bluuebunny/crossref_metadata_2025 huggingface dataset:
Nulliparas' Preferences for Epidural Analgesia: Their Effects on Actual Use in Labor
Authors: Goldberg Alisa B. , Cohen Amy , Lieberman Ellice
Published: March 2003

Background:
Few studies have directly examined the reasons for choices of pain relief during labor. The purpose of this study was to investigate if women's preferences for epidural analgesia in labor have an impact on the use of intrapartum epidural analgesia.
Methods:
Nulliparous women attending childbirth classes completed questionnaires about their antenatal preferences for the use of intrapartum epidural analgesia. Data on actual use of analgesia was obtained by chart review. The analysis included 303 women with either spontaneous or induced labor at term.
Results:
The 185 women who planned to receive epidural analgesia had a markedly higher rate of epidural use (91%) than the 110 women who hoped to avoid it (57%) (
p= 0.001). Of 237 epidurals administered, 169 (71%) were planned during the antenatal period. Among women receiving epidural analgesia, those planning to receive it tended to have more frequent early administration (≤ 3 cm cervical dilation) than women who unsuccessfully tried to avoid epidural use (54% vs. 24%,
p= 0.003).
Conclusion:
In our population of nulliparas, a woman's antenatal plan to receive epidural analgesia is strongly associated with her likelihood of receiving it. Women who plan to receive epidural analgesia have earlier administration.
Factors Predicting Cesarean Delivery for American Indian Women in New Mexico
Authors: Schiff Melissa , Rogers Catherine
Published: March 2003

Background:
American Indian women have one of the lowest cesarean delivery rates among all ethnic groups evaluated in the United States. Our objective was to identify risk factors for cesarean delivery among American Indian women in New Mexico.
Methods:
Live birth certificate data (1994) from the New Mexico Bureau of Vital Records and Health Statistics were used to compare American Indian women who had a cesarean delivery with those who had a vaginal delivery. We examined demographic, prenatal, and intrapartum factors to determine risk factors for cesarean delivery.
Results:
In 1994 American Indian women in New Mexico had a cesarean delivery rate of 12 percent. Risk factors for cesarean delivery included age equal to or over 35 years (OR = 1.8, 1.3–2.5) and nulliparity (OR = 1.9, 1.5–2.5). Obstetric risk factors included prematurity (OR = 2.3, 1.5–3.6), low birthweight (OR = 2.6, 1.7–4.2), diabetes (OR = 1.7, 1.1–2.5), pregnancy‐induced hypertension (OR = 2.6, 1.8–3.8), and labor and delivery complications (OR = 9.5, 7.5–12.1). Age less than 20 years was negatively associated with cesarean delivery (OR = 0.5, 0.3–0.7).
Conclusion:
American Indian women have risk factors for cesarean delivery that are similar to those reported in other populations. Future prospective research evaluating intrapartum management may help identify reasons for the low cesarean birth rate.
Does Team Midwife Care Increase Satisfaction with Antenatal, Intrapartum, and Postpartum Care? A Randomized Controlled Trial
Authors: Waldenström Ulla , Brown Stephanie , McLachlan Helen , Forster Della , Brennecke Shaun
Published: March 2003

Background:
Although policymakers have suggested that improving continuity of midwifery can increase women's satisfaction with care in childbirth, evidence based on randomized controlled trials is lacking. New models of care, such as birth centers and team midwife care, try to increase the continuity of care and caregiver. The objective of this study was to evaluate the effect of a new team midwife care program in the standard clinic and hospital environment on satisfaction with antenatal, intrapartum, and postpartum care in low‐risk women in early pregnancy.
Methods:
Women at Royal Women's Hospital in Melbourne, Australia, were randomly allocated to team midwife care (n = 495) or standard care (n = 505) at booking in early pregnancy. Doctors attended most women in standard care, and continuity of the caregiver was lacking. Satisfaction was measured by means of a postal questionnaire 2 months after the birth.Results:Team midwife care was associated with increased satisfaction, and the differences between the groups were most noticeable for antenatal care, less noticeable for intrapartum care, and least noticeable for postpartum care. The study found no differences between team midwife care and standard care in medical interventions or in women's emotional well‐being 2 months after the birth.Conclusion:Conclusions about which components of team midwife care were most important to increased satisfaction with antenatal care were difficult to draw, but data suggest that satisfaction with intrapartum care was related to continuity of the caregiver.
Do Women Get Posttraumatic Stress Disorder as a Result of Childbirth? A Prospective Study of Incidence
Authors: Ayers Susan , Pickering Alan D
Published: March 2003

Background:
Recent research suggests that a proportion of women may develop posttraumatic stress disorder after birth. Research has not yet addressed the possibility that postpartum symptoms could be a continuation of the disorder in pregnancy. This study aimed to test the idea that some women develop posttraumatic stress disorder as a result of childbirth, and to provide an estimate of the incidence using a prospective design, which controls for the disorder in pregnancy.
Method:
This prospective study assessed 289 women at three time points: 36 weeks gestation and 6 weeks and 6 months postpartum. The prevalence of posttraumatic stress disorder was assessed by questionnaire at each time point, and the incidence was examined after removing women who had severe symptoms of posttraumatic stress disorder or clinical depression in pregnancy.
Results:
After removing women at the first time point, 2.8 percent of women fulfilled criteria for the disorder at 6 weeks postpartum and this decreased to 1.5 percent at 6 months postpartum.
Conclusions:
The results suggest that at least 1.5 percent of women may develop chronic posttraumatic stress disorder as a result of childbirth. It is important to increase awareness about the disorder and to give health professionals access to simple screening tools. Intervention is possible at several levels, but further research is needed to guide this intervention.
Birth Position, Accoucheur, and Perineal Outcomes: Informing Women About Choices for Vaginal Birth
Authors: Shorten Allison , Donsante Jacki , Shorten Brett
Published: March 2003

Background: The literature is tentative in establishing links between birth position and perineal outcome. Evidence is inconclusive about risks and benefits of women's options for birth position. The objective of this study was to gain further evidence to inform perinatal caregivers about the effect of birth position on perineal outcome, and to assist birth attendants in providing women with information and opportunities for minimizing perineal trauma. Methods: Data from 2891 normal vaginal births were analyzed. Descriptive statistics were obtained for variables of interest, and cross‐tabulations were generated to explore possible relationships between perineal outcomes, birth positions, and accoucheur type. Logistic regression models were used to examine potential confounding and interaction effects of relevant variables. Results: Multiple regression analysis revealed a statistically significant association between birth position and perineal outcome. Overall, the lateral position was associated with the highest rate of intact perineum (66.6%) and the most favorable perineal outcome profile. The squatting position was associated with the least favorable perineal outcomes (intact rate 42%), especially for primiparas. A statistically significant association was demonstrated between perineal outcome and accoucheur type. The obstetrician group generated an episiotomy rate of 26 percent, which was more than five times higher than episiotomy rates for all midwife categories. The rate for tear requiring suture of 42.1 percent for the obstetric category was 5 to7 percentage points higher than that for midwives. Intact perineum was achieved for 31.9 percent of women delivered by obstetricians compared with 56 to 61 percent for three midwifery categories. Conclusion: Findings contribute to growing evidence that birth position may affect perineal outcome. Women's childbirth experiences should reflect decisions made in partnership with midwives and obstetricians who are equipped with knowledge of risks and benefits of birthing options and skills to implement women's choices for birth. Further identification and recognition of the strategies used by midwives to achieve favorable perineal outcomes is warranted. (BIRTH 29:1 March 2002)
Prevalence and Predictors of Women's Experience of Psychological Trauma During Childbirth
Authors: Soet Johanna E. , Brack Gregory A. , DiIorio Colleen
Published: March 2003

ABSTRACT: Background: The increased acceptance of the prevalence of trauma in human experience as well as its psychological consequences has led to revisions of diagnostic criteria for the disorder. The three purposes of this study were to examine the rates at which women experienced psychological trauma in childbirth, to explore possible causal factors, and to examine possible factors in the development of the disorder.

Methods: One hundred and three women from childbirth education classes in the Atlanta metropolitan area completed a survey in late pregnancy and a follow‐up interview approximately 4 weeks after the birth.

Results: The childbirth experience was reported as traumatic by 34 percent of participants. Two women (1.9%) developed all the symptoms needed to diagnose posttraumatic stress disorder, and 31 women (30.1%) were partially symptomatic. Regression analysis showed that antecedent factors (e.g., history of sexual trauma and social support) and event characteristics (e.g., pain in first stage of labor, feelings of powerlessness, expectations, medical intervention, and interaction with medical personnel) were significant predictors of perceptions of the childbirth as traumatic. The pain experienced during the birth, levels of social support, self‐efficacy, internal locus of control, trait anxiety, and coping were significant predictors of the development of posttraumatic stress disorder symptoms after the birth.

Conclusions: These findings suggest several intervention points for health care practitioners, including careful prenatal screening of past trauma history, social support, and expectations about the birth; improved communication and pain management during the birth; and opportunities to discuss the birth postpartum. (BIRTH 30:1 March 2003)
Effect of H. pylori Infection and CagA Status on Leukocyte Counts and Liver Function Tests: Extra‐Gastric Manifestations of H. pylori Infection
Authors: Graham David Y. , Osato Michael S. , Olson Carol A. , Zhang Jie , Figura Natale
Published: March 2003

Background.

It has been suggested that H. pylori infection is associated with abnormalities in total leukocyte count as well as the number of basophils and lymphocytes. In addition, CagA seropositivity has been associated with an increase in serum transaminase (SGOT) values. The aim of this study was to confirm the findings of previous subgroup analyses in patients before and after treatment for H. pylori infection and to ascertain whether the abnormalities reversed following successful treatment.

Methods.

Blood counts and serum transaminase levels were obtained prior to and following treatment of H. pylori infection of H. pylori‐infected duodenal ulcer patients. CagA status was assessed by Western blot of the H. pylori isolates obtained from the patients.

Results.

Ninety‐four ulcer patients were studied, including 77 with CagA‐positive H. pylori isolates (82%) and 17 with CagA‐negative H. pylori isolates. All study parameters remained within normal limits both before and after therapy. There were no significant changes in any study parameter in those who failed therapy. Successful therapy resulted in a significant fall in total white cell count (7413 ± 520 cmm to 6738 ± 410 cmm, for pretreatment vs. cured, respectively, p = 0.04) and was almost entirely accounted for by a reduction in the number of circulating polymorphonuclear leukocytes (4595 ± 370 cmm to 3855 ± 270 cmm for pretreatment vs. cured, respectively, p = 0.015). The pretreatment SGOT and basophil count were significantly higher in those with CagA‐positive H. pylori (SGOT = 23 ± 1 vs. 18.5 ± 1 U). Successful or failed therapy with follow‐up for 3 months post therapy did not result in a significant change of SGOT levels.

Conclusions.

We confirmed an increase in total leukocyte count and number of polymorphonuclear leukocytes in those with H. pylori infection. We also confirmed higher SGOT levels with CagA‐positive H. pylori infection, but the failure to resolve within 3 months of cure of the infection makes it unlikely to be a direct result of the H. pylori infection.
Assessment of a New Triple Agent Regimen for the Eradication of Helicobacter pylori and the Nature of H. pylori Resistance to This Therapy in Japan
Authors: Suzuki Junko , Mine Tetsuya , Kobayasi Intetsu , Fujita Toshiro
Published: March 2003

Background.

Multiple regimens for the eradication of Helicobacter pylori have been tested, but the best therapy has not been determined yet. To determine the efficacy of a new triple agent regimen using a combination of lansoprazole, amoxicillin, and clarithromycin against Helicobacter pylori (H. pylori), and to examine H. pylori resistance to this therapy in ineffective cases.

Methods.

We studied a total of 71 patients infected with H. pylori who had gastric ulcer (n~=~37) or duodenal ulcer (n~=~34) as confirmed by endoscopy. Patients received 1500~mg amoxicillin, 400~mg clarithromycin and 30~mg lansoprazole for 2~weeks followed by 30~mg lansoprazole for 6~weeks in patients with gastric ulcer or for 4~weeks in those with duodenal ulcer. Endoscopic examination was performed before treatment and at 1~month, 2~months, and 5~months after initiating treatment to check the status of ulceration and H. pylori infection.

Results.

The eradication rate of H. pylori was 92% (CI, 83–100%) in the gastric ulcer group and 94% (CI, 86–100%) in the duodenal ulcer group at 5~months, as determined by per‐protocol analysis. Resistance to clarithromycin was present in 1 of 71 (1%) patients before treatment and in 2 of 5 (40%) patients after treatment. No resistance to amoxicillin and lansoprazole was found in patients before or after treatment. The resistance to clarithromycin changed during the observation period.

Conclusions.

The new triple agent regimen was effective against H. pylori. Resistance to clarithromycin may not be permanent and it might be one of the risk factors which affect the efficacy of a clarithromycin‐based therapy.
Effectiveness of Omeprazole‐Amoxicillin‐Clarithromycin (OAC) Therapy for Helicobacter pylori Infection in a Japanese Population
Authors: Miwa Hiroto , Ohkura Ryuichi , Murai Toshio , Nagahara Akihito , Yamada Toshio , Ogihara Tatsuo , Watanabe Sumio , Sato Nobuhiro
Published: March 2003

Background. Omeprazole or lansoprazole, amoxicillin, clarithromycin (PPI/AC) therapy has been reported to provide a high cure rate of H. pylori infection with few adverse effects. Effectiveness of H. pylori therapy may vary among different geographic regions and patient populations. However, there are few reports in Japan as to its effectiveness. We have, therefore, studied the effectiveness of H. pylori therapy in a large group of Japanese patients.

Methods. For this study, 366 H. pylori‐positive patients with peptic ulcer disease or non‐ulcer dyspepsia (263 men and 103 women, mean age 48.5 years) were assigned to 6 groups, each receiving a different PPI/AC regimen. Group 1 received omeprazole (OPZ) 20 mg, amoxicillin (AMOX) 1500 mg, and clarithromycin (CAM) 400 mg; Group 2 OPZ 40 mg, AMOX 1500 mg, and CAM 400; and Group 3 OPZ 20 mg, AMOX 2000 mg, and CAM 600 mg daily for 14 days. The group treated with lansoprazole (LPZ) 30 mg, AMOX 1500 mg and CAM 400 mg was used for 14 days in Group 1L. OPZ 20 mg, AMOX 750 mg, and CAM 200 mg were given to Group 4 for 28 days and OPZ 20 mg, AMOX 1500 mg, CAM 400 mg was administered to Group 5 for 7 days. Cure of infection was assessed by the 13C urea breath test one month after completion of therapy.

Results. Cure rates calculated by excluding the patients who showed borderline value of 13C urea breath test (Δ13C value between 5 and 10‰ in Groups 1, 1L, 2, 3, 4, and 5 were 82.7% (95% CI; 74–90), 88.9% (76–96), 84.9% (72–93), 81.3% (67–91), 84.6% (72–93), and 85.1% (72–94) on an intention‐to‐treat basis, and 88% (80–94), 95.2% (84–99), 95.6% (85– 99), 90.7% (78–97), 95.7% (85–99) and 88.9% (76–96) on a per‐protocol basis, respectively. Adverse effects that affected compliance were observed in 10 of 237 patients on 14‐day regiments, one of 47 on a 28‐day regimen and one of 46 on a 7‐day regimen.

Conclusion. Two weeks PPI/AC therapy is highly effective for cure of H. pylori infection in the Japanese population. The low dose one month regimen and the one week OAC regimen were also effective in our patient population.
Effect of Smoking and Histological Gastritis Severity on the Rate of H. pylori Eradication with Omeprazole, Amoxicillin, and Clarithromycin
Authors: Kamada Tomoari , Haruma Ken , Komoto Kunihiko , Mihara Mitsuhiro , Chen Xing , Yoshihara Masaharu , Sumii Koji , Kajiyama Goro , Tahara Kazumasa , Kawamura Yuzuru
Published: March 2003

Background. The combination of omeprazole, amoxicillin, and clarithromycin is a common regimen against Helicobacter pylori. Several recent studies have shown that smoking, high intragastric acidity, and the degree of histological gastritis are associated with H. pylori eradication failure.

Materials and Methods. One hundred and thirty‐seven H. pylori–positive patients were treated with a 1‐week regimen composed of omeprazole, 20 mg once daily; amoxicillin, 500 mg; and clarithromycin, 200 mg thrice daily. Success of the treatment was evaluated by histology and the 13C‐urea breath test at least 4 weeks after completion of therapy. Data about age, gender, alcohol intake, smoking habits, and previous proton pump inhibitor intake were collected in patient interviews. We evaluated fasting gastric pH and the degree of histological gastritis before eradication of H. pylori.

Results. The overall eradication of H. pylori at 4 weeks was successful in 98 of 137 patients (72%). On the multivariate analysis, a low grade of inflammation in the antrum (p≤ .01; 95% confidence interval [CI], 2.34–16.75), low grade of activity in the fundus (p≤ .05; 95% CI, 1.31–9.65), and smoking (p≤ .05; 95% CI, 1.27–6.82) were the significant independent factors predicting treatment failure.

Conclusions. These findings indicate that H. pylori eradication therapy with omeprazole, amoxicillin, and clarithromycin is less effective in patients who smoke and more effective in patients with high scores of antral inflammation and fundal activity at baseline biopsy.
Pantoprazole Suppresses Helicobacter pylori Without Affecting Cure
Authors: Adamek Romuald J. , Szymanski Christian , Pfaffenbach Boris
Published: March 2003

Background. Short‐term, low‐dose triple regimens composed of proton‐pump inhibitors (PPI) and two antibiotics are the current gold standard therapy for cure of Helicobacter pylori infection. To date, the effect of PPI pretreatment on eradication outcome is not known. The aim of this study was to evaluate the influence of pretreatment with pantoprazole on the efficacy of an ensuing triple therapy.

Methods. In this open, randomized, monocenter, parallel group comparison, 107 patients with duodenal ulcer or functional dyspepsia were assigned to receive one of the following treatment regimens: a 7‐day triple therapy with pantoprazole, 40 mg bid; clarithromycin, 250 mg bid; and metronidazole, 400 mg bid, which was either preceded or followed by a 7‐day therapy with pantoprazole, 40 mg (P‐PCM or PCM‐P). Assessment of H. pylori status was performed by a biopsy urease test and 13C urea breath test at the initial visit and 13C urea breath test at all follow‐up visits.

Results. The 7‐day pantoprazole pretreatment resulted in a significant decline of the δ values of the 13C urea breath test. H. pylori infection was cured in 47 of 52 intention‐to‐treat patients of the P‐PCM group (90%; 95% confidence interval, 79–97%) and in 46 of 53 of the PCM‐P group (87%; 95% confidence interval, 75–95%).

Conclusions. Pretreatment with pantoprazole suppresses H. pylori but does not impair the efficacy of a consecutive short‐term, low‐dose triple therapy.
Four‐Day, Twice Daily, Quadruple Therapy with Amoxicillin, Clarithromycin, Tinidazole and Omeprazole to Cure Helicobacter pylori Infection: A Pilot Study
Authors: Calvet Xavier , Titó Llùcia , Comet Ricard , García Neus , Campo Ralel , Brullet Enric
Published: March 2003

Background. The best regimen for the treatment of Helicobacter pylori infection has yet to be defined. Four‐day quadruple therapy with tetracycline, metronidazole, bismuth, and a proton pump inhibitor has been shown to obtain a very high cure rate. However, the fact that it must be taken four times daily may interfere with compliance. The objective of the study was to test the efficacy and tolerability of a new 4‐day therapy with 4 drugs taken every 12 hours to cure H. pylori infection.

Patients and Methods. Fifty‐six consecutive patients with peptic ulcer disease and H. pylori infection were treated with an oral 4‐day course with omeprazole (20 mg/12 hours), clarithromycin (500 mg/12 hours), amoxicillin (1 g/12 hours) and tinidazole (500 mg/12 hours). Efficacy of the treatment was determined at least 2 months after therapy either by biopsy (in the case of gastric ulcer) or by 13C‐urea breath test. A second breath test was performed at least 6 months after therapy.

Results. Two patients were lost to follow‐up. Forty‐nine of the remaining 54 patients were cured at the first control [intention‐to‐treat cure rate: 87.5% (CI 95% 75–94%); per protocol cure rate: 90.7% (CI 95% 81–98%)]. Forty‐three of these 49 cured patients returned for a second 13C urea breath‐test at 6–12 months. Two of them were not cured, giving a long‐term cure rate of 85.5% per protocol and 73.2% by intention‐to‐treat. Compliance was good, although 25 patients had mild side effects.

Conclusion. This particular four‐day therapy is well tolerated, easy to follow, and achieves an acceptably high cure rate.
Controlled Trial of the Effect of Cinnamon Extract on Helicobacter pylori
Authors: Nir Yael , Potasman Israel , Stermer Eddi , Tabak Mina , Neeman Isaac
Published: March 2003

Background. Helicobacter pylori has been associated with the pathogenesis of antral gastritis, duodenal ulcer, and gastric lymphoma. Eradication of H. pylori has been shown to reverse or prevent relapse of these diseases. Antimicrobials employed in the eradication of H. pylori are not without adverse effects. Newer treatment modalities, therefore, are required. In vitro studies have shown the effectiveness of cinnamon extract against H. pylori and its urease. In this pilot study, we tested the activity of an alcoholic extract of cinnamon in a group of patients infected with H. pylori.

Materials and Methods. Fifteen patients (11 women, 4 men) aged 16 to 79 years were given 40 mg of an alcoholic cinnamon extract twice daily for 4 weeks; eight patients aged 35 to 79 (7 women, 1 man) received placebo. The amount of H. pylori colonization was measured by the 13C urea breath test before and after therapy.

Results. The mean urea breath test counts in the study and control groups before and after therapy were 22.1 and 23.9 versus 24.4 and 25.9, respectively. The cinnamon extract was well tolerated, and side effects were minimal.

Conclusions. We concluded that cinnamon extract, at a concentration of 80 mg /day as a single agent, is ineffective in eradicating H. pylori. Combination of cinnamon with other antimicrobials, or cinnamon extract at a higher concentration, however, may prove useful.
Factors That Affect Results of the 13C Urea Breath Test in Japanese Patients
Authors: Chen Xing , Haruma Ken , Kamada Tomoari , Mihara Mitsuhiro , Komoto Kunihiko , Yoshihara Masaharu , Sumii Koji , Kajiyama Goro
Published: March 2003

Background. The 13C urea breath test (UBT) is considered to be the most accurate way of diagnosing Helicobacter pylori infection. Our objective was to investigate the accuracy of the UBT in Japanese patients and the association of UBT values with histological findings.

Materials and Methods. A total of 169 consecutive patients were studied by endoscopy with histology, by serology with IgG antibody and test serum pepsinogen (PG), and by UBT. The association between UBT values and histological findings and the PG I / II ratio were analyzed in H. pylori–positive patients.

Results. Of 169 Japanese patients, 135 were H. pylori–positive on both histology and serology analysis, 27 were H. pylori–negative on both histology and serology analysis, and 7 patients showed differing results. Using a cutoff value of 2.5‰, test sensitivity was 100%, while specificity was 96%. Among the 135 H. pylori–positive patients, a significant relation was observed between UBT value and H. pylori colonization density of the corpus and antrum, neutrophil activity of the antrum, atrophy, and intestinal metaplasia of the corpus in the H. pylori–positive patients. Also, UBT values correlated with the PG I /II ratio. In multivariate analysis, the PG I /II ratio was the most important factor related to UBT values (odds ration [OR], 4.99; 95% confidence interval, 1.60–15.55).

Conclusions. The UBT is an accurate method for detecting H. pylori infection in the Japanese population, which shows a high prevalence of atrophic gastritis. Values are affected by H. pylori infection and by the severity of atrophic gastritis.
Differentiation of Clinical Helicobacter pullorum Isolates from Related Helicobacter and Campylobacter Species
Authors: Melito Pasquale L. , Woodward David L. , Bernard Kathryn A. , Price Lawrence , Khakhria Rasik , Johnson Wendy M. , Rodgers Frank G.
Published: March 2003

Background. Helicobacter pullorum, first detected in the liver and intestinal contents of poultry, was defined as a new species in 1994. This organism has since been isolated from humans with gastroenteritis. Phenotypic as well as genotypic methods have been used to identify H. pullorum associated with cases of human disease.

Materials and Methods. Clinical isolates were submitted for identification to the National Laboratory for Enteric Pathogens by Provincial Public Health Laboratories within Canada. Phenotypic characterization was conducted using a variety of growth and biochemical tests including oxidase, catalase, indoxyl acetate, H2S production in triple sugar iron (TSI) agar, antimicrobial susceptibility testing, and fatty acid analysis. Genotypic identification was performed using a polymerase chain reaction–restriction fragment–length polymorphism (PCR‐RFLP) analysis of a 1‐kb fragment of the Helicobacter 16S rRNA gene.

Results. During the last 7 years (1993–1999) a total of 11 isolates of H. pullorum were detected from patients with gastroenteritis for inclusion in this study. Typically, these isolates were oxidase and catalase positive, produced optimal growth at 42°C, and produced H2S in TSI. Of these 11 isolates, 1 showed DNase activity, while another did not produce H2S in TSI, and only 2 showed tolerance to 1% bile. Antimicrobial susceptibility assays indicated that 6 of the 11 strains were resistant to nalidixic acid. The fatty acid profiles of the isolates were similar to each other and provided a distinguishing profile from the other related species. Genetically identical and distinct species‐specific restriction fragment–length polymorphism (RFLP) patterns were produced using the restriction enzymes Bsr I and Dde I.

Conclusion. Phenotypic and genotypic procedures were used to identify H. pullorum. Interspecies phenotypic variability was apparent and supported the use of a polyphasic approach for identification. Similarities to the more prominent human pathogens Campylobacter coli and C. lari were also noted. The use of a combination of phenotypic and, in particular, genotypic markers for H. pullorum should prove valuable both for epidemiological investigations and for the diagnosis of disease related to this emerging human pathogen.
Helicobacter pylori Entry into Human Gastric Epithelial Cells: A Potential Determinant of Virulence, Persistence, and Treatment Failures	1
Authors: Björkholm Britta , Zhukhovitsky Vladimir , Löfman Carl , Hultén Kristina , Enroth Helena , Block Mats , Rigo Robert , Falk Per , Engstrand Lars
Published: March 2003

Background and Objectives. Intracellular location of Helicobacter pylori in human gastric epithelial cells has been observed in biopsies. Whether this reflects an ability to invade host cells and establish an intracellular niche remains to be determined.

Methods. The interactions between a clinical isolate of H. pylori and primary cell cultures from human gastric epithelium or the human epithelial cell line HEp‐2 were monitored using time‐lapse photography. This technique allows studies of the dynamics of host‐microbial interactions.

Results. H. pylori cells readily approached and established close contacts with epithelial cells followed by uptake of the bacteria into the cellular cytoplasm. Entry into epithelial cells was achieved through an active process of bacterial motility and penetration of the cell membranes. In conventional invasion assays using HEp‐2 cells, an increased internalization in a strain producing the vacuolating cytotoxin was observed, compared to the isogenic VacA knockout mutant.

Conclusion. Invasion of gastric epithelium represents a hitherto unappreciated trait of H. pylori that could contribute to the bacterium's ability to establish persistent infection that evades the mucosal immune defense and sometimes also antimicrobial therapy. A small number of bacterial cells with a transient intracellular habitat could serve as a seeder population, providing a backup for a constantly challenged and fluctuating luminal population.
Distinction of GastricHelicobacterspp. in Humans and Domestic Pets by Scanning Electron Microscopy
Authors: Stoffel Michael H. , Friess Armin E. , Burnens André , Schmassmann Adrian , Neiger Reto
Published: March 2003

Background.A number of differentHelicobacterspp. can colonize the stomach of humans and domestic pets. Difficulties encountered with primary isolation of these spiral microorganisms and their unusual inertia with respect to biochemical reactions still represent considerable obstacles to their characterization with classic tools. In addition, the high degree of similarity in the 16S rRNA sequence hampers differentiation ofHelicobacterspp. using routine molecular biological assays.

Materials and Methods.Samples from experimentally monoinfected mice, of naturally infected hosts, and of cultured strains were examined by scanning electron microscopy (SEM). In parallel, all samples were analyzed by molecular techniques to ascertain theHelicobacterspp. involved.

Results.Using the mouse samples as a reference, microorganisms found in naturally infected hosts were identified by SEM as belonging toH. pylori,H. felis, or a group consisting ofH. bizzozeroniiandH. heilmannii.A further spiral microorganism with unique morphology was found in a dog that was positive forH. salomonis, but the organism could not be recovered from experimentally infected mice. In culture, mostHelicobacterstrains lost their ultrastructural characteristics.

Conclusions.When gastricHelicobacterspp. were collected from their natural habitat and examined by SEM, relevant differences could be detected betweenH. felis,H. bizzozeroniiandH. heilmannii, andH. salomonis, respectively. SEM, therefore, seems to be a useful auxillary tool for the distinction of various gastricHelicobacterspp. as based on their ultrastructure.
Should Non‐Invasive Helicobacter pylori Testing Replace Endoscopy in Investigation of Dyspepsia?
Authors: McColl Kenneth
Published: March 2003

Our knowledge of Helicobacter pylori infection is now changing the way in which we investigate patients presenting with dyspepsia, with noninvasive H. pylori testing replacing endoscopy. Non‐invasive H. pylori testing has been shown to be useful in predicting the underlying diagnosis in patients presenting with dyspepsia. Several studies have shown that 20–50% of dyspeptic patients with a positive H. pylori test will have evidence of underlying ulcer disease or duodenitis. In contrast, less than 5% of dyspeptic patients with a negative H. pylori test will have evidence of ulcer disease and in these subjects, the likeliest diagnosis is gastroesophageal reflux disease. This has led to many groups recommending that noninvasive H. pylori testing should be used in place of endoscopy, with all those testing positive being given anti‐H. pylori therapy and those testing negative being treated symptomatically. One concern about nonendoscopic management of dyspeptic patients is the possibility of missing underlying malignancy but studies have shown that in western countries this is rare in patients less than 55 years of age presenting with dyspepsia in the absence of sinister symptoms. There is increasing evidence supporting eradication of H. pylori infection in dyspeptic patients without ulcer disease. Meta‐analysis of four prospective randomized trials indicates that such treatment is superior to placebo in about 10% of subjects. H. pylori‐positive dyspeptic patients are also recognized to have an increased risk of developing ulcer disease in the future which will be removed by treating the infection. Another justification for eradicating the infection in the absence of ulcer disease is the fact that H. pylori infection is now proven to be a risk factor for gastric cancer. Prospective randomized studies comparing endoscopy with noninvasive H. pylori testing in the management of dyspeptic patients indicate that managing dyspepsia by noninvasive H. pylori testing is at least as effective as endoscopic‐based management in producing symptomatic resolution and saves a substantial number of endoscopic procedures. There is therefore now substantial evidence indicating that noninvasive H. pylori testing should be used in place of endoscopy to determine the management of younger dyspeptic patients without sinister symptoms and who are not taking nonsteroidal anti‐inflammatory drugs.
Helicobacter pylori Infection in the Cat: Evaluation of Gastric Colonization, Inflammation and Function
Authors: Simpson Kenneth W. , Strauss‐Ayali Dalit , Straubinger Reinhard K. , Scanziani Eugenio , McDonough Patrick L. , Straubinger Alix F. , Chang Yung‐Fu , Esteves Maria I. , Fox James G. , Domeneghini Cynzia , Arebi Naila , Calam John
Published: March 2003

Background.

Further elucidation of the consequences of Helicobacter pylori infection on gastric mucosal inflammation and gastric secretory function would be facilitated by an animal model that is susceptible to infection with H. pylori, is broadly similar in gastric physiology and pathology to people, and is amenable to repeated non‐invasive evaluation. The goal of this study was to examine the interrelationship of bacterial colonization, mucosal inflammation and gastric secretory function in cats with naturally acquired H. pylori infection.

Materials and Methods.

Twenty clinically healthy cats with naturally acquired H. pylori infection (cagA−, picB) and 19 Helicobacter‐free cats were evaluated. Gastric colonization was determined by tissue urease activity, light microscopy, culture and PCR. The mucosal inflammatory response was evaluated by light microscopy, and by RT‐PCR of the pro‐inflammatory cytokines IL‐1α, IL‐1β, IL‐8 and TNF‐α in gastric mucosa. Gastric secretory function was assessed by measuring pentagastrin‐stimulated acid secretion, fasting plasma gastrin, and antral mucosal gastrin and somatostatin immunoreactivity.

Results.

H. pylori colonized the pylorus, fundus and cardia in similar density. Bacteria were observed free in the lumen of gastric glands and were also tightly adherent to epithelial cells where they were associated with microvillus effacement. Mononuclear inflammation, lymphoid follicle hyperplasia, atrophy and fibrosis were observed primarily in H. pylori‐infected cats, with the pylorus most severely affected. Neutrophilic and eosinophilic infiltrates, epithelial dysplasia, and up‐regulation of mucosal IL‐1β and IL‐8 were observed solely in infected cats. Fasting plasma gastrin concentrations and pentagastrin‐stimulated acid output were similar in both infected and uninfected cats. There was no relationship of bacterial colonization density or gastric inflammation to plasma gastrin concentrations or gastric acid output.

Conclusions.

The pattern of colonization and the mucosal inflammatory response in cats with naturally acquired H. pylori are broadly similar to those in infected people, particularly children, and non‐human primates. The upregulation of IL‐8 in infected cats was independent of cagA and picB. Our findings argue against a direct acid‐suppressing effect of H. pylori on the gastric secretory‐axis in chronically infected cats.

Abbreviations:

RT‐PCR, reverse transcriptase polymerase chain reaction, HLO; Helicobacter‐like organisms.
Helicobacter pylori CagA: Analysis of Sequence Diversity in Relation to Phosphorylation Motifs and Implications for the Role of CagA as a Virulence Factor
Authors: Evans Doyle J. , Evans Dolores G.
Published: March 2003

CagA is transported into host target cells and subsequently phosphorylated. Clearly this is a mechanism by which Helicobacter pylori could take control of one or more host cell signal transduction pathways. Presumably the end result of this interaction favors survival of H. pylori, irrespective of eventual damage to the host cell. CagA is noted for its amino acid (AA) sequence diversity, both within and outside the variable region of the molecule. The primary purpose of this review is to examine how variation in the type and number of CagA phosphorylation sites might determine the outcome of infection by different strains of H. pylori. The answer to this question could help to explain the widely disparate results obtained when H. pylori CagA status has been compared to type and severity of disease outcome in different populations, that is in different countries. Analysis of all available CagA sequences revealed that CagA contains both tyrosine phosphorylation motifs (TPMs) and cyclic‐AMP‐dependent phosphorylation motifs (CPMs). There are two potential CPMs near the N‐terminus of CagA and at least two in the repeat region; these are not all equally well conserved. We also defined a 48‐residue AA sequence, which includes the N‐terminal TPM at tyrosine (Y)‐122, which distinguishes between Eastern (Hong Kong‐Taiwan‐Japan‐Thailand) H. pylori isolates and those from the West (Europe‐Africa‐the Americas‐Australia). All 28 of the Eastern type CagA proteins have a functional N‐terminal TPM whereas 11 of 47 (23.4%) of the Western type contain an inactive motif, with threonine (T) replacing the critical aspartic acid (D) residue. Only 13 of 24 (54%) known CagA sequences have an active TPM in the repeat region and only one has two TPMs in this region. The potential TPM near the C‐terminus of CagA is not likely to be important since only 3 of 24 (12.5%) sequences were found to be intact. Protein database searches revealed that the AA sequence immediately following the TPM at Y‐122 in CagA is homologous with a pair of PDZ domains which are common in signal transducing proteins, particularly tyrosine phosphatases. This provides a theoretical link between CagA and many of the observed responses of host cells to H. pylori. In summary, not all CagA proteins are equal in their potential for initiating host cell responses via signal transduction pathways. The degree of functional diversity of this protein depends upon which phosphorylation motifs are critical to the biological activity of CagA.
Atrophic Gastritis and Intestinal Metaplasia in Japan: Results of a Large Multicenter Study
Authors: Asaka Masahiro , Sugiyama Toshiro , Nobuta Aichiro , Kato Mototsugu , Takeda Hiroshi , Graham David Y.
Published: March 2003

Background.

This study evaluated the relationship between Helicobacter pylori infection, atrophic gastritis and intestinal metaplasia in Japan.

Materials and Methods.

This was a multicenter study performed in 21 centers in Japan. A total of 2455 individuals were enrolled. H. pylori status was determined by validated ELISAs. Atrophic gastritis was diagnosed by histology, endoscopy with Congo Red dye scattering or the Kimura‐Takemoto endoscopic classification.

Results.

Atrophic gastritis increased from 9.4% in those less than 20 years of age to > 70% in those aged 60 or older and was strongly associated with H. pylori infection. The overall prevalence of atrophic gastritis in H. pylori infection was 82.9% (1272/1534) compared with 9.8% (90/921) among uninfected (OR = 44.8; 95% CI = 34.7–57.8). Intestinal metaplasia was present in 43.1% (542/1258) of H. pylori positive persons compared with 6.2% (51/823) among the uninfected (OR = 11.5; 95% CI = 8.5–15.5). Atrophic gastritis in H. pylori positive Japanese was very high in the younger generation (38.5% in those aged 20 or less and 58.5% in those 21–30).

Conclusions.

Atrophic gastritis and intestinal metaplasia were strongly associated with H. pylori and not with aging. The fall in prevalence of H. pylori in Japan has not been associated with a corresponding fall in the prevalence of atrophic gastritis among those with H. pylori infection. The high prevalence of the precursor lesion, atrophic gastritis with intestinal metaplasia, among those with H. pylori infection suggests that the risk of development of early gastric cancer will continue to remain high in Japan.
Significance of the Caspase Family in Helicobacter pylori Induced Gastric Epithelial Apoptosis
Authors: Potthoff A. , Ledig S. , Martin J. , Jandl O. , Cornberg M. , Obst B. , Beil W. , Manns M. P. , Wagner S.
Published: March 2003

Background and Aims.  H. pylori infection results in an increased epithelial apoptosis in gastritis and duodenal ulcer patients. We investigated the role and type of activation of caspases in H. pylori‐induced apoptosis in gastric epithelial cells.

Methods.  Differentiated human gastric cancer cells (AGS) and human gastric mucous cell primary cultures were incubated with H. pylori for 0.5–24 hours in RPMI 1640 medium, and the effects on cell viability, epithelial apoptosis, and activity of caspases were monitored. Apoptosis was analyzed by detection of DNA‐fragments by Hoechst stain®, DNA‐laddering, and Histone‐ELISA. Activities of caspases were determined in fluorogenic assays and by Western blotting. Cleavage of BID and release of cytochrome c were analyzed by Western blot. Significance of caspase activation was investigated by preincubation of gastric epithelial cells with cell permeable specific caspase inhibitors.

Results.  Incubation of gastric epithelial cells with H. pylori caused a time and concentration dependent induction of DNA fragmentation (3‐fold increase), cleavage of BID, release of cytochrome c and a concomittant sequential activation of caspase‐9 (4‐fold), caspase‐8 (2‐fold), caspase‐6 (2‐fold), and caspase‐3 (6‐fold). No effects on caspase‐1 and ‐7 were observed. Activation of caspases preceded the induction of DNA fragmentation. Apoptosis could be inhibited by prior incubation with the inhibitors of caspase‐3, ‐8, and ‐9, but not with that of caspase‐1.

Conclusions.  Activation of certain caspases and activation of the mitochondrial apoptotic pathway are essential for H. pylori induced apoptosis in gastric epithelial cells.
Helicobacter pylori CagA Containing ITAM‐Like Sequences Localized to Lipid Rafts Negatively Regulates VacA‐Induced Signaling In Vivo
Authors: Asahi Momoyo , Tanaka Yukie , Izumi Toshimasa , Ito Yoshiyuki , Naiki Hironobu , Kersulyte Dangeruta , Tsujikawa Kazutake , Saito Masakazu , Sada Kiyonao , Yanagi Shigeru , Fujikawa Akihiro , Noda Masaharu , Itokawa Yoshinori
Published: March 2003

Background. Helicobacter pylori CagA is injected into the host cell and tyrosine‐phosphorylated. We examined tyrosine‐phosphorylation sites of CagA, as well as the function of CagA proteins in vivo and in vitro.

Methods. After proteolytic digestion of CagA with lysyl endopeptidase, CagA tyrosine‐phosphorylation sites were determined using quadropolar time‐of‐flight (Q‐TOF) mass spectrometry analysis. Specific anti‐pY CagA polyclonal and anti‐CagA monoclonal antibodies were used to examine gastric mucosal biopsy specimens from H. pylori infected patients.

Results. Mass spectrometry identified five crucial tyrosine‐phosphorylation sites of CagA at Tyr893, Tyr912, Tyr965, Tyr999, and Tyr1033 within the five repeated EPIYA sequences of H. pylori (NCTC11637)‐infected AGS cells. CagA protein also had an immuno‐receptor tyrosine‐based activation motif (ITAM)‐like amino acid sequences in the 3′ region of the cagA, EPIYATIx27EIYATI, which closely resembled the ITAM. CagA proteins: (i) were localized to the 1% TritonX‐100 resistant membrane fraction (lipid rafts); (ii) formed a cluster of phosphorylated CagA protein complexes; (iii) associated with tyrosine‐phosphorylated GIT1/Cat1 (G protein‐coupled receptor kinase‐interactor 1/Cool‐associated tyrosine‐phosphorylated 1), substrate molecules of receptor type protein‐tyrosine phosphatase (RPTPζ/β), which is the receptor of VacA; and (iv) were involved in a delay and negative regulation of VacA‐induced signal. Furthermore, immunohistochemical staining of gastric mucosal biopsy specimens provided strong evidence that tyrosine‐phosphorylated CagA is found together with CagA at the luminal surface of gastric foveola in vivo.

Conclusion. These findings suggest an important role for CagA containing ITAM‐like sequences in the pathogenesis of H. pylori‐related disease.
Pathogenesis of Helicobacter pylori infection
Authors: Gerhard Markus , Rad Roland , Prinz Christian , Naumann Michael
Published: March 2003

Five years after publication of the complete genome sequence of Helicobacter pylori, research interest is shifting from the descriptive association of virulence factors with clinical outcome in infected patients to the molecular mechanisms of virulence factor action. This is particularly noticeable for VacA and CagA, for both of which detailed understanding of the interaction with host signalling pathways has accumulated over the last year. The role of H. pylori Lewis antigens for clinical outcome was further substantiated. Various strategies of H. pylori to fool or evade the human immune system are described, which all lead to the dysfunction of specific compartments of the host cellular immune system. Finally, a number of animal models indicate that inflammation is a key factor for gastric carcinogenesis, which is finally supported by a large prospective study identifying corpus atrophy and intestinal metaplasia as precancerous conditions.
Perceptions of Quality of Life in Hispanic Patients with Cancer
Authors: Juarez Gloria , Ferrell Betty , Borneman Tami
Published: March 2003

PURPOSE
: The purpose of this study was to describe perceptions of quality of life (QOL) of Hispanic patients with cancer pain.

DESCRIPTION OF STUDY
: This qualitative pilot study is guided by the conceptual framework of pain and QOL. From interviews with 17 Hispanic patients with cancer pain, data on perceptions of QOL were analyzed and are reported here.

RESULTS
: The study demonstrated the influence of culture on perceptions of QOL and the impact of pain on QOL. Several themes were identified for each domain of QOL, including physical, psychological, social, and spiritual well‐being. The role of the family and faith in God were important components of QOL for all patients.

CLINICAL IMPLICATIONS
: It is important for clinicians to devote greater attention to cultural assessment and to include cultural beliefs in cancer care to improve QOL for Hispanic patients. The role of the family and religious beliefs should be included in the planning and evaluation of each patient's care.