bluuebunny/crossref_metadata_2025 huggingface dataset:
Selectivity and functional diversity in arbuscular mycorrhizas of co‐occurring fungi and plants from a temperate deciduous woodland
Authors: Helgason T. , Merryweather J. W. , Denison J. , Wilson P. , Young J. P. W. , Fitter A. H.
Published: March 2003

1
The arbuscular mycorrhizal (AM) fungi colonizing plants at a woodland site in North Yorkshire (UK) have been characterized from the roots of five plant species (Rubus fruticosus agg. L., Epilobium angustifolium L., Acer pseudoplatanus L., Ajuga reptans L. and Glechoma hederacea L.), and identified using small‐subunit rRNA (SSUrRNA) gene amplification and sequencing.

2 Interactions between five plant species from the site and four co‐occurring glomalean fungi were investigated in artificial one‐to‐one AM symbioses. Three of the fungi were isolated from the site; the fourth was a culture genetically similar to a taxon found at the site. Phosphorus uptake and growth responses were compared with non‐mycorrhizal controls.

3 Individual fungi colonized each plant with different spatial distribution and intensity. Some did not colonize at all, indicating incompatibility under the conditions used in the experiments.

4

Glomus hoi consistently occupied a large proportion of root systems and out‐performed the other fungi, improving P uptake and enhancing the growth of four out of the five plant species. Only G. hoi colonized and increased P uptake in Acer pseudoplatanus, the host plant with which it associates almost exclusively under field conditions. Colonization of all plant species by Scutellospora dipurpurescens was sparse, and beneficial to only one of the host plants (Teucrium scorodonia). Archaeospora trappei and Glomus sp. UY1225 had variable effects on the host plants, conferring a range of P uptake and growth benefits on Lysimachia nummularia and T. scorodonia, increasing P uptake whilst not affecting biomass in Ajuga reptans and Glechoma hederacea, and failing to form mycorrhizas with A. pseudoplatanus.

5 These experimental mycorrhizas show that root colonization, symbiont compatibility and plant performance vary with each fungus–plant combination, even when the plants and fungi naturally co‐exist.

6 We provide evidence of physical and functional selectivity in AM. The small number of described AM fungal species (154) has been ascribed to their supposed lack of host specificity, but if the selectivity we have observed is the general rule, then we may predict that many more, probably hard‐to‐culture glomalean species await discovery, or that members of species as currently perceived may be physiologically or functionally distinct.
Colonization dynamics of the clonal moss Hylocomium splendens on islands in a Baltic land uplift area: reproduction, genet distribution and genetic variation
Authors: Cronberg Nils
Published: March 2003

Islands representing four stage classes, dated by their height above sea level, in a Baltic land uplift area were used to study genet level dynamics during colonization of the clonal moss Hylocomium splendens. Allozyme electrophoresis involving 10 polymorphic loci enabled accurate identification of 103 haplotypes from a sample of 694 shoots collected along transects across 10 islands.

The populations consisted initially of scattered colonies with single clones. The number of clones, and the tendency of colonies to be multiclonal, increased significantly with increasing age of islands, whilst their mean size decreased significantly. In the Skeppsvik Archipelago, H. splendens thus shows repeated recruitment.

The percentage male or female fertile shoots relative to sterile shoots was positively correlated with age of the islands. The sex ratios were skewed during early colonization.

Spore capsules were found only in the oldest succession stage‐classes. This can be explained by a greater chance for fertile males and females to grow within the fertilization range, which is limited to a few centimetres.

Genetic variation was accumulating with increasing population age. Correlations were stronger for mean number of alleles per locus (A) than for gene diversity (HS).

No isolation by distance was detected among populations, indicating efficient and essentially random gene flow, probably occurring via wind‐dispersed spores.
CLINICAL AUDIT: Audit in British general practice: domination or disillusionment?
Authors: Holden John D.
Published: March 2003

Abstract: The history of audit is traced over the past 30 years demonstrating how it has come to dominate attempts to improve the quality of patient care in British general practice. Nevertheless it is still uncertain whether audit usually or occasionally yields such improvements. There is much more to learn about audit including whether any benefits it brings are through professional education. I suggest that the use of audit as a foundation upon which clinical governance is built is not a secure one.
The Critical Care Research Network: a partnership in community‐based research and research transfer
Authors: Keenan Sean P. , Martin Claudio M. , . Kossuth Ma Jennifer D , Eberhard Jeannette , Sibbald William J.
Published: March 2003

The objectives of this study were to present a short history of the Critical Care Research Network (CCR‐Net), describe its approach to health services research and to summarize completed and current research projects. In doing this, we explored the question is this research network accomplishing its goals? We reviewed the medical literature to identify studies on similar types of Networks and also the evidence supporting the methodology used by CCR‐Net to conduct research using MEDLINE, HEALTHSTAR, CINAHL and the keywords network and health care or healthcare, benchmarking and health care or healthcare, and research transfer or research utilization. We also reviewed the bibliographies of retrieved articles and our personal files. In addition, we summarized the results of studies conducted by CCR‐Net and outlined those currently in progress. A review of the literature identified studies on two similar networks that appeared to be succeeding. In addition, the literature was also supportive of the general process used by CCR‐Net, although the level of evidence varied. Finally, the studies conducted to date within CCR‐Net follow the suggested methodology. At the time of this preliminary communication CCR‐Net appears to have adopted a valid approach to health services research within the area of Critical Care Medicine. Further direct evidence is required and appropriate studies are planned.
A recruitment strategy for cluster randomized trials in secondary care settings
Authors: Walker Anne E. , Campbell Marion K. , Grimshaw Jeremy M. , group the Tempest
Published: March 2003

Trials of educational or organizational interventions to change clinical practice require cluster randomization, that is, randomization of units such as hospitals or clinical teams rather than individual patients. Cluster randomization is relatively novel in health care settings and raises new methodological challenges, in particular: are units willing to be randomized at an organizational level; and, what procedures should be followed to successfully enrol all of the clinicians in a unit rather than individual clinicians as in conventional multicentre trials. This is particularly problematic for trials of large units such as hospitals. The aim of this study was to develop and partially evaluate a strategy to recruit acute, secondary care NHS hospitals in the UK into cluster randomized trials. Literature search and interviews with senior staff in acute hospitals and relevant national organizations were used to develop a recruitment strategy. The strategy was evaluated by inviting 32 randomly selected clinical directorates to participate in a trial feasibility study. A seven step recruitment strategy was developed: (1) Identify stakeholders and gatekeepers; (2) Inform stakeholders and gatekeepers; (3) Approach gatekeepers; (4) Local negotiation; (5) Conduct the research; (6) Feedback to gatekeepers; (7) Feedback to stakeholders. Key problems were the possibility of multiple gatekeepers and identification of all possible stakeholders in varying organizational structures. The strategy was effective in two respects. First, 32 (100%) of the directorates approached agreed to participate. Second, baseline data collection was successfully achieved in all of the directorates. However, the strategy is costly in terms of time and resources.

We conclude that NHS trusts are willing to participate in cluster randomized trials. This recruitment strategy is successful and could be widely adopted, but realistic time and financial cost estimates are required at the planning stage.
In vitro and in vivo effects of rabbit anti‐thymocyte serum on circulating leucocytes and production of complement fixing antibodies in thymectomized Oncorhynchus mykiss (Walbaum) infected with Cryptobia salmositica Katz 1951
Authors: Feng  , Woo
Published: March 2003

Rabbit anti‐thymocyte serum (RATS) against thymocytes of rainbow trout was toxic to leucocytes from intact and thymectomized rainbow trout at 10 °C under in vitro conditions. The total number of leucocytes decreased significantly in 24 h after RATS was injected intraperitoneally into intact rainbow trout, but the number returned to pre‐injection level within 1 week. RATS destroyed a lower percentage of leucocytes in thymectomized fish than in intact fish under both in vitro and in vivo conditions and the recovery in the number of leucocytes was slower in thymectomized fish. The parasitaemia, packed cell volume and production of complement fixing antibody in thymectomized and intact fish (injected with RATS before Cryptobia salmositica infection) were not significantly different from control fish (not injected with RATS), and they both acquired protective immunity against cryptobiosis on recovery. This indicates that RATS is not cytotoxic to B‐like cells in the lymphoid tissue which produce complement fixing antibody against C. salmositica and that the protective antigen in C. salmositica seems to be thymus‐independent.
Tissue localization of Aeromonas salmonicida in Atlantic salmon, Salmo salar L., following experimental challenge
Authors: Svendsen Y. S. , Dalmo R. A. , Bøgwald J.
Published: March 2003

Three groups of Atlantic salmon, Salmo salar L., were exposed to live, colony‐forming, radiolabelled Aeromonas salmonicida bacteria in a bath challenge: (1) fish with artificial wounds; (2) fish with a reduced epidermal mucus layer caused by removal of the mucus layer on two occasions by a swabbing procedure; and (3) a control group of untreated fish. Fish were killed 2, 6 and 24 h after challenge, and radioactivity (cpm g–1) was measured in the blood, mucus, skin, wound area, gills, anterior kidney, posterior kidney, spleen, midgut and hindgut. The highest levels of radioactivity were measured in the wound areas and in the gills. There was a significant positive correlation between the levels of radioactivity in the gills and blood, and between the mucus and skin at 2 h post‐challenge. Two hours after the bath challenge, live A. salmonicida bacteria were found in the blood of fish in the ‘swabbed’ and ‘artificial wound’ groups, and not in the control group. Twenty‐four hours after the bath challenge, the kidney of fish from all groups contained viable bacteria, whereas the blood was negative.
Gastric dilation and air sacculitis in farmed chinook salmon, Oncorhynchus tshawytscha (Walbaum)
Authors: Lumsden J S , Clark P , Hawthorn S , Minamikawa M , Fenwick S G , Haycock M , Wybourne B
Published: March 2003

A syndrome affecting cultured chinook salmon, Oncorhynchus tshawytscha (Walbaum), characterized by distended abdomens, gastric dilation, air sacculitis (GDAS), increased feed conversion rates and increased mortality has been recognized in New Zealand. Affected fish were most obvious in sea cages but were also present in fresh water. Mortality rates associated with this condition were highest in late summer and approached 6% per month. A dilated and flaccid stomach, without visible rugal folds containing copious oil, watery fluid or undigested feed was typical. Gastric mucosal ulceration or inflammation were not present. The air sacculitis consisted of a thickened, dilated bladder with a mixed mucosal inflammatory infiltrate and a luminal exudate associated with large numbers of morphologically diverse bacteria. Gastric dilation or air sacculitis occurred alone or together in the same fish. In a group of 20 subclinically affected fish with or without gastric dilation, there were no significant differences in weight, length, serum osmolality, sodium, total protein or packed cell volume. Twenty‐three severely affected fish had significantly (P < 0.05) higher serum osmolality but similar sodium and total protein to that of clinically normal fish.
Proliferative kidney disease: cellular aspects of the rainbow trout, Oncorhynchus mykiss (Walbaum), response to parasitic infection
Authors: Chilmonczyk S , Monge D , De Kinkelin P
Published: March 2003

Proliferative kidney disease (PKD) is an immunopathological condition of salmonid fish, caused by the hyperplastic response of their principal lymphoid tissues to infection with the spores of Tetracapsula bryosalmonae, a myxozoan parasite formerly designated proliferative kidney organism – unknown (PKX). In order to investigate the nature of cells involved in this host response and possible alterations of their functions during parasitic infection the course of PKD was studied by flow cytometry (FCM) techniques, using blood, pronephros and spleen leucocyte populations from rainbow trout infected by intraperitoneal (i.p.) injection with parasitic cells from infected donor fish. The parameters of the cellullar response studied were: cytogram of cell population, lymphoproliferation, phagocytosis, oxidative burst, and non‐specific cytotoxicity. The modifications of cell population distribution and function in the PKD‐infected fish mainly affected the pronephros cell populations and were coincident with the clinical phase of disease. During this phase, the lymphocytes constituted the major leucocyte cell population and underwent proliferation and were thus responsible for the renal tissue hyperplasia. Meanwhile, phagocytosis and oxidative burst were depressed. These data are in agreement with the patho‐epidemiological background of PKD where the enhancement of the fish sensitivity to bacterial infections reflects the impairment of certain cellular defence mechanisms of innate immunity.
Experimental Cryptobia salmositica (Kinetoplastida) infections in Atlantic salmon, Salmo salar L.: cell‐mediated and humoral immune responses against the pathogenic and vaccine strains of the parasite
Authors: Ardelli B F , Woo P T K
Published: March 2003

Hatchery‐reared Atlantic salmon, Salmo salar L., were vaccinated intraperitoneally (i.p.) with a live attenuated Cryptobia salmositica vaccine (either 100 000 or 5000 parasites fish−1) and 4 weeks later were challenged with the parasite (either 100 000 or 5000 parasites fish−1). Unvaccinated, infected salmon had high parasitaemias and were anaemic. Fish given a high dose (100 000 parasites fish−1) had higher parasitaemias than fish given the lower dose. Vaccinated fish had low parasitaemias and a mild anaemia, but recovered quickly after challenge. Complement‐fixing antibody increased in vaccinated fish after challenge and was highest at 2 weeks post‐challenge. The cell‐mediated response (both T cells and B cells) was depressed in infected fish until 4 weeks after infection. In vaccinated fish, the humoral response (i.e. B‐lymphocytes) was greater than the cell‐mediated response (i.e. T‐lymphocytes). In contrast, infected fish had a greater cell‐mediated than humoral immune response.
Audit in clinical practice: evaluating use of a nutrition screening tool developed for trauma nurses
Authors: Cooper N.
Published: March 2003

Background: The Nutrition Checklist screening tool was developed by dietitians for the trauma nursing staff at the John Radcliffe Hospital, Oxford. Its purpose was to identify those at nutritional risk so that dietetic assessment and intervention could be implemented. This paper focuses on a single day audit that was devised 5 months post‐initiation of the Nutrition Checklist.
Method: Data from 48 nursing care plans was used to measure compliance of recording a nutrition score (and re‐scoring where applicable) alongside the timing of dietetic referral and intervention.
Results: Sixty‐seven per cent (32/48) of trauma patients had a nutrition score recorded, however only 75% (24/32) of these patients were scored within 24 h of admission. Of those due for reassessment, only 38% (11/29) were rescored. Eighty‐eight per cent (23/26) of the patients who scored ≥ 3 (automatic referrals) were referred to the dietitian; the dietitian documented 100% (23/23) of referrals.
Conclusion: The audit suggests limited use of the screening tool by nurses. Collaboration between the nursing team, dietitian, consultant team, catering and clinical auditors could improve compliance in the use of the Nutrition Checklist and ultimately lead to improved clinical practice in nutritional care delivery. Despite its limitations, the audit exercise was a valuable learning experience in the maintenance of a nursing Nutrition Checklist. Further research is needed to assess whether the introduction of such a screening tool improves patient outcomes by minimizing nutrition‐related complications.
Process evaluation of a research workshop and follow‐up support to help practitioners from 13 weight management projects to carry out evaluations
Authors: Rayner  , Ziebland
Published: March 2003

Background: In October 1997 the Department of Health agreed to fund evaluations of 13 weight management projects and offer research training and support for the successful applicants.

Aims: To help the projects develop focused and relevant research questions for their evaluations; to encourage the use of appropriate methods to answer these research questions; and to help the projects set realistic timetables and budgets. A 2‐day seminar was held in Oxford and follow up support was available from the seminar tutors.

Methods: A process evaluation was conducted. Semistructured telephone interviews with all seminar participants took place 2 weeks after the seminar and again after the completion of the evaluation reports. An independent assessor compared the original proposals with the final reports.

Results: Eleven projects sent representatives to the seminar. All of the 11 projects that sent representatives to the seminar had subsequent contact with the tutors and submitted final reports in February 1998. The independent assessor concluded that for six projects there was improvement in the research questions and methods which were used and no change for the other five.

Conclusions: Recommendations include amending the selection procedure for funding evaluations and specific suggestions to improve the organization and content of the research training seminar and follow‐up support.
What are the characteristics of overweight and obese patients who achieve weight loss and what factors are most helpful? A quantitative and qualitative study of patients and interventions in a rural general practice
Authors: Roberts  , Ashley
Published: March 2003

Introduction and aims: Of the modifiable cardiovascular risk factors obesity remains the most difficult to influence. Sustained weight reduction is a rare outcome in general practice. A minority of patients do, however, succeed. This study attempts to identify characteristics of successful weight losers (SWL) in primary care and to identify other factors associated with success.

Method: The study was in two parts: (1) a case‐control review of the overweight and obese, using the existing data on cardiovascular risk factors in the practice collected over 8 years. The demographic and clinical characteristics of those achieving and maintaining 10% weight loss for at least 3 months were compared with the unsuccessful controls (UWL); (2) a qualitative study of the small group of successful weight losers, employing semistructured interviews in each patient’s home, looking for patient’s ideas on what led to success.

Results: One hundred and ninety‐eight initially overweight (BMI > 25 kg/m2) had follow up weight measurements recorded; 18 (9%) were SWLs. Success was associated with adverse coronary heart disease (CHD) risk profile, particularly with initial and follow‐up cholesterol levels where the association was highly significant (P < 0.0001). The qualitative study suggested a different profile of factors operating in initiation vs. maintenance of weight loss (predominant health related anxiety, in initiation, and enhanced self‐image, in maintenance).

Conclusions: SWLs are more likely to have modifiable CHD risk factors than UWLs. Some SWLs seem to make a global improvement in modifiable risk factors when they lose weight. Anxiety about health, either from health professional advice or screening, or from life events, is the commonest reason for initiating successful weight loss. Doctor and nurse advice was the principal initiating factor in several instances. Self‐generated positive feelings about weight loss are the commonest factors in sustaining weight loss, followed by support from family and friends and support and follow‐up by the Primary Health Care Teams.
A20. Health and social factors affecting the food choices and nutritional intake of elderly people with restricted mobility
Authors: Wylie C.
Published: March 2003

Background Little is known about the magnitude of health and social factors which affect the food choices and nutritional intake of elderly people with restricted mobility.

Aims The aim of this study was to investigate food choices in this population group.

Methods Semi structured taped interviews were used to capture expressions used in the indentification of health and social factors which affect food choices and nutritional intake of 12 female subjects and three male subjects over the age of 65 (age range 67–91 years, mean 80.6 years) living in the community with restricted mobility. Twenty‐four hour recall method of dietary assessment was undertaken in order to establish their dietary intake and meal patterns.

Results Intakes of fluid, fruit and vegetables and non starch polysaccharide were found to be inadequate. In addition, there was an infrequent consumption of cooked meals. Health and social factors which affect the food choices and nutritional intake in this group of the elderly population were identified as being inadequate money, inadequate food storage facilities, physical disabilities affecting food preparation, poor access to shops, difficulties in shopping, type of cooking facilities, loneliness and bereavements.

The dietary intake and food choices of the elderly population have often been shown to be affected by a combination of health, social and psychological factors which include living alone, being house bound, having swallowing difficulties and suffering from depression ( Davies and Knutson, 1991). The findings of this study further support such findings and highlighted three areas that affected the nutritional intake of a group of elderly people with restricted mobility. These were social (loneliness, bereavement), economic (budget for food, access to Social services) and physical (difficulties in shopping, preparing and cooking foods).

Conclusions It was concluded that elderly people living in the community with restricted mobility may be unable to consume an optimum nutritional intake due to the health and social factors were identified by this study which affect their food choices and nutritional intake.
Availability of micronutrients from dried, encapsulated fruit and vegetable preparations: a study in healthy volunteers
Authors: Leeds A. R. , Ferris E. A. E. , Staley J. , Ayesh R. , Ross F.
Published: March 2003

Background High levels of consumption of fruit and vegetables, which contain antioxidant nutrients including vitamins C and E as well as β‐carotene, are associated with reduced rates of atherosclerotic arterial disease and some cancers. Low plasma levels of these micronutrients are associated with an increased risk of chronic degenerative disease. While increasing consumption of fruit and vegetables would be desirable, many factors including cost tend to prevent this. Preparations of the active components of fruit and vegetables encapsulated to achieve convenience may contribute to solving this problem.

Aims This study was designed to determine whether two such supplements prepared from dehydrated fruit and vegetable extracts (Juice Plus+™ Fruit and Juice Plus+™ Vegetable) would result in elevation in blood concentrations of antioxidants to levels associated with lower disease risk.

Methods Sixteen healthy subjects (eight male, eight female, aged 18–52 years) were screened to exclude disease and to exclude any individual with a serum β‐carotene below 0.05 µmol L–1, and were divided into two groups of eight, each to consume either the fruit or vegetable preparation. Four days before administration of the capsules the subjects commenced a low β‐carotene diet. Venous blood samples for determination of vitamin C, vitamin E (as α‐tocopherol) and β‐carotene were taken in the morning on days 0, 2, 4, 6 and 7, after a 10‐h fast. Two capsules of either the fruit preparation (containing vitamin E 30 mg, vitamin C 150 mg and β‐carotene 6 mg) or vegetable preparation (containing vitamin E 30 mg, vitamin C 50 mg and β‐carotene 9 mg) were taken on days 0–6 inclusive with a 610‐kcal breakfast (47% energy from fat).

Results Serum β‐carotene levels rose significantly by 0.56 µmol L–1 and 0.54 µmol L–1 after fruit and vegetable preparations, respectively, by day 7, vitamin E levels rose significantly by 3.1 µmol L–1 after the fruit preparation but not after the vegetable preparation and vitamin C rose significantly from 28 to 62 µmol L–1, and from 32 to 50 µmol L–1 after the fruit and vegetable preparations, respectively. Plasma malondialdehyde, regarded as a general indicator of peroxidation, fell significantly by 19 × 10–5 µmol L–1 (about a 40% reduction) in both treatment groups.

Conclusions These results indicate that concentrated extracts of fruits and vegetables can raise blood antioxidant levels into the ranges associated with reduced risk of disease and that this reduces the concentration of a general measure of lipid peroxidation. Further studies, especially in those with disease characterized by increased oxidative stress, are indicated.
The relationship between nutritional knowledge, attitudes and dietary fat consumption in male students
Authors: Packman J. , Kirk S. F. L.
Published: March 2003

Background This pilot study aimed to explore the nutritional knowledge, attitudes and dietary fat consumption in male students attending Leeds Metropolitan University.

Methods A Food Frequency Questionnaire (FFQ) was used to determine the fat intakes of subjects. This was incorporated into a questionnaire designed to measure nutritional knowledge and attitudes. Questions were also asked about the subject characteristics, such as weight, height and alcohol consumption.

Results Eighty subjects were approached, from whom 56 questionnaires were returned completed. The results revealed few significant differences between subject characteristics according to fat intakes, with the exception of alcohol consumption, which was greater in the high fat consumers. The main findings of the study were that subjects with a high fat intake had significantly more negative attitudes towards reducing fat consumption compared with those who had a lower fat intake. However, there was no statistically significant difference between nutritional knowledge and fat consumption and no relationship was found between level of nutritional knowledge and attitudes.

Conclusion It was concluded that negative attitudes towards reducing fat consumption might be more important barriers to dietary change than level of nutritional knowledge in male students. This constitutes an important target for health promoters in encouraging dietary change in men.
Diet‐related knowledge, beliefs and actions of health professionals compared with the general population: an investigation in a community Trust
Authors: Barratt J.
Published: March 2003

Background

Dietary change is advocated for the prevention and treatment of a number of major diseases, and the implicit and explicit assumption is that health professionals have a major role in promoting diet change. Previous studies of doctors and nurses have shown their knowledge to be inadequate. Other health professionals have not been investigated.

Methods

Parts of a questionnaire used in a national study of the general public were administered to groups of health professionals from a variety of disciplines working in a community Trust. The results were compared with those from the study of the general public, for which the questionnaire had been devised.

Results

358 questionnaires were completed. There was little difference between the knowledge, beliefs and actions of health professionals and the general public.

Conclusion

If health professionals are to continue to be expected to promote healthy eating messages there will need to be a more systematic approach to their training about nutrition.
Case study of the clinical usefulness of bioelectrical impedance spectroscopy in evaluating nutritional status
Authors: Barendregt K. , Cox‐Reijven P. L. M. , Hogen E. van den , Beijer S. , Geerlings P. , Soeters P. B.
Published: March 2003

Bioelectrical impedance spectroscopy (BIS) can be a valuable tool in assessing changes in body composition. Although the validity of BIS in healthy subjects is relatively good, in patients considerably larger measurement errors have been reported. In this article the clinical usefulness of BIS in assessing nutritional status of one case study will be discussed. Interpretation of the predictions of BIS in this unstable patient was difficult. This is in agreement with the consensus that BIS does not give accurate prediction of body composition in individual patients. It is recommended that validation studies of BIS should focus on clinical aspects which can influence BIS measurements.
Effect of participant motivation on rapid dietary changes in an intervention trial
Authors: Poore K. M. , Depper J. B. , Heilbrun L. K. , Lababidi S. , Covington C. , Djuric Z.
Published: March 2003

Background

Dietary intervention research with free‐living subjects relies on the ability of study participants to meet their dietary goals within the study timeframe. Little is known about underlying factors affecting compliance.

Method

Here, we examined whether motivation to enrol in a trial of low‐fat and/or energy‐reduced diets influenced the ability of healthy women to reach their dietary goals quickly.

Results

Of the women who had energy‐reduction goals (n=43), the 18 with an altruistic reason for participation had a much higher energy reduction success rate at 4 weeks (83%) than the 25 who gave self‐rewarding reasons (48%).

Conclusions

Education, body weight, family history of cancer and previous diet experience did not appreciably affect dietary outcomes. This observation suggests that the societal importance of the research should be stressed in strategies that seek to affect rapid reduction of energy intake in clinical trials.
Comorbid Down's syndrome, Tourette syndrome and intellectual disability: registry prevalence and developmental course
Authors: Kerbeshian J. , Burd L.
Published: March 2003

The co‐occurrence of Tourette syndrome (TS) and Down's syndrome (DS) has been previously reported in the literature. In the present study, a retrospective record review was conducted using the North Dakota TS registry in order to ascertain the number of cases of TS and DS, and to develop case descriptions. We identified five cases from North Dakota. Two of these patients were simply comorbid for TS and DS. One was additionally comorbid for bipolar disorder, another for childhood disintegrative disorder and a third had a D/G group translocation. The association between DS and TS occured in 2% of TS patients. Contrary to the situation in patients with pervasive developmental disorders, the presence of TS in DS may be a negative prognostic indicator.
Early play behaviour in children with 5p‐ (Cri‐du‐Chat) syndrome
Authors: Sarimski K.
Published: March 2003

Background 5p‐ (Cri‐du‐Chat) syndrome (5p‐S) is a well defined chromosomal condition. While the physical symptoms have frequently been documented, the developmental and behavioural aspects of the syndrome have not been explored adequately, especially in young children.

Method Mental level, and complexity and style of play were analysed in 10 children who were homogeneously selected with respect to their chronological age (range = 2–7 years).

Results A high rate of distractability and alow level of object‐directed behaviours were observed in the play sessions. The findings were compared to two comparison groups (subjects with Down's syndrome or Cornelia‐de‐Lange syndrome) matched for mental age in order to analyse the specificity of these behavioural features for young children with 5p‐S.

Conclusions A low level of object‐directed behaviours may be an early precursor of hyperactivity, distractability and stereotypy, which have been reported to be the characteristic features of the behavioural phenotype of older individuals with 5p‐S.
Liposuction in Dercum's disease: impact on haemostatic factors associated with cardiovascular disease and insulin sensitivity
Authors: Berntorp  , Berntorp  , Brorson  , Frick
Published: March 2003

Berntorp E, Berntorp K, Brorson H, Frick K (University of Lund, Malmö, Sweden). Liposuction in Dercum's disease: impact on haemostatic factors associated with cardiovascular disease and insulin sensitivity. J Intern Med 1998; 243: 197–201.

Objective

To study the impact of adipose tissue removal by liposuction on factors associated with increased risk of cardiovascular atherosclerotic disease within the coagulation and fibrinolytic system and glucose metabolism.

Design, setting and subjects

Liposuction was performed in 53 patients with Dercum's disease. The levels of fibrinogen, von Willebrand factor antigen (VWF:Ag) and plasminogen activator inhibitor type 1 activity (PAI‐1) were measured preoperatively, and 2 weeks, 4 weeks and 3 months postoperatively. In a subsample of 10 patients, insulin sensitivity was determined before and 2–4 weeks after surgery using the 2‐h euglycaemic hyperinsulinaemic clamp technique. The study was performed as a single‐centre study.

Main outcome measure

Fibrinogen, PAI‐1 and VWF:Ag levels, and glucose uptake before and after removal of adipose tissue.

Results

Weight reduction was sustained throughout the follow‐up period with a mean decrease from 90.7 to 86.6 kg (P < 0.0001). There was a slight increase in levels of coagulation factors 2 and 4 weeks postoperatively, probably in reaction to the surgical trauma. After 3 months the values had returned to preoperative levels except for PAI‐1, which still showed a slight increase (P < 0.05). In the subsample of 10 patients, glucose uptake was improved (P < 0.05) from a short‐term perspective after surgery.

Conclusion

Surgical removal of adipose tissue, without change in lifestyle, does not seem to improve the levels of coagulation and fibrinolytic factors associated with cardiovascular atherosclerotic disease, whereas glucose takeup may be facilitated and insulin sensitivity increases from a short‐term perspective.
The importance of tubulointerstitial injury in the early phase of primary glomerular disease
Authors: Hruby  , Smolska  , Filipowski  , Rabczyn'ski  , Cies'lar  , Kopec'
Published: March 2003

Hruby Z, Smolska D, Filipowski H, Rabczyn'ski J, Cies'lar E, Kopec' W, Dulawa J. (University of Medicine, Wroczlaw; and Silesian Academy of Medicine, Katowice; Poland). The importance of tubulointerstitial injury in the early phase of primary glomerular disease. J Intern Med 1998; 243: 215–22.

Objectives

As tubulointerstitial damage is regarded secondary to glomerular injury in primary glomerulopathies, we assessed lesions to renal tubulointerstitium in recently diagnosed primary glomerular diseases and evaluated their impact on progression of the disease during the first 2 years after diagnosis.

Design

A nonrandomized prospective study assessing tubulointerstitial morphometry at diagnosis, markers of tubular function within the next 6 months and progression of the disease (creatinine clearance) during 24 months' follow‐up.

Setting

Single tertiary referral centre.

Subjects

Forty‐six patients with primary glomerular disease, the diagnostic oligobiopsy performed within 2 months of the onset of clinical symptoms.

Interventions

All patients were subjected to anti‐inflammatory/immunosuppressive treatment.

Main outcome measures

Alterations in results of tubulointerstitial morphometry and tubular function tests, correlations between these variables and parameters of nephrosis/renal function, selection of the most accurate predictor of disease progression within 24 months after diagnostic biopsy.

Results

Function of proximal tubules, markedly deteriorated at the time of diagnosis, significantly improved 6 months later (urinary β2‐microglobulin: P < 0.0025), along with reduction in proteinuria (P < 0.00125). No appreciable alterations in function of distal tubules were noted. Morphometric indices revealing interstitial expansion and tubular atrophy significantly correlated with creatinine clearance at 6 months (P= 0.032) and were the best predictors of deteriorating renal function at 24 months. Excretion of β2‐microglobulin at the time of diagnosis was the best marker for impairment of glomerular filtration 6 months later.

Conclusions

Significant damage to cortical tubulointerstitium occurs concurrently with glomerular injury in primary glomerulopathies and may predict the clinical course of the disease already in its initial phase.
Cardiopathia fantastica exposed by rapid sequential serum creatine kinase analysis
Authors: Harvey  , Johnston
Published: March 2003

Harvey CJ, Johnston JD (St. Thomas' Hospital, London, UK). Cardiopathia fantastica exposed by rapid sequential serum creatine kinase analysis (Case Report). J Intern Med 1998; 243: 323–26.

Rapid, sequential serum creatine kinase measurements may be used to exclude acute myocardial infarction in patients presenting with acute chest pain. Two cases of cardiopathia fantastica (the cardiac variant of Munchausen's syndrome) are described. Both patients presented with symptoms of acute myocardial infarction and had electrocardiographic changes consistent with this diagnosis. Both patients also had a raised serum creatine kinase level at the time of presentation but were unable to mimic the rise in serum creatine kinase associated with acute myocardial infarction. Munchausen's syndrome was suspected when both patients responded poorly to news that their enzyme results excluded acute myocardial infarction.
Exercise‐induced aortic flow parameters in early postmenopausal women and middle‐aged men
Authors: Lev  , Pines  , Drory  , ROTMENScH  , Tenenbaum  , Fisman
Published: March 2003

Lev EI, Pines A, Drory Y, Rotmensch HH, Tenenbaum A, Fisman EZ (Tel‐Aviv Sourasky Medical Centre and the Sackler Faculty of Medicine, Tel‐Aviv University, Tel‐Aviv, Israel, and The Cardiac Rehabilitation Institute, Tel‐Hashomer, Israel). Exercise‐induced aortic flow parameters in early postmenopausal women and middle‐aged men. J Intern Med 1998; 243: 275–80.

Objective

.Exercise Doppler echocardiography has been recognised as an accurate method for the assessment of left ventricular function in patients with coronary artery disease. Gender differences in aortic flow parameters during exercise have not been well established. The aims of this study were to compare basal ejection Doppler indexes in healthy early postmenopausal women with those of men, and to assess the effects of both isometric and dynamic exercises on these parameters.

Design

Intergroup comparison between early postmenopausal women and middle‐aged men

Subjects

Fifteen healthy women with a mean age of 55 (SD 5) years and 15 healthy men aged 52 (SD 4) were evaluated.

Setting

.Women were recruited from a menopause clinic and men from a primary cardiovascular prevention program at a cardiac rehabilitation institute.

Interventions

.Isometric exercise was performed with a 2‐hand bar dynamometer, and dynamic exercise with a supine ergometer. Echo Doppler examination was performed at rest and at peak isometric and dynamic exercise with a pulsed Doppler transducer.

Results

Both types of exercise resulted in higher values of hemodynamic parameters in the women, with most figures reaching statistical significance. Most aortic flow parameters during rest and exercise were also significantly higher in the women.

Conclusions

.The unexpected higher values in hemodynamic and aortic flow parameters in early postmenopausal women as compared with middle aged men may shed light on a peculiar aspect of gender differences in cardiovascular function, perhaps specific to this age group and related to menopausal transition.
Polymyalgia rheumatica in a patient with acute tubulointerstitial nephritis due to Sjögren's syndrome
Authors: Hisahara S. , Ohkoshi N. , Shoji S. , Muro K. , Yamaguchi N. , Kobayashi M. , Koyama A.
Published: March 2003

.Hisahara Shin, Ohkoshi Norio, Shoji Shin'ichi, Muro Kaori, Yamaguchi Naoto, Kobayashi Masaki, Koyama Akio (University of Tsukuba, Japan). Polymyalgia rheumatica in a patient with acute tubulointerstitial nephritis due to Sjögren's syndrome (Case Report). J Intern Med 1998: 244: 83–6.

A 68‐year‐old Japanese woman with polymyalgia rheumatica associated with acute tubulointerstitial nephritis and subclinical Sjögren's syndrome is described. Gallium scintigraphy showed marked accumulation in both kidneys and the salivary glands. Renal biopsy revealed lymphocytic infiltration in the tubulointerstitium. She was treated with intravenous high‐dose methylprednisolone followed by oral prednisolone. Her clinical symptoms improved. This is the first report of this particular association.
Effect of residual endogenous insulin secretion on the abnormal oxytocin response to hypoglycaemia in insulin‐dependent diabetics
Authors: Volpi  , Chiodera  , Capretti  , Caffarri  , Giuliani  , Caiazza  , Coiro
Published: March 2003

. Volpi R, Chiodera P, Capretti L, Caffarri G, Giuliani N, Caiazza A, Coiro V (University of Parma, Hospital of Codogno, Hospital of Guastalla, Hospital of Fidenza, Italy). Effect of residual endogenous insulin secretion on the abnormal oxytocin response to hypoglycaemia in insulin‐dependent diabetics. J Intern Med 1998; 244: 43–8.

Objectives

Arginine‐vasopressin (AVP) and oxytocin (OT) secretions are abnormally stimulated by hypoglycaemia in patients with IDDM. Since previous studies showed that AVP secretion is influenced by the persistence of residual endogenous insulin secretion, we wondered whether this factor also regulates OT secretion.

Design

Case‐control study: the OT response to insulin‐induced hypoglycaemia was measured in normal and diabetic patients with or without residual endogenous insulin secretion.

Subjects

Ten normal male subjects, 10 C‐peptide positive (CpP) and 11 C‐peptide negative (CpN) male diabetic patients.

Tests

Preliminary studies: plasma C‐peptide levels were measured after intravenous administration of 1 mg glucagon.

Insulin tolerance test (ITT): diabetics were studied after optimization of their metabolic status by 3 days of treatment with constant subcutaneous insulin infusion. CpP and CpN diabetics and normal controls were tested with an intravenous administration of 0.15 IU per kg body weight insulin. Blood samples for OT assay were taken just before the rapid injection of insulin (time 0) and at time 15, 30, 45 and 60 min.

Results

The basal concentrations of OT were similar in all groups. Insulin induced a similar hypoglycaemic nadir in all groups at 30 min, even though diabetic groups showed a delayed recovery in blood glucose levels. The glycaemic pattern was similar in all diabetic patients. Hypoglycaemia‐induced OT rise was significantly higher in the two diabetic groups than in the normal group. However, CpN patients showed significantly higher OT increments than CpP subjects.

Conclusions

These data indicate that a residual endogenous insulin secretion exerts a partial protective action against the hypothalamic‐pituitary disorder affecting the OT secretory system in IDDM.
Ischaemia monitoring with on‐line vectorcardiography during dobutamine stress echocardiography in patients after an episode of unstable coronary artery disease
Authors: Lundin P. , Eriksson S. V. , AndrÉn B. , LindahL B. , Tornvall P. , Melcher A.
Published: March 2003

. Lundin P, Eriksson SV, Andrén B, Lindahl B, Tornvall P, Melcher A (Danderyd Hospital, Danderyd, University Hospital, Uppsala, Karolinska Hospital, Stockholm, Sweden). Ischaemia monitoring with on‐line vectorcardiography during dobutamine stress echocardiography in patients after an episode of unstable coronary artery disease. J Intern Med 1998; 244: 61–70.

Objectives

This study investigated the ability of on‐line vectorcardiography (VCG) to detect myocardial ischaemia as assessed by dobutamine stress echocardiography after an episode of unstable coronary artery disease.

Design

Dobutamine stress test (incrementally infused doses of 5, 10, 20, 30 and 40 μg kg−1 per minute) was performed during simultaneous VCG monitoring. QRS vector difference (QRS‐VD), ST vector magnitude (ST‐VM), ST change vector magnitude (STC‐VM) and T change vector magnitude (TC‐VM) were monitored. A new wall motion abnormality or worsening of abnormal wall motion was regarded as indicating a positive dobutamine stress test.

Subjects

Fifty‐five patients with unstable angina pectoris and 16 patients with an acute non‐Q‐wave myocardial infarction were studied 5–8 days after admission.

Results

A positive dobutamine stress test was observed in 37 patients (52%). The sensitivity, specificity and total accuracy of identifying patients with a positive dobutamine stress test by VCG were: 38%, 91% and 63% for QRS‐VD; 59%, 88% and 73% for ST‐VM; 84%, 79% and 82% for STC‐VM; and 86%, 23% and 56% for TC‐VM. Patients with a positive dobutamine stress test showed higher maximum VCG values than patients with a negative dobutamine stress test (QRS‐VD, P < 0.01; ST‐VM, P < 0.001; STC‐VM, P < 0.001). The maximum VCG values were related to the number of segments showing new or worsening wall motion abnormality (QRS‐VD: r= 0.41, P < 0.001; ST‐VM: r= 0.44, P < 0.001; STC‐VM: r= 0.57, P < 0.001).

Conclusion

STC‐VM and ST‐VM seem to be the best VCG variables for detection of myocardial ischaemia as assessed by dobutamine stress echocardiography.
Somatostatin receptor expression in multiple endocrine neoplasia and in von hippel–lindau disease
Authors: Lamberts  , Hofland  , Lely A. J. V. D. , De Herder
Published: March 2003

Lamberts SWJ, Hofland LJ, Lely AJVD, de Herder WW (Erasmus University Rotterdam, The Netherlands). Somatostatin receptor expression in multiple endocrine neoplasia and in von hippel– lindau disease (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 569–71.

Somatostatin receptors are expressed on the majority of neuroendocrine tumours. The presence of these receptors is clinically useful. First, long‐term treatment with somatostatin analogues controls hormonal hypersecretion, which controls flushing attacks, watery diarrhoea, hypoglycaemia and electrolyte disorders in patients with carcinoids and islet cell tumours. Secondly, somatostatin receptor imaging is used to localize primary neuroendocrine tumours and to visualize the spread of the disease. Thirdly internalization of somatostatin receptors by primary neuroendocrine tumours opens the possibility of carrying out radio‐ and chemotherapy with somatostatin analogues coupled to beta‐emitting radionuclides and chemotherapeutic drugs. The presence and role of somatostatin receptors on the tumours which occur in multiple endocrine neoplasia and von Hippel–Lindau disease are discussed.