bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparative Study on the Safety and Efficacy of Tamsulosin and Alfuzosin in the Management of Symptomatic Benign Prostatic Hyperplasia: A Randomized Controlled Clinical Trial
Authors: Lapitan MCM , Acepcion V , Mangubat J
Published: February 2013

This randomized, double-blind, parallel-design trial compared the efficacy and safety of tamsulosin and alfuzosin in 76 men with symptomatic benign prostatic hyperplasia. Patients were randomized to receive 0.2 mg tamsulosin once daily orally ( n = 40) or 10 mg alfuzosin once daily orally ( n = 36), and changes in the International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax) and the Danish prostatic symptom sexual function score and morbidity rates were compared after 8 weeks of treatment. There was a mean overall decrease in the IPSS, with no significant difference between the treatment groups. There was an overall increase in the Qmax, which again was similar in the two groups. There was no significant change in the sexual function scores in either group. The incidence of adverse events was similar for tamsulosin (25%) and alfuzosin (19.4%) therapy. In conclusion, both treatment regimens similarly improved the IPSS and Qmax, did not alter sexual function and were well tolerated.
Primary Hydatid Disease in Femoral Muscles
Authors: Kazakos CJ , Galanis VG , Verettas D-AJ , Polychronidis A , Simopoulos C
Published: February 2013

Usually, intramuscular hydatid cysts are secondary, resulting from the spread of cysts from other areas either spontaneously or after operations for hydatidosis in other regions. We present an unusual case of a primary hydatid cyst found in the left thigh of a 35-year-old woman, presenting as an enlarging soft-tissue tumour. Ultrasound, computed tomography and magnetic resonance imaging examinations revealed a multilocular intramuscular cyst in the anterior aspect of her left thigh, and no disease at any other location. We removed the entire cyst surgically, and macroscopic and microscopic histopathological examinations confirmed the diagnosis of muscular hydatidosis. Three years after the operation there had been no recurrence. In regions where hydatidosis is endemic, a tumour in any part of the body should be considered a hydatid cyst until proven otherwise.
Effect of 24-Week Treatment with Telmisartan on Myocardial Structure and Function: Relationship to Insertion/Deletion Polymorphism of the Angiotensin-Converting Enzyme Gene
Authors: Conrady AO , Kiselev IO , Usachev NI , Krutikov AN , Yakovleva OI , Polunicheva EV , Ovchinnikova OA , Panov AV
Published: February 2013

The aim of the present study was to assess the effect of treatment with the angiotensin II receptor blocker telmisartan for 24 weeks on myocardial structure and function in patients with essential hypertension, and the relationship between this effect and the structural polymorphism of the angiotensin-converting enzyme (ACE) gene. Thirty-five patients with essential hypertension and left ventricular hypertrophy (LVH) without other associated morbidity were included in an open-label, non-comparative study. The patients were treated with telmisartan 40-80 mg once daily. In the final analysis, there were 29 patients who received the full course of treatment and were evaluated echocardiographically before and after treatment by the same blinded investigator, and myocardial structure and function were analysed. The myocardial mass of the left ventricle was determined in M-mode. Assessment of diastolic function of transmitral blood flow was performed using pulsed Doppler echocardiography. All patients were genotyped for insertion/deletion (I/D) polymorphism of the ACE gene. Telmisartan produced a significant reduction in left ventricular mass index from 140.4 ± 48.6 to 128.7 ± 40.6 g/m2 that was accompanied by an improvement in characteristics of diastolic function. The decrease in LVH was more significant in the ID genotype group than in the II and DD groups. Thus, prolonged treatment with telmisartan is accompanied by an improvement in myocardial structure, expressed as a reduction in left ventricular mass and function that is more marked in patients with ID genotype of the ACE gene.
Ventricular and Vascular Remodelling – Effects of the Angiotensin II Receptor Blocker Telmisartan and/or the Angiotensin-Converting Enzyme Inhibitor Ramipril in Hypertensive Patients
Authors: Petrovic J , Petrovic D , Vukovic N , Zivanovic B , Dragicevic J , Vasiljevic Z , Babic R
Published: February 2013

Angiotensin II induces inflammatory activation of vascular smooth muscle cells and can cause left ventricular hypertrophy (LVH). Telmisartan is an angiotensin II receptor blocker with demonstrated beneficial effects on cardiac and vascular structure and function in animal models. The angiotensin-converting enzyme inhibitor ramipril also reduces ventricular and vascular remodelling. The open-label study observed 75 treatment-naïve, moderately or severely hypertensive (systolic blood pressure 160-190 mmHg, diastolic blood pressure 90-110 mmHg) patients (age range, 42-58 years) treated with once-daily telmisartan 40 mg force-titrated to 80 mg after 1 month (n = 25), once-daily ramipril 2.5 mg force-titrated to 5 mg after 1 month (n = 25), or once-daily telmisartan 40 mg plus ramipril 2.5 mg (n = 25); the total duration of treatment was 6 months. At baseline, blood pressure, left ventricular mass index (LVMI), carotid intima-media thickness (IMT) and carotid cross-sectional intima-media area (CSA) were measured. Measurements were repeated 1, 3 and 6 months after initiation of treatment. After 6 months, comparable blood pressure reductions were achieved with the three treatments. Reductions in LVMI after 6 months' treatment were 11.4%, 9.9% and 15.6% with telmisartan, ramipril, and telmisartan plus ramipril, respectively. Respective reductions in IMT were 14.6%, 12.0% and 18.2%, and for CSA were 7.8%, 4.3% and 11.5%. In conclusion, treatment with telmisartan or ramipril for 6 months resulted in regression of LVH and vascular remodelling. When a combination of telmisartan and ramipril was administered, additional regression and remodelling occurred.
Efficacy of Pulsed Electromagnetic Therapy for Chronic Lower Back Pain: A Randomized, Double-blind, Placebo-controlled Study
Authors: Lee PB , Kim YC , Lim YJ , Lee CJ , Choi SS , Park SH , Lee JG , Lee SC
Published: February 2013

This randomized, double-blind, placebo-controlled clinical trial studied the effectiveness of pulsed electromagnetic therapy (PEMT) in patients with chronic lower back pain. Active PEMT ( n = 17) or placebo treatment ( n = 19) was performed three times a week for 3 weeks. Patients were assessed using a numerical rating scale (NRS) and revised Oswestry disability scores for 4 weeks after therapy. PEMT produced significant pain reduction throughout the observation period compared with baseline values. The percentage change in the NRS score from baseline was significantly greater in the PEMT group than the placebo group at all three time-points measured. The mean revised Oswestry disability percentage after 4 weeks was significantly improved from the baseline value in the PEMT group, whereas there were no significant differences in the placebo group. In conclusion, PEMT reduced pain and disability and appears to be a potentially useful therapeutic tool for the conservative management of chronic lower back pain.
CD14 Receptor Gene Promoter Polymorphism: Awakening Maternal Immunity during Pregnancy
Authors: Lim JE , Kim T , Lee NW , Oh MJ , Seol HJ , Min JY , Kim HJ
Published: February 2013

We investigated whether monocyte CD14 receptor gene promoter polymorphisms were associated with the development and severity of pre-eclampsia. We genotyped the CD14-260 C/T polymorphism in 36 preeclamptic patients and 52 healthy pregnant controls. A total of 30.6% and 69.4% of pre-eclamptic patients had the C and T alleles, respectively, and 48.0% and 52.0% of the controls, respectively. More pre-eclamptic patients were TT homozygotes compared with controls (50.0% versus 13.5%). In pre-eclamptic patients, the TT homozygotes exhibited a significantly higher mean systolic blood pressure compared with the non-TT homozygotes (173 ± 28 mmHg versus 153 ± 22 mmHg). We also noted a tendency towards increased proteinuria and placental abruption in the TT homozygotes compared with the non-TT homozygotes. We conclude that CD14 gene promoter polymorphisms appear to be a risk factor for pre-eclampsia. With further research, these findings might form the basis of a prognostic tool for pre-eclampsia.
Non-invasive Assessment of Respiratory Muscle Function and its Relationship to Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease
Authors: Chlumský J , Filipova P , Terl M
Published: February 2013

Most patients with chronic obstructive pulmonary disease (COPD) have impaired respiratory muscle function. Maximal oesophageal pressure correlates closely with exercise tolerance and seems to predict the distance walked during the 6-min walk test. This study assessed the non-invasive parameters of respiratory muscle function in 41 patients with COPD to investigate their relationship to pulmonary function tests and exercise tolerance. The COPD patients, who demonstrated the full range of airway obstruction severity, had a mean forced expiratory volume in 1 s of 42.5% predicted (range, 20–79% predicted). Both the maximal inspiratory muscle strength and non-invasive tension-time index were significantly correlated with the degree of lung hyperinflation, as expressed by the ratio of residual volume to total lung capacity, and the distance walked in 6 min. We conclude that respiratory muscle function was influenced mainly by lung hyperinflation and that it had an important effect on exercise tolerance in COPD patients.
Angiotensin-II Receptor Antagonist Alleviates Non-alcoholic Fatty Liver in KKAy Obese Mice with Type 2 Diabetes
Authors: Yu F , Takahashi T , Moriya J , Kawaura K , Yamakawa J , Kusaka K , Itoh T , Sumino H , Morimoto S , Kanda T
Published: February 2013

We examined the effects of the angiotensin-II receptor antagonist candesartan on non-alcoholic fatty liver (NAFL) and circulating adiponectin concentrations in KKAy obese mice with type 2 diabetes mellitus. The KKAy mice were randomly assigned to receive either candesartan at a once-daily dose of 10 mg/kg ( n = 5) or placebo ( n = 5). The differences in liver weight, histological evaluation of hepatic lipid infiltration, serum adiponectin concentration and hepatic adiponectin mRNA levels between the two groups were determined on day 7 after treatment was initiated. Candesartan-treated mice demonstrated significantly lower liver weights and reduced lipid droplets in hepatic cells compared with control mice. The circulating adiponectin levels and hepatic expression of adiponectin mRNA were significantly higher in candesartan-treated mice than control mice. These results suggest that candesartan might alleviate NAFL through elevation of circulating adiponectin levels in KKAy obese mice with type 2 diabetes mellitus.
Cholinesterase Inhibitors in the Clinical Management of Alzheimer's Disease: Importance of Early and Persistent Treatment
Authors: Seltzer B
Published: February 2013

Alzheimer's disease is a neurodegenerative disease that greatly affects the quality of life of patients and their caregivers and places a heavy cost burden on the healthcare system. The cholinesterase inhibitors (ChEIs) donepezil, rivastigmine and galantamine have a central role in the treatment of Alzheimer's disease in the mild to moderate stages. Clinical trials with ChEIs have demonstrated therapeutic benefits for symptoms of cognition, function and behaviour across the disease course. These agents are most effective when started early in the disease course and used persistently, without treatment gaps. Early recognition of Alzheimer's disease and a global evaluation of treatment effectiveness are therefore essential. This article identifies barriers to early recognition and effective care of patients with Alzheimer's disease and discusses practical strategies to overcome them.
Effect of Underground Working on Vitamin D Levels and Bone Mineral Densities in Coal Miners: A Controlled Study
Authors: Sarikaya S , Özdolap Ş , Mungan AG , GümüşTaş Ş , Koç Ü , Güven B , Beğendik F
Published: February 2013

The aim of this study was to determine the effect of underground working on 25-hydroxyvitamin D (25-OHD) levels and bone mineral density (BMD) values in coal miners. Fifty coal miners working underground and 50 surface workers as controls, matched for age and body mass index, from Zonguldak, Turkey, were recruited to the study. Levels of 25-OHD, biochemical bone markers, and lumbar spine and femur BMD values were measured in all study participants. Lumbar spine and femur BMD values were significantly higher in underground workers compared with surface workers, but there was no significant difference in 25-OHD levels between the two groups. Duration of underground working, age, 25-OHD levels, cigarette consumption and dietary calcium intake were not correlated with BMD values. Underground physical working does not seem to be a significant risk factor for low 25-OHD levels or low BMD values.
Cytokeratin Expression in Subungual Squamous Cell Carcinoma
Authors: Kurokawa I , Senba Y , Kakeda M , Nishimura K , Hakamada A , Isoda K , Yamanaka K , Mizutani H , Tsubura A
Published: February 2013

Cytokeratin expression in subungual squamous cell carcinoma was investigated in order to evaluate the origin and state of differentiation of the tumour. The tumour nests contained cytokeratin 14, 16 and 17, which were also expressed in the nail bed. Therefore, cytokeratin expression in subungual squamous cell carcinoma may reflect its indolent clinical prognosis.
Valdecoxib Provides Effective Pain Relief following Acute Ankle Sprain
Authors: Diaz JA , Cuervo C , Valderrama AM , Kohles J
Published: February 2013

We sought to determine whether valdecoxib is as effective as diclofenac in treating acute ankle sprain. Patients ( n = 202) with acute first-and second-degree ankle sprain were randomized to valdecoxib (40 mg twice daily on day 1 followed by 40 mg once daily on days 2-7) or diclofenac (75 mg twice daily). The primary efficacy end-point was the Patient's Assessment of Ankle Pain visual analogue scale (VAS, 0-100 mm) value on day 4. Valdecoxib was as efficacious as diclofenac in treating the signs and symptoms of acute ankle sprain. The mean VAS reduction in ankle pain on day 4 was not different between groups; the two-sided 95% confidence interval for the between-group difference was within the pre-specified limit for non-inferiority (10 mm). There were no significant differences between groups for all secondary efficacy end-points. The two treatments were similarly effective and well tolerated for treatment of acute ankle sprain.
Expression of Ephrin in Retinal Neovascularization and Iris Rubeosis
Authors: Yuuki T , Kanda T , Kishi S
Published: February 2013

We investigated expression of ephrin-B2 and Eph-B4 in the retinal tissues of six primate eyes with neovascularization and iris rubeosis secondary to laser-induced central retinal vein occlusion and in tissue from 10 human eyes with proliferative diabetic retinopathy. Two primate eyes with rubeosis and retinal neovascularization were enucleated 1, 2 and 4 weeks after the creation of central retinal vein occlusion. Antibodies were localized using the avidin–biotin reaction. In the primate eyes, ephrin-B2 was negative at 1 week and positive at 2 and 4 weeks in the rubeotic tissue, but was positive only at 2 weeks in the retinal neovascular membrane. Eph-B4 was negative in all the primate eye specimens. In the human tissue, ephrin-B2 was detected in two of the five eyes with rubeosis and three of the five eyes with retinal neovascularization. These data suggest that ephrin-B2 is a key regulator of neovascularization.
Interleukin-6-induced Activation of Signal Transducer and Activator of Transcription-3 in Ruptured Rotator Cuff Tendon
Authors: Nakama K , Gotoh M , Yamada T , Mitsui Y , Yasukawa H , Imaizumi T , Higuchi F , Nagata K
Published: February 2013

The aim of this study was to examine interleukin-6 production and the activation of signal transducer and activator of transcription-3 (STAT3) in ruptured rotator cuff tendon. Specimens of ruptured rotator cuff tendons were analysed using real-time reverse transcriptase polymerase chain reaction, Western blotting and immunohistochemistry. Specimens of co-existing inflammatory subacromial synovia were examined for comparison. The level of interleukin-6 messenger RNA was increased in ruptured rotator cuff tendon as well as in subacromial synovium. Western blot analysis showed constitutive production of activated, phosphorylated STAT3 in ruptured rotator cuff tendon and co-existing subacromial synovium. Immunohistochemical examination detected cells producing interleukin-6, interleukin-6 receptor and phosphorylated STAT3 in ruptured rotator cuff tendon, mainly in proliferative vessels and, to a lesser extent, in tendon fibroblasts around the vessels. This study demonstrates that activation of STAT3 induced by interleukin-6 is promoted mainly by proliferative vessels in ruptured rotator cuff tendon.
Echocardiographic and Clinical Abnormalities in Patients with Psoriasis
Authors: Biyik I , Narin A , Bozok MA , Ergene O
Published: February 2013

We investigated the incidence and severity of echocardiographic and clinical abnormalities in patients with psoriasis and their relationship to the severity, duration and type of psoriasis and other related factors. A total of 216 psoriasis patients and 216 control subjects were included in this study. Left and right heart dimensions, wall thicknesses, wall motion abnormalities, valvular disturbances, and systolic and diastolic functions were examined using two-dimensional and Doppler echocardiographic techniques. Left ventricular hypertrophy, left ventricular diastolic dysfunction, left ventricular wall motion abnormalities and valvular pathologies, especially mitral and tricuspid valve prolapse, were significantly more frequent in patients with psoriasis. Systolic and diastolic blood pressures were significantly higher in psoriasis patients. Significant correlations were found between: (i) psoriasis vulgaris and tricuspid valve prolapse; (ii) palmo-plantar psoriasis and valvular pathologies; and (iii) disease duration and left ventricular diastolic dysfunction and systolic and diastolic blood pressures. Physicians should be aware that cardiovascular abnormalities are common in patients with psoriasis.
The Potential Role of Phagocytic Capacity in the Osteolytic Process Induced by Polyethylene Wear Particles
Authors: Fang H-W , Yang C-B , Chang C-H , Huang C-H , Liu H-L , Fang S-B
Published: February 2013

Osteolysis induced by ultra-high molecular weight polyethylene wear particles is the major cause of long-term failure of artificial joints. We examined the effects of wear particles on bioactivity by analysing the biophysical aspects of particle phagocytosis. We estimated the maximum number of internalized particles (the phagocytic capacity) for particles of various sizes and shapes. We demonstrated that elongated particles had a smaller phagocytic capacity than spherical particles of the same volume. A review of the literature showed that the ratio of particle concentration (number of particles/number of cells) to phagocytic capacity is critical for particle-induced biological responses. When this ratio was < 1, the biological response was approximately proportional to the ratio itself. When this ratio was > 1, limited changes in the biological response were observed. The saturation level of the phagocytic capacity for a particle population appears to reflect the degree of polyethylene particle-induced biological response.
Intensive Care Unit Stay of More than 14 Days after Cardiac Surgery is Associated with Non-cardiac Organ Failure
Authors: Hein OV , Birnbaum J , Wernecke KD , Konertz W , Spies C
Published: February 2013

Some studies have shown an association between a prolonged intensive care unit (ICU) stay and risk factors such as mediastinal re-exploration, advanced age, low ejection fraction, lung disease and organ failure. The aim of this retrospective study was first to evaluate peri-operative risk factors ( n = 2683) and secondly to evaluate long-term survival ( n = 2563) in cardiac surgery patients with an ICU stay > 14 days. Long-term survival was assessed in an observational 3-year follow-up study. An ICU stay of > 14 days was associated independently with respiratory failure and dialysis-dependent acute renal failure, and with a significantly lower survival rate. Since an ICU stay is associated with a higher hospital and long-term mortality, measures should be taken throughout the entire hospital stay to identify and reduce the risk of organ failure.
The Frequency of Symptoms in Transient Ischaemic Attack: Analysis of Nanjing Stroke Register Program Data
Authors: Zhu W , Liu X , Xu G , Liu X , Zhou G , Zhang H
Published: February 2013

The clinical characteristics of 172 patients experiencing single or multiple (two or more) transient ischaemic attacks (TIAs) were investigated. Risk factors, clinical manifestations and vascular examinations were compared. Intracranial and extra-cranial large-artery disease (stenosis ≥ 50%) occurred more frequently in multiple-TIA patients than in single-TIA patients, and weakness and atrial fibrillation were observed more frequently in single TIA than in multiple TIA patients. The type of aetiological examination performed in TIA patients should depend on the frequency of attacks.
Progressive Supranuclear Palsy-like Parkinsonism Resulting from Occupational Exposure to Lead Sulphate Batteries
Authors: Sanz P , Nogue S , Vilchez D , Vilchez J , Casal A , Logroscino G
Published: February 2013

A 53-year-old man who had worked for 17 years manufacturing car batteries, with overt exposure to lead, developed a clinical picture initially characterized by signs of parkinsonism, followed by atypical signs such as loss of memory, reduction of eye movement, dysarthria, chorealike dyskinesia and sexual impotence. The diagnosis of atypical parkinsonism was eventually changed to progressive supranuclear palsy-like parkinsonism. The patient was treated with various anti-Parkinson's disease drugs, including levodopa, with modest improvement. The symptoms deteriorated progressively, leading to permanent occupational disability with noticeable limitation of daily activities. Toxicological studies revealed abnormally high blood levels of lead. Discontinuation of lead exposure was followed first by clinical stabilization and then steady improvement. This case confirms recent reports that link exposure to lead and its compounds with degenerative diseases of the central nervous system, such as Parkinson's disease.
Leucocyte-depleted Blood Cardioplegia
Authors: Ozkara C , Guler N , Kutay V , Guducuoglu H , Kiymaz A , Ozcan S
Published: February 2013

The effect of the depletion of leucocytes from cardioplegic and initial myocardial reperfusion blood on the inflammatory response and myocardial protection in patients with unstable angina undergoing cardiopulmonary bypass (CPB) was studied. Patients were allocated randomly to a leucocyte-depleted (LD) group or a control group. The LD group received continuous retrograde LD isothermic blood cardioplegia and the control group received isothermic blood cardioplegia. Blood samples were collected at seven time-points before, during and after the procedure. Total leucocyte counts of cardioplegia blood in the LD group were significantly lower than in the control group, but systemic leucocyte and neutrophil counts after CPB did not differ between the groups. The levels of adhesion molecules, cytokines, elastase and malondialdehyde were significantly increased after CPB in both groups and reached peak values 2-6 h after surgery; no other significant differences were found. LD cardioplegia and myocardial reperfusion did not attenuate the endothelial and neutrophil-mediated components of the CPB-induced inflammatory response, which may lead to myocardial reperfusion injury.
BCL6 Gene Mutations in Transitional Cell Carcinomas
Authors: Cho HY , Park HS , Lin Z , Kim I , Joo KJ , Cheon J
Published: February 2013

The B-cell lymphoma-6 ( BCL6) gene was initially identified at a translocation site observed frequently in diffuse large B-cell lymphomas. In the present study, BCL6 mutations at the 5′ non-coding region in 47 cases of transitional call carcinoma (TCC) were analysed using polymerase chain reaction–single-strand conformation polymorphism. The results were compared with data obtained previously by immunohistochemical staining for the BCL6 protein. Overall, BCL6 mutations were observed in 44.7% of cases. Mutation of the 5′ non-coding region was not correlated with histological grade of the tumour; however, the better the histological grade, the greater the mutation rate of the E1.12 fragment. The BCL6 mutation occurred independently of over-expression of the protein. The BCL6 gene mutation and the protein expression were detectable in a large proportion of TCCs. BCL6 protein over-expression as well as BCL6 gene mutation of the E1.12 fragment may play an important role in the morphological differentiation of TCC.
Monitoring Vaccination Coverage in Istanbul Using the Lot Quality Assurance Sampling and Geographic Information System
Authors: Alkoy S , Ulugtekin N , Dogru AO
Published: February 2013

The quality of vaccination services provided for children aged 12-23 months was determined in different districts of Istanbul, Turkey. Quality was assessed through a lot quality assurance sampling method, using data extracted from interviews conducted in 2001 with the mothers or carers of the children. Concurrently, geographic information system technology was used for integrated evaluation of the data from different lots and for presentation of the results as thematic maps. The results of this study helped to identify districts of the city in which vaccination services were below the expected level of quality and where an unacceptable number of children were not being fully vaccinated. Subsequent to this study, actions were taken by the agencies responsible to improve the coverage and quality of the vaccination services in these districts of Istanbul.
The Role of Vitamins and Minerals in Energy Metabolism and Well-Being
Authors: Huskisson E , Maggini S , Ruf M
Published: February 2013

Physicians are frequently confronted with patients complaining of fatigue, tiredness and low energy levels. In the absence of underlying disease, these symptoms could be caused by a lack of vitamins and minerals. Certain risk groups like the elderly and pregnant women are well-recognized. Our aim was, therefore, to find out if other, less well-established groups might also be at risk. Thus, the objectives of this review are: to describe the inter-relationship between micronutrients, energy metabolism and well-being; identify risk groups for inadequate micronutrient intake; and explore the role of micronutrient supplementation in these groups. A review of the literature identified an important group at risk of inadequate micronutrient intake: young adults, often women, with a demanding lifestyle who are physically active and whose dietary behaviour is characterized by poor choices and/or regular dieting. Micronutrient supplementation can alleviate deficiencies, but supplements must be taken for an adequate period of time.
A Ropivacaine-Lidocaine Combination for Caudal Blockade in Haemorrhoidectomy
Authors: Ye F , Feng YX , Lin JJ
Published: February 2013

A single dose of caudal lidocaine does not provide a sufficiently long anaesthetic duration and is not generally used for complicated anorectal surgery. This study evaluated the safety and efficacy of a ropivacaine–lidocaine combination for caudal anaesthesia in patients undergoing haemorrhoidectomy. A total of 287 haemorrhoid patients with successful initial caudal anaesthesia were randomized to receive either a mixture of 0.375% ropivacaine and 1.0% lidocaine (ropi–lido group; n = 146) or 1.0% lidocaine alone (placebo-lido group; n = 141). Significantly fewer patients in the ropi–lido group required intra-operative supplemental anaesthesia than in the placebo-lido group. Patients treated with the ropivacaine–lidocaine combination had significantly lower scores for pain at each post-operative time point, and a longer mean time to the first requirement for post-operative analgesic than patients in the placebo-lido group. These results suggest that caudal anaesthesia with a combination of ropivacaine and lidocaine is a safe and effective method of inducing anaesthesia during haemorrhoidectomy.
Evaluation of Serum Hyaluronic Acid Level and Hyaluronidase Activity in Acute and Chronic Hepatitis C
Authors: Isman FK , Kucur M , Baysal B , Ozkan F
Published: February 2013

Following major tissue injury, hyaluronic acid production increases as a rapid response survival mechanism. Increased hyaluronic acid production and turnover are often associated with increased hyaluronidase activity, the enzyme that degrades hyaluronic acid. We investigated whether hyaluronic acid and hyaluronidase can be used as non-invasive markers of acute disease activity in hepatitis C by studying 26 patients with acute hepatitis C, 89 with chronic hepatitis C and 32 healthy controls. Chronic hepatitis C subjects were classified into five subgroups according to the stage of liver fibrosis. Serum aspartate aminotransferase and alanine aminotransferase activities and hyaluronic acid levels were increased in hepatitis C patients compared with the controls. Serum hyaluronic acid elevation correlated with disease progression. Serum hyaluronidase activities were also increased in patients compared with the controls, but decreased with disease progression. We conclude that both hyaluronidase and hyaluronic acid may be useful as early non-invasive serum indicators of disease activity in acute hepatitis C.
Efficacy of Beclomethasone Dipropionate HFA 200 μg Once Daily in Chronic Obstructive Pulmonary Disease and Bronchial Asthma
Authors: Tatsis G , Kotsifas K , Filaditaki V , Makrantoni G , Boulia S
Published: February 2013

The efficacy and safety of once-daily beclomethasone dipropionate (BDP; 200 μg), in combination with the propellant hydrofluoroalkane-134a (HFA) was compared with that of budesonide turbuhaler (BUD-TH) 400 μg twice daily and fluticasone propionate inhaler (FP-IH) 250 μg twice daily in 40 patients with bronchial asthma or chronic obstructive pulmonary disease. All patients had used inhaled corticosteroids for at least 1 month. On randomization, 20 patients were switched to HFA-BDP and 20 patients remained on their existing BUD-TH or FP-IH treatment. After 8 weeks, HFA–BDP demonstrated a greater improvement in spirometric values, respiratory symptoms and β2-agonist use. No significant local adverse effects were observed. Blood cortisol levels remained in the normal range in both groups. We conclude that HFA–BDP (200 μg once-daily) offered more benefit in terms of clinical and spirometry indices than BUD-TH (400 μg twice daily) or FP-IH (250 μg twice daily) in patients with moderate asthma and chronic obstructive pulmonary disease.
Hydrogen Peroxide Stimulates Pigment Epithelium-derived Factor Gene and Protein Expression in the Human Hepatocyte Cell Line OUMS-29
Authors: Nakamura K , Yamagishi S , Yoshida T , Matsui T , Imaizumi T , Inoue H , Sata M
Published: February 2013

Pigment epithelium-derived factor (PEDF) may have a protective role in atherosclerosis and is associated with the presence of components of the metabolic syndrome. Since oxidative stress has been postulated to play an important role in the pathogenesis of vascular injury in the metabolic syndrome, this study investigated the effects of hydrogen peroxide (H2O2) on PEDF in the immortalized human hepatocyte cell line OUMS-29. PEDF gene expression was measured using quantitative real-time reverse transcription–polymerase chain reaction and PEDF protein expression was analysed by Western blot. H2O2 upregulated PEDF mRNA levels and increased PEDF protein production in OUMS-29 cells in time- and dose-dependent manners. The anti-oxidant N-acetylcysteine significantly blocked H2O2-induced PEDF overexpression in OUMS-29 cells. These results suggest that hepatic PEDF levels may be elevated to counteract the effects of oxidative stress. H2O2- induced PEDF overproduction in the liver may act as a negative feedback system against vascular damage in the metabolic syndrome.
Predictive Models for Post-operative Nausea and Vomiting in Patients Using Patient-controlled Analgesia
Authors: Lee YY , Kim KH , Yom YH
Published: February 2013

This study identified predictive factors for post-operative nausea and vomiting (PONV) in patients using patient-controlled analgesia (PCA) and developed five predictive model pathways to calculate the probability of PONV using decision tree analysis. The sample consisted of 1181 patients using PCA. Data were collected using: a specifically designed check-off form to collect patient-, surgery-, anaesthesia- and post-operation-related data; the Beck Anxiety Inventory® to measure pre-operative anxiety; and a visual analogue scale, to measure post-operative pain. The incidence of PONV was 27.7%. Nine factors were highly predictive of PONV in our five model pathways: gender, obesity, anxiety, history of previous PONV, history of motion sickness, inhalation of nitrous oxide during operation, use of inhalational agents, starting oral fluid/food intake after operation, and post-operative pain. With these five predictive model pathways, we can predict the probability of PONV in an individual patient according to their individual characteristics.
Effects of Simvastatin on Lung Injury Induced by Ischaemia–Reperfusion of the Hind Limbs in Rats
Authors: Sun XF , Wang LL , Wang JK , Yang J , Zhao H , Wu BY , Wang YF , Wang L
Published: February 2013

We investigated whether simvastatin reduces lung injury caused by ischaemia–reperfusion of the hind limbs in rats. The control group underwent dissection of bilateral femoral arteries; another group (I/R group) underwent ischaemia of bilateral hind limbs for 2 h followed by 3 h reperfusion; and two other groups were pretreated with 5 or 10 mg/kg per day simvastatin for 3 days and then underwent ischaemia–reperfusion. The control and I/R group rats received placebo (water) instead of simvastatin. The lungs of the I/R rats showed marked histopathological changes compared with the other groups. Lung tissue myeloperoxidase, malondialdehyde, neutrophil count and lung injury scores in both simvastatin groups were significantly lower than in the I/R group; 10 mg/kg per day simvastatin significantly reduced lung water content although 5 mg/kg per day did not. Expression of haem oxygenase-1 (HO-1) protein in lung tissue was significantly greater in the simvastatin groups than in the I/R group. Simvastatin protects against lung injury associated with lower extremity ischaemia–reperfusion by reduction of neutrophil aggregation and oxidative damage, and upregulation of HO-1 expression in the injured lung.
Evaluation of Acute Myocardial Infarction In-hospital Mortality Using a Risk-adjustment Model Based on Japanese Administrative Data
Authors: Hayashida K , Imanaka Y , Sekimoto M , Kobuse H , Fukuda H
Published: February 2013

This study aimed to develop a new risk-adjustment method to assess acute myocardial infarction (AMI) in-hospital mortality. Risk-adjustment was based on variables obtained from administrative data from Japanese hospitals, and included factors such as age, gender, primary diagnosis and co-morbidity. The infarct location was determined using the criteria of the International Classification of Diseases (10th version). Potential co-morbidity risk factors for mortality were selected based on previous studies and their critical influence analysed to identify major co-morbidities. The remaining minor co-morbidities were then divided into two groups based on their medical implications. The major co-morbidities included shock, pneumonia, cancer and chronic renal failure. The two minor co-morbidity groups also demonstrated a substantial impact on mortality. The model was then used to assess clinical performance in the participating hospitals. Our model reliably employed the available data for the risk-adjustment of AMI mortality and provides a new approach to evaluating clinical performance.
Trauma Patients' Desire for Autonomy in Medical Decision Making is Impaired by Smoking and Hazardous Alcohol Consumption – a Bi-national Study
Authors: Neuner B , Dizner-Golab A , Gentilello LM , Habrat B , Mayzner-Zawadzka E , Górecki A , Weiss-Gerlach E , Neumann T , Schlattmann P , Perka C , Spies CD
Published: February 2013

This cross-sectional investigation studied the association between substance use and patients' desire for autonomy in medical decision making (MDM) in two trauma settings. A total of 102 patients (age 42.7 ≤ 17.4 years, 70.6% male) admitted to an orthopaedic service in Warsaw, Poland, and 1009 injured patients (age 34.6 ≤ 12.8 years, 62.3% male) treated in an emergency department in Berlin, Germany, were enrolled. Patients' desire for autonomy in MDM was evaluated with the Decision Making Preference Scale of the Autonomy Preference Index. Substance use (hazardous alcohol consumption and/or tobacco use) and educational level were measured. Linear regression techniques were used to determine the association between substance use and desire for autonomy in MDM. Substance use was found to be independently associated with a reduced desire by the patient for autonomy in medical decision making. No differences in patients' desire for autonomy were observed between the study sites. Empowerment strategies that encourage smokers or patients with hazardous alcohol consumption to participate in MDM may increase the effectiveness of health promotion and injury prevention efforts in this population.
Combined Use of Low-dose Bupivacaine, Colloid Preload and Wrapping of the Legs for Preventing Hypotension in Spinal Anaesthesia for Caesarean Section
Authors: Kaya S , Karaman H , Erdogan H , Akyilmaz A , Turhanoglu S
Published: February 2013

We tested the hypothesis that using a combination of methods would result in a greater reduction in the incidence of hypotension due to spinal anaesthesia in caesarean sections compared with using each method on its own. A total of 120 patients were randomly allocated to the following four treatment groups: 10 mg bupivacaine 0.5% intrathecally plus 500 ml Ringer lactate solution (group B); 4 mg bupivacaine 0.5% plus 25 μg fentanyl plus 500 ml Ringer lactate solution (group F); 4 mg bupivacaine 0.5% plus 25 μg fentanyl intrathecally plus 500 ml Gelofusine® intravenously (group G); and 4 mg bupivacaine 0.5% plus 25 μg fentanyl intrathecally plus 500 ml Gelofusine® intravenously plus tight wrapping of the lower extremities with an Esmarch bandage (group E). The Esmarch bandage was only loosely applied in groups B, F and G. Hypotension was detected in 100% of the patients in group B compared with 70.0%, 46.7% and 23.3% of those in groups F, G and E, respectively. Hypotension was thus reduced by using a combination of several methods.
An Approach to the Detection of Lesions in Mammograms Using Fuzzy Image Processing
Authors: Bayram B , Acar U
Published: February 2013

An algorithm was developed in this study, using rule-based fuzzy logic, to enable masses that are hard to recognize or detect in mammograms to become more readily perceptible. Small lesions, such as microcalcifications and other masses that are hard to recognize, especially on film-scan mammograms, were processed through segmentation. A total of 40 mammograms were used and they were classified by radiologists into three groups: those with microcalcifications ( n = 15), those with tumours ( n = 15), and those with no lesions ( n = 10). Five mammograms were taken as training data sets from each of the groups with microcalcifications and tumours. The algorithm was then applied to data not taken for training. The algorithm achieved a mean accuracy of 99% compared with the findings of the radiologists.
Effective Screening of Informative Single Nucleotide Polymorphisms using the Novel Method of Restriction Fragment Mass Polymorphism
Authors: Hwang S-H , Oh H-B , Choi S-E , Hong SP , Yoo W
Published: February 2013

Restriction fragment mass polymorphism (RFMP) was applied to pooled DNA for selecting informative single nucleotide polymorphisms (SNPs). A total of 225 coding non-synonymous SNPs (cnSNPs) from immunomodulating genes known to be involved in the pathogenesis of asthma were selected from the National Center for Biotechnology Information's (NCBI) SNP database (dbSNP). DNA samples from 200 healthy Koreans were pooled, amplified by polymerase chain reaction, digested with restriction enzymes and the fragments analysed by mass spectrometry. Only 30 of the 225 cnSNPs (13.3%) were informative, i.e. had a minor allele frequency > 10%. The percentage of informative cnSNPs varied according to the validation status of the dbSNP, being 42.3% (22/52) when validated by multiple submissions and frequency data, 8.7% (2/23) when validated by multiple submissions alone and 9.1% (3/33) when validated by frequency data alone. Most of the 112 unvalidated cnSNPs were not informative. In conclusion, the RFMP method using pooled DNA is useful in selecting informative SNPs, as also is validation status in the dbSNP.
Microalbuminuria in Thai Essential Hypertensive Patients
Authors: Buranakitjaroen P , Phoojaroenchanachai M , Saravich S
Published: February 2013

Essential hypertensive patients (176 males and 329 females), aged 58.0 ± 11.2 years were enrolled in a cross-sectional study conducted from February to March 2006 to investigate the prevalence and risk factors for microalbuminuria in hypertensive patients attending the Outpatient Department of Siriraj Hospital, Bangkok, Thailand. Macroalbuminuria was detected in 11 (2.2%) patients and microalbuminuria in 94 (18.6%) patients. Only male aged ≥ 45 years or female aged ≥ 55 years correlated significantly with a high occurrence of microalbuminuria, while calcium channel blocker and statin users were protected against microalbuminuria. The presence of microalbuminuria was not associated with age ≥ 60 years, male gender, current/previous smokers, hypertension duration ≥ 10 years, lack of blood pressure normalization, metabolic syndrome, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and multi-drug use. Risk factor recognition for microalbuminuria will enable physicians to identify cases that should be screened for microalbuminuria.
The Effect of Chlorogenic Acid Enriched Coffee on Glucose Absorption in Healthy Volunteers and Its Effect on Body Mass When Used Long-term in Overweight and Obese People
Authors: Thom E
Published: February 2013

The results from a clinical study performed in 12 healthy volunteers with different coffee products containing glucose show that instant coffee enriched with chlorogenic acid induced a reduction in the absorption of glucose of 6.9% compared with the control. No such effects were seen with normal or decaffeinated instant coffee. In a second, comparative, randomized, double-blind, 12-week study we investigated the effect on the body mass of 30 overweight people, compared with normal instant coffee. The average losses in mass in the chlorogenic acid enriched and normal instant coffee groups were 5.4 and 1.7 kg, respectively. We conclude that chlorogenic acid enriched instant coffee appears to have a significant effect on the absorption and utilization of glucose from the diet. This effect, if the coffee is used for an extended time, may result in reduced body mass and body fat when compared with the use of normal instant coffee.
The Relationship between Left Ventricular Mass Index and Insulin Sensitivity, Postprandial Glycaemia, and Fasting Serum Triglyceride and Adiponectin Levels in Patients with Type 2 Diabetes
Authors: Top C , Şahan B , Önde ME
Published: February 2013

The relationship between left ventricular mass index (LVMI) and insulin sensitivity, postprandial glycaemia, fasting serum triglyceride and adiponectin was investigated in 70 patients with type 2 diabetes. Serum fasting insulin, C-peptide, high-sensitivity C-reactive protein (hs-CRP), glycated haemoglobin (HbA1c), postprandial glycaemia, lipids and fasting serum adiponectin levels were measured. Ventricular hypertrophy was assessed at rest by electrocardiography and echocardiography. Insulin sensitivity was assessed using the homeostasis model assessment index (HOMA-IR). LVMI was assessed using the Devereux formula. Study patients had lower than normal HOMA-IR, and higher than normal serum fasting insulin levels and LVMI, and tended to have reduced insulin sensitivity. Pearson's correlation coefficient showed a statistically significant correlation between fasting serum adiponectin and LVMI, fasting serum insulin, HOMA-IR, HbA1c, serum postprandial glucose and hs-CRP. There were no statistically significant correlations between LVMI and serum hs-CRP or HOMA-IR. The results indicate the importance of fasting serum adiponectin in the development of cardiovascular complications, such as increased LVMI.
Stapled Haemorrhoidopexy versus Ferguson Haemorrhoidectomy: A Prospective Study with 2-Year Postoperative Follow-up
Authors: Sabanci U , Ogun I , Candemir G
Published: February 2013

Patients with grade III or IV haemorrhoids underwent stapled haemorrhoidopexy or Ferguson haemorrhoidectomy (50 patients in each group) between June 2000 and April 2003. Six patients (12.0%) receiving stapled haemorrhoidopexy experienced complications: bleeding (2.0%) and haematoma (4.0%); late complications were anal fissure (4.0%) and recurrence of haemorrhoidal disease (2.0%). Bleeding was treated during the operation by suture ligation and fissures by sphincterotomy; haematomas resolved spontaneously with conservative medical treatment. Of those undergoing Ferguson haemorrhoidectomy, no bleeding occurred postoperatively, however urinary retention was seen in three patients (6.0%) We conclude that Ferguson haemorrhoidectomy was safer than stapled haemorrhoidopexy for bleeding complications, but stapled haemorrhoidopexy was superior to the Ferguson technique in terms of postoperative pain (4.2 versus 7.4 on day 1 after operation, decreasing to 2.2 versus 4.2 at 1 week for stapled haemorrhoidopexy compared with Ferguson haemorrhoidectomy, respectively), duration of hospital stay (92% undergoing stapled haemorrhoidopexy discharged on postoperative day 1) and time to return to normal activities (10.0 ± 1 versus 28.0 ± 2 days, respectively).
Ophthalmoplegia with Diffuse Large B Cell Lymphoma: Vital Differential Diagnosis
Authors: Muzammil S , Kreze OD
Published: February 2013

Ophthalmoplegia is an unusual finding in diffuse large B cell lymphoma. This report describes the case of a 72-year old male patient who presented with ophthalmoplegia but no gross neurological manifestations and an isolated mass in the left upper thigh. His ophthalmoplegia improved from his first cycle of systemic and intrathecal chemotherapy, his thigh mass effusion spontaneously resolved, and his laboratory tests also showed improvement. The patient remained well, though weak, for several months with no other neurological signs. He subsequently died from clinically diagnosed pulmonary embolism.