bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional deterioration and selenium‐vitamin E treatment in myotonic dystrophy. A placebo‐controlled study
Authors: Örndahl G. , Grimby G. , Grimby A. , Johansson G. , Wilhelmsen L.
Published: August 2009

Abstract. Objectives. The aim of the investigations was to study the effect of a combined selenium and vitamin E treatment in patients with myotonic dystrophy.

Design. A double‐blind placebo‐controlled trial.

Subjects. Twenty‐seven patients with myotonic dystrophy divided into an experimental (n = 13) and a control (n = 14) group.

Interventions. The experimental group was given increasing doses for 4 months up to a maximum of 1.6 mg selenium and 800 mg vitamin E daily and the control group a corresponding number of placebo tablets. The total treatment period was 2 years.

Main outcome measures. Muscle strength (knee extension, knee flexion, hand‐grip), maximal walking speed for 30 m, function in daily activities (disability), well‐being and cognitive functioning.

Results. Before treatment, muscle strength showed moderately or markedly reduced values as did maximal walking speed. Disability was most markedly demonstrated in instrumental ADL‐activities. Spatial ability was reduced in the majority of patients. During the 2‐year follow‐up period, the hand‐grip strength and maximal walking speed decreased in both groups (P < 0.01). The reduction was not significantly different according to an ‘intention‐to‐treat‐analysis’. However, there was a significantly larger decline (P < 0.01) in the left‐hand grip strength in the control group when all the patients with complete treatment compliance were included.

Conclusions. A useful set of measurements has been developed for following functional deterioration in myotonic dystrophy. No conclusive evidence of beneficial effects of selenium and vitamin E treatment has been produced.
Metabolic remission with octreotide in patients with insulinoma
Authors: Von Eyben F. E. , Grodum E. , Gjessing H. J. , Hagen C. , Nielsen H. Bech
Published: August 2009

Abstract. Objectives. The efficacy of octreotide was studied in a group of patients with biochemical evidence of insulinoma.

Design. A phase‐II study

Setting. A university department of internal medicine.

Subjects. Seven patients with biochemical evidence of insulinoma and without metastatic lesions.

Intervention. Daily treatment with octreotide, a somatostatin analogue, mainly within the dosage of 100–300 μg day‐1. The treatment was continued in patients with biochemical evidence of response or until surgery was undertaken.

Main outcome. Five patients avoided hypoglycaemic symptoms and had normalization of blood glucose values for a median of 15+ months (range 0.2–54 months). Two did not improve metabolically. The treatment was well tolerated and had no deleterious effects on blood glucose regulation.

Conclusion. Octreotide seems to be a promising treatment for many of the patients with insulinoma who are not suitable for surgery.
Asystole with electroconvulsive therapy*
Authors: Kaufman K. R.
Published: August 2009

Abstract. The rare complication of asystole with beta‐adrenergic blockade by labetalol following electroconvulsive therapy (ECT) is described with a literature review of cardiac mechanisms (33 references).
Effects of captopril on renal function in healthy uninephrectomized subjects and in healthy control subjects
Authors: Nielsen C. B. , Pedersen E. B.
Published: August 2009

Objectives. To study the importance of the reninangiotensin‐II system for renal haemodynamics and sodium and water handling in the adapted remnant kidney in healthy uninephrectomized subjects.

Design. Case‐control study.

Setting. All subjects were investigated at laboratory C, Department of Medicine and Nephrology, Skejby Hospital.

Subjects. Fourteen healthy uninephrectomized (Unx) and 14 matched healthy control subjects (Cs). Intervention. Captopril, 25 mg orally.

Main outcome measures. The glomerular filtration rate (GFR) and renal plasma flow (RPF) were measured by the constant infusion clearance technique using 125I‐iothalamate and 131I‐hippuran as reference substances, tubular function was evaluated by the lithium clearance technique (CLi), urinary flow rate (V), sodium excretion (UNaV), fractional sodium excretion (FENa), mean blood pressure (MBP) and heart rate (HR) were measured by conventional methods and plasma levels of angiotensin II (Ang‐II), aldosterone (Aldo), arginine vasopressin (AVP) and atrial natriuretic peptide (ANP) were measured by radioimmunoassay.

Results. In both groups captopril ingestion resulted in a significant decrease in the MBP (Unx: 87.1 to 83.5 and Cs: 86.8 to 83.8 mmHg, median values), filtration fraction (Unx: 24.6 to 22.1 and Cs: 24.1 to 22.5%, median values) and Ang‐II (Unx: 10.5 to 7.7 and Cs: 12 to 7.6 pmol‐1. median values). Single kidney GFR, V, and CLi were unchanged in both groups. FENa and single kidney RPF were significantly increased in only the Cs group; FENa (Unx: 1.81 to 1.91 and Cs: 1.56 and 1.90%, median values). The plasma level of ANP was significantly decreased in only the Unx group.

Conclusion. The data suggest that sodium handling in the remnant kidney in uninephrectomized subjects could be less sensitive to Ang‐II than in healthy control subjects, and that this might be as a result of adaptive changes in the distal parts of the nephron.
Fulminant hepatitis with severe lactate acidosis in HIV‐infected patients on didanosine therapy
Authors: Bissuel F. , Bruneel F. , Habersetzer F. , Chassard D. , Cotte L. , Chevallier M. , Bernuau J. , Lucet J.‐C. , Trepo C.
Published: August 2009

We report two cases of fulminant hepatic failure in HIV‐1‐infected patients treated with didanosine (ddI). Clinical manifestations including vomiting, diarrhoea and dyspnoea were identical in both cases. Biological data mainly revealed hepatic failure and lactic acidosis. Histological examination of liver biopsies showed diffuse microvesicular steatosis. The outcome was fatal in both patients.

The only comparable case previously reported (Lai et al., 1991) showed close similarities in the clinical, biological and histological manifestations with microvesicular steatosis. This prompted us to suspect that ddI might be responsible for fulminant hepatitis in all three AIDS patients. This toxic effect may be added to the list of potential adverse events occurring during ddI therapy.
Monoplegia following carotid sinus massage
Authors: Ferguson S. , Ellis C. J.
Published: August 2009

Serious complications after carotid sinus massage are rare. A case is described of monoplegia complicating carotid sinus massage in an elderly patient without symptoms or signs of cerebrovascular disease. We remind physicians of this potential complication and suggest that alternative therapies be considered prior to the use of carotid sinus massage in this age group.
Apolipoprotein (a) phenotypes and lipoprotein (a) concentrations in patients with type III hyperlipoproteinaemia
Authors: FEUSSNER G. , FEUSSNER V. , ZIEGLER R.
Published: August 2009

Abstract. Objectives. The familial lipoprotein disorder type III hyperlipoproteinaemia (HLP) carries a marked increase in the risk of accelerated and premature atherosclerosis, but there is considerable variation amongst affected individuals in their susceptibility to cardiovascular disease (CVD). Therefore, it was the aim of our study to investigate the possible influence of lipoprotein (a) [Lp(a)] in the pathogenesis of type III HLP.

Design. Apolipoprotein (a) [apo(a)] phenotypes and Lp(a) concentrations were determined in patients with the disease and in an appropriate control group.

Setting. University out‐patient lipid disorder clinic.

Subjects. Seventy‐six apoE‐2 homozygous patients with type III HLP and 76 normolipidaemic and healthy age‐ and sex‐matched controls.

Main outcome measures. The frequencies of different apo(a) phenotypes and their correlations with Lp(a) serum concentrations were determined in patients and controls.

Results. Lp(a) concentrations were not significantly different in type III HLP patients (14.1±19.1 mg dl‐1) as compared with the controls (13.3±16.2 mg dl‐1; P = 0.549, NS). In addition, there was no significant difference in apo(a) phenotype frequencies amongst both groups (0.2 > P > 0.1).

Conclusions. We conclude that the apo(a) polymorphism does not participate (to a significant extent) in the phenotypical expression of type III HLP.
Carotid intima‐media thickness: correlation with the British Regional Heart Study risk score
Authors: GEROULAKOS G. , O'GORMAN D. , NICOLAIDES A. , SHERIDAN D. , ELKELES R. , SHAPER A. G.
Published: August 2009

Abstract. Objectives. The thickness of the intima‐media (IMT) layer of the common carotid artery is a marker of severe and extensive coronary artery disease and it has been reported that it is related to the presence of risk factors for atherosclerosis. The purpose of this study was to establish whether the IMT correlates with the British Regional Heart Study (BRHS) risk score which identifies a large proportion of men who may experience a major ischaemic heart disease event within 5 years of initial screening.

Subjects. High resolution ultrasonography was used to measure the thickness of the intima‐media layer in 89 individuals. The BRHS risk score of these individuals was also recorded.

Main outcome measures. Correlation between the carotid IMT and the BRHS score.

Results. The IMT was linearly related to the BRHS score (r = 0.56; P < 0.001). There was a highly significant difference between the mean IMT in individuals with a risk score greater and those with a risk score lesser than the 80th percentile (P < 0.001).

Conclusion. It is concluded that the IMT may be a useful surrogate end‐point or biological marker of coronary artery disease and might be considered for use in prospective studies and clinical trials.
Mild haemophilia A in Iceland: clinical genetic studies of three families with the same mutation
Authors: JENSSON Ó. , BERNVIL S. STENBJERG , JÖNSÖDTTIR S. , INGERSLEV J.
Published: August 2009

Abstract. Objectives. The aim of the study was to define the phenotype in three families with mild haemophilia A and to determine restriction fragment length polymorphisms (RFLP), which could support a hypothesis of a common progenitor of the families.

Design. Family survey.

Setting. Index cases were identified in and outside hospital and a family survey for symptoms and signs of bleeding in family members and sampling for coagulation and RFLP studies were mostly carried out in the field.

Subject. Family members with and without symptoms of bleeding were selected for investigation and normal spouses and unrelated individuals were investigated for control.

Interventions. Medical advice regarding affected family members were given to the families and their physicians.

Main outcome measures. Bleeding time, factor VIII activity, quantification of factor VIII: Ag, von Wille‐brand factor (vWF) Ag and vWF ristocetin assay. Typing of RFLP polymorphisms for genetic homogeneity.

Results. Bleeding manifestations are present in both sexes in the three families although more frequent and more severe in the males. The level of factor VIII activity is between 10 and 20% in most affected males whereas 35–60% is found approximately in 2/3 of female carriers and in 1/3 of them factor VIII activity is within the normal range. It is suggested that screening for this mild haemophilia A gene by a molecular genetic method would be of clinical value now, its mutation having been detected.

Conclusions. Transmission of mild haemophilia A through six to seven generations is demonstrated by the study. The mild haemophilia A type described is the most prevalent of haemophilia A types in Iceland (population 260000, 1992). The founder effect was confirmed by studies of RFLP polymorphisms.
Silent pulmonary embolism in patients with deep venous thrombosis. Incidence and fate in a randomized, controlled trial of anticoagulation versus no anticoagulation
Authors: NIELSEN H. KRIEMER , HUSTED S. E. , KRUSELL L. R. , FASTING H. , CHARLES P. , HANSEN H. H.
Published: August 2009

Abstract. Objectives. A high frequency of asymptomatic pulmonary embolism (PE) in patients with deep venous thrombosis (DVT) has been reported, but information about the outcome of the patients with PE remains sparse. The aims of the present study were to assess the prevalence of silent PE in patients with symptomatic, venographically proven DVT, and to evaluate the natural history of silent PE.

Design. Consecutive patients from one centre of primary care were included in a randomized, open study with blinded control. All patients gave written, informed consent.

Subjects. Eighty‐seven consecutive patients with venographically proven DVT and with a perfusionventilation lung scintigraphy performed within 48 h of the DVT diagnosis were included. On the 10th and 60th days the lung scintigraphy was repeated in 80 and 60 patients, respectively. All the patients were followed for 3 months in the out‐patient clinic.

Interventions. All patients were ambulated from the first day and were allocated randomly to no anticoagulant (non‐AC) therapy or to AC therapy with intravenous heparin infusion for at least 6 days and oral AC therapy for 3 months.

Results. Forty‐three of these patients had a high probability lung scintigraphy for PE. Distal vein and femoral vein thrombosis embolized in 33 and 53% of patients, respectively. The progression rate after 60 days was 3% in both the AC and the non‐AC group and after 10 days the rates were 13 and 8%, respectively.

Conclusions. A high frequency of silent PE in patients with DVT both above and below the knee is demonstrated. AC treatment did not influence the resolution rate of PE or the rate of clinical PE in a 3‐month follow‐up period.
Peripartum cardiomyopathy—three cases
Authors: FORSSELL G. , LASKA J. , OLOFSSON C. , OLSSON M. , MOGENSEN L.
Published: August 2009

Abstract. Three cases of peripartum cardiomyopathy (PPCM) are presented, each illustrating a clinically important aspect of the disorder. One patient survived despite extreme haemodynamic deterioration, one died suddenly 2 months post partum although clinically recovered, and one died during a subsequent pregnancy. The cases demonstrate the severity and the unpredictable course of PPCM, which remains a challenge both to scientists and to clinicians.
High rate of nonspecific anti‐hepatitis C reactivity amongst homosexual men in comparison with that found in other sexually active groups and blood donors
Authors: ANDREU J. , ABAD M. A. , SANCHEZ‐QUIJANO A. , TORRONTERAS R. , LUQUE F. , HERAS J. GARCIA DE LAS , SOTO B. , PINEDA J. A. , LEAL M. , LISSEN E.
Published: August 2009

Abstract. Objectives. To investigate the concordance of antihepatitis C virus (anti‐HCV) reactivity by a second‐generation enzyme immunoassay (EIA‐2) and by a four‐antigen recombinant immunoblot assay (4‐RIBA) in homosexual men, in comparison with that found in other sexually active groups and blood donors.

Design. Prospective study.

Setting. Tertiary referral centre, Seville, Spain.

Subjects. A total of 1203 subjects were studied. Eight hundred and three were sexually active individuals: 547 female prostitutes, 88 heterosexual men who had frequent sexual intercourse with prostitutes, and 168 homosexual men. All of them denied blood transfusion and parenteral drug use. In addition, 400 voluntary blood donors were selected at random.

Main outcome measures. All serum samples were screened for anti‐HCV by EIA‐2 and repeatedly reactive sera were tested by 4‐RIBA. Homosexual men were also screened for anti‐human immunodeficiency virus (anti‐HIV), hepatitis B virus (HBV) markers and gammaglobulin concentration. Finally, serum samples from homosexual men reactive for anti‐HCV by EIA‐2 were analyzed for HCV‐RNA by polymerase chain reaction (PCR).

Results. Concordance between EIA‐2 and 4‐RIBA in female prostitutes (71.4%), clients of prostitutes (75.0%), and blood donors (83.3%) was significantly higher than in homosexual men (38.8%) (P < 0.04). In this collective the concordance between 4‐RIBA and PCR was 85.7% for positive cases and 88.8% for negative ones, and EIA‐2 ratios in reactive sera were significantly higher in 4‐RIBA confirmed cases (P < 0.0001). No correlation between false positive EIA‐2 results and presence of HIV infection, HBV markers or hypergammaglobulinaemia was found in homosexual men by univariate analysis.

Conclusions. There is a high level of non‐specific anti‐HCV reactivity by EIA‐2 amongst homosexual men in comparison with that found in other sexually active groups and blood donors. The true prevalence of HCV infection amongst homosexual men could be even lower than previously described.
A 5‐year prospective, observational study of the withdrawal of antihypertensive treatment in elderly people
Authors: Ekbom T. , Lindholm L. H. , Odén A. , Dahlöf B. , Hansson L. , Wester P.‐O. , Scherstén B.
Published: August 2009

Abstract. Objectives. To observe blood pressure, cardiovascular events, and total mortality after withdrawing antihypertensive treatment for elderly patients.

Design. Multicentre observational study.

Setting. Sweden. A 5‐year follow‐up of 333 elderly hypertensive patients, aged 70–84 years (mean age 75.2 ± sd 3.8 years, 68% females). In all, 74 out of the 333 patients (22%) died during the study period.

Method. After withdrawal of the antihypertensive therapy, all patients started in the untreated state and during the 5‐year follow‐up they could then either remain in the untreated state, or be reverted to blood‐pressure‐lowering drug treatment because of hypertension or other diseases, e.g. angina pectoris, oedema, congestive heart failure, etc.

Results. The probability of remaining without treatment for 5 years was estimated to be 20%. During the state of no treatment the patients had a lower total mortality risk than that of the general Swedish population, matched for age and sex. They also had a lower risk of cardiovascular events than those in the treated states. Markers indicating a successful withdrawal were monotherapy in low doses and relatively low blood pressure before withdrawal.

Conclusion. These results suggest that with frequent check‐ups, withdrawal of antihypertensive therapy in the elderly can be tried without increased risk of cardiovascular events.
Disturbances of T‐cell interactions with endothelium and the extracellular matrix proteins in a patient with Takayasu arteritis
Authors: IMIElA J. , GÓRSKI A. , DYBOWSKA B. , MALECKI R. , NOSARZEWSKI J.
Published: August 2009

Abstract. T‐cell interactions with endothelium and the extracellular matrix proteins were studied in vitro in a patient with Takayasu arterisis. Markedly enhanced spontaneous adhesiveness to cultured endothelium and collagen IV and fibronectin were found to be paralleled by abolished responses to the costimulating action of collagens I and IV and fibronectin. Those abnormalities were partly corrected by immunosuppressive therapy. Aberrant interactions of T cells with endothelium and the extracellular matrix proteins may underlay the pathogenesis of some forms of vasculitis.
A comparison of severe gastric damage as a result of pirprofen and naproxen treatment in rheumatoid arthritis: a controlled endoscopic study
Authors: MONTRONE F. , PETRILLO M. , CARUSO I. , PORRO G. BIANCHI
Published: August 2009

Abstract. Objective. The aim of this controlled endoscopic study was to compare the therapeutic efficacy and the gastric tolerance of two nonsteroidal antiinflammatory drugs, pirprofen versus naproxen.

Design. A randomized endoscopic double‐blind double‐dummy study.

Setting. The gastrointestinal unit of a teaching hospital.

Subjects. Forty patients suffering from rheumatoid arthritis were enrolled. After an initial upper gastrointestinal endoscopy to rule out the presence of gastric mucosal lesions, the patients were randomly allocated in a double‐blind, double‐dummy manner, to receive either pirprofen (400 mg t.i.d.) or naproxen (500 mg b.i.d.) for 4 weeks; endoscopic control followed this treatment period, or was anticipated in the event of painful dyspepsia.

Interventions. Endoscopy at the beginning of the study and at 4 weeks, or anticipated in the event of painful dyspepsia.

Main outcome measures. Primary outcome measure of the study was the possibility that pirprofen was less toxic to the gastric mucosa than naproxen, and at least as effective.

Results. Both drugs proved effective in relieving clinical symptoms, without a statistically significant difference. Gastric mucosa lesions were observed in 90% of pirprofen‐treated patients and in 60% of those on naproxen (P = 0.03). The most severe lesions (grades 3 and 4) were found in 65% of subjects treated with pirprofen, as opposed to 15% of those treated with naproxen (P = 0.001).

Conclusions. This study shows that pirprofen is at least as active as naproxen in relieving rheumatic symptoms, but its administration results in a significantly severe degree of gastric damage.
Low pulse‐wave amplitude during reactive leg hyperaemia: an independent, early marker for ischaemic heart disease and death Results from the 21‐year follow‐up of the prospective cohort study ‘Men born in 1914’, Malmö, Sweden
Authors: HEDBLAD B. , ÖGREN M. , JANZON L. , ISACSSON S.‐O. , LINDELL S. E.
Published: August 2009

Abstract. Objective. To study the incidence of myocardial infarction, all‐cause mortality and mortality from ischaemic heart disease in relation to arterial leg blood flow determined by venous occlusion plethysmography of the calf.

Design. A prospective cohort study ‘Men born in 1914’.

Setting. Malmö, a city in southern Sweden with 256000 inhabitants, and a single referral hospital.

Subjects. Six‐hundred and thirty‐six 55‐year‐old men, randomly selected from the general population. None of them had signs or symptoms of leg artery disease.

Main outcome measures. All‐cause mortality, morbidity and mortality from ischaemic heart disease during 21 years of follow‐up following the initial examination in 1968.

Results. A low pulse‐wave amplitude (i.e. < 5 mm) during reactive hyperaemia was, independently of other known arteriosclerotic risk factors, associated with a higher cardiac event rate of 37.1% (relative risk: 2.2; 95% CI: 1.3–3.6) and a higher all‐cause mortality rate of 62.9% (relative risk: 1.7; 95% CI: 1.2–2.4) during 21 years of follow‐up. No other plethysmographically recorded variable was associated with an increased mortality and cardiac event rate.

Conclusions. The plethysmographically recorded pulse‐wave amplitude during reactive hyperaemia can be used as an early independent marker to identify individuals at risk of developing ischaemic heart disease and death at an early age.
Subclinical coeliac disease: an anthropometric assessment
Authors: CORAZZA G. R. , DI SARIO A. , SACCO G. , ZOLI G. , TREGGIARI E. A. , BRUSCO G. , GASBARRINI G.
Published: August 2009

Abstract. Objectives. To evaluate the prevalence of malnutrition in patients with untreated coeliac disease (CD) according to their pattern of presentation, and the effect of gluten‐free diet (GFD) upon nutritional status.

Design. Cohort prospective study.

Setting. All subjects were seen at the outpatient ‘malabsorption’ clinic of the Department of Medical Pathology I, University of Bologna (referral centre), Bologna.

Subjects. Eighty consecutive patients with CD (48 with classical and 32 with subclinical presentation), 15 patients with dermatitis herpetiformis (DH) and 40 healthy volunteers (members of the hospital staff).

Main outcome measures. The nutritional status was evaluated by anthropometric measurements (percentage of ideal body weight for height and sex, percentage of standard triceps skinfold thickness and percentage of ideal arm‐muscle circumference).

Results. The overall prevalence of malnutrition in our series of CD patients was 53%. Prevalence of malnutrition (actual body weight less than 90% of the ideal) was significantly higher in classical coeliacs (67%) than in subclinical ones (31 %, P < 0.002), in patients with DH (13%, P < 0.0003) and in healthy volunteers (13%, P < 0.0001). At diagnosis, percentage values of ideal body weight, triceps skinfold thickness and arm‐muscle circumference were significantly lower (P < 0.0001, P < 0.0002 and P < 0.003, respectively) in classical coeliacs (84.5 ± 10.6, 71.2±28.1 and 87.1±10.8, respectively) than in subclinical coeliacs (95.5±9.1, 105.6±41.0 and 94.8±10.6, respectively). After GFD, 33% of classical and only 3% of subclinical coeliacs were still malnourished.

Conclusions. Prevalence of malnutrition in CD is lower than was previously thought. CD patients with classical presentation may require a longer period of GFD to achieve a significant improvement of their nutritional status, with respect to those with subclinical presentation, probably because of a greater extent of intestinal damage. Finally, a careful evaluation of dietary habits is usually sufficient to identify incomplete adherence to GFD as the reason for nonimprovement of the nutritional status in patients with CD.
Hip and distal arm fracture rates in peri‐ and postmenopausal insulin‐treated diabetic females
Authors: MELCHIOR T. M. , SØRENSEN H. , TORP‐PEDERSEN C.
Published: August 2009

Abstract. Objectives. Hip and distal arm fractures are associated with osteoporosis in the postmenopausal female. In diabetic patients, bone mass has been found to be reduced leading to the hypothesis that diabetes is a risk factor for osteoporosis. Whether this has any clinical implication has only been sparsely elucidated.

Design. A cross‐sectional case‐control study.

Setting. All insulin‐treated diabetic females above the age of 40 years who regularly visited the Steno Memorial Hospital out‐patient clinic in 1989. Periand postmenopausal females from the general population living in a similar suburban region of Copenhagen admitted to Glostrup University Hospital because of a hip or Colles' fracture between 1 January 1989 and 31 October 1990.

Subjects. The study comprised 748 insulin‐treated diabetic females. Thirty hip fractures and 82 Colles' fractures were reported after the age of 40 years. Out of 26 564 females from the general population, 622 were admitted to Glostrup hospital because of a hip or Colles' fracture.

Methods/intervention. Answers based on questionnaires sent to all diabetic females, and the use of hospital files and hospital registers.

Results. In diabetic females aged 40–49 years, Colles' fracture rate was 2/1000 years and hip fracture rate 0.43/1000 years. Fracture rate increased with age and, amongst 80–89‐year‐old diabetic females, the frequency of both fracture rates was 31/1000 years. These rates were slightly lower than the rates in the general female population. The relative risk of Colles' fracture in diabetic females aged 40–49 years was 0.3±0.2 (95% confidence limits) and that of hip fracture 1.O±1.1. In diabetic females aged 80–89 years, the risk of Colles' fracture and hip fracture were 1.3±1.1 and 1.0±0.9. Fracture rate was not associated with the development of diabetic complications, long‐term metabolic control, or age at diagnosis.

Conclusion. Our results suggest that diabetic osteopenia does not have any clinical impact on fracture risk.
Limited joint mobility in type 1 diabetic patients: correlation to other diabetic complications
Authors: ARKKILA P. E. T. , MD I. M. KANTOL , VIIKARI J. S. A.
Published: August 2009

Abstract. Objectives. To examine the association between limited joint mobility (LJM) and complications of diabetes in adult patients with type 1 diabetes.

Design. Cross‐sectional study in diabetic patients and healthy controls.

Setting. The study was performed at the department of medicine in Turku University Hospital (n = 103), a private diabetes outpatient clinic (n = 153) and the municipal health centre of Turku (n = 29), Finland.

Subjects. We studied 285 diabetic patients [age (mean ± SD): 33.4 ± 10.0 years] and 288 healthy nondiabetic controls [age (mean ± SD): 32.3 ± 9.2].

Main outcome measures. The limitations of several joints were examined with a goniometer. The diabetic patients were assessed in terms of the following complications: background and proliferative retinopathy, peripheral symmetrical polyneuropathy, autonomic neuropathy, impotence as well as clinical and incipient nephropathy; serum lipid values were also measured.

Results. The prevalences of LJM were 58% and 14% in diabetic patients and in healthy controls, respectively. The diabetic patients with LJM had a 2.8‐fold risk of proliferative retinopathy [95% confidence interval (CI): 1.1–7.3] and a 3.6‐fold risk of nephropathy (95% CI: 1.4–9.3) compared to patients without LJM, when the confounding effect of the duration of diabetes was excluded. LJM was not related to metabolic control of diabetes, microalbuminuria, autonomic neuropathy or impotence. The association between LJM and peripheral symmetrical polyneuropathy was exclusively explained by the duration of diabetes. The correlation between LJM and serum total and low‐density lipoprotein cholesterol was dependent on the association between LJM and nephropathy. LJM did not relate to serum high‐density lipoprotein cholesterol or triglyceride values.

Conclusions. The diabetic patients with LJM had an increased risk of proliferative retinopathy and nephropathy compared to patients without LJM.
Differential expression of enteric neuroimmune‐network in invasive and acute watery diarrhoea
Authors: Sarker P. , Bhuiyan T. R. , Qadri F. , Alam N. H. , Wretlind B. , Bishop A. E. , Mathan M. , Agerberth B. , Andersson J. , Raqib R.
Published: August 2009

Abstract  We aimed to evaluate the changes of nerve morphology and distribution of neurotransmitters and neuropeptides in the rectum of Shigella flexneri‐infected patients and in the duodenum of Vibrio cholerae O1‐infected patients. Nerve morphology was observed by transmission electron microscopy. Immunoreactivity of nerve growth factor (NGF), neurotransmitters and neuropeptides in tissues were studied by immunohistochemistry. Ultrastructural analysis of intestinal biopsy revealed persisting axons degeneration throughout the study period in all patients. Regeneration was already evident at the acute stage with marked increase at late convalescence. Both acute shigellosis and cholera were accompanied by increased expression of NGF and histamine and decreased expression of serotonin that was restored at convalescence. Immunoreactivity of vasoactive intestinal peptide (VIP) was increased during acute cholera, whereas in shigellosis VIP‐ and substance P‐immunoreactive nerves appeared at early convalescence. Both shigellosis and cholera induced long‐lasting degeneration of enteric neuronal axons, despite the presence of ongoing proliferation and regeneration processes. Neurotransmitters and neuropeptides may play differential roles in invasive and watery diarrhoea.
Molecular tools to investigate Rhizoctonia solani distribution in soil
Authors: Budge G. E. , Shaw M. W. , Colyer A. , Pietravalle S. , Boonham N.
Published: August 2009

Real‐time PCR protocols were developed to detect and discriminate 11 anastomosis groups (AGs) of Rhizoctonia solani using ribosomal internal transcribed spacer (ITS) regions (AG‐1‐IA, AG‐1‐IC, AG‐2‐1, AG‐2‐2, AG‐4HGI+II, AG‐4HGIII, AG‐8) or β‐tubulin (AG‐3, AG‐4HGII, AG‐5 and AG‐9) sequences. All real‐time assays were target group specific, except AG‐2‐2, which showed a weak cross‐reaction with AG‐2tabac. In addition, methods were developed for the high throughput extraction of DNA from soil and compost samples. The DNA extraction method was used with the AG‐2‐1 assay and shown to be quantitative with a detection threshold of 10−7 g of R. solani per g of soil. A similar DNA extraction efficiency was observed for samples from three contrasting soil types. The developed methods were then used to investigate the spatial distribution of R. solani AG‐2‐1 in field soils. Soil from shallow depths of a field planted with Brassica oleracea tested positive for R. solani AG‐2‐1 more frequently than soil collected from greater depths. Quantification of R. solani inoculum in field samples proved challenging due to low levels of inoculum in naturally occurring soils. The potential uses of real‐time PCR and DNA extraction protocols to investigate the epidemiology of R. solani are discussed.
Results of a prospective allocation policy of expanded criteria donors kidneys based on clinical parameters
Authors: Re L , Curcio D , Rial M , Goldberg J , Casadei D
Published: August 2009

Re L, Curcio D, Rial M, Goldberg J, Casadei D. Results of a prospective allocation policy of expanded criteria donors kidneys based on clinical parameters. Clin Transplant 2009 DOI: 10.1111/j.1399‐0012.2009.01053.x © 2009 John Wiley & Sons A/S.

Abstract:  The ideal system to allocate expanded criteria donors (ECD) kidneys has not been fully elucidated. In a previous retrospective study, we reported that donor clinical characteristics were more predictive of transplant outcome than biopsy findings. Subsequently, we decided to use ECD kidneys solely based on a clinical scoring system. To elucidate the value of the pre‐transplant biopsy, the patients were divided in two groups according to the suitability of the kidney they received for single or double transplantation as determined by a histological scoring system (HS). All kidneys were transplanted as a single (vs. dual) transplant. We studied whether a HS of the pre‐transplant biopsy was predictive of outcome of single transplant ECD kidneys. Recipients (n = 48) were divided into two groups by whether the histologic system suggested single or double transplants be done. There were no differences between groups in two‐yr outcomes. We conclude that a clinical scoring system can predict which ECD kidney donors can be safely used as single transplants in a cohort of low immunological risk de novo kidney transplant recipients. Use of the clinical scoring system maximizes organ use.
Pure and mixed manic subtypes: a review of diagnostic classification and validation
Authors: Cassidy Frederick , Yatham Lakshmi N , Berk Michael , Grof Paul
Published: August 2009

Objective:  To review issues surrounding the diagnosis and validity of bipolar manic states.

Methods:  Studies of the manic syndrome and its diagnostic subtypes were reviewed emphasizing historical development, conceptualizations, formal diagnostic proposals, and validation.

Results:  Definitions delineating mixed and pure manic states derive some validity from external measures. DSM‐IV and ICD‐10 diagnosis of bipolar mixed states are too rigid and less restrictive definitions can be validated. Anxiety is a symptom often overlooked in diagnosis of manic subtypes and may be relevant to the mixed manic state. The boundary for separation of mixed mania and depression remains unclear. A ‘pure’ non‐psychotic manic state similar to Kraepelin’s ‘hypomania’ has been observed in several independent studies.

Conclusions:  Issues surrounding diagnostic subtyping of manic states remain complex and the debates surrounding categorical versus dimensional approaches continue. To the extent that categorical approaches for mixed mania diagnosis are adopted, both DSM‐IV and ICD‐10 are too rigid. Inclusion of non‐specific symptoms in definitions of mixed mania, such as psychomotor agitation, does not facilitate and may hinder the diagnostic separation of pure and mixed mania. The inclusion of a diagnostic seasonal specifier for DSM‐IV, which is currently based on seasonal patterns for depression might be expanded to include seasonal patterns for mania. Boundaries between subtypes may be ‘fuzzy’ rather than crisp, and graded approaches could be considered. With the continued development of new tools, such as imaging and genetics, alternative approaches to diagnosis other than the purely symptom‐centric paradigms might be considered.
Pediatric bipolar disorder: validity, phenomenology, and recommendations for diagnosis
Authors: Youngstrom Eric A , Birmaher Boris , Findling Robert L
Published: August 2009

Objective:  To find, review, and critically evaluate evidence pertaining to the phenomenology of pediatric bipolar disorder and its validity as a diagnosis.

Methods:  The present qualitative review summarizes and synthesizes available evidence about the phenomenology of bipolar disorder (BD) in youths, including description of the diagnostic sensitivity and specificity of symptoms, clarification about rates of cycling and mixed states, and discussion about chronic versus episodic presentations of mood dysregulation. The validity of the diagnosis of BD in youths is also evaluated based on traditional criteria including associated demographic characteristics, family environmental features, genetic bases, longitudinal studies of youths at risk of developing BD as well as youths already manifesting symptoms on the bipolar spectrum, treatment studies and pharmacologic dissection, neurobiological findings (including morphological and functional data), and other related laboratory findings. Additional sections review impairment and quality of life, personality and temperamental correlates, the clinical utility of a bipolar diagnosis in youths, and the dimensional versus categorical distinction as it applies to mood disorder in youths.

Results:  A schema for diagnosis of BD in youths is developed, including a review of different operational definitions of ‘bipolar not otherwise specified.’ Principal areas of disagreement appear to include the relative role of elated versus irritable mood in assessment, and also the limits of the extent of the bipolar spectrum – when do definitions become so broad that they are no longer describing ‘bipolar’ cases?

Conclusions:  In spite of these areas of disagreement, considerable evidence has amassed supporting the validity of the bipolar diagnosis in children and adolescents.
Phylogenetic and biological species diversity within the Neurospora tetrasperma complex
Authors: MENKIS A. , BASTIAANS E. , JACOBSON D. J. , JOHANNESSON H.
Published: August 2009

The objective of this study was to explore the evolutionary history of the morphologically recognized filamentous ascomycete Neurospora tetrasperma, and to reveal the genetic and reproductive relationships among its individuals and populations. We applied both phylogenetic and biological species recognition to a collection of strains representing the geographic and genetic diversity of N. tetrasperma. First, we were able to confirm a monophyletic origin of N. tetrasperma. Furthermore, we found nine phylogenetic species within the morphospecies. When using the traditional broad biological species recognition all investigated strains of N. tetrasperma constituted a single biological species. In contrast, when using a quantitative measurement of the reproductive success, incorporating characters such as viability and fertility of offspring, we found a high congruence between the phylogenetic and biological species recognition. Taken together, phylogenetically and biologically defined groups of individuals exist in N. tetrasperma, and these should be taken into account in future studies of its life history traits.
Multicentre experience with a simple blood salvage technique in patients with ruptured ectopic pregnancy in sub‐Sahelian West Africa
Authors: Priuli G. , Darate R. , Perrin R. X. , Lankoande J. , Drouet N.
Published: August 2009

Background and Objective  Haemorrhage from ruptured ectopic pregnancy is a major cause of maternal death in Africa. The experience in three hospitals in salvaging intraperitoneal blood with a perforated metallic conical funnel is reported.

Method  The blood was transfused back to the patient immediately after salvaging. Data were collected concerning the patient, her clinical state and haemoglobin levels throughout her stay in hospital, the diagnosis, the transfusion, and the complications encountered.

Results  Two hundred and twelve patients were reported prospectively. The preoperative haemoglobin level was 70·6 ± 18·7 g/l (n = 132). After transfusion of 681 ± 389 ml (n = 212) of salvaged blood, haemoglobin levels reached 84·7 ± 10·5 g/l (n = 23) 6 days postoperatively. Twenty‐two patients, half of whom had a life‐threatening haemodynamic state, were also given donor blood. Twenty patients still had severe anaemia on leaving hospital (blood haemoglobin < 70 g/l). No untoward outcomes attributable to the reinfusion were seen.

Conclusion  The surgical treatment of ruptured ectopic pregnancy with intraperitoneal haemorrhage was rendered safe and efficient with this new salvaging equipment.
Bone development of suckling piglets after prenatal, neonatal or perinatal treatment with dexamethasone
Authors: Śliwa E. , Dobrowolski P. , Piersiak T.
Published: August 2009

In mammals, the release from growth‐inhibiting conditions results in catch‐up growth. To investigate animal evidence for whether prenatal dexamethasone (DEX) treatment leads to the development of growth restriction especially reduced mineralization of skeleton, and release from it leads to the phenomenon of catch‐up, piglets were prenatally exposed to DEX (3.0 mg/sow per day−2) during the last 24 days of prenatal life and tested further in two different ways: discontinued at birth and continued administration of DEX (0.5 mg/kg day−2) to piglets through 30 days of neonatal life. Using dual energy X‐ray absorptiometry methods, bone mineral density (BMD) and bone mineral content (BMC) were measured. The three‐point bending test was applied to determine the mechanical properties of the bones. Furthermore, geometric properties of the bones were assessed. Serum concentration of osteocalcin (OC) was determined. Histomorphological analysis of the ribs was also performed. The consequences of neonate DEX treatment and in utero DEX exposure were reflected in a dramatic decrease of BMD, BMC and blood serum OC concentration and geometric parameters of piglets’ bones. Prenatal action of DEX during the last 24 days of pregnancy resulted in continued neonatal modification of bone tissues, thus diminishing bone quality, and negatively influenced structural development and mechanical properties, finally increasing the risk of fractures of ribs and limb bones. Prenatal DEX treatment limited to the last 24 days of foetal life did not reduce the term birth weight and the growth of suckling piglets followed up to 30 days of neonatal life, and catch‐up in bone mineralization did not occur.
Effect of maize starch concentration in the diet on starch and cell wall digestion in the dairy cow
Authors: Van Vuuren A. M. , Hindle V. A. , Klop A. , Cone J. W.
Published: August 2009

An in vivo experiment was performed to determine the effect of level of maize starch in the diet on digestion and site of digestion of organic matter, starch and neutral detergent fibre (NDF). In a repeated change‐over design experiment, three cows fitted with a rumen cannula and T‐piece cannulae in duodenum and ileum received a low‐starch (12% of ration dry matter) and a high‐starch (33% of ration dry matter) diet. Starch level was increased by exchanging dried sugar beet pulp by ground maize. After a 2‐week adaptation period, feed intake, rumen fermentation parameters (in vivo and in situ), intestinal flows, faecal excretion of organic matter, starch and NDF were estimated. When the high‐starch diet was fed, dry matter intake was higher (19.0 kg/day vs. 17.8 kg/day), and total tract digestibility of organic matter, starch and NDF was lower when the low‐starch diet was fed. Maize starch concentration had no significant effect on rumen pH and volatile fatty acid concentration nor on the site of digestion of organic matter and starch and rate of passage of ytterbium‐labelled forage. On the high‐starch diet, an extra 1.3 kg of maize starch was supplied at the duodenum in relation to the low‐starch diet, but only an extra 0.3 kg of starch was digested in the small intestine. Digestion of NDF was only apparent in the rumen and was lower on the high‐starch diet than on the low‐starch diet, mainly attributed to the reduction in sugar beet pulp in the high‐starch diet. It was concluded that without the correction for the reduction in NDF digestion in the rumen, the extra supply of glucogenic (glucose and propionic acid) and ketogenic nutrients (acetic and butyric acid) by supplemented starch will be overestimated. The mechanisms responsible for these effects need to be addressed in feed evaluation.
Metabolic and luteal function in winter‐calving Spanish beef cows as affected by calf management and breed
Authors: Álvarez‐Rodríguez J. , Palacio J. , Sanz A.
Published: August 2009

This experiment aimed at evaluating the effect of calf management and breed on the metabolic and luteal function of post‐partum beef cows fed at maintenance. Fifty multiparous cows, 22 Parda de Montaña (PA) and 28 Pirenaica (PI), were assigned to either suckling once‐daily for 30 min (RESTR) or ad libitum (ADLIB) from the day after calving. Blood samples were collected to analyse metabolites [non‐esterified fatty acids (NEFA), β‐hydroxybutyrate, total protein and urea)], insulin‐like growth factor‐I (IGF‐I) and progesterone (P4) at different intervals. Cows from RESTR maintained their live‐weight (LW) over the first 3 months post‐partum, whereas ADLIB cows lost nearly 4% LW. Both genotypes showed similar LW gains during this period (p > 0.10). Calf daily gains were lower in RESTR than in ADLIB treatment (p < 0.05), but similar across breeds (p > 0.10). Milk and lactose production were lower in RESTR cows than in ADLIB (p < 0.05). Milk and protein yield were greater in PA than in PI breed (p < 0.05). Serum NEFA, total protein and urea were higher in PI cows suckling ADLIB than in the rest (p < 0.05). Cows from PI breed had greater NEFA values than PA ones on the first week post‐partum (p < 0.001). Circulating IGF‐I was not affected by suckling frequency, breed nor their interaction (p > 0.10). Suckling frequency, but not breed, affected the interval from calving to first ovulation (p < 0.001), being shorter in RESTR than in ADLIB cows. In conclusion, the ad libitum suckling practice improved cow milk yield and offspring gain compared to once‐daily suckling for 30 min from the day after calving, at the expense of impairing the onset of cyclicity. The effect of calf management was confounded with breed on the studied blood biochemical constituents, but any of these metabolites influenced the role of endocrine IGF‐I in these genotypes.
Dose–response relationship of inhaled corticosteroids and cataracts: A systematic review and meta‐analysis
Authors: WEATHERALL Mark , CLAY Jennifer , JAMES Kate , PERRIN Kyle , SHIRTCLIFFE Philippa , BEASLEY Richard
Published: August 2009

Background and objective:  The risk of cataracts associated with the long‐term use of inhaled corticosteroids (ICS) is poorly recognized, yet may be of major public health importance. The aim of this study was to determine the dose–response relationship of ICS use and risk of cataracts in adults.

Methods:  A systematic review and meta‐analysis was performed of case–control studies of cataracts and ICS use, which included at least two doses of ICS and in which the number of cases and controls using each dose of ICS was reported. The primary outcome variable was risk of cataracts.

Results:  Four case–control studies were identified, with a total of 46 638 cases and 146 378 controls. There was a significant relationship between the risk of cataracts and ICS dose, with a random effects pooled odds ratio for risk of cataracts per 1000 µg increase in daily beclomethasone dipropionate dose of 1.25 (95% CI: 1.14–1.37).

Conclusions:  The risk of cataracts was increased by approximately 25% for each 1000 µg per day increase in the dose of beclomethasone dipropionate or equivalent. These findings reinforce the importance of prescribing within the therapeutic dose–response range for ICS in asthma and the need to determine the dose–response relationship for the efficacy of ICS in COPD. Screening for the presence of cataracts could usefully be undertaken in older subjects with asthma and COPD, particularly current or ex‐smokers.