bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of pioglitazone and metformin efficacy using homeostasis model assessment
Authors: Nagasaka S. , Aiso Y. , Yoshizawa K. , Ishibashi S.
Published: December 2004

Aims  To compare clinical efficacy of two different insulin sensitizers, pioglitazone and metformin, and to reveal factors that influence the clinical efficacy.

Methods  Seventy‐eight Japanese subjects with Type 2 diabetes mellitus poorly controlled with sulphonylureas [38 men and 40 women, aged 57 ± 9 years, body mass index 25.2 ± 1.4 kg/m2, and HbA1c 8.3 ± 0.6% (means ± sd)] were randomly assigned to groups for the addition of either pioglitazone or metformin and followed up for 4 months. A decrease in HbA1c levels was compared with baseline factors including homeostasis model assessment of insulin sensitivity (HOMA‐R) and β‐cell function (HOMA‐β) with 71 subjects who completed the study.

Results  The overall decrease in HbA1c levels was similar for the pioglitazone (−1.2 ± 0.2%) and metformin (−1.3 ± 0.1%) groups. In the pioglitazone group, the decrease in HbA1c levels was negatively correlated with baseline HOMA‐R (r = −0.698, P < 0.0001) and HOMA‐β (r = −0.680, P < 0.0001). In contrast, the decrease was positively correlated with baseline HOMA‐β (r = 0.556, P = 0.0004) in the metformin group. Multivariate analysis revealed that either HOMA‐R or HOMA‐β was a main determinant of the decrease in HbA1c levels in the pioglitazone group. In the metformin group, baseline levels of fasting glucose were also included as an independent determinant in addition to HOMA‐β. The subjects with greater HOMA‐R (≥ 4.0) or HOMA‐β (≥ 40%) displayed better response to pioglitazone than to metformin, and vice versa.

Conclusions  In Type 2 diabetic subjects poorly controlled with sulphonylureas, addition of pioglitazone or metformin resulted in a comparable reduction in HbA1c levels. Subjects with greater insulin resistance or preserved β‐cell function displayed better response to pioglitazone, whereas subjects with reduced β‐cell function displayed better response to metformin.

Diabet. Med. 21, 136–141 (2004)
No nephropathy in Type 2 diabetic patient with POEMS syndrome with an elevated plasma VEGF
Authors: Baba T. , Østerby R. , Neugebauer‐Baba S. , Nozawa Y. , Watanabe T. , Sakurai K. , Katoh T. , Watanabe T.
Published: December 2004

Vascular endothelial growth factor (VEGF) is considered to have a role in the pathogenesis of diabetic retinopathy. Recent experimental observations that anti‐VEGF neutralizing antibody fully abolished the hyperfiltration and the increase in urinary albumin excretion suggested the contribution of VEGF to the development of diabetic nephropathy, as well. Here, we present a case of POEMS (Crow–Fukase) syndrome with Type 2 diabetes, which was associated with elevated plasma VEGF level, but no sign of diabetic nephropathy. The findings obtained from this case did not support the hypothesis that VEGF may enhance the development of diabetic nephropathy.
Paternal phenotype is associated with microalbuminuria in young adults with Type 1 diabetes mellitus of short duration
Authors: Schultz C. J. , Dalton R. N. , Selwood M. , Dunger D. B. , Neil H. A. W.
Published: December 2004

Aims  Susceptibility to diabetic nephropathy has not yet been causally linked to any genetic factors. We investigated in nuclear families whether parental ambulatory blood pressure, lipids and urine albumin excretion were early markers of risk of microalbuminuria in young adults with Type 1 diabetes.

Subjects and methods  A subset of 98 young adults from the Oxford Regional Prospective Study were followed from diagnosis until aged ≥ 16 years and duration of diabetes ≥ 5 years (probands). Of these subjects, 24 developed microalbuminuria (males ≥ 3.5 mg/mmol; females ≥ 4 mg/mmol) and were designated cases, whereas 74 were controls. Family medical history, 24‐h ambulatory blood pressure, urine albumin to creatinine ratio (ACR), non‐fasting lipid profile and apolipoproteins (A1 and B) were measured in mothers and fathers.

Results  The prevalence of a parental hypertension (taking anti‐hypertensive medication or daytime blood pressure > 140/90 mmHg), was similar in cases and controls (29% vs. 35%; χ2 test, P = 0.3). The systolic blood pressure night to day ratio and also ACR were higher in the fathers of cases when compared with the fathers of controls [systolic 0.88 (0.08), n = 14 vs. 0.85 (0.12), n = 53, P = 0.041]; [ACR median (IQ range) 0.6 mg/mmol (0.2–16.9) vs. 0.47 mg/mmol (0.3–3.7), P = 0.049]. Paternal night‐time systolic blood pressure, night to day systolic blood pressure ratio and ACR were correlated with an index of susceptibility to albuminuria (r = 0.25, P = 0.042, n = 69 and r = 0.28, P = 0.022, n = 0.67 and r = 0.24, P = 0.029, n = 0.85, respectively).

Conclusions  Higher paternal ACR and night to day ratio of ambulatory blood pressure, but not parental hypertension or maternal factors, are associated with microalbuminuria in young adults with Type 1 diabetes.
Aggregation of features of the metabolic syndrome is associated with increased prevalence of chronic complications in Type 2 diabetes
Authors: Costa L. A. , Canani L. H. , Lisbôa H. R. K. , Tres G. S. , Gross J. L.
Published: December 2004

Aims  To investigate the association of features of the metabolic syndrome with the prevalence of chronic complications.

Methods  A cross‐sectional study was conducted with 548 patients with Type 2 diabetes mellitus (DM). Metabolic syndrome was diagnosed in the presence of at least two of the following: hypertension, dyslipidaemia, obesity, and microalbuminuria.

Results  Patients with the metabolic syndrome (85%) had a higher prevalence of peripheral vascular disease (PVD) (35% vs. 18%), retinopathy (44% vs. 20%), distal sensory neuropathy (DSN) (44% vs. 24%), micro‐ and macroalbuminuria (38% vs. 28%) and coronary artery disease (CAD) (53% vs. 36%). The more metabolic syndrome features (none/one, two, three or four), the higher the proportion of diabetes complications: PVD 18%, 31%, 37% and 38%; stroke 1.0%, 4.5%, 5.9% and 11.3%; retinopathy 20%, 38%, 42% and 64%; DSN 24%, 32%, 49% and 57%; micro‐ and macroalbuminuria 28%, 36% and 41%; and CAD 36%, 44%, 52% and 60% (P < 0.05).

Conclusions  The metabolic syndrome and the aggregation of its components were significantly associated with macro‐ and microvascular complications in Type 2 DM patients.
Higher carotid‐radial pulse wave velocity in healthy offspring of patients with Type 2 diabetes
Authors: McEleavy O. D. , McCallum R. W. , Petrie J. R. , Small M. , Connell J. M. C. , Sattar N. , Cleland S. J.
Published: December 2004

Aims  To determine whether carotid‐radial pulse wave velocity (crPWV), a simple non‐invasive measurement of muscular artery structure and function, is increased in offspring of patients with Type 2 diabetes compared with well‐matched controls with no family history of diabetes. Serum levels of intercellular adhesion molecule‐1 (sICAM‐1) were also examined.

Methods  Offspring (n = 19, M = 8) were recruited via contact with patients attending clinics. Controls (n = 19, M = 8) were recruited by advertisement. crPWV was measured using COMPLIOR. Blood pressure and heart rate were determined and fasting blood taken for measurement of metabolic and endothelial parameters.

Results  Offspring and controls were well matched [mean (sd)] for age [33.1 (9.6) vs. 32.8 (9.5) years], body mass index [24.8 (4.9) vs. 24.3 (3.4) kg/m2], waist circumference [78.3 (2.3) vs. 76.3 (2.5) cm], and systolic blood pressure [120 (9.3) vs. 119 (14.2) mmHg]. crPWV was 10% higher in the offspring [9.94 (1.3) m/s] compared with controls [9.01 (1.2) m/s, P = 0.02] despite similar pulse pressure [52 (10.5) vs. 53.5 (9.3) mmHg] and resting heart rate [71 (8.7) vs. 69 (14.0) beats/min]. They also showed a trend toward higher sICAM‐1 [217 (55) vs. 188 (40) ng/ml, P = 0.07] concentrations which were also strongly correlated to crPWV in offspring (r = 0.63, P = 0.004).

Conclusions  Vascular dysfunction in the form of increased muscular artery stiffness is present from an early stage in subjects at higher risk of developing diabetes. This may be secondary to impaired activation of endothelial signalling pathways in the context of inherited insulin resistance.
Influence of alcohol on cognitive performance during mild hypoglycaemia; implications for Type 1 diabetes
Authors: Cheyne E. H. , Sherwin R. S. , Lunt M. J. , Cavan D. A. , Thomas P. W. , Kerr D.
Published: December 2004

Aims  Alcohol and hypoglycaemia independently affect cognitive function. This may be relevant for insulin‐treated diabetic patients who drive motor vehicles. The aim of this study was to examine the effect of mild hypoglycaemia (2.8 mmol/l) with modest alcohol intoxication (levels below UK driving limits) on intellectual performance in patients with Type 1 diabetes.

Methods  A hyperinsulinaemic glucose clamp (60 mU/m2) was used to study 17 subjects [age 35 ± 8 years, HbA1c 8.1 ± 1.4% (mean ± sd)] on four occasions: (A) euglycaemia (4.5 mmol/l) with placebo, (B) euglycaemia with alcohol, (C) hypoglycaemia (2.8 mmol/l) with placebo, and (D) hypoglycaemia with alcohol. Cognitive performance was assessed using four‐choice reaction time (4CRT, primary outcome), measurements of general intellectual skills [trail making B (TMB) and digit symbol substitution (DSST)], and visual information processing [visual change detection (VCD)]. A test related to driving performance (hazard perception) was also used.

Results  In experiments B and D the average blood alcohol level was 43 mg/dl. This was associated with deterioration in 4CRT {+ 35 ms [95% confidence interval (CI) 20, 50]} and TMB, whereas hypoglycaemia without alcohol increased 4CRT only [+ 39 ms (95% CI 5, 73)]. However, when alcohol was combined with hypoglycaemia, there was marked deterioration in all the cognitive function tests [4CRT 74 ms (95% CI 35, 113), TMB, DSST and VCD]. Hazard perception was not affected. The effect of alcohol was no different in euglycaemia than in hypoglycaemia, i.e. there was no interaction. Whereas hypoglycaemia did not reduce the likelihood that the subjects would drive, alcohol did.

Conclusions  The cumulative effect of alcohol and hypoglycaemia on cognitive function together has implications for driving in patients with Type 1 diabetes. Both independently impair cognitive function and together the effects are additive. Patients with Type 1 diabetes should be educated about hypoglycaemia and driving and should avoid alcohol completely if planning to drive.
Young children who abandon error behaviourally still have to free themselves mentally: a retrospective test for inhibition in intuitive physics
Authors: Freeman Norman H. , Hood Bruce M. , Meehan Caroline
Published: December 2004

When preschoolers overcome persistent error, subsequent patterns of correct choices may identify how the error had been overcome. Children who no longer misrepresented a ball rolling down a bent tube as though it could only fall vertically, were asked sometimes to approach and sometimes to avoid where the ball landed. All children showed requisite task‐switching flexibility. The pattern of 4‐year‐olds’ correct choices among different places showed unnecessary avoidance of any place that would previously have tempted them into a vertical‐approach error, 5‐year‐olds rebounded into a reversal, and 7‐year‐olds were flexible. The data attest to an inhibition mechanism, ruling out competing possibilities.
THE IMPACT OF NEW ACCOUNTING STANDARDS ON JAPANESE COMPANIES
Authors: Mizuno Mitsuru
Published: December 2004

Abstract.  As a result of a series of reforms initiated in the latter half of 1990s, accounting standards in Japan have become virtually equivalent to international accounting standards. The impact of the accounting reform on Japanese firms has been significant. This paper reviews the so‐called ‘Accounting Big Bang’ and assesses its impact on Japanese firms. It concludes that Japanese firms are now required to place greater emphasis than previously on an improvement in the return on their assets and on an enhancement in the values of their stock market shares.
CHINESE INDUSTRIAL POLICY AND THE REDUCTION OF STATE‐OWNED SHARES IN CHINA'S LISTED COMPANIES
Authors: Ke Li , Tongliang An
Published: December 2004

Abstract.  Reducing the proportion of state‐owned shares (SOSs) in China is a complicated undertaking, related to several issues on the reform agenda such as the strategic reform of the national economy, industrial policies, the sustainable development of listed companies, the evolution of the ownership structure and the establishment of a social security system. By our analysis, since the quantity of SOSs is continuously increasing, it requires thorough and differentiated reduction strategies based on the industrial structure of SOSs, industrial policies, timing issues, etc., and should follow this process all along; i.e. SOSs → key corporations → key industries → state economy.
‘A LUTA CONTINUA’ (THE STRUGGLE CONTINUES): REJOINDER TO WATKINS
Authors: Tooley James
Published: December 2004

It is unclear why Watkins ignored a fundamental point of my article: education for the poor can be financed by the state or through private means, by those who are not poor so affordability of education need not be an issue. The fact that the poor are willing to pay fees when alternative state education is free is an indictment of state education in developing countries. The poor simply cannot wait in the hope that the state might provide better education. Their needs are urgent and can be met by private schools.
ECONOMICS, RELIGION AND THE DECLINE OF EUROPE1
Authors: Ferguson Niall
Published: December 2004

This article asks whether there is any casual connection between the contemporaneous decline in industriousness and religiosity in Europe over the past 25 years. In the United States working hours and levels of religious faith and observance have held steady or even increased over this period. But in most European countries they have declined together. Could this be a posthumous vindication of Max Weber's thesis about the Protestant work ethic and the rise of capitalism? Though there clearly are some important links between religion and economic behaviour, the article concludes that the evidence does not perfectly fit Weber's theory, which emphasised abstinence rather than consumption as a determinant of economic development.
Optic neuritis, multiple sclerosis and human leukocyte antigen: results of a 4‐year follow‐up study
Authors: Amirzargar A. A. , Tabasi A. , Khosravi F. , Kheradvar A. , Rezaei N. , Naroueynejad M. , Ansaripour B. , Moradi B. , Nikbin B.
Published: December 2004

In the present study the relation between human leukocyte antigen (HLA), optic neuritis (ON) and multiple sclerosis (MS) has been investigated in 56 Iranian patients (46 females and 10 males). HLA‐A and ‐B typing by microlymphocytotoxicity method and HLA‐DRB, DQA and DQB by polymerase chain reaction based on sequence specific primers method was performed for the selected patients with ON. The diagnosis of clinically defined MS (CDMS) was confirmed in 15 of them (26.7%) during their follow‐up. HLA‐A24 was significantly higher in ON patients, whilst A23, A26, and A30 showed a significant decrease in these patients. HLA‐A10 and A26 were absent in CDMS patients and A2 and A11 were significantly decreased in ON and CDMS patients. HLA‐B5, B51, B38, B27, and B35 were significantly increased in ON patients compared with control subjects. HLA‐B44, B16 and B38 alleles were not present in CDMS patients. Regarding DR locus, the frequency of HLA‐DRB1*15 and DRB1*04 has been increased in CDMS patients, whilst the frequency of HLA‐DRB1*07 and *11 was much higher in ON patients. In DQA region, the most frequent allele in the MS patients was DQA1*0102, which was significantly higher than ON patients, and control group. The frequency of DQA1*0103 was significantly increased in both patients group. In DQB1, the frequency of DQB1*0602 increased significantly in the MS patients. In conclusion existence of common genetic basis for early manifestations of MS could be suggested.
CSF from MS patients can induce acute conduction block in the isolated optic nerve
Authors: Centonze D. , Rossi S. , Boffa L. , Versace V. , Palmieri M. G. , Caramia M. D. , Bernardi G.
Published: December 2004

In the present in vitro electrophysiological study, the acute effects of the cerebrospinal fluid (CSF) from multiple sclerosis (MS) and control subjects were measured on the axonal conduction of rat optic nerve, a central tract that is commonly affected in MS. Optic nerve compound action potential (CAP) amplitude was insensitive to the application of CSF obtained from the whole population of non‐MS patients and from seven of 15 MS CSF. In the remaining eight MS cases, conversely, a time‐dependent depression of CAP amplitude was observed. The reversible blockade of ion channels by soluble substances might account, at least in part, for the transient symptoms often seen in MS patients.
Fulminant acute disseminated encephalomyelitis mimicking acute bacterial menigoencephalitis
Authors: Harloff A. , Rauer S. , Hofer M. , Klisch J. , Els T.
Published: December 2004

Most patients with acute disseminated encephalomyelitis (ADEM) recover quickly under corticosteroid treatment and have a favourable long‐term prognosis. We report on a young woman with acute onset of an extensive and solitary white‐matter lesion in the left hemisphere. Fever, high pleocytosis and elevated protein in cerebrospinal fluid initially suggested bacterial meningoencephalitis. The patient died from brain herniation despite maximal conservative therapy. Histological changes in necropsy were consistent with the diagnosis ADEM. Treatment options of fulminant ADEM are discussed.
Assessment of Migraine Severity Using the Migsev Scale: Relationship to Migraine Features and Quality of Life
Authors: El Hasnaoui A , Vray M , Blin P , Nachit-Ouinekh F , Boureau F ,   HEMISHERE study group∗
Published: December 2004

We have recently developed an instrument to describe and categorize severity of migraine attacks from patient self-report, the MIGSEV questionnaire. We have now performed a large prospective survey using this tool to evaluate migraine severity in 2979 patients consulting for headache in France, included by 1164 general practitioners, 174 neurologists and 82 gynaecologists. The objective of the study was to determine the prevalence of severity grades in a large population who consults for migraine, to test the concordance between severity calculated from physician-derived and patient-derived data, and to test the relevance of the concept of severity as applied to diagnosis, other measures of the burden of migraine, and to health-related quality of life. Severe attacks were reported in around one-fifth of the sample. Physician- and patient-derived data provided concordant estimates of severity in 71% of cases, the discordant cases representing principally an underestimate by the physician of headache severity. Migraine severity was associated with frequent, long-lasting and treatment-resistant attacks, and with poor quality of life. The MIGSEV questionnaire is proposed as a simple measure of severity for the diagnosis and management of migraineurs, suitable for use both by physicians and patients.
The Taking of a Position: A Reinterpretation of the Elaboration Likelihood Model
Authors: COOK ANDREW J. , MOORE KEVIN , STEEL GARY D.
Published: December 2004

This article explains how data associated with attitude change and persuasion in mainstream psychology and social psychology can be reinterpreted as evidence of the agentive ability of taking a position. A critical review is made of the elaboration likelihood model and a position model is adapted from positioning theory. The postulates of the elaboration likelihood model are then subjected to critical scrutiny by means of comparison with our position model. In this way regularities associated with attitude change and persuasion are interpreted as evidence of a deliberative process, involving negotiation and the use of supporting and opposing arguments. We present this as evidence of the commonly held agentive ability to position oneself and anticipate the positions of others.
Social Constructionism as Cognitive Science
Authors: DICKINS THOMAS E.
Published: December 2004

Social constructionism is a broad position that emphasizes the importance of human social processes in psychology. These processes are generally associated with language and the ability to construct stories that conform to the emergent rules of "language games". This view allows one to espouse a variety of critical postures with regard to realist commitments within the social and behavioural sciences, ranging from outright relativism (language constructs all of our concepts) to a more moderate respect for the "barrier" that linguistic descriptions can place between us and reality. This paper first outlines some possible social construction‐ist viewpoints and then goes on to show how each of them conforms to the basic principles of information theory. After establishing this relation the paper then argues that this leads to a great deal of commonality between social construction‐ist positions and the baseline aims of cognitive science. Finally, the paper argues that, if information theory is held in common, this both suggests future research collaborations and helps to "mop up" some of the arguments surrounding realist commitments.
The Cognitive Origins of Bourdieu's Habitus
Authors: LIZARDO OMAR
Published: December 2004

This paper aims to balance the conceptual reception of Bourdieu's sociology in the United States through a conceptual re‐examination of the concept of Habitus. I retrace the intellectual lineage of the Habitus idea, showing it to have roots in Claude Levi‐Strauss structural anthropology and in the developmental psychology of Jean Piaget, especially the latter's generalization of the idea of operations from mathematics to the study of practical, bodily‐mediated cognition. One important payoff of this exercise is that the common misinterpretation of the Habitus as an objectivist and reductionist element in Bourdieu's thought is dispelled. The Habitus is shown to be instead a useful and flexible way to concep‐tualize agency and the ability to transform social structure. Thus ultimately one of Bourdieu's major contributions to social theory consists of his development of a new radical form of cognitive sociology, along with an innovative variety of multilevel sociological explanation in which the interplay of different structural orders is highlighted. In keeping with the usual view, the goal of sociology is to uncover the most deeply buried structures of the different social worlds that make up the social universe, as well as the "mechanisms" that tend to ensure their reproduction or transformation. Merging with psychology, though with a kind of psychology undoubtedly quite different from the most widely accepted image of this science, such an exploration of the cognitive structures that agents bring to bear in their practical knowledge of the social worlds thus structured. Indeed there exists a correspondence between social structures and mental structures, between the objective divisions of the social world . . . and the principles of vision and division that agents apply to them (Bourdieu, 1996b[1989], p. 1).
Determining the direction of contact metamorphic fluid flow: an assessment of mineralogical and stable isotope criteria
Authors: CARTWRIGHT I. , BUICK I. S.
Published: December 2004

ABSTRACT One‐dimensional fluid advection‐dispersion models predict differences in the patterns of mineralogical and oxygen isotope resetting during up‐ and down‐temperature metamorphic fluid flow that may, in theory, be used to determine the fluid flow direction with respect to the palaeotemperature gradient. Under equilibrium conditions, down‐temperature fluid flow is predicted to produce sharp reaction fronts that separate rocks with isobarically divariant mineral assemblages. In contrast, up‐temperature fluid flow may produce extensive zones of isobarically univariant mineral assemblages without sharp reaction fronts. However, during contact metamorphism, mineral reaction rates are probably relatively slow compared with fluid velocities and distended reaction fronts may also form during down‐temperature fluid flow. In addition, uncertainties in the timing of fluid flow with respect to the thermal peak of metamorphism and the increase in the variance of mineral assemblages due to solid solutions introduce uncertainties in determining fluid flow directions. Equilibrium down‐temperature flow of magmatic fluids in contact aureoles is also predicted to produce sharp δ18O fronts, whereas up‐temperature flow of fluids derived by metamorphic devolatilization may produce gradational δ18O vs. distance profiles. However, if fluids are channelled, significant kinematic dispersion occurs, or isotopic equilibrium is not maintained, the patterns of isotopic resetting may be difficult to interpret. The one‐dimensional models provide a framework in which to study fluid‐rock interaction; however, when some of the complexities inherent in fluid flow systems are taken into account, they may not uniquely distinguish between up‐ and down‐temperature fluid flow. It is probably not possible to determine the fluid flow direction using any single criterion and a range of data is required.
Correlation Between Lipophilicity and Triptan Outcomes
Authors: Pascual Julio , Muñoz Pedro
Published: December 2004

Background.—It has been suggested that triptans achieving higher central nervous system (CNS) levels should have an advantage in efficacy, if central actions are important.

Objective.—Our aim was to correlate the efficacy and tolerability results of triptans with their lipophilicity.

Methods.—Data for response and pain free at 2 hours, recurrence, adverse events (AE), CNS AE, and chest symptoms taken from Ferrari et al's meta‐analysis publications for the recommended doses of oral triptans were correlated with their lipophilicity coefficients (logDpH7.4 =−2.1 almotriptan < −1.5 sumatriptan < −1.0 zolmitriptan < −0.7 rizatriptan < −0.2 naratriptan < 0.5 eletriptan).

Results.—We found no significant correlation between lipophilicity coefficients and any of the analyzed parameters. There was, however, some correlation between lipophilicity and CNS AE (P= .09, r= 0.74) and, to a lesser degree, with a reduction in recurrence rate (r=−0.36). The r values for response and pain free with placebo correction ranged from 0.04 to 0.34, suggesting almost no correlation between lipophilicity and efficacy variables.

Conclusions.—According to this analysis, a higher lipophilicity does not seem crucial to improve triptan efficacy. This physico‐chemical property, however, correlates with higher CNS AE and, possibly, lower recurrence rates.
Zolmitriptan 5 mg Nasal Spray: Efficacy and Onset of Action in the Acute Treatment of Migraine—Results From Phase 1 of the REALIZE Study
Authors: Gawel Marek , Aschoff Jürgen , May Arne , Charlesworth Bruce R. ,   REALIZE Study Team
Published: December 2004

Objectives.—The objective of phase 1 (reported here) of this two‐phase study was to assess the efficacy of zolmitriptan 5 mg nasal spray, in terms of ability to provide relief from all migraine symptoms, in a controlled setting, designed to replicate clinical practice.

Background.—Zolmitriptan nasal spray has been shown to be fast acting and highly effective in the treatment of migraine, as assessed using standard endpoints, such as headache response and pain‐free rates.

Methods.—In the double‐blind first phase of the study, patients with migraine were randomized to receive zolmitriptan 5 mg nasal spray or placebo to treat a single migraine attack. Attacks were treated according to patients' normal patterns of use, in order to closely reflect clinical practice; that is, no specific regimen was dictated in terms of time to treatment or at what level of pain intensity the headache should be treated. Patients could take a second dose of study medication or an agreed escape medication if adequate pain relief had not been achieved 2 hours after the first dose. The primary efficacy endpoint was total symptom relief (freedom from pain, nausea, photophobia, and phonophobia) 1 hour after the first dose. Secondary efficacy endpoints included headache response, pain‐free status and sustained pain‐free status, and ability to perform normal activities.

Results.—The intention‐to‐treat population comprised 461 zolmitriptan nasal spray recipients and 451 placebo recipients. The total symptom relief rate 1 hour post‐dose was significantly higher in the zolmitriptan 5 mg nasal spray group than in the placebo group (14.5% vs. 5.1%; P < .0001); the difference between the groups was significant from 30 minutes post‐dose. Treatment with zolmitriptan nasal spray, compared with placebo, also produced a higher headache response rate from 10 minutes post‐dose (15.1% vs. 9.1%; P= .0079) and a higher pain‐free rate from 30 minutes post‐dose (7.7% vs. 3.2%; P= .0039). Zolmitriptan nasal spray was also significantly superior to placebo in terms of sustained pain‐free status and patients' ability to perform normal activities. Zolmitriptan nasal spray was well tolerated.

Conclusions.—These findings confirm the efficacy demonstrated by zolmitriptan nasal spray in previous clinical trials.
Intracranial Hypertension Induced by Rofecoxib
Authors: Jacob Saiju , Rajabally Yusuf A.
Published: December 2004

Several secondary causes are implicated in the etiology of idiopathic intracranial hypertension. Rofecoxib is a selective cyclo‐oxygenase (COX)‐2 inhibitor, now being increasingly used in place of nonselective nonsteroidal anti‐inflammatory drugs (NSAIDs). We report a case of intracranial hypertension in a 69‐year‐old man 3 weeks after the commencement of rofecoxib therapy with reversal of clinical findings on drug withdrawal.
Cluster‐Like Headache Aura Status
Authors: Langedijk Marc , Van Der Naalt Joukje , Luijckx Gert Jan , De Keyser Jacques
Published: December 2004

We describe a patient with successive attacks (40 to 90 minutes) of cluster‐like headache associated with aphasia, and contralateral hemihypesthesia and hemiplegia. The condition can best be described as cluster‐like headache aura status.
Qualitative Analysis of Medicare Claims in the Last 3 Years of Life: A Pilot Study
Authors: Barnato Amber E. , Labor Renee E. , Freeborne Nancy E. , Jayes Robert L. , Campbell Diane E. , Lynn Joanne
Published: December 2004

Objectives: To study end‐of‐life care of a representative sample of older people using qualitative interpretation of administrative claims by clinicians and to explore whether this method yields insights into patient care, including continuity, errors, and cause of death.

Design: Random, stratified sampling of decedents and all their Medicare‐covered healthcare claims in the 3 years before death from a 5% sample of elderly fee‐for‐service beneficiaries, condensation of all claims into a chronological clinical summary, and abstraction by two independent clinicians using a standardized form.

Setting: United States.

Participants: One hundred Medicare fee‐for‐service older people without disability or end‐stage renal disease entitlement who died in 1996 to 1999 and had at least 36 months of continuous Part A and Part B enrollment before death.

Measurements: Qualitative narrative of the patient's medical course; clinician assessment of care continuity and apparent medical errors; cause, trajectory, and place of death.

Results: The qualitative narratives developed by the independent abstracters were highly concordant. Clinicians felt that 75% of cases lacked continuity of care that could have improved the quality of life and the way the person died, and 13% of cases had a medical error identified by both abstracters. Abstracters disagreed about assignment of a single cause of death in 28% of cases, and abstracters and the computer algorithm disagreed in 43% of cases.

Conclusion: Qualitative claims analysis illuminated many problems in the care of chronically ill older people at the end of life and suggested that traditional vital statistics assignation of a single cause of death may distort policy priorities. This novel approach to claims review is feasible and deserves further study.
Prediction of On‐Road Driving Performance in Patients with Early Alzheimer's Disease
Authors: Brown Laura B. , Ott Brian R. , Papandonatos George D. , Sui Yunxia , Ready Rebecca E. , Morris John C.
Published: December 2004

Objectives: Physicians and family members frequently are asked to provide information about driving ability in patients with Alzheimer's disease (AD), yet there has been little research on the validity of their assessments of driving performance.

Design: Cross‐sectional.

Setting: Participants were recruited from the neurology department of a community hospital affiliated with Brown Medical School.

Participants: Participants included 75 older adults (17 with mild AD, 33 with very mild AD, and 25 elderly controls).

Measurements: The participant him/herself, an informant, and an experienced neurologist rated each participant's driving ability on a 3‐point rating scale (safe, marginal, unsafe). A professional driving instructor also completed a standardized 108‐point on‐road driving assessment of each participant and then rated driving ability on the 3‐point scale. Ratings were compared with the on‐road driving score and with each other.

Results: Only the neurologist's rating of the participants' driving abilities was significantly related to on‐road driving score. When related to the instructor's safety rating, the neurologist's ratings were the most sensitive and specific. Mini‐Mental State Examination score was a borderline covariate for the neurologist's rating. Overall, the instructor was the most stringent rater of participant driving ability, followed by the neurologist, the informant, and the participant.

Conclusion: An experienced neurologist's assessment of driving competence may be a valid predictor of driving performance of patients with early AD.
Attitudes of Asian‐Indian Hindus Toward End‐of‐Life Care
Authors: Deshpande Ohm , Reid M. Carrington , Rao Arun S.
Published: December 2004

The population of older adults in the United States is increasing in cultural diversity. Thus, an appreciation of cultural perspectives regarding end‐of‐life care may benefit practicing physicians. This article addresses end‐of‐life care issues from the perspective of Hinduism—a faith embraced by a growing demographic of the U.S. population—and also reviews basic Hindu philosophical concepts salient to caring for patients at the end of life.
Combination vincristine and plasma exchange as initial therapy in patients with thrombotic thrombocytopenic purpura: one institution's experience and review of the literature
Authors: Ziman Alyssa , Mitri Michael , Klapper Ellen , Pepkowitz Samuel H. , Goldfinger Dennis
Published: December 2004

BACKGROUND:  Thrombotic thrombocytopenic purpura (TTP) was once a highly fatal disease with mortality reaching nearly 95 percent; however, application of therapeutic plasma exchange (TPE) has dramatically increased survival. Nevertheless, mortality remains substantial (10%‐30% in many published reports), requiring the search for more efficacious treatments. Vincristine (VCR) has been generally reserved for refractory TTP. Despite its effectiveness in a salvage mode, VCR has not been widely advocated as first‐line therapy in conjunction with TPE. We previously reported improved survival when VCR and TPE were administered at presentation in patients treated from 1979 to 1994. Utilizing this standardized approach, outcomes of an additional group of patients and the results of a literature review of VCR therapy for TTP are reported.

STUDY DESIGN AND METHODS:  Medical records of all patients with a diagnosis of TTP treated between 1995 and 2002 at Cedars‐Sinai Medical Center were reviewed. TPE was performed daily, exchanging 1.25 plasma volumes, until the platelet count normalized. Patients received VCR 1.4 mg/m2, (up to 2.0 mg total dose) after the first TPE. A literature review of all publications utilizing VCR in the management of TTP was performed with MEDLINE.

RESULTS:  Twelve consecutive patients meeting the diagnostic criteria received treatment with VCR and TPE. All patients achieved durable remission. Patients tolerated VCR without significant complications.

CONCLUSION:  Our 100 percent survival rate, as well as evidence garnered from the literature review, suggests that combination therapy with VCR and TPE at presentation might be more effective than TPE alone and therefore warrants consideration as first‐line therapy for TTP patients.
A novel cis‐AB allele derived from a unique 796C>A mutation in exon 7 of ABO gene
Authors: Tzeng Cheng‐Hwai , Chen Ying‐Ju , Lyou Jau‐Yi , Chen Pei‐Shan , Liu Hsueng‐Mei , Hu Hui‐Yu , Lin Jeong‐Shi , Yu Lung‐Chih
Published: December 2004

BACKGROUND:  The cis‐AB phenotype is very rare, and only three genotypes that correspond to specific ABO allele changes have been reported. Cis‐AB01 involves the A102 allele with a nonsynonymous substitution G803C in exon 7, whereas cis‐AB02 and cis‐AB03 involve different nonsynonymous substitutions A796C and C700T, respectively, on the B101 allele background. The nucleotide substitutions give rise to a change of the respective glycosyltransferase, resulting in varying bifunctional AB transferase activities.

STUDY DESIGN AND METHODS:  Two cis‐AB phenotypes were identified in a Taiwanese C. family and two unrelated individuals, respectively. Serologic studies, molecular cloning, and sequencing of exon 6 and exon 7 were carried out to determine their respective phenotypic characteristics and cis‐AB alleles. A cohort of 300 AB‐phenotype, healthy random individuals served as controls.

RESULTS:  A novel cis‐AB allele is uncovered out of the three family members, of which a 796C>A substitution occurs predicting an amino acid change at residue 266 of leucine to methionine on the background of A102 allele. It is serologically like cis‐AB03, an A2B phenotype, but molecularly different. Both of the two unrelated individuals are of cis‐AB01 allele, and all of the 300 AB blood group controls are excluded cis‐AB phenotype.

CONCLUSION:  The C. family described carries a novel cis‐AB allele that differs molecularly from all previously reported cis‐AB alleles.
Molecular genetic methods for diagnosis and antibiotic resistance detection of mycobacteria from clinical specimens
Authors: SHAMPUTA I. C. , RIGOUTS AND L. , PORTAELS F.
Published: December 2004

Mycobacteria comprise a diverse group of bacteria that are widespread in nature, some of which cause significant disease in humans. Members of the Mycobacterium tuberculosis complex (MTBC) are the most important human pathogens of the genus Mycobacterium. Traditional methods for detection and identification of mycobacteria include microscopy, culture and phenotypic tests. These methods either lack sensitivity, specificity, or are time consuming. Advances in the field of molecular biology have provided rapid diagnostic tools that have reduced the turnaround times for detecting MTBC and drug resistance in cultures and directly in clinical specimens from weeks to days. This review discusses the molecular genetic techniques for detecting and identifying MTBC as well as drug resistance of mycobacteria in clinical specimens.
Molecular genetic methods for the diagnosis of fastidious microorganisms
Authors: FENOLLAR FLORENCE , RAOULT DIDIER
Published: December 2004

Technological innovations in the detection and identification of microorganisms using molecular techniques such as polymerase chain reaction (PCR) have ushered in a new era with respect to diagnostic microbiology. PCR using universal or specific primers followed by identification of amplified product, mainly by sequencing, has enabled the rapid identification of cultured or uncultured bacteria. Thus, PCR may allow quick diagnosis of infections caused by fastidious pathogens for which culture could be extremely difficult. However, several pitfalls, such as false positives, have been observed with PCR, underlining the necessity to interpret the results obtained with caution. At present, certain improvements in the molecular genetic methods may be helpful for the diagnosis of infectious diseases. Indeed, the recent development of bacterial genome sequencing has provided an important source of potential targets for PCR, allowing rational choice of primers for diagnosis and genotyping. In addition, the development of new techniques such as real‐time PCR offers several advantages in comparison to conventional PCR, including speed, simplicity, reproducibility, quantitative capability and low risk of contamination. Herein, we review the general principles of PCR‐based diagnosis and molecular genetic methods for the diagnosis of several hard‐to‐culture bacteria, such as Rickettsia spp., Ehrlichia spp., Coxiella burnetii, Bartonella spp., Tropheryma whipplei and Yersinia pestis.
Beschriftete altsüdarabische Sockel, Stelen‐ und Grabstatuettenbasen und Steinplatten
Authors: Hayajneh Hani
Published: December 2004

Mit diesem Artikel folgt nun der fünfte Beitrag über die altsüdarabischen Inschriften auf Fotoaufnahmen aus dem Nachlaß des verstorbenen Professors Mahmūd al‐Ghul. Beschrifteten Grabstatuettenbasen sowie Steinplatten werden bearbeitet und kommentiert.
An archaeological survey of northern Fujairah, United Arab Emirates
Authors: Brass Leanne , Britton Georgia
Published: December 2004

This article presents the results of an archaeological survey conducted in northern Fujairah, United Arab Emirates, in 1995. It aims to serve as a reference point for anyone doing further research or study in Fujairah or elsewhere in the region and to assist in any conservation plans for this area. An overview of the survey methodology and description and interpretation of the sixty seven recorded sites is provided with accompanying images and plans.
Particulated bone grafts – effectiveness of bone cell supply
Authors: Springer Ingo N.G. , Terheyden Hendrik , Geiß Stefan , Härle Franz , Hedderich Jürgen , Açil Yahya
Published: December 2004

Abstract
Objective: The objective of this study was to measure the amount of viable bone cells present in different types of bone graft.

Material and methods: Bone chips were harvested from the trabecular or cortical bone of the mandible or the iliac crest and either milled or not. The average size of unmilled bone particles was 5×5×5 mm and that of milled was 2×2×2 mm. Drill sludge was obtained using either a ball reamer, a diamond ball or an implant drill (the latter from mandibular bone and of average dimension 1×1×1 mm). A measure of 0.5 g of each category was cultured in Dulbecco's modified Eagle's medium with additives for four weeks. Cell counts were performed. An analysis of the osteocalcin synthesis, the alkaline phosphatase (ALP) activity, the collagen types and the concentration of bone‐specific collagen cross‐links in medium supernatants was performed.

Results: Cells stained positively for osteocalcin and ALP in all groups. Bone‐specific collagen cross‐links could be quantified and collagen of types I and V was present with no difference in all groups. Unmilled spongy bone chips revealed greater cell counts than milled (P<0.05). Spongy bone chips revealed greater cell counts than cortical bone chips (P<0.05). Drill sludge obtained by hard alloy ball reamer showed the least amount of viable cells (P<0.05).

Conclusions: Bone milling reduces the quantity of osteoblasts. Bone obtained by the ball reamer supplies a smaller number of cells than bone obtained by other methods. Unmilled spongy bone chips appear to offer the greatest amount of viable osteoblasts.
Microbiological and clinical effects of chlorhexidine enclosed in fixtures of 3I‐Titamed® implants
Authors: Groenendijk Edith , Dominicus Jan J. K. , Moorer Wilfred R. , Aartman Irene H. A. , Van waas Marinus A. J.
Published: December 2004

Abstract: This double‐blind study used a split‐mouth design to investigate the microbio‐logical and clinical effects of 0.2% chlorhexidine enclosed in fixtures. Twelve patients had 46 fixtures implanted. At second‐stage surgery, a microbiological sample (baseline sample) of the inner parts of the fixtures was taken. Then, a 0.2% chlorhexidine solution was applied into the inner space of 23 fixtures (test group), and in 23 fixtures saline was applied (control group). Abutments were installed and gingival index, plaque index and crevicular fluid flow were monitored weekly. After 6 weeks, a second microbiological sample of the inner part of the fixtures was taken.

At baseline, viable bacteria were detected within 46% of the fixtures. After 6 weeks, bacteria were found in 87% of the fixtures. The numbers of bacteria in the control group were significantly higher than those in the test group. The results indicate that, after first‐stage surgery, contamination of the inner spaces of the fixtures is commonplace. Application of a 0.2% chlorhexidine solution at second‐stage surgery inhibits growth or acquisition of bacteria in the fixtures. In both test and control groups, the crevicular fluid flow as well as the gingival index decreased during the experimental period. At 4, 5 and 6 weeks after chlorhexidine application, these values in the test group appeared lower, but did not attain statistical significance.
A prospective evaluation of Frialoc® implants with ball‐abutments in the edentulous mandible: 1‐year results
Authors: Cune Marco S. , Verhoeven Jan Willem , Meijer Gert J.
Published: December 2004

Abstract: Several surgical and prosthetic concepts for the treatment of patients with mandibular atrophy and related lower denture problems are proposed and described in the literature. The present study discusses and evaluates the use of a new single‐stage implant and overdenture with ball‐attachment for this purpose. This study evaluates the clinical performance of the implants and abutments and addresses surgical and prosthetic complications that were encountered. Eighteen fully edentulous patients received two, single‐stage Frialoc® implants (Friadent, Mannheim, Germany). The implants were left to osseointegrate for 3 months and were subsequently provided with ball‐abutments and loaded through a mandibular overdenture. After 1‐year of clinical service, two implants were lost, which accumulated to a 1‐year survival rate of 93.9% (SE 4.2%). Patient satisfaction was high, and prosthetic complications and postinsertion maintenance were minimal. Three abutments loosened, one of which subsequently broke after 5 months of loading. Retightening of the attachment (gold matrix) was performed on seven occasions in four patients. Soft tissue response was excellent. Although minor hypertrophy of the peri‐implant mucosa was observed, hardly any marginal bone loss between baseline and 1‐year observations occurred. Short‐term results indicate that mandibular implant overdenture treatment by means of two ball‐abutments, using Frialoc® implants and prosthetic components, leads to good clinical results, both from an objective and a subjective perspective.