal alcohol ablation reduced the left ventricular outflow tract obstruction and eliminated recurrent bleeding. The case resembles Heyde's syndrome, i.e. the association between occult gastrointestinal bleeding and aortic valve stenosis, where resolution of blood loss after corrective aortic valve surgery has also been reported.
Multiple risk factor intervention reduces cardiovascular risk in hypertensive patients with echolucent plaques in the carotid artery
Authors: Schmidt C. , Fagerberg B. , Wikstrand J. , Hulthe J. ,   ON BEHALF OF THE RIS STUDY GROUP
Published: December 2004

Abstract.  Schmidt C, Fagerberg B, Wikstrand J, Hulthe J on behalf of the RIS Study Group (Wallenberg Laboratory for Cardiovascular research, Sahlgrenska University Hospital, Göteborg University, Gothenburg, Sweden for the RIS Study Group*). Multiple risk factor intervention reduces cardiovascular risk in hypertensive patients with echolucent plaques in the carotid artery. J Intern Med 2003; 253: 430–438.

Objective.  In a previously published randomized 6‐year study we observed that multiple risk factor intervention reduced cardiovascular risk in high‐risk hypertensive men, and that this effect was confined to patients with carotid artery plaques. Hypothetically, the underlying mechanism might have been a stabilization of echolucent, instable, rupture‐prone plaques. The aim of the present study was to examine plaque characteristics by B‐mode ultrasound in the previous intervention study, and also to investigate the relationship between plaque characteristics at baseline and cardiovascular events during the 6‐year follow‐up in the two randomization groups.

Methods.  High resolution B‐mode ultrasound was used to characterize plaque echogenicity in four subgroups – dominantly echolucent, substantially echolucent, dominantly echogenic, and uniformly echogenic.

Results.  In the usual care group 17 of 32 (53%) patients with echolucent plaques at baseline suffered from a combined end‐point (any death or nonfatal myocardial infarction or nonfatal stroke) during follow‐up compared with seven of 28 (25%) patients in the intervention group (P = 0.036). The corresponding numbers in patients with echogenic plaques were n = 4/13 (31%) and n = 4/17 (24%), respectively (NS). In the usual care group 11 of 33 (33%) patients with no plaques suffered from a combined end‐point during follow‐up compared with 11 of 30 (37%) in the intervention group.

Conclusion.  Our data indicate that the beneficial effect of the multiple risk intervention programme was confined to those patients with echolucent plaques. The data have to be confirmed with a large‐scale trial.
Congestive heart failure is associated with the rate of bone loss
Authors: Nishio K. , Mukae S. , Aoki S. , Itoh S. , Konno N. , Ozawa K. , Satoh R. , Katagiri T.
Published: December 2004

Abstract.  Nishio K, Mukae S, Aoki S, Itoh S, Konno N, Ozawa K, Satoh R, Katagiri T (School of Medicine Showa University, Hatanodai, Shinagawa‐ku, Tokyo, Japan). Congestive heart failure is associated with the rate of bone loss. J Intern Med 2003; 253: 439–446.

Aims.  To characterize relationships between mineral homeostasis, bone turnover, bone mass, and congestive heart failure (CHF), we evaluated 75 women with mild to moderate CHF.

Methods and results.  We examined the association in annual rate of change in spinal bone mineral density (BMD) with polymorphism of the vitamin D receptor (VDR) gene. Compared with the control group, the CHF group had reduced left ventricular ejection fraction (LVEF: 68.2 ± 7.5% vs. 60.2 ± 12.9%; P = 0.0249), human atrial natriuretic peptide (hANP) was elevated (hANP: 10.7 ± 4.7 pmol L−1 vs. 25.8 ± 24.2 pmol L−1; P = 0.001) and had lower peak VO2 (22.3 ± 7.5 mL kg−1 min−1 vs. 15.8 ± 7.4 mL kg−1 min−1; P = 0.0429). The CHF patients with the VDR FF genotype had a significantly high annual rate of decrease in BMD. In the CHF patients with the VDR FF genotype, urinary calcium excretion (FECa) was elevated (1.40 ± 0.91% vs. 2.39 ± 1.40%; P = 0.028), and serum bone‐type alkaline phosphatase (B‐ALP) was reduced (62.6 ± 13.7 IU L−1 vs. 47.0 ± 18.6 IU L−1; P = 0.0123). Also, FECa was correlated positively with furosemide dose (R = 0.881; P = 0.0087) and hANP concentrations (R = 0.635; P = 0.0147) and negatively with ΔBMD (R = 0.72; P = 0.044) in the CHF patients with the VDR FF genotype.

Conclusion.  The CHF patients with the VDR FF genotype have higher rates of bone loss. These patients may need to increase their calcium intake and BMD may need to be followed more carefully over time.
Intermittent versus on‐demand use of a very low calorie diet: a randomized 2‐year clinical trial
Authors: Lantz H. , Peltonen M. , Ågren L. , Torgerson J. S.
Published: December 2004

Abstract.  Lantz H, Peltonen M, Ågren L, Torgerson JS (Sahlgrenska University Hospital, Göteborg, Sweden). Intermittent versus on‐demand use of a very low calorie diet: a randomized 2‐year clinical trial. J Intern Med 2003; 253: 463–471.

Objectives.  To compare two different very low calorie diet (VLCD)‐based weight maintenance strategies.

Design and setting.  A randomized 2‐year clinical trial performed at the Department of Body Composition and Metabolism, Sahlgrenska University Hospital, Sweden.

Subjects.  A total of 334 patients, body mass index (BMI) >30 kg m−2, aged 18–60 years.

Interventions.  All the patients started with 16 VLCD weeks. Subjects in the intermittent group were then scheduled to use VLCD for 2 weeks every third month, whilst patients in the on‐demand group were instructed to use VLCD whenever their body weight passed an individualized cut‐off level. Irrespective of the treatment group, all the subjects were recommended a hypocaloric diet during VLCD‐free periods.

Main outcome measures.  Changes in body weight, body composition, anthropometric variables and cardiovascular risk factors.

Results.  Completers in both groups maintained highly significant weight losses after 2 years: 7.0 ± 11.0 kg (6.2 ± 9.5%) in the intermittent group and 9.1 ± 9.7 kg (7.7 ± 8.1%) in the on‐demand group (P < 0.001, ns between groups). Male completers in the on‐demand group lost significantly more weight than men in the intermittent group, 14.5 ± 11.0 kg vs. 4.0 ± 10.5 kg, respectively (P < 0.01). Most cardiovascular risk factors improved during the first year, whilst anthropometric measures, insulin, HDL‐ and LDL‐cholesterol were also significantly improved after 2 years of treatment.

Conclusion.  Clinically significant weight reductions were achieved after 2 years of VLCD‐based treatment. The structure of VLCD treatment during the maintenance phase did not affect weight loss in the total study population, whilst male subjects might benefit from the VLCD on‐demand strategy.
Insulinoma presenting with hyperandrogenism: a case report and a literature review
Authors: Stanciu I. N. , Pitale S. , Prinz R. A. , Jakate S. , Webb G. , Steiner D. , Braithwaite S. , Gordon D. , Emanuele M. A.
Published: December 2004

Abstract. Stanciu IN, Pitale S, Prinz RA, Jakate S, Webb G, Steiner D, Braithwaite S, Gordon D, Emanuele MA (Loyola University Medical Center and Hines VA Hospital, Maywood IL, USA; Rush Presbyterian St Luke's Medical Center, Chicago, IL, USA; University of Chicago, Chicago, IL; and UNC Diabetes Care Center, Durham, NC, USA). Insulinoma presenting with hyperandrogenism: a case report and a literature review (Case Report). J Intern Med 2003; 253: 484–489.

An 18‐year‐old woman presented with a 6‐month history of amenorrhoea and hyperandrogenism. Three months later she developed several episodes of fasting hypoglycaemia and was subsequently diagnosed with an insulinoma. Hyperinsulinaemia was observed in association with an elevated serum testosterone level. Surgical removal of the insulinoma resulted in resolution of the clinical and biochemical features of the polycystic ovarian syndrome (PCOS). Polycystic ovarian syndrome is unusual in a patient having an insulinoma. The rarity of this association may be the result of the late age of onset of this type of tumour, intermittent secretion of excessive insulin by the tumour, the degree of hyperinsulinism or other factors extrinsic to the insulin receptor that may facilitate insulin activity. However, we could not discover how our patient differs in having had PCOS from the majority of women with insulinoma who do not. If other patients with insulinoma are subsequently found to have hyperandrogenism, then this tumour might be added to the differential diagnosis of causes of anovulatory cycles and hyperandrogenaemia, although rare the association would be uncommon.
Benefit and risk perceptions in transfusion medicine: blood and blood substitutes
Authors: Lowe K. C. , Ferguson E.
Published: December 2004

Abstract.  Lowe KC, Ferguson E (University of Nottingham, Nottingham, UK). Benefit and risk perceptions in transfusion medicine: blood and blood substitutes (Minisymposium). J Intern Med 2003; 253: 498–507.

Blood transfusion is a remarkably safe, routine procedure in clinical medicine. However, little attention has focused on the perceptions of risk associated with the receipt of blood, blood products or ‘blood substitutes’. It is pertinent to ask (i) what key stakeholder groups know about transfusion, (ii) how safe they perceive blood/blood products to be, (iii) how the latter information might influence their own and others' perceptions of risk linked to transfusion, and (iv) the extent to which approved blood substitutes might be preferred over autologous or donor blood. An appreciation of what stakeholders perceive to be the benefits and risks of the receipt of blood and blood substitutes will inform future transfusion strategies. To obtain such information, a programme of research has been initiated at Nottingham. Surveys have targeted key stakeholder groups, namely, UK adult blood donors and nondonors, anaesthetists, general practitioners and health care journalists. Experimental studies examining message framing and cueing have also been conducted with undergraduate students. Such research will improve misunderstandings about current issues associated with blood donation and transfusion against the backdrop of changing public trust of health care professionals and attitudes and expectations on blood safety and benefits of blood substitutes.
Serum uric acid in traditional Pacific Islanders and in Swedes
Authors: Lindeberg S. , Cordain L. , Råstam L. , Ahrén B.
Published: December 2004

Background.  In some western populations, increased serum uric acid has been positively associated with cardiovascular disease, possibly because hyperuricaemia could be an untoward part of the insulin‐resistant metabolic syndrome. However, there is evidence that uric acid is a free radical scavenger capable of inhibiting LDL oxidation. Amongst the traditional horticulturalists of Kitava, Trobriand Islands, Papua New Guinea, cardiovascular disease, hypertension, hyperinsulinaemia and abdominal obesity are absent or rare. In contrast, serum triglycerides are similar to Swedish levels.

Objective.  To compare serum uric acid between nonwesternized and westernized populations.

Methods.  Fasting levels of serum uric acid were measured cross‐sectionally in 171 Kitavans aged 20–86 years and in 244 randomly selected Swedish subjects aged 20–80 years.

Results.  There were small differences in serum uric acid between the two populations, although a slight increase with age was found only in Swedish males (r = 0.20; P = 0.03) and females (r = 0.36; P < 0.0001). Above 40 years of age, uric acid was approximately 10% lower in Kitavans, a difference which was statistically significant only in males, possibly because of the limited number of females. Regarding hyperuricaemia, two Kitavan males had uric acid above 450 μmol L−1 whilst none of the females was above 340 μmol L−1. Amongst the Swedish subjects, five of 117 males and 19 of 127 females had hyperuricaemia according to these definitions.

Conclusion.  The rather similar uric acid levels between Kitava and Sweden imply that uric acid is of minor importance to explain the apparent absence of cardiovascular disease in Kitava.
Oral snuff impairs endothelial function in healthy snuff users
Authors: Rohani M. , Agewall S.
Published: December 2004

Aims.  Oral snuff is a less dangerous drug and therefore a good substitute for cigarette smoking. The aim of this study was to determine whether oral moist snuff induces acute endothelial dysfunction. Previous studies have shown that endothelial dysfunction predicts cardiovascular morbidity.

Methods and results.  Twenty healthy middle‐aged snuff users underwent ultrasound assessment of endothelial‐dependent flow‐mediated dilatation (FMD) of the brachial artery. FMD measurements were performed in duplicate at baseline and then 20 and 35 min after the administration of 1 g portion‐bag‐packed moist snuff or placebo. Ten of the subjects were examined twice according to a randomized cross‐over procedure, once with snuff and once with placebo. All images were arbitrarily analysed off‐line by a single blinded observer. FMD values declined significantly from 3.4 ± 2.0% to 2.3 ± 1.3% (P < 0.05) 35 min after the administration of 1 g oral moist snuff. Heart rate, systolic and diastolic blood pressure increased significantly (P < 0.05) after snuff administration. All parameters remained unchanged after placebo.

Conclusions.  Oral moist snuff significantly impaired FMD of the brachial artery. As endothelial dysfunction predicts cardiovascular morbidity, use of oral snuff should be discouraged.
Body composition and bone mineral density in long‐standing type 1 diabetes
Authors: Ingberg C.‐M. , Palmér M. , Åman J. , Arvidsson B. , Schvarcz E. , Berne C.
Published: December 2004

Objectives.  To study body composition and bone mineral density (BMD) in adult patients with long‐standing type 1 diabetes mellitus.

Research design and methods.  In a population‐based study, body composition and BMD were evaluated by dual energy X‐ray absorptiometry in 38 patients with type 1 diabetes since childhood, compared with 38 age‐ and sex‐matched controls. The mean age was 43 years (range 33–55 years) and the mean duration of diabetes was 33 years (range 28–37 years).

Results.  Besides a tendency to a reduced abdominal fat mass in diabetic males, no difference was observed in fat mass, muscle mass, or BMD between the groups. Significant correlations were found between insulin dosage and whole body fat mass in diabetic females and between serum cholesterol levels and abdominal fat mass in diabetic males.

Conclusion.  Patients with long‐standing type 1 diabetes with onset in childhood and adolescence seem to show only minor differences in body composition and no difference in BMD compared with closely matched healthy controls.
Substance P induces activation, adherence and migration of equine eosinophils
Authors: Foster A. P. , Cunningham F. M.
Published: December 2004

The tachykinin, substance P (SP), affects eosinophil function by direct and indirect mechanisms and has been shown to cause equine eosinophils to adhere to vascular endothelium and to release cytokines that increase cell adherence. The aim of this study was to determine whether SP could act directly on equine eosinophilsin vitro. Eosinophil activation was also compared in cells from normal ponies and those with insect hypersensitivity as SP may be released in the skin of hypersensitive animals. SP caused equine eosinophils to adhere, migrate and produce superoxide, although high concentrations were required to produce these effects [10 ± 2% adherence, 45 ± 20 cells/0.3 mm2and 48 ± 7 nmol (of reduced cytochrome C)/106cells, respectively, at 3 × 10−4 m]. That the 7–11, but not the 1–7, amino acid fragment of SP caused superoxide production, suggested the effects of SP were receptor mediated. Eosinophils from hypersensitive ponies produced more superoxide in response to SP, but not phorbol myristate acetate or histamine, over the concentration range tested when compared with cells from normal ponies. The data obtained in this study suggest that although SP can directly activate equine eosinophils, in view of the high concentrations required, such actions may be of less relevance physiologically than other SP‐mediated effects.
Pharmacodynamics, chiral pharmacokinetics and PK–PD modelling of ketoprofen in the goat
Authors: Arifah A. K. , Landoni M. F. , Lees P.
Published: December 2004

There have been few studies of the pharmacodynamics of nonsteroidal antiinflammatory drugs (NSAIDs) using PK–PD modelling, yet this approach offers the advantage of defining the whole concentration–effect relationship, as well as its time course and sensitivity. In this study, ketoprofen (KTP) was administered intravenously to goats as the racemate (3.0 mg/kg total dose) and as the single enantiomers,S(+) KTP andR(−) KTP (1.5 mg/kg of each). The pharmacokinetics and pharmacodynamics of KTP were investigated using a tissue cage model of acute inflammation. The pharmacokinetics of both KTP enantiomers was characterized by rapid clearance, short mean residence time (MRT) and low volume of distribution. The penetration ofR(−) KTP into inflamed (exudate) and noninflamed (transudate) tissue cage fluids was delayed but area under the curve values were only slightly less than those in plasma, whereasMRTwas much longer. TheS(+) enantiomer of KTP penetrated less readily into exudate and transudate. Unidirectional inversion ofR(−) toS(+) KTP occurred. Both rac‐KTP and the separate enantiomers produced marked inhibition of serum thromboxane B2(TxB2) synthesis (ex vivo) and moderate inhibition of exudate prostaglandin E2(PGE2) synthesis (in vivo); pharmacodynamic variables forS(+) KTP wereEmax(%) = 94 and 100; IC50(μg/mL) = 0.0033 and 0.0030;N = 0.45 and 0.58, respectively, whereEmaxis the maximal effect, IC50the plasma drug concentration producing 50% ofEmaxandNthe slope of log concentration/effect relationship. The IC50ratio, serum TxB2:exudate PGE2was 1.10. Neither rac‐KTP nor the individual enantiomers suppressed skin temperature rise at, or leucocyte infiltration into, the site of acute inflammation. These data illustrate for KTP shallow concentration–response relationships, probable nonselectivity of KTP for cyclooxygenase (COX)‐1 and COX‐2 inhibition and lack of measurable effect on components of inflammation.
Effects of midazolam and sarmazenil on the equine electroencephalogram during anaesthesia with halothane in oxygen1
Authors: Johnson C. B. , Bloomfield M. , Taylor P. M.
Published: December 2004

The electroencephalographic (EEG) effects of a rapid infusion of midazolam and sarmazenil following a bolus of midazolam were investigated in eight Welsh mountain ponies anaesthetized with 0.8% halothane in oxygen. The peak plasma concentration of midazolam was 2.13 ± 0.34 ng/mL (mean ± SD) occurring 5 min after the start of the infusion. Sarmazenil concentrations were not measured. The 95% spectral edge frequency of the EEG decreased by a maximum of 39.8 ± 15.8%, 10 min after the start of the midazolam infusion. No changes were seen in median frequency of the EEG or the second differential of the middle latency auditory evoked response. The variability of median frequency (F50) and spectral edge frequency (F95) were reduced by a maximum of 80 ± 7 and 84 ± 7%, respectively. The sarmazenil infusion reversed the effects of a bolus of midazolam on the variability of F50 and the magnitude and variability of F95. The second differential of the middle latency auditory evoked potential (DD) was increased by 56.4 ± 69.3%, 10 min after the start of the sarmazenil infusion. There were no statistically significant differences in EEG variables between the baseline of the midazolam infusion and 10 min after the start of the sarmazenil infusion. Midazolam infusion resulted in specific and unusual changes in the EEG of anaesthetized ponies. These changes were completely reversed by sarmazenil infusion. The data presented suggest that sarmazenil has no intrinsic effect upon the EEG.
Renal blood flow in hypercholesterolemic pigs is increased by chronic antioxidant treatment
Authors: De Nigris F. , Demontis M. P. , Rodriguez‐Porcel M. , Anania V. , Lerman L. O. , Napoli C.
Published: December 2004

Oxygen radical species can influence vascular tone, and antioxidants may have hemodynamic and vascular effects. To date, the vascular effects of chronic intervention with a combination of antioxidant vitamins E and C on renal blood flow (RBF) in hypercholesterolemia (which increases oxidative stress) have not been fully defined. The aim of this intervention study was to explore the involvement of increased oxidative stress in pig RBF disturbance by using chronic dietary antioxidant vitamin intervention. Responses of RBF to the acetylcholine (Ach) were measured in vivo using electron beam computed tomography (EBCT). Acetylcholine significantly increased RBF in normal and hypercholesterolemic + vitamins (P < 0.05 for both), but not in hypercholesterolemic pigs (P=0.1). In normocholesterolemic + vitamins pigs, Ach infusion did not induce any further increase in RBF, but RBF was similar to that observed in normal and hypercholesterolemic + vitamins under the same conditions, and tended to be higher than in hypercholesterolemic pigs (P=0.06). Thus, antioxidants improve RBF in hypercholesterolemic pigs and this effect may help to prevent renal diseases and hypertension in animals.
A randomized trial to assess the efficacy of interferon alpha in combination with ribavirin in the treatment of interferon alpha nonresponders with chronic hepatitis C: superior efficacy of high daily dosage of interferon alpha in genotype 1
Authors: Tassopoulos N. C , Tsantoulas D. , Raptopoulou M. , Vassiliadis T. , Kanatakis S. , Paraskevas E. , Vafiadis I. , Avgerinos A. , Tzathas C. , Manolakopoulos S. , Ketikoglou I. , Aggelis P. , Goritsas K. , Giannoulis G. , Hatzis G G. , Thomopoulos K. , Akriviadis E. , Sypsa V. , Hatzakis A.
Published: December 2004

Summary. A randomized trial was conducted to assess the efficacy of daily (QD) or thrice weekly (TIW) administration of interferon‐α (IFN) in high doses in combination with ribavirin (1.0–1.2 g/day) in patients with chronic hepatitis C (CHC) who were nonresponders to previous IFN monotherapy. Interferon was administered as 10 MU IFN (QD or TIW) for 4 weeks, followed by 5 MU IFN (QD or TIW) for 20 weeks, and then by 3 MU IFN (QD or TIW) for 24 weeks. Sustained virological response (SVR) was evaluated in 142 patients who received at least one dose of medication. One‐fourth of the patients achieved SVR, 26% of those treated with IFN QD and 25% of those treated with IFN TIW (P = 0.85). For genotype 1 patients, SVR rates were 32.4 and 15.8% for IFN QD and IFN TIW, respectively, whereas for genotype non‐1 patients the corresponding SVR rates were 20.6 and 36.4%, respectively (test of homogeneity: P = 0.031). This finding was further confirmed by multivariate logistic regression analysis where a statistically significant interaction (P = 0.012) was found between treatment and HCV genotype indicating that the IFN QD regimen was superior to IFN TIW among genotype 1 patients whereas, among genotype non‐1 patients, the two treatments were similar (odds ratio of SVR in IFN QD vs IFN TIW: 3.33 among genotype 1 patients, 95% CI: 1.00–11.14). In conclusion, re‐treatment of patients not responding to previous IFN monotherapy with a combination of high daily dose of IFN with ribavirin may be beneficial for genotype 1 infected patients.
High sustained virological response in chronic hepatitis C by combining induction and prolonged maintenance therapy
Authors: Vrolijk J. M. , Bekkering F. C. , Brouwer J. T. , Hansen B. E. , Schalm S. W.
Published: December 2004

Summary.  Chronic hepatitis C patients with genotype 1 infection, liver cirrhosis, high viral load, or those who have not responded to anti‐viral treatment in the past have limited chances of clearing the virus, even with pegylated interferon–ribavirin therapy. In this study we treated such patients with a treatment schedule that combines high dose induction Interferon (IFN), prolonged daily IFN and ribavirin treatment. Twenty‐four consecutive patients were included in this study with either genotype 1 infection, cirrhosis, previous non‐response to IFN or a combination of these poor‐response characteristics. Patients were treated with 10 million units (MU) of IFN daily for 4 weeks followed by 5 MU/day until week 24, 3 MU/day until week 52 and 3 MU thrice weekly until week 76 in combination with 1–1.2 g ribavirin daily. HCV RNA levels were assessed weekly until week 4 and at least once every 3 months thereafter, by a validated assay with a detection limit below 500 copies/mL. Both intention to treat (ITT) and per protocol (PP) analysis showed a high sustained virological response (ITT 67%, PP 80%). A virological response occurred rapidly (before 8 weeks of treatment) in all patients with a sustained response. Relapse after stopping therapy was observed in only 5%. Side‐effects were observed frequently, and six patients had to be hospitalized. With this new treatment regimen that combines induction‐ and prolonged daily interferon treatment with ribavirin it seems possible to eliminate hepatitis C virus in the majority of patients that have an a priori limited chance of sustained response. Further clinical evaluation of intensive interferon and ribavirin combination therapy (now also including PEG‐interferon) is recommended in centres that can provide close patient monitoring and experienced hepatological support.
Alarming prevalence of hepatitis‐B infection among the Jarawas – a primitive Negrito tribe of Andaman and Nicobar Islands, India
Authors: Murhekar M. V. , Murhekar K. M. , Sehgal S. C.
Published: December 2004

Summary. Jarawas, a classical hunter–gatherer tribe of Andaman and Nicobar islands have lived in isolation for several centuries. It is only recently have they started to come in contact with the outsiders, shedding their hostility. Since then, several disease outbreaks have been reported amongst them. Screening of sera samples collected during one such outbreak showed very high endemicity of hepatitis‐B infection with over 60% of the individuals positive for hepatitis B surface antigen (HBsAg). The rates of HBsAg observed among the Jarawas are probably the highest ever reported in the world and warrant immediate control measures which would prevent further spread of this infection in the community.
Evidence of patient‐to‐patient transmission of hepatitis C virus through contaminated intravenous anaesthetic ampoules
Authors: Tallis G. F. , Ryan G. M. , Lambert S. B. , Bowden D. S. , McCaw R. , Birch C. J. , Moloney M. , Carnie J. A. , Locarnini S. A. , Rouch G. J. , Catton M. G.
Published: December 2004

Summary. Two separate cases of acute hepatitis C virus (HCV) infection following medical procedures, arthroscopy and colonoscopy, are reported. In both episodes, patient risk factors were reviewed, and staff and other patients' sera were tested for HCV antibodies and RNA. HCV RNA positive samples were genotyped, sequenced, and subjected to phylogenetic analysis. No risk factors for HCV infection were identified for either case except for medical procedures. HCV RNA positive patients were identified preceding both cases on the respective theatre lists. HCV infection in a second low risk patient was also identified. Nucleic acid sequencing and phylogenetic analysis of HCV from the two putative source patients and the three recipient patients demonstrated a high degree of relatedness respectively. The results suggest that patient‐to‐patient transmission occurred in both episodes via contamination of intravenous anaesthetic ampoules with HCV used on multiple patients. Injectable medication ampoules should not be used for more than one patient.
Analysis of clinical, biochemical and viral factors associated with early relapse after lamivudine treatment for hepatitis B e antigen‐negative chronic hepatitis B patients in Taiwan
Authors: Huang Y.‐H. , Wu J.‐C. , Chang T.‐T. , Sheen I.‐J. , Lee P.‐C. , Huo T.‐I. , Su C.‐W. , Wang Y.‐J. , Chang F.‐Y. , Lee S.‐D.
Published: December 2004

Summary.  The efficacy of lamivudine for HBeAg‐negative chronic hepatitis B (CHB) Chinese patients has not been fully investigated. The role of the Hepatitis B virus (HBV) genotype on the treatment effect of lamivudine is controversial. Thirty‐two consecutive patients with HBeAg‐negative CHB were enrolled. All patients were treated with lamivudine 100 mg once daily of 7–12 months duration. The mean total period of follow‐up since entry for all patients was 24 ± 3.5 months. HBV genotypes were classified by polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) and verified by sequencing. Precore (G1896A) and basic core promoter (BCP, A1762T & G1764A) mutations were determined by PCR and direct sequencing. Twenty‐one (65.6%) patients were infected by genotype B and, 11 (34.4%) by genotype C. G1896A was predominant in genotype B infected patients (95.2%vs 63.6%, P = 0.037). At the end of treatment, 31 (96.8%) and 14 (43.8%) patients achieved biochemical and virological responses, respectively. The biochemical and virological response rates were 40.6 and 0% at 12 months after treatment. Eighteen (56.3%) patients had biochemical relapse within 12 months after withdrawal of lamivudine. By multivariate analysis, the pretreatment serum level of HBV DNA ≥12 Meq/mL was the only factor associated with early biochemical relapse (Odds ratio = 9.333, 95% CI = 1.497 ∼ 58.197, P = 0.017). In conclusion, the virological effect of lamivudine for HBeAg‐negative CHB is transient. Most patients had biochemical relapse within 12 months after lamivudine treatment regardless of HBV genotype. A high pretreatment viral load is the determinant for early biochemical relapse.
Lamivudine treatment during pregnancy to prevent perinatal transmission of hepatitis B virus infection
Authors: van Zonneveld M. , van Nunen A. B. , Niesters H. G. M. , de Man R. A. , Schalm S. W. , Janssen H. L. A.
Published: December 2004

Summary.  Vertical transmission of hepatitis B virus (HBV) can occur occasionally despite vaccination of the child. This vaccination breakthrough has been associated with high maternal viraemia. We treated eight highly viraemic (HBV‐DNA ≥ 1.2 × 109 geq/mL) mothers with 150 mg of lamivudine daily during the last month of pregnancy. HBV‐DNA, hepatitis B surface antigen (HBsAg), anti‐HBs and anti‐HBc of their offspring were measured at birth and at 3, 6 and 12 months, respectively. Twenty‐four children, born to untreated HBsAg‐positive mothers with HBV‐DNA levels ≥1.2 × 109 geq/mL served as historical controls. All children received passive‐active immunization at birth and were followed‐up for 12 months. In the lamivudine group one of the eight children (12.5%) was still HBsAg and HBV‐DNA positive at the age of 12 months. All other children seroconverted to anti‐HBs and maintained seroprotection. In three children, HBV‐DNA was temporarily detected by polymerase chain reaction. In the untreated historical control group, perinatal transmission occurred in seven of 25 children (28%). In highly viraemic HBsAg‐positive mothers, reduction of viraemia by lamivudine therapy in the last month of pregnancy may be an effective and safe measure to reduce the risk of child vaccination breakthrough. This approach should be evaluated in a large controlled trial.
Overexpression of a DEAD box/RNA helicase protein, rck/p54, in human hepatocytes from patients with hepatitis C virus‐related chronic hepatitis and its implication in hepatocellular carcinogenesis
Authors: Miyaji K. , Nakagawa Y. , Matsumoto K. , Yoshida H. , Morikawa H. , Hongou Y. , Arisaka Y. , Kojima H. , Inoue T. , Hirata I. , Katsu K. , Akao Y.
Published: December 2004

Summary. Hepatitis C virus (HCV) infection is the most common cause of chronic hepatitis, which frequently progresses to hepatocellular carcinoma. The pathogenesis of its persistent infection and tumour progression has not been fully characterized yet. The RCK gene was previously cloned at the breakpoint of the t(11;14)(q23;q32) chromosome translocation observed in human B‐cell lymphoma cell line RC‐K8. The RCK protein, rck/p54, which is a 54‐kDa cytoplasmic protein belonging to the DEAD box/RNA helicase family, is considered to facilitate the translation of mRNA(s) of genes for cell proliferation and malignant transformation not only in B‐cell lymphomas having the t(11;14) translocation but also in other solid tumours. The aim of this work was to examine the involvement of rck/p54 in carcinogenesis of hepatocellular carcinoma from HCV‐related chronic hepatitis. We examined the expression of rck/p54 in 29 cases of HCV‐related chronic hepatitis and eight cases of hepatocellular carcinoma by immunohistochemistry and Western blot analysis. Twenty‐six of 29 cases with HCV‐related chronic hepatitis and all cases with hepatocellular carcinoma tested overexpressed rck/p54 protein. The expression of rck/p54 was lowered by treatment with IFN‐α in two cases who showed the decrease in HCV RNA levels. These findings suggest that rck/p54 protein is possibly involved in the replication of HCV genomes in hepatocytes and in tumourigenesis of hepatocellular carcinomas.
Peginterferon α‐2a (40 kDa): an advance in the treatment of hepatitis B e antigen‐positive chronic hepatitis B
Authors: Cooksley W. G. E. , Piratvisuth T. , Lee S.‐D. , Mahachai V. , Chao Y.‐C. , Tanwandee T. , Chutaputti A. , Chang W. Yu , Zahm F. E. , Pluck N.
Published: December 2004

Current therapies for chronic hepatitis B (CHB) have a number of limitations, and better treatment options are needed. Peginterferon α‐2a (40 kDa) is superior to conventional interferon α‐2a in the treatment of chronic hepatitis C. This is the first report on peginterferon α‐2a (40 kDa) in the treatment of CHB. In this phase II study, 194 patients with CHB not previously treated with conventional interferon‐α were randomized to receive weekly subcutaneous doses of peginterferon α‐2a (40 kDa) 90, 180 or 270 μg, or conventional interferon α‐2a 4.5 MIU three times weekly. Twenty‐four weeks of therapy were followed by 24 weeks of treatment‐free follow‐up. All subjects were assessed for loss of hepatitis B e antigen (HBeAg), presence of hepatitis B antibody (anti‐HBe), suppression of hepatitis B virus (HBV) DNA, and normalization of serum alanine transaminase (ALT) after follow‐up.

At the end of follow‐up, HBeAg was cleared in 37, 35 and 29% of patients receiving peginterferon α‐2a (40 kDa) 90, 180 and 270 μg, respectively, compared with 25% of patients on conventional interferon α‐2a. The combined response (HBeAg loss, HBV DNA suppression, and ALT normalization) of all peginterferon α‐2a (40 kDa) doses combined was twice that achieved with conventional interferon α‐2a (24%vs 12%; P = 0.036). All treatment groups were similar with respect to frequency and severity of adverse events. These results indicate that peginterferon α‐2a (40 kDa) is superior in efficacy to conventional interferon α‐2a in chronic hepatitis B based on clearance of HBeAg, suppression of HBV DNA, and normalization of ALT.
A non‐invasive technique for identifying individual badgers Meles meles
Authors: DIXON DAVID R.
Published: December 2004

Individual badgers Meles meles can be reliably identified in the field on the basis of variation in the appearance of the tail. Tests of the technique using video surveillance demonstrated that in 95% of instances individuals were identified correctly on the basis of tail patterns. It is possible that tail patterns and posture may be a significant means of communication in this species.
Small mammals in new farm woodlands
Authors: MOORE N. P. , ASKEW N. , BISHOP J. D.
Published: December 2004

A number of recently planted farm woodlands, along with adjacent agricultural land and hedgerows were surveyed using live traps to compare their importance for small mammals. Small mammal numbers were far higher in newly planted woodlands than in both hedgerows and agricultural land. Seven species were trapped in farm woods compared with five in hedgerows and two in agricultural land. The most frequently trapped species in the establishing woodlands was the harvest mouse Micromys minutus, followed by the wood mouse Apodemus sylvaticus. The potential importance of newly planted farm woodlands for small mammals is discussed.