bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of force–velocity relationships of vastus lateralis muscle in isokinetic and in stretch‐shortening cycle exercises
Authors: Finni T. , Ikegawa S. , Lepola V. , Komi P. V.
Published: December 2004

Aim:  This study investigated the force–velocity characteristics of the vastus lateralis (VL) muscle fascicle and muscle–tendon unit (MTU) in isolated lengthening and shortening actions, and during natural movement.

Methods:  Four subjects performed maximal eccentric and concentric knee extensions (60, 120 and 180° s−1). Unilateral counter movement jumps and drop jumps in the sledge apparatus served as natural movements. Vastus lateralis fascicle lengths were determined from ultrasonography. In vivo patellar tendon forces (PTF) were measured with an optic fibre technique. Patellar tendon force was derived to VL force according to the cross‐sectional area of the muscle. Force in the direction of fascicle was calculated by dividing the VL force value by cosine of the fascicle angle. Force–velocity curves were constructed using angle specific values from isokinetic knee extensions (classical curve) and using instantaneous values from jumping exercises.

Results:  In the fascicle level, we did not find an enhanced muscle force in the jumping performances as compared with the classical force–velocity curve. In the muscle–tendon level, the instantaneous force at high muscle–tendon shortening speeds exceeded that extrapolated according to Hill's equation.

Conclusion:  This difference between fascicle and muscle–tendon behaviour suggests that the neural input in fast stretch‐shortening cycle exercises minimizes the length changes in muscle fascicle and enables storage and recoil of energy from elastic components that contributes to the enhanced mechanical output of the MTU during the push‐off phase.
Effect of intensive exercise‐induced testicular gametogenic and steroidogenic disorders in mature male Wistar strain rats: a correlative approach to oxidative stress
Authors: Manna I. , Jana K. , Samanta P. K.
Published: December 2004

Aims:  In order to investigate the effects of intensive exercise on reproductive dysfunctions in relation to oxidative stress, a total of 12 male rats (age: 3 months, weight: 127 ± 2.86 g) were randomly divided into: (1) control group (CG, n = 6) and (2) experimental group (Exp. G, n = 6).

Methods:  An exercise protocol of 3 h swimming day−1, 5 days week−1 was followed for 4 weeks in Exp. G, with no exercise in CG. All the animals were killed; blood, testes and the accessory sex organs were collected for estimation of different parameters.

Results:  A significant diminution (P < 0.001) was noted in testicular Δ5, 3β‐hydroxy‐steroid dehydrogenase (Δ5, 3β‐HSD), 17β‐hydroxy steroid dehydrogenase (17β‐HSD); plasma levels of testosterone, luteinizing hormone (LH); preleptotine spermatocytes (pLSc), midpachytene spermatocytes (mPSc) and stage 7 spermatids (7Sd); with no significant alteration in follicle stimulating hormone (FSH) and spermatogoia A (Asg) after intensive exercise. A significant elevation (P < 0.001) in malondialdehyde (MDA) and conjugated dienes (CD) along with significant reduction (P < 0.001) in glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), glutathione‐s‐transferase (GST) and peroxidase were found in testes of Exp. G. Moreover, the somatic index of testes and accessory sex organs were also decreased significantly (P < 0.001) after exercise. High correlations have been found in 17 β‐HSD with CAT (r = 0.90, P < 0.05) and peroxidase (r = 0.83, P < 0.05), epididymal somatic index with CD (r = −0.91; P < 0.05) and GSH (r = 0.84, P < 0.05).

Conclusion:  The present study focused an chronic intensive exercise‐induced oxidative stress that may cause dysfunctions in male reproductive system including steroidogenesis and spermatogenesis.
Mathematical analysis of atelectasis formation in middle ears with sealed ventilation tubes
Authors: Fink N. , Ar A. , Sadé J. , Barnea O.
Published: December 2004

Aim:  A mathematical model was developed to identify time periods of atelectasis induction in middle ear (ME) ventilated via ventilating tubes (VT). Atelectatic ears are characterized by a total gas pressure lower than 760 mmHg.

Methods:  Ventilating tubes were deliberately sealed and ME gas content changed in the presence of a preset blood gas pressure. Once sealed, CO2 rapidly diffuses out of the blood via lining tissues into the ME cleft. This results in initially a total ME pressure rise followed by a decrease in subatmospheric pressures. Time periods for atelectasis reformation was determined once ME pressure crossed the 760 mmHg value and continued to decline as the atelectasis reached higher grades.

Results:  Time periods calculated by the model varied from 18 to 125 min in ME cavities ranging in volume from 0.5 to 3.5 mL, respectively. These results were calculated for conditions of venous blood in the lining mucosa blood and are consistent with prior clinical tests that measured an induced return to previous atelectasis state following the closure of the VT in 33 tested ears within 25–120 min (43 min on average).

Conclusions: The model demonstrates that under the above conditions, diffusive gas transfer in relation to blood gas content is the leading mechanism to alterations in ME pressure and volume. It may be used as a tool to determine ME physiological cavity volume of ears with VT.
Effect of low‐load resistance training on the tendon properties in middle‐aged and elderly women
Authors: Kubo K. , Kanehisa H. , Miyatani M. , Tachi M. , Fukunaga T.
Published: December 2004

Aim:  The purposes of this study were to determine the age‐related changes in the tendon‐aponeurosis structures and to investigate the effects of low‐load resistance training on the tendon‐aponeurosis structures in middle‐aged and elderly women.

Methods:  Fifty‐one women (55.8 ± 13.7 years, range: 21–77 years) volunteered to take part in the present study. Furthermore, 11 middle‐aged and elderly women (49.7 ± 9.2 years) performed the low‐load resistance training, i.e. squat using body weight, for 6 months. The elongation of the tendon and aponeurosis of the vastus lateralis muscle was directly measured by ultrasonography, while the subjects performed ramp isometric knee extension up to the voluntary maximum, followed by a ramp relaxation. The relationship between the estimated muscle force (Fm) and tendon elongation (L) during the ascending phase was fitted to a linear regression, the slope of which was defined as stiffness. The percentage of the area within the Fm‐L loop to the area beneath the curve during the ascending phase was calculated as hysteresis.

Results:  Maximal strain (L/initial tendon length) and stiffness of the tendon‐aponeurosis structures decreased significantly with ageing. In contrast, the hysteresis increased significantly with ageing. In addition, low‐load resistance training produced no significant change in stiffness and hysteresis, but significantly increased the maximal elongation of tendon‐aponeurosis structures from 23.3 ± 2.1 mm to 24.8 ± 2.2 mm (P = 0.045).

Conclusion:  These results suggest that increasing age results in a decrease in the elasticity of tendon‐aponeurosis structures and an increase in their viscosity. Furthermore, the low‐load resistance training made the elasticity of tendon‐aponeurosis structures increase.
Left ventricular volume changes during supine exercise in young endurance athletes
Authors: Sundstedt M. , Jonason T. , Ahrén T. , Damm S. , Wesslén L. , Henriksen E.
Published: December 2004

Aim:  The primary objective of the study was to measure the relative left ventricular volumes and the changes in left ventricular ejection fraction during supine position from rest to exercise in young endurance athletes. The secondary objective was to examine if there were gender differences regarding the volume reply and ejection fraction with exercise.

Method:  Sixty‐five (35 female and 30 males) young healthy Swedish orienteers participated in the study. Left ventricular volume and ejection fraction changes between rest and submaximal supine bicycle exercise were measured with radionuclide ventriculography.

Results:  The mean left ventricular end‐diastolic volume increased by 13% (P < 0.001) but there was no change in end‐systolic volume. Stroke volume was found to increase by 21% (P < 0.001). Left ventricular ejection fraction increased significantly (>0.04 units) in 54% of the athletes from rest to exercise; 5% of the athletes showed a decrease in ejection fraction. A negative correlation was found between ejection fraction at rest and the difference in ejection fraction from rest to exercise (r = −0.38, P = 0.002). There were no gender differences in the left ventricular volume changes or ejection fraction.

Conclusion:  During submaximal supine exercise, the adjustments in cardiac volumes in endurance athletes were small. There were no gender disparities concerning the left ventricular volume reply during exercise.
Somato‐sympathetic vasoconstriction to intranasal fluid administration with consecutive decrease in nasal nitric oxide
Authors: Landis B. N. , Beghetti M. , Morel D. R. , Giger R. , Rimensberger P. C. , Lacroix J. S.
Published: December 2004

Aim:  Patients suffering from non‐allergic chronic rhinosinusitis (NACRS) increasingly use intranasal saline sprays. They report better nasal comfort.

Methods:  In order to better understand this phenomenon, we studied intranasal laser Doppler flowmetry (LDF) and nasal nitric oxide (NO) variations evoked by local administration of saline, histamine, N‐acetylcysteine (NAC) and lidocaine at room temperature (22 °C).

Results:  There was a significant (P < 0.05) 14 ± 3.8% decrease in LDF signal after 30 s, which lasted for 60–90 s, for all the substances applied at 22 °C. This pharmaco‐independent vasoconstriction was further studied in patients under general anaesthesia (GA), with saline at 37 °C and after intranasal adrenaline treatment. While GA did not influence the vasoconstriction, saline at 37 °C and adrenaline pre‐treatment abolished it. Nasal NO is influenced by vasoconstriction. Therefore we investigated, whether the observed vasoconstriction also changes nasal NO. A significant (P < 0.001) 8.03 ± 0.59% decrease in nasal NO was recorded 60 s after administration of all the substances, and under GA after 22 °C saline application. This NO decrease was absent after intranasal adrenaline pre‐treatment. An additional experiment tested the effect of nose blowing on nasal NO concentration. We registered an NO decrease with a similar pattern than observed with the other substances.

Conclusions: Intranasal fluid nebulization at 22 °C induces a sympathetic mediated, transient vasoconstrictor reflex response. This somato‐sympathetic vasoconstriction induces a decrease in nasal NO. Both could be related to the subjective comfort experienced by NACRS patients using intranasal saline sprays.
Exercise training improves ageing‐induced decrease in eNOS expression of the aorta
Authors: Tanabe T. , Maeda S. , Miyauchi T. , Iemitsu M. , Takanashi M. , Irukayama‐Tomobe Y. , Yokota T. , Ohmori H. , Matsuda M.
Published: December 2004

Aims:  Ageing impairs endothelial function such as the regulation of vascular tone. The release of nitric oxide (NO), which has a potent vasodilator effect and antiatherosclerotic property, is decreased in the aorta of aged rats. Exercise training, however, has been reported to increase the expression of endothelial NO synthase (eNOS) in the aorta of young rats. In aged rats, it is not known whether the expression of eNOS is altered by exercise training. We hypothesized that exercise training would improve the ageing‐induced decrease in eNOS expression in vessels, and examined the messenger RNA (mRNA) and protein expression of eNOS in the aorta of sedentary‐young rats (sedentary‐young group; 4 months old), sedentary‐aged rats (sedentary‐aged group; 23 months old), and swim‐trained aged rats (training‐aged group; 23 months old, swimming training for 8 weeks, 5 days week−1, 90 min day−1).

Results:  Body weight was significantly lower, and citrate synthase activity in the epitrochlearis muscle was significantly higher in the training‐aged group compared with the sedentary‐aged group. The mRNA expression of eNOS in the aorta was significantly higher in the training‐aged group than in the sedentary‐aged group, while it was significantly lower in both the sedentary‐aged and training‐aged groups than in the sedentary‐young group. The expression of eNOS protein in the aorta was also significantly higher in the training‐aged group than in the sedentary‐aged group, while it was also significantly lower in the sedentary‐aged group, but not in the training‐aged group, than in the sedentary‐young group.

Conclusion:  The present results revealed that the production of eNOS in the aorta decreases with ageing, and that the decreased production is increased by exercise training in aged rats, which may produce beneficial effects on the impaired cardiovascular system caused by ageing.
Additivity of adrenaline and contractions on hormone‐sensitive lipase, but not on glycogen phosphorylase, in rat muscle
Authors: Langfort J. , Ploug T. , Ihlemann J. , Baranczuk E. , Donsmark M. , Górski J. , Galbo H.
Published: December 2004

Aim:  Hormone‐sensitive lipase (HSL) has been proposed to regulate triacylglycerol (TG) breakdown in skeletal muscle. In muscles with different fibre type compositions the influence on HSL of two major stimuli causing TG mobilization was studied.

Methods:  Incubated soleus and extensor digitorum longus (EDL) muscles from 70 g rats were stimulated by adrenaline (5.5 μm, 6 min) or contractions (200 ms tetani, 1 Hz, 1 min) in maximally effective doses or by both adrenaline and contractions.

Results:  Hormone‐sensitive lipase activity was increased significantly by adrenaline as well as contractions, and the highest activity (P < 0.05) was seen with combined stimulation [Soleus: 0.40 ± 0.03 (SE) m‐unit mg protein−1 (basal), 0.65 ± 0.02 (adrenaline), 0.65 ± 0.03 (contractions), 0.78 ± 0.03 (adrenaline and contractions); EDL: 0.18 ± 0.01, 0.30 ± 0.02, 0.26 ± 0.02, 0.32 ± 0.01]. Glycogen phosphorylase activity was always increased more by adrenaline compared with contractions [Soleus: 60 ± 4 (a/a + b)% vs. 46 ± 3 (P < 0.05); EDL: 60 ± 5 vs. 39 ± 6 (P < 0.05)]. After combined stimulation glycogen phosphorylase activity in soleus [59 ± 3 (a/a + b)%] was identical to and in EDL [45 ± 4 (a/a + b)%] smaller (P < 0.05) than the activity after adrenaline only.

Conclusions:  In slow‐twitch oxidative as well as in fast‐twitch glycolytic muscle HSL is activated by both adrenaline and contractions. These stimuli are partially additive indicating at least partly different mechanisms of action. Contractions may impair the enhancing effect of adrenaline on glycogen phosphorylase activity in muscle.
Specific phase related patterns of trunk muscle activation during lateral lifting and lowering
Authors: Huang Q.‐M. , Andersson E. A. , Thorstensson A.
Published: December 2004

Aim:  Lateral bending of the trunk has been demonstrated to be a risk factor in connection with injuries to the spine and its surrounding tissues. Adequate co‐ordination of muscle controlling movement and stabilization of the trunk is essential to avoid injury. However, little is yet known about the responses of the lumbar trunk muscles during lateral lifting and lowering. The present investigation was therefore designed to study these responses.

Methods:  In six subjects performing lateral lifting and lowering of different loads (0–40 kg) held laterally in one hand, the activities of eight trunk muscles were recorded using intramuscular electrodes. In addition, the angular motion of the trunk from side to side was measured from video recordings. Electromyographic amplitudes on both the contra‐ and ipsi‐lateral sides (ipsi = towards the loaded hand) were analysed in relation to defined phases of trunk motion.

Results:  Three periods of trunk muscle activation were generally observed, two from the contralateral muscles at the beginning and end of the motion and one from the ipsilateral muscles during the mid‐part of the motion. The activities of the contralateral muscles increased, whereas the activities of the ipsilateral muscles decreased with increasing load. The degree of bilateral co‐activation was greater in ventral than in dorsal muscles, in lowering compared with lifting, and in no‐load or low‐load compared with heavy load conditions.

Conclusion:  The co‐ordination of trunk muscle activations during side‐to‐side trunk movements is dependent on trunk position and load. It is speculated that ventral muscles, particularly the oblique and transverse abdominal muscles, are relatively more involved than the other trunk muscles in trunk stabilization, especially in connection with lowering of a light hand‐held load.
Growth hormone and prolactin responses during partial and whole body warm‐water immersions
Authors: Koska J. , Rovensky J. , Zimanova T. , Vigas M.
Published: December 2004

Aim:  To elucidate the role of core and skin thermoreceptors in the release of growth hormone (GH) and prolactin (PRL), a sequence of two experiments using whole‐body (head‐out) and partial (one forearm) hot water immersions was performed.

Methods:  Experiment 1: Nine healthy men were exposed to head‐out and partial water immersions (25 min, 38–39 °C).

Results:  Head‐out immersion increased the core temperature (38.0 ± 0.1 vs. 36.7 ± 0.1 °C, P < 0.001) and plasma concentration of the hormones (GH, 16.1 ± 4.5 vs. 1.2 ± 0.4 ng mL−1, P < 0.01; PRL, 9.1 ± 1.0 vs. 6.4 ± 0.4 ng mL−1, P < 0.05). During the partial immersion the core temperature was slightly elevated (36.8 ± 0.1 vs. 36.6 ± 0.1, P < 0.001), the concentration of GH increased (4.8 ± 1.7 vs. 0.6 ± 0.3, P < 0.05), while plasma PRL decreased (7.6 ± 0.8, 6.0 ± 0.6, 5.2 ± 0.6, P < 0.01). Experiment 2: Seven volunteers immersed one forearm once in 39 °C and once in 38 °C water. The measurements were performed in 5‐min intervals. The GH concentration increased gradually from the beginning of the immersions (min 10; 39 °C: 1.9 ± 1.0 vs. 0.6 ± 0.3 ng mL−1, P < 0.01; 38 °C: 0.19 ± 0.03 vs. 0.14 ± 0.03, P < 0.05) and peaked after their completion (39 °C: +10 min, 3.7 ± 2.0, P < 0.001; 38 °C: +15 min, 0.86 ± 0.61, P < 0.01). The core temperature was unchanged until min 15 of the 39 °C bath. Thereafter, it increased about 0.15 °C above the baseline (P < 0.01). Immersion in 38 °C water did not induce core temperature changes.

Conclusions: Peripheral thermoreceptors are involved in GH release when the body is exposed to elevated environmental temperature while a substantial elevation of core temperature is a precondition of PRL release.
The diagnosis of coeliac disease
Authors: Abdulkarim A. S. , Murray J. A.
Published: December 2004

Coeliac disease is a chronic inflammatory condition associated with small intestinal injury that results in the malabsorption of different nutrients. The damaging factor is gluten present in wheat, barley and rye. The diagnosis relies on the clinical picture of the patient, serological markers for coeliac disease, characteristic findings of small intestinal biopsy and, eventually, clinical improvement on a gluten‐free diet. Our strategies for the diagnosis of coeliac disease have changed dramatically within the last 10 years. The advent of serological markers with high sensitivity and specificity is changing our understanding of the disease and its prevalence. Treatment includes a life‐long gluten‐free diet to prevent the recurrence of symptoms and other potential consequences. Most coeliac disease remains under‐diagnosed; the utilization of more accurate serological tests and a greater awareness of its many presentations will aid its identification.
Therapy of osteoporosis in patients with Crohn's disease: a randomized study comparing sodium fluoride and ibandronate
Authors: Von Tirpitz C. , Klaus J. , Steinkamp M. , Hofbauer L. C. , Kratzer W. , Mason R. , Boehm B. O. , Adler G. , Reinshagen M.
Published: December 2004

Background : Osteoporosis is a frequent complication in Crohn's disease. Although the efficacy of both sodium fluoride and aminobisphosphonates in postmenopausal osteoporosis has been investigated in long‐term therapy studies, no long‐term results are available regarding the effect of these agents in the management of osteoporosis in patients with Crohn's disease.

Methods : Eighty‐four patients with Crohn's disease and pathological bone mineral density findings were randomized to receive either vitamin D3 (1000 IU) and calcium citrate (800 mg) daily (group A) or sodium fluoride (25 mg b.d., group B) or intravenous ibandronate (1 mg every 3 months, group C) in addition to daily calcium/vitamin D substitution. On admission to the study and after 12 and 27 months, patients underwent dual‐energy X‐ray absorptiometry and radiological examination of the spine.

Results : Sixty‐eight patients completed the 1‐year observation period and were available for the intention‐to‐treat analysis. No new vertebral fractures were diagnosed. In group A, lumbar bone density increased by 2.6% (P = 0.066, N.S.), in group B by 5.7% (P = 0.003) and in group C by 5.4% (P = 0.003). Therapy with sodium fluoride was associated with an increase in osteocalcin (N.S.), whereas administration of ibandronate was associated with a decrease in the resorption parameter, carboxy‐terminal cross‐linked type‐I collagen telopeptide (P < 0.05). Both sodium fluoride and ibandronate resulted in significant decreases in the serum concentration of osteoprotegerin after 9 months (P < 0.001).

Conclusions : The findings of the present study show that both sodium fluoride and ibandronate are effective in combination with calcium and vitamin D substitution in the management of osteopenia and osteoporosis in patients with Crohn's disease. Both agents are safe and well tolerated, and induce continuous increases in lumbar bone density.
The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40 000 subjects
Authors: Hungin A. P. S. , Whorwell P. J. , Tack J. , Mearin F.
Published: December 2004

Aim : To determine the prevalence, symptom pattern and impact of the irritable bowel syndrome, across eight European countries, using a standardized methodology.

Methods : A community survey of 41 984 individuals was performed using quota sampling and random digit telephone dialling to identify those with diagnosed irritable bowel syndrome or those meeting diagnostic criteria, followed by in‐depth interviews.

Results : The overall prevalence was 11.5% (6.2–12%); 9.6% had current symptoms, 4.8% had been formally diagnosed and a further 2.9%, 4.2% and 6.5% met the Rome II, Rome I or Manning criteria, respectively. Bowel habit classification varied by criteria: 63% had an ‘alternating’ bowel habit by Rome II vs. 21% by self‐report. On average, 69% reported symptoms lasting for 1 h, twice daily, for 7 days a month. Irritable bowel syndrome sufferers reported more peptic ulcer (13% vs. 6%), reflux (21% vs. 7%) and appendectomy (17% vs. 11%), but not hysterectomy, cholecystectomy or bladder procedures. Ninety per cent had consulted in primary care and 17% in hospital; 69% had used medication. Irritable bowel syndrome substantially interfered with lifestyle and caused absenteeism.

Conclusions : Irritable bowel syndrome is common with major effects on lifestyle and health care. The majority of cases are undiagnosed and the prevalence varies strikingly between countries. Diagnostic criteria are associated with varying prevalences and bowel habit sub‐types. This limits their utility in clinical practice and the transferability of research findings using them.
High eradication rates of Helicobacter pylori with a new sequential treatment
Authors: Zullo A. , Vaira D. , Vakil N. , Hassan C. , Gatta L. , Ricci C. , De Francesco V. , Menegatti M. , Tampieri A. , Perna F. , Rinaldi V. , Perri F. , Papadìa C. , Fornari F. , Pilati S. , Mete L. S. , Merla A. , Potì R. , Marinone G. , Savioli A. , Campo S. M. A. , Faleo D. , Ierardi E. , Miglioli M. , Morini S.
Published: December 2004

Background : Eradication rates of Helicobacter pylori with standard triple therapy are disappointing, and studies from several countries confirm this poor performance.

Aim : To assess the eradication rate of a new sequential treatment regimen compared with conventional triple therapy for the eradication of H. pylori infection.

Methods : One thousand and forty‐nine dyspeptic patients were studied prospectively. H. pylori‐infected patients were randomized to receive 10‐day sequential therapy [rabeprazole (40 mg daily) plus amoxicillin (1 g twice daily) for the first 5 days, followed by rabeprazole (20 mg), clarithromycin (500 mg) and tinidazole (500 mg) twice daily for the remaining 5 days] or standard 7‐day treatment [rabeprazole (20 mg), clarithromycin (500 mg) and amoxicillin (1 g) twice daily]. H. pylori status was assessed by histology, rapid urease test and 13C‐urea breath test at baseline and 6 weeks or more after completion of treatment.

Results : Higher eradication rates were found with the sequential regimen compared to the standard regimen (intention‐to‐treat: 92% vs. 74%, P < 0.0001; per protocol: 95% vs. 77%, P < 0.0001). Higher eradication rates were also seen in patients with peptic ulcer disease and non‐ulcer dyspepsia. In both treatments, compliance was similar (> 90%), as was the rate of side‐effects, which were mild.

Conclusions : This 10‐day sequential treatment regimen achieves high eradication rates in peptic ulcer disease and non‐ulcer dyspepsia.
Stool antigen for the diagnosis of Helicobacter pylori infection in cirrhosis: comparative usefulness of three different methods
Authors: Calvet X. , Quesada M. , Roselló M. , Salceda F. , Sanfeliu I. , Dalmau B. , Gil M.
Published: December 2004

Background : Helicobacter pylori infection may lead to peptic ulcer disease, and causes significant morbidity in patients with cirrhosis. The measurement of H. pylori antigens in human stools has been proposed as a valuable, non‐invasive, diagnostic tool. A number of tests have recently been commercialized. However, very few data are available on their reliability in patients with cirrhosis.

Aim : To evaluate the usefulness of three new tests — HpSA (Meridian Diagnostics Inc., Cincinnati, OH, USA), Simple H. pyl (OPERON S.A., Zaragoza, Spain) and FemtoLab H. pylori (Connex, Martinsried, Germany) — in the diagnosis of H. pylori infection in cirrhotic patients.

Methods : H. pylori infection was determined in 79 cirrhotic patients (48 men, 31 women; age range, 29–82 years; mean, 62 ± 11 years) by concordance of histology and urea breath test. The sensitivity, specificity and positive and negative predictive values of each stool test were calculated.

Results : According to the reference method, the sensitivities of HpSA, Simple H. pyl and FemtoLab H. pylori immunoassays were 76%, 87% and 78%, respectively, and their specificities were 93%, 62% and 79%, respectively.

Conclusions : Faecal tests are non‐invasive and easy‐to‐perform tools for the diagnosis of H. pylori infection. However, their sensitivity and specificity seem to be non‐optimal in patients with cirrhosis.
The prophylactic use of a proton pump inhibitor before food and alcohol
Authors: O'leary C. , McCarthy J. , Humphries M. , Shanahan F. , Quigley E.
Published: December 2004

Background : Patients report that the prophylactic consumption of a proton pump inhibitor minimizes gastrointestinal symptoms expected to be provoked by late‐night food and alcohol consumption. The efficacy of this practice has not been studied formally.

Aim : To perform a randomized, double‐blind, placebo‐controlled trial of a single dose of lansoprazole (30 mg) taken prior to a large meal and alcohol consumption.

Methods : Study subjects were recruited randomly from local primary care and hospital physicians. Each participant (n = 56; 37 male, 19 female; mean age, 38 years) completed questionnaires before and after the meal. Approximately 90 min prior to the provocative meal, participants were witnessed taking either placebo or 30 mg lansoprazole. Bar tokens were dispensed to permit the accurate quantification of alcohol consumption (mean, 15 units).

Results : Forty per cent of subjects reported significant reflux symptoms. For the entire group, there was no significant difference between lansoprazole and placebo. Post‐prandial reflux was more frequent in those consuming > 15 units of alcohol (13/26, 50%) compared with those consuming < 15 units (7/30, 24%; P < 0.05). In the group who consumed > 15 units of alcohol, lansoprazole was associated with a lower rate of heartburn (5/15, 33%) compared with placebo (8/11, 73%; P < 0.05).

Conclusion : A single dose of a proton pump inhibitor prior to indulgence was only associated with reduced heartburn in those consuming > 15 units of alcohol.
Response, relapse and mucosal immune regulation after infliximab treatment in fistulating Crohn's disease
Authors: Agnholt J. , Dahlerup J. F. , Buntzen S. , Tøttrup A. , Nielsen S. Lyhne , Lundorf E.
Published: December 2004

Background : Infliximab reduces mucosal inflammation in some, but not all, patients with Crohn's disease.

Aim : To monitor clinical data and changes in mucosal cytokine levels after infliximab treatment to identify differences between responders and non‐responders.

Methods : Twenty‐six patients with fistulating Crohn's disease received three infliximab infusions at weeks 0, 2 and 6. Follow‐up was for 1 year and included clinical examination, colonoscopy, ano‐rectal ultrasound and magnetic resonance imaging. Biopsies were taken at weeks 0, 8, 26 and 52. Cell cultures were established and analysed for tumour necrosis factor‐α, interferon‐γ and interleukin‐10 levels, and related to clinical status and fistula healing.

Results : Eleven of 15 patients (73%) with active disease (Crohn's disease activity index > 150) obtained remission (Crohn's disease activity index < 150) at 8 weeks. In in vitro cell cultures, there was reduced tumour necrosis factor‐α and interleukin‐10 production at week 26, with the latter persistent throughout the study period. When the disease deteriorated or relapsed, there was increased interferon‐γ production in in vitro cell cultures. Fistula healing was associated with reduced production of interferon‐γ, tumour necrosis factor‐α and interleukin‐10.

Conclusions : Infliximab down‐regulates mucosal immune activation in Crohn's disease. Monitoring of mucosal cytokine levels after infliximab treatment by whole biopsy cultures may be useful as interleukin‐10, tumour necrosis factor‐α and interferon‐γ production are different in responders and at relapse.
Eradication of Helicobacter pylori increases nocturnal intragastric acidity during dosingwith rabeprazole, omeprazole, lansoprazole and placebo
Authors: Williams M. P. , Usselmann B. , Chilton A. , Sercombe J. , Nwokolo C. U. , Pounder R. E.
Published: December 2004

Background : The eradication of Helicobacter pylori decreases the antisecretory activity of omeprazole and lansoprazole. Rabeprazole is a potent proton pump inhibitor that may not be affected as greatly by H. pylori status.

Aim : To compare the effect of H. pylori eradication on intragastric acidity and plasma gastrin during dosing with lansoprazole, omeprazole, rabeprazole and placebo.

Methods : Twenty‐four healthy H. pylori‐infected volunteers were studied on day 7 of dosing with placebo, lansoprazole 30 mg, omeprazole 20 mg and rabeprazole 20 mg, before and at least 5 weeks after H. pylori eradication. On each occasion, the 24‐h intragastric acidity was measured by gastric aspiration. Plasma gastrin concentrations were measured hourly from 08.00 to 13.00 h.

Results : Sixteen subjects completed the study. For all three drugs and placebo, H. pylori eradication increased intragastric acidity, particularly nocturnal acidity, and decreased plasma gastrin. There were no differences between the three drugs with respect to 24‐h acidity, percentage of time pH > 4 or 5‐h plasma gastrin, either before or after H. pylori eradication. Before eradication, the percentage nocturnal time at pH > 3 was significantly greater during rabeprazole than during lanso‐prazole dosing.

Conclusions : The increase in intragastric acidity seen after H. pylori eradication during dosing with proton pump inhibitors is a drug–class effect, particularly affecting nocturnal acid control. This is related to increased spontaneous intragastric acidity after H. pylori eradication.
A rapid, low‐dose, 13C‐urea tablet for the detection of Helicobacter pylori infection before and after treatment
Authors: Gatta L. , Vakil N. , Ricci C. , Osborn J. F. , Tampieri A. , Perna F. , Miglioli M. , Vaira D.
Published: December 2004

Background : A new urea breath test (UBT) has been described which uses a tablet formulation of 13C‐urea with citric acid and allows breath sampling to be performed as early as 10 min after ingestion of the tablet.

Aim : To assess the diagnostic accuracy of tablet‐based 13C‐UBTs (50 and 100 mg 13C‐urea) before and after Helicobacter pylori eradication treatment, compared with an endoscopy gold standard and a conventional 13C‐UBT (75 mg 13C‐urea).

Methods : Two hundred dyspeptic patients underwent endoscopy, followed by tablet‐based 13C‐UBTs (50 and 100 mg 13C‐urea) and a conventional 13C‐UBT (75 mg 13C‐urea). H. pylori‐infected patients were prescribed treatment and asked to return 4–6 weeks after the end of therapy for repeat endoscopy and 13C‐UBTs.

Results : One hundred and thirteen patients were infected with H. pylori. The sensitivity and specificity of the conventional 13C‐UBT were both 100%; the sensitivity and specificity of the 100‐mg tablet‐based 13C‐UBT were 100% and 98.85%, respectively. For the 50‐mg tablet‐based 13C‐UBT, cut‐off values of the difference over baseline of between 1.65 and 3.15 provided a sensitivity and specificity of 100%. At follow‐up, the sensitivity and specificity of the conventional and 100‐mg tablet‐based 13C‐UBTs were both 100%. For the 50‐mg tablet‐based 13C‐UBT, cut‐off values of the difference over baseline of between 1.49 and 1.56 gave a sensitivity and specificity of 100%.

Conclusions : New 10‐min 13C‐UBTs using tablet formulations of 13C‐urea with citric acid are reliable for the assessment of H. pylori status pre‐ and post‐treatment.
Role of immunosuppression in the development of quinolone‐resistant Escherichia coli spontaneous bacterial peritonitis and in the mortality of E. coli spontaneous bacterial peritonitis
Authors: Cereto F. , Molina I. , González A. , Del Valle O. , Esteban R. , Guardia J. , Genescà J.
Published: December 2004

Background : Norfloxacin decreases the incidence of spontaneous bacterial peritonitis in cirrhotics, but promotes the appearance of quinolone‐resistant Escherichia coli.

Aim : To define the characteristics of quinolone‐resistant E. coli spontaneous bacterial peritonitis.

Methods : E. coli‐positive ascitic fluid cultures were identified during a 6‐year period. Data on quinolone‐sensitive and quinolone‐resistant E. coli spontaneous bacterial peritonitis were compared.

Results : One hundred and two E. coli‐positive ascitic fluid cultures were detected. Cirrhotics accounted for 67 cases. Spontaneous bacterial peritonitis was found in 47 of the 67 (70%) cases [35 (74%) caused by quinolone‐sensitive and 12 (26%) caused by quinolone‐resistant E. coli]. Norfloxacin prophylaxis was higher in the quinolone‐resistant group (92% vs. 6%, P < 0.001). Compared with patients with quinolone‐sensitive E. coli spontaneous bacterial peritonitis, those with quinolone‐resistant E. coli spontaneous bacterial peritonitis showed a higher prevalence of associated immunosuppressive factors (immunosuppressive drugs, human immunodeficiency virus infection or cancer) (92% vs. 20%, P < 0.001). Steroid therapy was independently associated with quinolone‐resistant E. coli spontaneous bacterial peritonitis (odds ratio, 49; 95% confidence interval, 3.4–699; P = 0.004). The Child–Pugh score (P = 0.03), immunosuppression (P = 0.02) and renal failure (P = 0.01) were independent predictors of E. coli spontaneous bacterial peritonitis‐related mortality.

Conclusions : Associated immunosuppression is an important co‐factor for the development of quinolone‐resistant E. coli spontaneous bacterial peritonitis and for E. coli spontaneous bacterial peritonitis‐related mortality.
Non‐alcoholic fatty liver disease
Authors: Alba L. M. , Lindor K.
Published: December 2004

Non‐alcoholic fatty liver disease is a clinicopathological condition that comprises a wide spectrum of liver damage, ranging from simple steatosis to steatohepatitis, advanced fibrosis and cirrhosis. Non‐alcoholic steatohepatitis represents only a stage within the spectrum of non‐alcoholic fatty liver disease and is defined pathologically by the presence of steatosis together with necro‐inflammatory activity. The true prevalence of non‐alcoholic fatty liver disease is unknown, but it is estimated that it affects 10–24% of the general population in different countries. The diagnosis of non‐alcoholic fatty liver disease is based upon convincing evidence of absent or minimal alcohol consumption, compatible histological changes in liver biopsy and the exclusion of other liver diseases. The natural history of non‐alcoholic fatty liver disease remains to be defined. Patients with pure steatosis on liver biopsy follow a relatively benign course, whereas patients with histological necro‐inflammatory changes and/or fibrosis may progress to end‐stage liver disease. An initial step in the treatment of non‐alcoholic fatty liver disease is the management of associated conditions, such as obesity, diabetes mellitus and hyperlipidaemia. Non‐alcoholic fatty liver disease patients with steatohepatitis and/or fibrosis on liver biopsy may benefit from investigational pharmacological therapy. Patients with decompensated cirrhosis from non‐alcoholic fatty liver disease may be candidates for liver transplantation.
Cost‐effectiveness analysis of therapeutic strategies for patients with chronic hepatitis C previously not responding to interferon
Authors: San Miguel R. , Mar J. , Cabasés J. M. , GuilléN‐Grima F. , Buti M.
Published: December 2004

Background: The efficacy of combination therapy in patients with chronic hepatitis C previously not responding to interferon monotherapy is lower than that in naive patients, and there has been no economic evaluation in this population.

Aim: To develop a cost‐effectiveness analysis of therapeutic regimens with interferon‐alpha and ribavirin in previous interferon non‐responders.

Methods: A Markov simulation model was used to project the clinical and economic outcomes of five different therapeutic strategies, including a ‘no treatment’ alternative, using the health care system perspective. The efficacy data for the different doses and durations were obtained from a previously performed meta‐analysis. A sensitivity analysis was performed to test the robustness of the model, analysing changes in different variables.

Results: Applying a 3% discount rate, the standard patient on combination therapy for 12 months showed increases of 0.80 years and 1.55 quality‐adjusted life years, when compared with the ‘no treatment’ strategy. This option led to an incremental cost‐effectiveness ratio of 11 767 euros per year of life gained and 6073 euros per quality‐adjusted life year.

Conclusions: Combination therapy with interferon plus ribavirin is cost‐effective in previous interferon non‐responders and is within the range of some well‐accepted medical interventions in our health care system.
Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia
Authors: Koloski N. A. , Talley N. J. , Huskic S. S. , Boyce P. M.
Published: December 2004

Background : The drivers of conventional and, especially, alternative health care use for irritable bowel syndrome and functional dyspepsia are not clear.

Aim : To determine the predictors of conventional and alternative health care use for irritable bowel syndrome and functional dyspepsia.

Methods : Two hundred and seven subjects with irritable bowel syndrome or functional dyspepsia, identified from a previous population survey, were included in the study. Individuals with irritable bowel syndrome/functional dyspepsia were defined as consulters (n = 103) if they had visited their doctor for gastrointestinal symptoms more than once in the past year. Controls (n = 100) did not report having any abdominal pain. Subjects were given structured interviews to assess the Diagnostic and Statistical Manual – version IV (DSM‐IV) and International Classification of Disorders – version 10 (ICD‐10) psychiatric diagnosis for anxiety, depression, somatization or any psychiatric diagnosis, aspects of health care use and symptom factors.

Results : About one‐half (n = 103, 49.8%) of community subjects with irritable bowel syndrome/functional dyspepsia had sought conventional care for gastrointestinal symptoms in the past 12 months. Lifetime rates for alternative health care use for gastrointestinal symptoms were 20.8% (n = 43). Independent predictors of conventional health care use were more frequent abdominal pain, greater interference of gastrointestinal symptoms with work and activities and a greater satisfaction with the physician–patient relationship. Being female independently predicted alternative health care use.

Conclusions : Psychological morbidity did not predict conventional or alternative health care use for gastrointestinal symptoms. Other factors were more important.
Non‐steroidal anti‐inflammatory drugs, aspirin and newly diagnosed colitis: a case–control study
Authors: Gleeson M. H. , Davis A. J. M.
Published: December 2004

Background : There have been a number of reports of colitis following exposure to non‐steroidal anti‐inflammatory drugs (NSAIDs) and salicylates.

Aim : To conduct a case–control analysis of new cases of colitis, with particular reference to the usage of NSAIDs and salicylates prior to the development of the disease.

Methods : One hundred and five consecutive new cases of colitis presenting to a single gastroenterologist were questioned about their recent usage of NSAIDs and salicylates. For comparison, the frequency of usage of these compounds was studied in two groups of 105 age‐ and sex‐matched controls taken from hospitalin‐patients and community cases attending the Accident and Emergency Department.

Results : Of the 105 cases of colitis studied, 78 patients (74%) had been taking NSAIDs or salicylates prior to or during the development of their disease. By comparison, 20% of community controls were using NSAIDs or salicylates (P < 0.001) and 30% of hospital in‐patients were taking these compounds (P < 0.001). Comparison of these frequencies with those of the colitis group gave odds ratios of 9.1 (4.5, 21.9) with the community controls and 6.2 (3.2, 13.5) with the hospital controls.

Conclusions : In new patients presenting with colitis, there is a significantly high frequency of antecedent exposure to NSAIDs or salicylates, supporting the concept that these agents may be important in the pathogenesis of colitis.
Trends in oesophageal and gastric cancer incidence, mortality and survival in England and Wales 1971–1998/1999
Authors: Newnham A. , Quinn M. J. , Babb P. , Kang J. Y. , Majeed A.
Published: December 2004

Background : In England and Wales, 7% of cancers diagnosed in 1997 were oesophageal or gastric cancer.

Aim : To review the epidemiology of these cancers in England and Wales using cancer registration data from 1971 to 1998 and mortality data from 1971 to 1999.

Methods : We calculated age‐specific and age‐standardised incidence and mortality rates; crude and relative survival by age group; age‐standardised relative survival; and relative survival by socio‐economic status.

Results : The age‐standardised incidence of oesophageal cancer increased from 7.6 to 12.8 per 100 000 men and from 4.2 to 5.7 per 100 000 women. The incidence of gastric cancer decreased from 31.8 to 18.9 per 100 000 men and from 15.1 to 7.3 per 100 000 women. For both cancers, the 1‐ and 5‐year age‐standardised relative survival improved for men and women from 1971–1975 to 1992–1994; the 5‐year age‐standardised relative survival was significantly higher in women than in men diagnosed in 1992–1994; for some periods from 1971–1975 to 1986–1990, the 1‐year relative survival was significantly higher in the least deprived men than in the most deprived men.

Conclusions : Survival improved for both cancers over the study period, but there were unexplained differences related to sex and deprivation.
Trends in the subsite and morphology of oesophageal and gastric cancer in England and Wales 1971–1998
Authors: Newnham A. , Quinn M. J. , Babb P. , Kang J. Y. , Majeed A.
Published: December 2004

Background : The incidence of adenocarcinoma of the oesophagus and gastric cardia has increased in many countries.

Aim : To describe the trends in the subsite and morphology of oesophageal and gastric cancer using cancer registry data from 1971 to 1998.

Methods : We calculated the overall age‐standardised incidence in each year; the age‐standardised incidence by subsite, by morphology and by subsite and morphology; and the ratio of the rates in men and women in 1971 and 1998.

Results : The incidence of oesophageal adenocarcinoma increased from 1.5 to 7.0 per 100 000 men and from 0.4 to 1.5 per 100 000 women. The incidence of cancer at the cardia also increased, from 2.0 to 5.4 per 100 000 men and from 0.6 to 1.4 per 100 000 women, but the incidence of gastric cancer without a specified subsite decreased markedly from 21.3 to 9.3 per 100 000 men and from 10.7 to 4.2 per 100 000 women.

Conclusions : Although some of the increase in the incidence of adenocarcinoma of the gastric cardia is probably real, this interpretation is limited by the proportion of cancers without specified subsites or morphologies.
Clinical and pathological implications of IgG antibody responses toHelicobacter pyloriand its virulence factors in non‐ulcer dyspepsia
Authors: Xia H. H.‐X. , Talley N. J. , Blum A. L. , O'Morain C. A. , Stolte M. , Bolling‐Sternevald E. , Mitchell H. M.
Published: December 2004

Aim : To determine whether pre‐treatment antibody response to Helicobacter pylori virulence factors predicts eradication success and symptom relief 12 months after triple therapy in non‐ulcer dyspepsia.

Methods : H. pylori‐positive patients with non‐ulcer dyspepsia received 1‐week omeprazole‐based triple therapy, or omeprazole plus placebos. Symptoms were assessed using a validated Likert scale. Gastric biopsies taken before and 12 months after treatment were used for histological examination. Pre‐treatment blood samples were used for the detection of anti‐H. pylori immunoglobulin G (IgG) antibodies, and specific IgG antibodies to 19.5‐, 26.5‐, 30‐, 35‐, 89‐ (VacA) and 116‐kDa (CagA) antigens of H. pylori.

Results : IgG antibodies to the six antigens were detected in 62%, 96%, 88%, 47%, 54% and 78% of patients, respectively. The presence of antibody to 19.5‐, 26.5‐ or 30‐kDa antigen was associated with an increased anti‐H. pylori IgG absorbance index. IgG absorbance indices were greater in those with H. pylori eradication (vs. persistent infection). The prevalence of antibodies to the six antigens was not significantly different between those with symptom relief vs. those without. The 19.5‐kDa antigen (P = 0.018) and VacA (P = 0.001) were independent risk factors for body gastritis.

Conclusions : An increased pre‐treatment anti‐H. pylori IgG absorbance index may be a useful predictor of the success of eradication therapy. Although the 19.5‐kDa antigen and VacA were associated with body gastritis, none of the six antigens tested predicted symptom relief after triple therapy.