bluuebunny/crossref_metadata_2025 huggingface dataset:
Profile of patients with lower back pain in Dr Saiful Anwar Hospital, Malang, Indonesia
Authors: Djais Nursamsu , Kalim Handono
Published: March 2003

Aim: To determine the profile of patients with lower back pain (LBP).

Methods: A retrospective study was carried out on patients who presented to Dr Saiful Anwar Hospital (a referral hospital), Malang, Indonesia, from January to December 2000.

Results: During the 1‐year period of the study, 456 patients with LBP presented at the Dr Saiful Anwar Hospital. There were 206 female patients (45.2%) with an average age of 46 ± 14.1 years (range: 17–86 years) and 250 male patients (54.8%) with an average age of 45 ± 13.9 years (range: 17–82 years). There were 219 patients affected under the age of 45 years (48%). The educational background of cases was 77 (16.4%) with an academic education, 142 (31.1%) with senior high school, 66 (14.5%) with junior high school, 82 (18%) with elementary school and 89 (19.5%) with an unknown educational background.

Conclusions: Lower back pain was more frequent in men than in women. There were no differences statistically in the prevalence of LBP according to age group, sex and educational level.
A case of recurrent parotid swelling, syncope, arthritis and nephrotic syndrome
Authors: Thong Bernard Yu‐Hor , Lau Tang‐Ching , Chong Pek‐Yoon , Chew Stephen Tec‐Huan , Tan Puay‐Hoon
Published: March 2003

The differential diagnoses and histopathological findings of a case of recurrent parotid swelling, syncope, arthritis and nephrotic syndrome will be discussed. Primary Sjögren's syndrome is rarely associated with granulomatous inflammation, panniculitis and systemic amyloidosis. Multi‐organ failure, in particular cardiac amyloidosis, is potentially fatal.
State of the art: Juvenile idiopathic arthritis
Authors: Manners Prudence J.
Published: March 2003

Juvenile idiopathic arthritis (JIA) is the most common of the autoimmune musculoskeletal conditions in children. As awareness of this condition increases, so too does the apparent prevalence reported from countries around the world, suggesting that significant numbers of children with JIA have previously gone undiagnosed. Prevalence varies with race and possibly geography. However, JIA should no longer be considered as a rare condition.

In the past decade, there have been definite advances in understanding the pathogenesis of JIA, and there have been parallel advances in therapies. There have been fairly modest advances in the classification of JIA, but there is at least heightened international debate on the issue, which will lead to progress. It is estimated that nearly one‐third of children with this condition continue into adult life with inflammatory joint disease, and therefore the burden of disease remains significant.
Implications of geitonogamous pollination for floral longevity in Iris gracilipes
Authors: Ishii H. S. , Sakai S.
Published: March 2003

We analysed the longevity of individual flowers with respect to the effects of the floral display size of a plant (number of flowers open at one time) and spatial arrangement of flowers in Iris gracilipes (A. Gray). We found that the actual floral longevity of this species (about 2 days) was much shorter than that predicted by the model of Schoen and Ashman (about 7–10 days).

 A large display size and an overlap of flowering periods within a shoot facilitated successive pollinator probes within a plant, though the frequency of pollinator visits per flower was independent of display size. Consequently, the cost of geitonogamous selfing increased with an increase in display size and an overlap of flowering periods within a shoot. The short floral longevity of this species would be effective in such situations because shorter floral longevity leads to a smaller display size and a smaller overlap of flowering periods within a shoot.

 A small display size and small overlap of flowering periods within a shoot could also be realized by the strategy that staggers the flowering period of each flower without floral longevity being shortened (extended blooming). However, a mutant plant with an extended blooming schedule would be unlikely to invade the population because of the stabilizing selection pressure on the flowering date. This may be why such a short floral longevity, rather than extended blooming, has evolved in this species.
Why do flowers of a hummingbird‐pollinated mistletoe face down?
Authors: TADEY M. , AIZEN M. A.
Published: March 2003

Pendant flowers are common among hummingbird‐pollinated plants. A downward orientation of the flower or inflorescence could represent an adaptation to avoid either flower flooding or direct pollen losses from anthers or stigmas under rainy conditions.

 We studied the adaptive significance of this trait experimentally in Tristerix corymbosus Kuijt (Loranthaceae), a mistletoe native to the temperate forests of southern South America. We applied three treatments: (i) natural pendant inflorescences; (ii) inflorescences tethered to face up; and (iii) inflorescences tethered to face down (as a control for tethering). We also considered natural exposure to rain as a second factor.

 The treatments did not differ significantly in either nectar volume or concentration. Flowers exposed to rain for most of their lives contained more diluted nectar than those that remained dry, but this result did not depend on either inflorescence or flower orientation.

 We found significantly fewer pollen tubes in styles of flowers from inflorescences tethered to face up than in flowers receiving the other two treatments, but this could not be attributed to a direct effect of rain exposure. Inflorescence orientation did not affect either the number of pollen grains left in anthers or seed set. No strong evidence was found for differential visitation by hummingbirds in relation to a flower’s angle.

 The results of this work support neither the flower‐flooding nor the pollen‐protection hypothesis. However, a flower’s orientation may affect the extent of within‐flower self‐pollination or the efficiency of pollen transfer from a hummingbird’s bill onto a flower’s stigma.
Pulsatile, nyctohemeral and entropic characteristics of GH secretion in adult GH‐deficient patients: selectively decreased pulsatile release and increased secretory disorderliness with preservation of diurnal timing and gender distinctions
Authors: Roelfsema Ferdinand , Biermasz Nienke R. , Veldhuis Johannes D.
Published: March 2003

introduction The present clinical investigation uses a high‐precision GH immunofluorometric assay to examine the postulate that principally the amplitude mode of GH secretory control is disrupted in adults with GH deficiency.

patients and methods To this end, we investigated GH secretory dynamics in a cohort of 19 adult GH‐deficient (GHD) patients and 19 age‐, gender‐ and body mass index‐matched controls. GHD was established by blunted (< 7 mU/l) GH release during insulin‐induced hypoglycaemia. Twenty‐four‐hour serum GH concentration profiles obtained by 10‐min sampling were analysed by deconvolution, cosinor analysis and approximate entropy to appraise pulsatile, diurnally rhythmic, and pattern‐dependent GH secretion, respectively.

results Deconvolution analysis revealed that pulsatile GH release was decreased by threefold, due to amplitude‐specific damping, detectable GH secretory burst frequency was paradoxically increased by twofold, but basal non‐pulsatile GH release was fully preserved. GH half‐life in patients and controls was similar, thus excluding major kinetic differences. The acrophase (time of maximum) of the 24‐h GH rhythm was unchanged. The regularity of the GH release process, as measured by ApEn, was decreased profoundly in GHD patients (P < 10−8). The changes in GH secretion were similar in irradiated and nonirradiated patients. Daily GH secretion was also comparable in male and female GHD patients, but plasma IGF‐I concentrations were higher in male than female patients (P = 0·031). Furthermore, the gender‐specific GH ApEn difference, evident in controls, was still demonstrable in patients (P = 0·017). The ratio of plasma IGF‐I and pulsatile GH production was increased threefold in patients (P = 0·004), pointing to increased sensitivity to GH in GH deficiency and/or non‐GH‐dependent IGF‐I production.

conclusions The present detailed analyses of daily GH secretory dynamics in patients with (moderate) GH deficiency document an amplitude‐specific decrease in pulsatile GH secretion, which is partly compensated for by increased GH pulse frequency. The remarkably disorderly patterns of GH secretion in patients identify other major alterations in GH neuroregulation in such individuals, reflecting withdrawal of expected GH and/or IGF‐I repression of pulsatile GH secretion. Preservation of the nyctohemeral timing of GH release and the gender contrast in GH ApEn in GHD patients would also be consistent with partial retention of central neuroregulation and GH/IGF‐I feedback‐dependent control in hypopituitary subjects.
Contraindicated NSAIDs are frequently prescribed to elderly patients with peptic ulcer disease
Authors: Visser Loes E. , Graatsma Hayo H. , Stricker Bruno H. Ch.
Published: March 2003

Aims  To establish the frequency with which NSAIDs were prescribed to elderly patients after admission to hospital for serious gastrointestinal complications and to study which factors are determinants of the prescription of these contraindicated drugs.

Methods  A retrospective cohort study of patients from The Rotterdam Elderly Study, a prospective population‐based cohort study of people older than 55 years of age was carried out. Elderly patients with a hospital admission for serious gastrointestinal complications were followed until prescription of an NSAID, death, removal to another area or end of the study period, whichever came first. The following baseline determinants for receiving a contraindicated prescription were studied: gender, age, presence of rheumatoid arthritis or osteoarthritis, presence of cardiovascular risk factors, number of GP visits, number of visits to a medical specialist, cognitive function and the prescriber being a GP or a medical specialist.

Results  Prescriptions of an NSAID after discharge from hospital, were identified in 73 patients (73%). Fifty‐one percent were prescribed aspirin of whom the large majority used it as an antithrombotic agent, and 49% were prescribed a nonaspirin NSAID after discharge from hospital. Twenty percent of the patients used more than one NSAID on one or more occasions after discharge. For patients who were prescribed NSAIDs before admission as well as after discharge, the proportion of contraindicated prescriptions with concomitant use of antiulcer drugs rose significantly from 0.19 before discharge to 0.60 after discharge for aspirin and from 0.11 to 0.61 for nonaspirin NSAIDs. In the multivariate analysis the only remaining factor with prognostic influence on prescription of NSAIDs was a history of NSAID use before cohort enrolment. A history of rheumatoid arthritis or osteoarthritis was not associated with NSAID prescription after discharge.

Conclusions  Contraindicated NSAIDs are prescribed to a great extent in elderly patients, despite their greater vulnerability for life‐threatening gastrointestinal blood loss. It is remarkable that a history of rheumatoid arthritis or osteoarthritis is no significant determinant for receiving a contraindicated prescription, which suggests that these drugs are mainly prescribed for uncomplicated arthralgia.
Dihydroergotamine: discrepancy between arterial, arteriolar and pharmacokinetic data
Authors: De Hoon, J. N. J. M. , Poppe K. A. , Thijssen H. H. W. , Struijker‐Boudier H. A. J. , Van Bortel L. M. A. B.
Published: March 2003

Aims  To investigate the peripheral vascular effects and pharmacokinetics of dihydroergotamine (DHE) 0.5 mg after a single subcutaneous administration in humans.

Methods  A double‐blind, placebo‐controlled cross‐over study was performed in 10 healthy male subjects. A wash‐out period of 2 weeks separated the two study periods. During each period, just before and at regular intervals after drug administration, vascular measurements were performed and venous blood samples were drawn. Vessel wall properties were assessed at the brachial artery, by ultrasound and applanation tonometry. Blood pressure and heart rate were recorded with an oscillometric device. Forearm blood flow was measured with venous occlusion plethysmography. For all parameter‐time curves the area under the curve (AUC) was calculated. Differences in AUC after placebo and DHE (ΔAUC) were analysed and the time‐course of the difference assessed. DHE pharmacokinetics were analysed according to a two‐compartment open model with an absorption phase.

Results  AUC for blood pressure, heart rate and forearm vascular resistance did not change after DHE. Brachial artery diameter and compliance decreased (P < 0.01); ΔAUC (95% confidence interval) equalled −8.81 mm h (−12.97/−4.65) and −0.98 mm2 kPa−1 h (−1.61/−0.34), respectively. Diameter decreased (P < 0.05) from 1 until 24 h after DHE (peak decrease 9.7% at 10 h); compliance from 2 until 32 h (24.8% at 2 h). Time to reach maximum plasma concentration of DHE averaged 0.33 ± 0.08 h (± s.e.mean); terminal half‐life was 5.63 ± 1.15 h.

Conclusions  DHE decreased diameter and compliance of the brachial artery whereas forearm vascular resistance remained unchanged. Thus, DHE acts on conduit arteries without affecting resistance arteries. Furthermore, a discrepancy was demonstrated between the plasma concentrations of DHE which rapidly reach peak levels and quickly decline, and its long lasting vasoconstrictor activity.
Risk of suicide in users of β‐adrenoceptor blockers, calcium channel blockers and angiotensin converting enzyme inhibitors
Authors: Sørensen Henrik Toft , Mellemkjær Lene , Olsen Jørgen H.
Published: March 2003

Aims  To examine the risk of suicide in users of β‐adrenoceptor blockers, calcium channel blockers, and angiotensin converting enzyme inhibitors.

Methods  We conducted a cohort study based on linkage of a population‐based prescription registry in North Jutland County, Denmark, and the nationwide Death Registry. From 1989 to 1995 there were 58 529 users of β‐adrenoceptor blockers, calcium channel blockers, and angiotensin converting enzyme inhibitors. The mortality rates from suicides in the cohort members were compared with the rates in the general population.

Results
One hundred and four suicides occurred in the cohorts. The standardized mortality ratio for suicide in users of β‐adrenoceptor blockers was 1.6 (95% confidence interval: 1.2–2.1), in users of calcium channel blockers 1.2 (95% confidence interval: 0.8–1.7), and in users of angiotensin converting enzyme inhibitors 1.2 (95% confidence interval: 0.7–1.8). In users of β‐adrenoceptor blockers, the risk of suicide was increased during the first 12 months after the start of therapy, standardized mortality ratio 2.1 (95% confidence interval: 1.2–3.5). There was a trend in the standardized mortality ratio of suicide from 0.9 (95% confidence interval: 0.4–1.9) in users of β‐adrenoceptor blockers with low lipid solubility, to 1.6 (0.8–2.8) and 2.7 (1.7–4.1) in users of β‐adrenoceptor blockers with medium and high lipid solubility, respectively.

Conclusions
Users of medium and high lipid soluble β‐adrenoceptor blockers may have an increased risk of suicide. Users of calcium channel blockers and angiotensin converting enzyme inhibitors do not seem to have a significantly increased risk of suicide.
Adverse drug reactions in patients admitted to hospital identified by discharge ICD‐10 codes and by spontaneous reports
Authors: Cox A. R. , Anton C. , Goh C. H. F. , Easter M. , Langford N. J. , Ferner R. E.
Published: March 2003

Aims  We studied the international classification of disease (ICD) hospital discharge codes to find unreported adverse drug reactions (ADRs), and asked doctors about their attitudes to reporting some of these cases.

Methods  We examined the ICD codes assigned on discharge to identify ADRs and compared these with spontaneous reports made to the Committee on Safety of Medicines (CSM). Doctors involved were sent brief résumés of cases and asked if they would report them.

Results  49 of 21 365 patient episodes were coded on discharge as ADRs, of which 33 were ‘reportable’. Fourteen spontaneous reports were received by the CSM during the same period. The two groups did not overlap. 25 of 60 doctors responded to our questionnaire, and would have reported only 8 of 75 cases outlined.

Conclusions  The ICD coding allowed us to identify important ADRs which most doctors would not report spontaneously.
Herb–drug interactions: Review and assessment of report reliability
Authors: Fugh‐Berman Adriane , Ernst E.
Published: March 2003

Aims  The aim of this systematic review was to assess the published clinical evidence on interactions between herbal and conventional drugs.

Methods  Four electronic databases were searched for case reports, case series or clinical trials of such interactions. The data were extracted and validated using a scoring system for interaction probability.

Results  One hundred and eight cases of suspected interactions were found. 68.5% were classified as ‘unable to be evaluated’, 13% as ‘well‐documented’ and 18.5% as ‘possible’ interactions. Warfarin was the most common drug (18 cases) and St John's wort the most common herb (54 cases) involved.

Conclusion  Herb–drug interactions undoubtedly do occur and may put individuals at risk. However our present knowledge is incomplete and more research is urgently needed.
Variability of cytochrome P450 1A2 activity over time in young and elderly healthy volunteers
Authors: Simon T. , Becquemont L. , Hamon B. , Nouyrigat E. , Chodjania Y. , Poirier J. M. , Funck‐Brentano C. , Jaillon P.
Published: March 2003

Aims  To assess the age‐associated changes over time of plasma paraxanthine/caffeine (PAX/CAF) ratios used as a probe for CYP1A2 activity.

Methods  Intraindividual and interindividual variabilities in PAX/CAF ratio were compared by phenotyping with caffeine, 16 young and 16 elderly healthy subjects on five occasions.

Results
 PAX/CAF ratio variability was comparable regardless of age (intraindividual CV: 17.6 ± 6% and 16.2 ± 5.9%, interindividual CV: 48.1 ± 2.9% and 42.7 ± 3.6% in young and elderly, respectively). The PAX/CAF ratio was lower in elderly than in young subjects (95% CI for the difference: 0.004, 0.32) but the difference was not significant in nonsmokers compared separately.

Conclusions  The variability over time of the PAX/CAF ratio is not influenced by age.
What benefit do patients expect from adding second and third antihypertensive drugs?
Authors: Leaman Hannah , Jackson Peter R.
Published: March 2003

Aims  To discover whether patients have the same expectations of benefit from taking the first and any additional drugs for the treatment of hypertension and to investigate any patient characteristics which predict willingness to take treatment.

Methods  This was an anonymous questionnaire survey carried out in a single primary care group. A random sample of patients from the practice list stratified by age and gender were surveyed to determine what benefit they required before deciding to receive first and subsequent drugs to treat hypertension. They were asked to indicate the largest number needing treatment for 5 years (NNT5) to prevent myocardial infarction in 1 (smallest benefit) that would persuade them of the need for treatment. Demographic information which might explain variability in enthusiasm for treatment was also collected.

Results Participants required far higher benefit to consider drug treatment than expected with a mean NNT5 for the first treatment of 15.0 (95% CI 12.3, 17.8). Marginal benefit demanded for the addition of second and third treatments was at least as great with an NNT5 of 13.2 (95% CI 10.8, 15.7) and NNT5 of 11.0 (95% CI 8.6, 13.4). Additional factors influencing willingness to take treatment were gender with a difference in NNT5 between men and women of 7.1 (95% CI 1.7, 12.5), difficulty in making the decision (very easy vs very difficult) of 14.9 (95% CI 6.0, 23.8), and years in full time education 2.0 (95% CI 0.9, 3.0) for each additional year of education. Any slope of NNT5 with increasing number of tablets disappeared when gender, years in education, and difficulty in reaching a decision were taken into account simultaneously.

Conclusions  People may have greater expectation of benefit from antihypertensive drug treatment than it provides. They certainly do not view the addition of subsequent drugs as any lesser step than starting the first in terms of the benefit expected. Full understanding of both the risks and benefits may be of critical importance with those spending longer in full time education and those expending more effort in making the decision accepting more treatment. The discrepancy between benefit expected and that available demands further research into methods of determining patients’ expectations and informing individual patient decisions.
Effect of aspirin on vasodilation to bradykinin and substance P in patients with heart failure treated with ACE inhibitor
Authors: Davie Andrew P. , McMurray John J. V.
Published: March 2003

Aims  We wanted to examine some of the mechanisms by which aspirin might be responsible for counteraction of the effects of ACE inhibitors. Aspirin has been reported to counteract the effects of ACE inhibitors in patients with heart failure. Despite this, there is little evidence on what the mediator of such an effect might be, although there is some evidence to implicate bradykinin and, perhaps, substance P.

Methods  Twelve patients with congestive heart failure treated with an ACE inhibitor were studied on two occasions, after abstaining from aspirin for 14 days, and after 14 days of aspirin 150 mg once daily. Forearm blood flow was measured by venous occlusion plethysmography during intrabrachial infusions of bradykinin and substance P, before and after intrabrachial aspirin.

Results  Bradykinin caused profound vasodilation (peak 390%, 95% confidence intervals (CI) 300, 480%; P < 0.01), substance P slightly less (peak 222%, 95% CI 162, 283%; P < 0.01). Intra‐brachial aspirin had no effect on its own. The response to bradykinin was unchanged by intrabrachial aspirin (peak 404%, 95% CI 304, 504%) or oral aspirin (peak 320%, 95% CI 209, 431%; P = 0.2). The response to substance P was unchanged by intrabrachial aspirin (peak 226%, 95% CI 171, 281%) or oral aspirin (peak 220%, 95% CI 142, 297%; P = 0.86).

Conclusions  Aspirin has no effect on the vasodilator response to bradykinin and substance P in patients with heart failure treated with an ACE inhibitor. Neither bradykinin nor substance P is likely to contribute to the reported interaction between aspirin and ACE inhibitors.
Pharmacokinetics and anticonvulsant effects of diazepam in children with severe falciparum malaria and convulsions
Authors: Ogutu B. R. , Newton C. R. J. C. , Crawley J. , Muchohi S. N. , Otieno G. O. , Edwards G. , Marsh K. , Kokwaro G. O.
Published: March 2003

Aims  Convulsions are a common complication of severe malaria in children and are associated with poor outcome. Diazepam is used to terminate convulsions but its pharmacokinetics and pharmacodynamics have not been studied in this group. Accordingly, we carried out a comparative study of the pharmacokinetics of intravenous (i.v.) and rectal (p.r.) diazepam.

Methods  Twenty‐five children with severe malaria and a convulsion lasting >5 min were studied. Sixteen children received diazepam intravenously (i.v.; 0.3 mg kg−1) and nine rectally (p.r.; 0.5 mg kg−1). Plasma diazepam concentrations were measured by reversed phase high‐performance liquid chromatography. The duration of convulsions, depth of coma, respiratory and cardiovascular parameters were monitored.

Results  Median maximum plasma diazepam concentrations of 634 (range 402–1507) ng ml−1 and 423 (range 112–1953) ng ml−1 were achieved at 5 and 25 min following i.v. and p.r. administration, respectively. All patients except three (one i.v. and two p.r.) achieved plasma diazepam concentration >200 ng ml−1 within 5 min. Following p.r. administration, plasma diazepam concentrations were more variable than i.v. administration. A single dose of i.v. diazepam terminated convulsions in all children but in only 6/9 after p.r. administration. However, nine children treated with i.v. and all those treated with p.r. diazepam had a recurrence of convulsions occurring at median plasma diazepam concentrations of 157 (range: 67–169) and 172 (range: 74–393) ng ml−1, respectively. All the children in the i.v. and four in the PR diazepam group who had recurrence of convulsions required treatment. None of the children developed respiratory depression or hypotension.

Conclusions  Administration of diazepam i.v. or p.r. resulted in achievement of therapeutic concentrations of diazepam rapidly, without significant cardio‐respiratory adverse effects. However, following p.r. administration, diazepam did not terminate all convulsions and plasma drug concentrations were more variable.
Management ofHelicobacter pylorieradication – the influence of structured counselling and follow‐up
Authors: Al‐Eidan F. A. , McElnay J. C. , Scott M. G. , McConnell J. B.
Published: March 2003

Aims Helicobacter pylori(H. pylori) eradication rate varies according to the treatment regimen used and other factors, e.g. antimicrobial resistance and patient compliance. The aim of the present study was to evaluate the influence of patient counselling and follow‐up onH. pylorieradication rates and to document the effectiveness of a 1 week eradication regimen consisting of lansoprazole (30 mg once daily), amoxicillin (1 g twice daily) and clarithromycin (500 mg twice daily).

Methods Seventy‐six dyspeptic patients, who at endoscopy were found to have gastritis, duodenitis or ulceration, and a positiveH. pyloriurease test, were recruited. Patients were randomly assigned to an intervention group (n = 38) or a control group (n = 38). Intervention patients received their medicines via the hospital pharmacy and were counselled (and followed up) by a hospital pharmacist. Control patients were given a standard advice sheet and referred to their GP who prescribed the same therapy.

Results Intervention patients exhibited a statistically significant improvement in theH. pylorieradication rate (94.7%vs73.7%;P = 0.02) and compliance (92.1%vs23.7;P < 0.001). Of the 64H. pylorieradicated patients, 62 were able to eliminate their antisecretory medication compared with only 12 of theH. pyloripersistent patients (P < 0.001). A pharmacoeconomic evaluation indicated that counselling and follow‐up reduced the direct costs of eradication by approximately £30 per patient.

Conclusions Structured patient counselling and follow‐up can have a significant effect onH. pylorieradication rates and should be a routine part of therapy.
Frequency of adverse drug reactions in children: A prospective study
Authors: Jonville‐Béra Annie Pierre , Giraudeau Bruno , Blanc Pascal , Beau‐Salinas Frèdèrique , Autret‐Leca Elisabeth
Published: March 2003

Aims  To assess the frequency of adverse drug reactions (ADRs) in children in France.

Methods  In a prospective study over a period of 1 week, we evaluated the incidence of ADRs (1) as a cause of admission to a regional children's hospital; (2) occurring during hospitalization in a regional children's hospital; and (3) as a cause of consultation with private paediatricians.

Results  Four out of 260 children were admitted to the regional children's hospital for ADRs (1.53% [0.42, 3.89]) and six developed ADRs during hospitalization (2.64% [0.97, 5.66]), 4/428 attended the Accident and Emergency Department for ADRs (0.93% [0.25, 2.37]) and 8/1192 consulted a private paediatrician for ADRs (0.67% [0.29, 1.31]).

Conclusions  Our results are in agreement with the incidence of ADRs in children found in others countries.
Evaluating a putative mimetic relationship between two butterflies, Adelpha bredowii and Limenitis lorquini
Authors: Prudic Kathleen L. , Shapiro Arthur M. , Clayton Nicola S.
Published: March 2003

Abstract 1. A laboratory bioassay experiment was performed in order to investigate a long‐standing putative mimetic relationship between two butterflies, the Lorquin's admiral Limenitis lorquini and the California sister Adelpha bredowii (Lepidoptera, Nymphalidae). These butterfly species are commonly sympatric in their broad distribution on the west coast of the United States. The wing colour pattern of L. lorquini differs from the patterns exhibited by its North American congeners, resembling A. bredowii instead.

2. The feeding responses of California scrub jays Aphelocoma californica (Passeriformes, Corvidae) to these prey types and a known palatable control, the buckeye butterfly Junonia coenia (Lepidoptera, Nymphalidae), were examined quantitatively. The birds usually demonstrated long handling times of A. bredowii before consumption, while L. lorquini was manipulated and consumed at the same rate as the control butterfly. The birds also exhibited feather ruffling and bill wiping after consuming A. bredowii while they did not exhibit such behaviours after consuming L. lorquini and J. coenia.

3. The birds did not discriminate between the dorsal colour patterns of the two species in a choice experiment.

4. Because A. bredowii was moderately unpalatable to the captive scrub jays and the birds were not discriminating in their choice, this suggests a Batesian mimetic relationship between L. lorquini and A. bredowii.
Factors associated with plasma lipids and lipoproteins in Type 1 diabetes mellitus: the EURODIAB IDDM Complications Study
Authors: Idzior‐Walus B. , Mattock M. B. , Solnica B. , Stevens L. , Fuller J. H. ,   the EURODIAB IDDM Complications Study Group
Published: March 2003

Aim  To assess the determinants and prevalence of hyperlipidaemia in Type 1 diabetic patients in the EURODIAB IDDM Complications Study.

Methods  Standardized questionnaire data were obtained and anthropometric and biochemical measurements performed on 3159 Type 1 diabetic patients, randomly selected from 31 diabetes clinics. Plasma lipid levels were determined centrally, using enzymatic methods

Results  Plasma total cholesterol, high‐density lipoprotein cholesterol (HDL‐C), and HDL subfractions were higher in women than in men, while plasma triglycerides were higher in men (P < 0.001). Total cholesterol, low‐density lipoprotein cholesterol (LDL‐C) and HDL‐C and HDL‐C subfractions were, as expected, significantly associated with age and HbA1c in both sexes. Age and HbA1c adjusted values of triglyceride, total cholesterol, LDL‐C, HDL‐C and HDL3‐C in men and triglyceride and HDL2‐C in women showed significant associations with central obesity, measured as the waist to hip ratio (WHR). Current smokers had lipid profiles characteristic of insulin resistance in comparison to nonsmokers. Significant positive associations were observed between hypertension and plasma triglycerides, total cholesterol and LDL‐C in men and women. In men, degree of physical activity was negatively associated with triglyceride and positively related to HDL‐C and HDL3‐C. The prevalence of LDL‐hypercholesterolaemia (LDL‐C > 3.35 mmol/L) was 45% in men and in women, while plasma triglyceride levels > 1.7 mmol/L were observed in 12% of men and 8% of women.

Conclusion  The results of this study indicate that lipid levels in Type 1 diabetic patients are strongly influenced by smoking habit and central obesity in a way that is characteristic of the insulin resistance syndrome.

Diabet. Med. 18, 786–796 (2001)
Functional topography of the human nonREM sleep electroencephalogram
Authors: Finelli Luca A. , Borbély Alexander A. , Achermann Peter
Published: March 2003

The sleep EEG of healthy young men was recorded during baseline and recovery sleep after 40 h of waking. To analyse the EEG topography, power spectra were computed from 27 derivations. Mean power maps of the nonREM sleep EEG were calculated for 1‐Hz bins between 1.0 and 24.75 Hz. Cluster analysis revealed a topographic segregation into distinct frequency bands which were similar for baseline and recovery sleep, and corresponded closely to the traditional frequency bands. Hallmarks of the power maps were the frontal predominance in the delta and alpha band, the occipital predominance in the theta band, and the sharply delineated vertex maximum in the sigma band. The effect of sleep deprivation on EEG topography was determined by calculating the recovery/baseline ratio of the power spectra. Prolonged waking induced an increase in power in the low‐frequency range (1–10.75 Hz) which was largest over the frontal region, and a decrease in power in the sigma band (13–15.75 Hz) which was most pronounced over the vertex. The topographic pattern of the recovery/baseline power ratio was similar to the power ratio between the first and second half of the baseline night. These results indicate that changes in sleep propensity are reflected by specific regional differences in EEG power. The predominant increase of low‐frequency power in frontal areas may be due to a high ‘recovery need’ of the frontal heteromodal association areas of the cortex.
Long‐lasting hippocampal potentiation and contextual memory consolidation
Authors: Sacchetti Benedetto , Lorenzini Carlo Ambrogi , Baldi Elisabetta , Bucherelli Corrado , Roberto Marisa , Tassoni Giovanna , Brunelli Marcello
Published: March 2003

In order to ascertain whether there are hippocampal electrophysiological modifications specifically related to memory, exploratory activity and emotional stress, extracellular electrical activity was recorded in hippocampal slices prepared from the brains of male adult rats. Several groups of animals were employed: (i) rats which had freely explored the experimental apparatus (8 min exposure); (ii) rats which had been subjected, in the same apparatus, to a fear conditioning paradigm training entailing the administration of aversive electrical footshocks (8 min exposure); (iii) rats to which the same number of aversive shocks had been administered in the same apparatus, but temporally compressed so as to make difficult the association between painful stimuli and the apparatus (30 s exposure); (iv) naïve rats never placed in the apparatus. Half of the rats from each treatment group were used for retrieval testing and the other half for hippocampal excitability testing. The conditioned freezing response was exhibited for no less than 4 weeks. Hippocampal excitability was measured by means of input–output curves (IOC) and paired‐pulse facilitation curves (PPF). Retrieval testing or brain slices preparation were performed at increasing delays after the training sessions: immediately afterwards or after 1, 7 or 28 days. Only the rats subjected to the fear conditioning training exhibited freezing when placed again in the apparatus (retrieval testing). It was found that IOCs, with respect to naïve rats, increased in the conditioned animals up to the 7‐day delay. In free exploration animals the IOCs increased only immediately after the training session. In all other rats no modification of the curves was observed. IOC increases do not appear to imply presynaptic transmitter release modifications, because they were not accompanied by PPF modifications. In conclusion, a clear‐cut correlation was found between the increase in excitability of the Schaffer collateral–CA1 dendrite synapses and freezing response consolidation.
Phospholipase A2 mediates ischemic injury in the hippocampus: a regional difference of neuronal vulnerability
Authors: Arai Ken , Ikegaya Yuji , Nakatani Yoshihito , Kudo Ichiro , Nishiyama Nobuyoshi , Matsuki Norio
Published: March 2003

Although it is well known that the hippocampal CA1 subfield is highly vulnerable to ischemic injury, cellular mechanisms leading to this neuronal degeneration are not fully understood. Using organotypic cultures of rat hippocampal slices, we determined whether phospholipase A2 (PLA2) is activated in response to ischemic conditions (OGD; oxygen and glucose deprivation). The PLA2 activity in the pyramidal cell layer increased immediately following a 35‐min exposure to OGD, which was likely to be mediated by selective activation of cytosolic Ca2+‐dependent PLA2 subtype (cPLA2). This enhancement lasted for at least 24 h. Interestingly, no apparent increase was detected in the dentate gyrus. Twenty‐four hours after the OGD exposure, neuronal death was detected mainly in the CA1 region of hippocampal slices. To examine whether the PLA2 activation is causally or protectively involved in the ischemic injury, we investigated the effect of pharmacological blockade of PLA2 on the OGD‐induced neuronal death. The PLA2 inhibitor bromophenacyl bromide efficiently prevented the cell death in a concentration‐dependent manner. Similar results were obtained for the selective cPLA2 inhibitor AACOCF3. However, the Ca2+‐independent PLA2 inhibitor bromoenol lactone and the secretory PLA2 inhibitor LY311727 were virtually ineffective. These results suggest that cPLA2 plays a causative role in the neuronal death following OGD exposure. Thus, the present study may provide novel therapeutic targets for the development of neuroprotective agents.
Blockade of superoxide generation prevents high‐affinity immunoglobulin E receptor‐mediated release of allergic mediators by rat mast cell line and human basophils
Authors: Yoshimaru T. , Suzuki Y. , Matsui T. , Yamashita K. , Ochiai T. , Yamaki M. , Shimizu K.
Published: March 2003

Background Previous studies have shown that rat peritoneal mast cells and mast cell model rat basophilic leukaemia (RBL‐2H3) cells generate intracellular reactive oxygen species (ROS) in response to antigen challenge. However, the physiological significance of the burst of ROS is poorly understood.

Objective The present study was undertaken to investigate the role of superoxide anion in mediator release in rat and human cell systems.

Methods RBL‐2H3 cells were directly stimulated with anti‐rat FcεRI α‐subunit monoclonal antibody (mAb). For the analysis of human cell system, leucocytes were isolated by dextran sedimentation from healthy volunteers or from patients, and challenged either with anti‐human FcεRI mAb or with the relevant antigens. Superoxide generation was determined by chemiluminescence‐based methods. The releases of histamine and leukotrienes (LT)s were determined by enzyme‐linked immunosorben assay (ELISA).

Results Cross‐linking of FcεRI on RBL‐2H3 cells or on human leucocytes from healthy donors by the anti‐FcεRI mAb resulted in a rapid generation of superoxide anion, as determined by chemiluminescence using superoxide‐specific probes. Similarly, leucocytes from patients generated superoxide anion in response to the challenge with the relevant allergen but not with the irrelevant allergen. Furthermore, diphenyleneiodonium (DPI), a well‐known inhibitor of flavoenzymes suppressed the superoxide generation and the release of histamine and LTC4 induced by the anti‐FcεRI mAb or by allergen in parallel.

Conclusion These results indicate that both RBL‐2H3 cells and human basophils generate superoxide anion upon FcεRI cross‐linking either by antibody or by allergen challenge and that blockade of the generation prevents the release of allergic mediators. The findings strongly support the role of superoxide generation in the activation of mast cells and basophils under both physiological and pathological conditions. The findings suggest that drugs regulating the superoxide generation have potential therapeutic use for allergic disorders.
Effects of birch pollen and traffic particulate matter on Th2 cytokines, immunoglobulin E levels and bronchial hyper‐responsiveness in mice
Authors: Fernvik E. , Peltre G. , Sénéchal H. , Vargaftig B. B.
Published: March 2003

Background Health effects due to air pollution arizing from motor vehicles are a major public and political concern world‐wide. Epidemiological studies have shown that the manifestations of asthma are increased by air pollution in already affected individuals.

Objective To investigate the potential role of air‐polluted tunnel dust (traffic particulate matter, TPM) or pure carbon core particles in the initiation and persistence of experimental allergic inflammation.

Methods BP2 mice were immunized with birch pollen alone (group B) or pollen together with TPM (group A), or with birch pollen and Al(OH)3 (group C), or with birch pollen and carbon core particles (group D). Before methacholine challenge they were challenged intranasally and thereafter bronchial hyper‐reactivity (BHR) was evaluated in a whole‐body plethysmograph. Levels of Th2 cytokines, fibronectin and lactate dehydrogenase (LDH) were determined, and differential counts were performed in the bronchoalveolar lavage (BAL) fluid. Sera were collected for determination of antibody titres and cytokine levels.

Results Specific IgE titres, BHR, the number of recruited eosinophils and levels of fibronectin and LDH in BAL were increased in mice immunized and challenged with a mixture of birch pollen and TPM. However, mice immunized with birch pollen alone and challenged intranasally with pollen or a mixture of pollen and TPM demonstrated the highest levels of IL‐4 and IL‐5.

Conclusion This study highlights the importance of the exposure to a combination of particulate matters and pollen allergens, in the induction of allergic disease in the airways, and we have demonstrated that polluted tunnel dust has an effect on both the inflammatory and immunological components of experimental allergy. Immunization and challenge with carbon core particles together with birch pollen increased neither the BHR nor the specific IgE production significantly. Our results therefore strongly suggest that it is most likely to be the organic phase bound to the carbon core of the diesel exhaust particles that might have an important adjuvant effect in the induction of experimental allergy.
Cell migration and organization in the intestinal crypt using a lattice‐free model
Authors: Meineke F. A. , Potten C. S. , Loeffler M.
Published: March 2003

We present a novel class of spatial models of cell movement and arrangement applied to the two‐dimensional cellular organization of the intestinal crypt. The model differs from earlier approaches in using a dynamic movement on a lattice‐free cylindrical surface. Cell movement is a consequence of mitotic activity. Cells interact by viscoelastic forces. Voronoi tessellation permits simulations of individual cell boundaries. Simulations can be compared with experimental data obtained from cell scoring in sections. Simulation studies show that the model is consistent with the experimental results for the spatial distribution of labelling indices, mitotic indices and other observed phenomena using a fixed number of stem cells and a fixed number of transit cell divisions.
The use of emergency contraception in Australasian emergency departments
Authors: Millar J Robert , Leach Deborah S , Maclean Andrew V , Kovacs Gabor T
Published: March 2003

Objective:

To review the prescribing of emergency contraception by emergency departments in Australasia and compare it with other providers.

Methods:

A postal questionnaire was sent to the director of each of the 79 Australasian College for Emergency Medicine accredited emergency deparatments in Australasia inquiring about the availability and prescribing habits for emergency contraception within each department.

Results:

Of the 79 emergency departments, 69 (87.3%) responded to the questionnaire and were aware of the ‘emergency contraception regimen’. The majority of departments prescribed appropriately (56%) and only one department did not arrange adequate follow up. Anti‐emetics are always used by 45 departments (78.9%). Discussion of future contraceptive needs at the time of presentation was only undertaken by 25 departments (43.9%). Written clinical guidelines for emergency contraception were present in 28 departments (40.6%).

Conclusions:

Emergency departments are accessed by patients requesting contraception following unprotected intercourse or contraceptive failure. The prescribing of emergency contraception in Australasian emergency departments is comparable with other providers but substantial improvements could be made. Suggestions to assist this improvement include written clinical guidelines and patient information and purpose‐made medication packs.
Emergency department triage of indigenous and non‐indigenous patients in tropical Australia
Authors: Johnston‐Leek Malcolm , Sprivulis Peter , Stella Julian , Palmer Didier
Published: March 2003

Objective:

To examine the relationship between ethnicity and triage at a tertiary hospital emergency department.

Methods:

Electronic Emergency Department Information System data analysis was used to examine the relationship between ethnicity and triage allocation and process times between 1 April 1999 and 29 June 1999. Outcome measures were waiting times by triage category and admission rate by triage category.

Results:

There were 9614 attendances: 1949 indigenous (20.3%), 7328 non‐indigenous (76.2%) and 337 (3.5%) had no ethnicity recorded. Indigenous patients were more often female (1033; 53%, CI 51–55%) than non‐indigenous patients (3078; 42.0%, CI 41–43%,P < 0.001). Indigenous patients presented more often with illness (70% CI 68–72%) rather than injury (30%, CI 28–32%), compared with the non‐indigenous patients, illness (64%, CI 63–65%), injury (36%, CI 35–37%,P < 0.001). Indigenous patients were more likely to be triaged to national triage scale categories 1, 2 or 3 (36%, CI 34–38%) than non‐indigenous patients (32%, CI 31–33%,P = 0.011). Admission rates for indigenous patients were higher than non‐indigenous patients across all urgency categories and were within national triage scale guidelines. Non‐indigenous admission rates were well below national triage scale guidelines for all urgency categories. The overall admission rate for indigenous patients was double (33%, CI 31–35%) that for non‐indigenous patients (16%, CI 15–17%,P < 0.001). There was no significant difference between indigenous and non‐indigenous waiting times.

Conclusion:

Indigenous patients are more likely to present with illness rather than injury and are more likely to require admission than non‐indigenous patients. Indigenous patients are triaged in accordance with Australasian triage guidelines. Many non‐indigenous patients should be triaged to lower urgency categories to allow resource allocation towards higher acuity indigenous and non‐indigenous patients.
Paediatic emergency departments: Old needs, new challenges and future opportunities
Authors: Browne Gary J
Published: March 2003

See Commentary, page 405.
Comparative sequence analysis of four myosin heavy chain isoforms expressed in porcine skeletal muscles: Sequencing and characterization of the porcine myosin heavy chain slow isoform
Authors: CHIKUNI Koichi , MUROYA Susumu , TANABE Ryo‐ichi , NAKAJIMA Ikuyo
Published: March 2003

A nucleotide sequence including the full coding region for the myosin heavy chain (MyHC) slow isoform was determined from the longissimus skeletal muscle. The deduced amino acid sequence was 1935 residues, which was the same length as the human and rat MyHC‐slow isoforms. The porcine MyHC‐slow isoform showed 97.6% and 97.4% amino acid identities to the human and rat isoforms on their entire regions, respectively. The functional regions were also highly conserved among mammalian MyHC‐slow isoforms. Amino acid substitutions between the porcine MyHC‐slow and MyHC‐fast isoforms were concentrated on the functional regions. Loop 1, the controlling region of nucleotide binding and release, was conserved among the fast isoforms, but not between the slow and fast isoforms. Loop 2, a part of the actin binding region, was not conserved among any of the isoform types, and the most substitutions in this region were found in the slow isoform. The myosin essential light chain binding region was conserved among the fast isoforms, except for some substitutions in the 2b isoform, but was clearly different in the slow isoform. The myosin regulatory light chain binding region was conserved among the fast isoforms, but not between the slow and fast isoforms. These results indicate that the functional difference between the porcine MyHC‐slow and ‐fast isoforms are controlled by the sequence diversity at the four functional regions compared.