bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of pegylated interferon/ribavirin combination in ‘real world’ patients with chronic hepatitis C virus infection
Authors: BORRONI G. , ANDREOLETTI M. , CASIRAGHI M. A. , CERIANI R. , GUERZONI P. , OMAZZI B. , TERRENI N. , SALERNO F. 
Published: July 2010

SummaryBackground  Clinical trials have shown that the combination of pegylated interferon/ribavirin induces a sustained virological response in 54–63% of patients with chronic hepatitis C virus infection, but its effectiveness in day‐to‐day clinical practice is less clear.Aim  To verify if the efficacy of pegylated interferon/ribavirin combination in ‘real world’ patients is comparable to that observed in trials.Methods  The medical records of 397 consecutive naïve patients with chronic hepatitis C virus infection treated with pegylated interferon/ribavirin combination in nontertiary hospital settings were reviewed in order to assess the response to anti‐viral treatment.Results  The sustained virological response rate achieved in this population was similar to that recorded in registration trials (total population: 64%; genotype 1: 46%; genotypes 2–3: 84%). Also, the premature discontinuation rate (15%) was similar to that observed in registration trials, but there were fewer dose reductions in one or both medications (26%). We confirmed the association between adherence and sustained virological response among the patients infected with hepatitis C virus genotype 1 who were treated for ≥80% of the planned duration of treatment.Conclusion  The effectiveness of pegylated interferon/ribavirin therapy and factors predicting an sustained virological response in everyday clinical practice mirror those reported in randomized‐controlled studies.
Access to care, socioeconomic deprivation and colon cancer survival
Authors: DEJARDIN O. , BOUVIER A. M. , FAIVRE J. , BOUTREUX S. , DE POUVOURVILLE G. , LAUNOY G. 
Published: July 2010

SummaryBackground  The influence of socioeconomic environment on cancer survival has been established in numerous studies in the EU and the US, prognosis being constantly poorer for the most underprivileged patients.Aim  To investigate the influence of distance to care centre and deprivation on colon cancer survival, using a multilevel Cox model and taking into account cancer stage at diagnosis and treatment modalities.Methods  The study population comprised all cases of colon cancer diagnosed between 1997 and 2000 in two French areas covered by specialized cancer registries (n = 2066).Results  Road distance to the nearest reference care centre was associated with poorer prognosis even after adjustment for stage at diagnosis (P for trend = 0.01). Subgroups analysis showed that this association was maximal for patients with advanced cancer [RR = 1.27 (1.04–1.51); P for trend = 0.015] for whom access to chemotherapy varying according to distance explained the major part of geographic inequalities in survival.Conclusions  The major effect of distance from reference care centre on survival suggests that current regional health planning does not guarantee equity in cancer management. Improvement in access to adjuvant therapy, especially for patients with advanced cancers, seems crucial for reducing geographic disparities in colon cancer survival.
Systematic review: glucocorticosteroids for alcoholic hepatitis – a Cochrane Hepato‐Biliary Group systematic review with meta‐analyses and trial sequential analyses of randomized clinical trials
Authors: RAMBALDI A. , SACONATO H. H. , CHRISTENSEN E. , THORLUND K. , WETTERSLEV J. , GLUUD C. 
Published: July 2010

SummaryBackground  Glucocorticosteroids versus placebo or no intervention for patients with alcoholic hepatitis have been evaluated for more than 35 years. However, the results of randomized trials and meta‐analyses differ substantially.Aim  To review all randomized clinical trials of glucocorticosteroids vs. placebo or no intervention for patients with alcoholic hepatitis.Methods  We searched for randomized trials published before July 2007. The trials were assessed for risk of bias.Results  We included 15 trials with a total of 721 randomized patients. The overall mortality rate was 39.5%. Twelve of the fifteen trials were at risk of bias. Glucocorticosteroids did not statistically reduce mortality compared with placebo or no intervention (relative risk 0.83, 95% CI 0.63–1.11). Glucocorticosteroids significantly reduced mortality in the subgroup of trials with patients with Maddrey’s score of at least 32 or hepatic encephalopathy and with low‐bias risk. In all analyses, heterogeneity was significant and substantial. Trial sequential analyses using heterogeneity‐adjusted information size demonstrated no significant effect of glucocorticosteroids on mortality. Weighted logistic regression analyses taking prognostic factors at randomization into consideration found no significant effect of glucocorticosteroids on mortality.Conclusions  The current evidence base of mainly heterogeneous with high bias risk trials does not support the use of glucocorticosteroids in alcoholic hepatitis. Large, low‐bias risk placebo‐controlled randomized trials are needed.
Systematic review: combination therapies for treatment‐naïve chronic hepatitis B
Authors: KUMAR M. , SARIN S. K. 
Published: July 2010

SummaryBackground  There is a renewed interest in use of combination therapies in treatment‐naïve chronic hepatitis B (CHB) because of limitations of monotherapies.Aim  To discuss the current status of combination therapies in treatment‐naïve CHB.Methods  PubMed search was done using ‘combination’, ‘sequential’ and ‘chronic hepatitis B’ as the search terms.Results  The two most popular combination therapies include ‘combination of nucleos(t)ide analogues’ and ‘combination of interferons and nucleos(t)ide analogues’. Combination therapies using two nucleos(t)ide analogues do not lead to higher long‐term efficacy. However, addition of a nucleos(t)ide analogue with a good resistance profile to a nucleos(t)ide analogue with a lower genetic barrier to resistance decreases the risk of emergent resistance to the latter. Greater sustained virological, biochemical and seroconversion rates are observed with addition of lamivudine to conventional interferon, but pegylated‐interferon monotherapy is equally effective as combination with lamivudine. Again, resistance to lamivudine is lower with its combination with interferons.Conclusions  The answer to the question whether hepatitis B can be treated better with combination or monotherapy remains largely unknown. Additional trials are warranted of combination therapies of peginterferon and potent nucleos(t)ide analogues or therapies with the combined use of nucleos(t)ide analogues or immunomodulators.
Review article: medication non‐adherence in ulcerative colitis – strategies to improve adherence with mesalazine and other maintenance therapies
Authors: HAWTHORNE A. B. , RUBIN G. , GHOSH S. 
Published: July 2010

SummaryBackground  Significant number of patients with ulcerative colitis (UC) fail to comply with treatment.Aims  To review issues surrounding medication non‐adherence in inflammatory bowel disease (IBD), including the clinical and health service implications in the UK, and discuss strategies for optimizing medication adherence.Methods  Articles cited were identified via a PubMed search, utilizing the words IBD, adherence, compliance, medication and UC.Results  Medication non‐adherence is multifactorial involving factors other than dosing frequency. Male gender (OR: 2.06), new patient status (OR: 2.14), work and travel pressures (OR: 4.9) and shorter disease duration (OR: 2.1), among others are proven predictors of non‐adherence in UC. These indicators can identify ‘at‐risk’ patients and allow an individually tailored treatment approach to be introduced that optimizes medication adherence. A collaborative relationship between physician and patient is important; several strategies for improving adherence have been proven effective including open dialogue that takes into consideration the patient’s health beliefs and concerns, providing educational (e.g. verbal/written information, self‐management programmes) and behavioural interventions (e.g. calendar blister packs, cues/reminders).Conclusions  Educational and behavioural interventions tailored to individual patients can optimize medication adherence. Additional studies combining educational and behavioural interventions may provide further strategies for improving medication adherence rates in UC.
Review article: molecular, pathological and therapeutic features of human enteric neuropathies
Authors: DI NARDO G. , BLANDIZZI C. , VOLTA U. , COLUCCI R. , STANGHELLINI V. , BARBARA G. , DEL TACCA M. , TONINI M. , CORINALDESI R. , DE GIORGIO R. 
Published: July 2010

SummaryBackground  Considerable information has been gathered on the functional organization of enteric neuronal circuitries regulating gastrointestinal motility. However, little is known about the neuropathophysiological mechanisms underlying gastrointestinal motor disorders.Aim  To analyse the most important pathological findings, clinical implications and therapeutic management of idiopathic enteric neuropathies.Methods  PubMed searches were used to retrieve the literature inherent to molecular determinants, pathophysiological bases and therapeutics of gastrointestinal dysmotility, such as achalasia, gastroparesis, chronic intestinal pseudo‐obstruction, Hirschsprung’s disease and slow transit constipation, to unravel advances on digestive disorders resulting from enteric neuropathies.Results  Current data on molecular and pathological features of enteric neuropathies indicate that degenerative and inflammatory abnormalities can compromise the morpho‐functional integrity of the enteric nervous system. These alterations lead to a massive impairment in gut transit and result in severe abdominal symptoms with associated high morbidity, poor quality of life for patients and established mortality. Many pathophysiological aspects of these severe conditions remain obscure, and therefore treatment options are quite limited and often unsatisfactory.Conclusions  This review of enteric nervous system abnormalities provides a framework to better understand the pathological processes underlying gut dysmotility, to translate this knowledge into clinical management and to foster the development of targeted therapeutic strategies.
Epidemiological study of gastro‐oesophageal reflux disease: reflux in spouse as a risk factor
Authors: NASSERI‐MOGHADDAM S. , MOFID A. , GHOTBI M.‐H. , RAZJOUYAN H. , NOURAIE M. , RAMARD A.‐R. , ZAER‐REZAIE H. , HABIBI R. , RAFAT‐ZAND K. , MALEKZADEH R. 
Published: July 2010

SummaryBackground  Gastro‐oesophageal reflux disease (GERD) is a growing health‐care problem with variable distribution.Aim  To assess GERD prevalence and risk factors and their possible correlation with pathophysiology in a population‐based study.Methods  Individuals aged 18–65 years were enrolled through random cluster sampling in Tehran. Previously validated self‐administered questionnaires were used.Results  Of the 2500 questionnaires, 2057 were analysed (mean age: 34.8 ± 13.0 years, 55.1% female). Frequent GERD was seen in 18.2%. Minor symptoms increased prevalence. Female gender (OR: 1.55, 95% CI: 1.01–2.41), BMI >30 kg/m2 (OR: 1.79, 95% CI: 1.03–3.12), less education (OR: 1.52, 95% CI: 1.02–2.27), smoking (OR: 1.83, 95% CI: 1.12–2.99), NSAID use (OR: 4.23, 95% CI: 1.66–10.74) and GERD in spouse (OR: 1.82, 95% CI: 1.18–2.82) were associated with frequent GERD on multivariable analysis. GERD in first‐degree relatives (OR: 1.73, 95% CI: 1.23–2.43) and asthma (OR: 4.09, 95% CI: 1.27–13.15) correlated with infrequent GERD. Minor symptoms correlated with GERD history in first‐degree relatives, coffee consumption and NSAID use. Prevalence in the past 3 months was similar to that in the past 12 months (P < 0.05).Conclusions  Gastro‐oesophageal reflux disease is common in Tehran. The association of ‘infrequent symptoms’ with GERD history in first‐degree relatives and ‘frequent symptoms’ with GERD history in spouse may point to the presence of yet unknown precipitating environmental factors inducing GERD in a genetically susceptible host. Minor GERD symptoms seem to have independent contribution to GERD. Assessing GERD in the past 3 months predicts prevalence in the past year.
Prospective evaluation of transient elastography for the diagnosis of hepatic fibrosis in Asians: comparison with liver biopsy and aspartate transaminase platelet ratio index
Authors: CHANG P.‐E. , LUI H.‐F. , CHAU Y.‐P. , LIM K.‐H. , YAP W.‐M. , TAN C.‐K. , CHOW W.‐C. 
Published: July 2010

SummaryBackground  Transient elastography (TE) is a reliable non‐invasive predictor of hepatic fibrosis, but data on TE in Asians are limited.Aim  To evaluate prospectively the accuracy of TE for diagnosis of hepatic fibrosis in Asians compared with APRI (aspartate transaminase to platelet ratio index).Methods  One hundred and twenty consecutive patients who underwent liver biopsy were enrolled. TE (Fibroscan) was performed by two independent operators. Fibrosis was graded by two independent pathologists using the METAVIR classification. Area under receiver operating curves (AUROC) were used to evaluate the accuracy of TE and APRI in diagnosing significant fibrosis (F ≥ 2) and cirrhosis (F4).Results  Predominant aetiologies were hepatitis B (48%), non‐alcoholic steatohepatitis (14%) and hepatitis C (8%). TE was unsuccessful in five patients (4.2%) because of small inter‐costal space (three patients), obesity and ascites. There was good correlation between TE and fibrosis (r = 0.606). AUROC for diagnosis of significant fibrosis was 0.856 (95% CI 0.779–0.932) for TE and 0.673 (95% CI 0.568–0.777) for APRI. AUROC for diagnosis of cirrhosis was 0.924 (95% CI 0.857–0.990) for TE and 0.626 (95% CI 0.437–0.815) for APRI. Optimal TE value was 9.0 kPa for diagnosis of significant fibrosis and 16.0 kPa for cirrhosis with specificity/sensitivity/PPV/NPV/accuracy of 82.6%/85.2%/80.9%/86.7%/84.1% and 88.9%/82.7%/32.0%/98.8%/83.2%, respectively.Conclusions  Transient elastography is a reliable predictor of hepatic fibrosis in Asians. Failure of TE in Asians is commonly because of small inter‐costal space. TE is superior to APRI for non‐invasive diagnosis of hepatic fibrosis and cirrhosis.
Underutilization of gastroprotective strategies in aspirin users at increased risk of upper gastrointestinal complications
Authors: TARGOWNIK L. E. , METGE C. J. , LEUNG S. 
Published: July 2010

SummaryBackground  Aspirin use is with an increased risk of upper gastrointestinal complications (UGICs). Proton pump inhibitors (PPIs) decrease the risk of UGICs among aspirin users. The distribution of risk factors for UGIC and PPI utilization among aspirin users remains uncharacterized.Aim  To determine the prevalence and predictors of PPI use in high‐risk aspirin users.Methods  Using questionnaires and administrative records, we collected information on aspirin and PPI utilization and risk factors for UGICs from a stratified random sample of subjects with established cardiovascular disease. We calculated the proportion of aspirin users with UGIC risk factors and determined the prevalence of PPI use among aspirin users with risk factors. Regression analysis was used to determine predictors of PPI use among aspirin users.Results  Overall response rate was 35%, of whom 86% were regular aspirin users. Seventy‐one per cent of aspirin users had at least one risk factor (in addition to cardiac disease) for the development of UGICs. Although a history of UGIC was predictive of PPI use, 44% of aspirin users with a prior history of UGICs did not receive a concomitant PPI, and only 23% of subjects with additional UGIC risk factors were prescribed a PPI.Conclusion  There is a high prevalence of UGIC risk factors among aspirin users, and many are not prescribed PPIs as a gastroprotective strategy.
Clinical trial: effectiveness of Lactobacillus rhamnosus (strains E/N, Oxy and Pen) in the prevention of antibiotic‐associated diarrhoea in children
Authors: RUSZCZYŃSKI M. , RADZIKOWSKI A. , SZAJEWSKA H. 
Published: July 2010

SummaryBackground  Convincing evidence that probiotic administration can lower the risk of antibiotic‐associated diarrhoea is limited to certain micro‐organisms.Aim  To determine the efficacy of administration of Lactobacillus rhamnosus (strains E/N, Oxy and Pen) for the prevention of antibiotic‐associated diarrhoea in children.Methods  Children (aged 3 months to 14 years) with common infections were enrolled in a double‐blind, randomized, placebo‐controlled trial in which they received standard antibiotic treatment plus 2 × 1010 colony forming units of a probiotic (n = 120) or a placebo (n = 120), administered orally twice daily throughout antibiotic treatment. Analyses were by intention to treat.Results  Any diarrhoea (≥3 loose or watery stools/day for ≥48 h occurring during or up to 2 weeks after the antibiotic therapy) occurred in nine (7.5%) patients in the probiotic group and in 20 (17%) patients in the placebo group (relative risk, RR 0.45, 95% confidence interval, CI 0.2–0.9). Three (2.5%) children in the probiotic group developed AAD (diarrhoea caused by Clostridium difficile or otherwise unexplained diarrhoea) compared to nine (7.5%) in the placebo group (RR 0.33, 95% CI 0.1–1.06). No adverse events were observed.Conclusion  Administration of L. rhamnosus (strains E/N, Oxy and Pen) to children receiving antibiotics reduced the risk of any diarrhoea, as defined in this study.
Pilot study: Gelafundin (polygeline) 4% plus antibiotics in the treatment of high‐risk cirrhotic patients with spontaneous bacterial peritonitis
Authors: Cartier M. , Terg R. , Lucero R. , Muñoz A. , Romero G. , Levi D. , Miguez C. , Abecasis R. 
Published: July 2010

Aliment Pharmacol Ther2010;32:43–48SummaryBackground Cirrhotic patients with spontaneous bacterial peritonitis (SBP) have elevated rates of renal impairment and mortality. It has been shown that cefotaxime plus albumin infusion decrease renal impairment compared with antibiotic treatment alone, in patients with serum bilirubin >4 mg/dL or creatinine >1 mg/dL.Aim To assess clinical outcomes of high‐risk cirrhotic patients with SBP who were treated with antibiotics associated with Gelafundin (polygeline) 4%.Methods Twenty nine cirrhotic patients with SBP and serum bilirubin >4 mg/dL or creatinine >1 mg/dL were enrolled. Ceftriaxone was administered in doses of 2 g/day and Gelafundin 4% was given intravenously at 1.5 g/kg of body weight at the time of the diagnosis, followed by 1 g/kg on day 3. Renal impairment was defined as nonreversible deterioration of renal function during hospitalization.Results Eight patients (27.5%) had basal renal failure. Infection resolved in 28 (96.6%) patients. Renal impairment occurred in four patients (13.8%), and three patients (10.4%) died during hospitalization. Mortality within 90 days after discharge was 34.5% (10 patients).Conclusion The rates of renal impairment and mortality in high‐risk patients with SBP suggest that Gelafundin 4% administration given with ceftriaxone may be a less expensive therapeutic alternative to albumin.
Intestinal B cell‐activating factor: an indicator of non‐IgE‐mediated hypersensitivity reactions to food?
Authors: Lied G. Arslan , Lillestøl K. , Valeur J. , Berstad A. 
Published: July 2010

Aliment Pharmacol Ther 2010; 32: 66–73SummaryBackground  Medically confirmed hypersensitivity reactions to food are usually IgE‐mediated. Non‐IgE‐mediated reactions are not only seldom recognized but also more difficult to diagnose.Aim  To examine B cell‐activating factor (BAFF) in serum and gut lavage fluid of patients with self‐reported food hypersensitivity, and to study its relationship to atopic disease.Methods  Gut lavage fluid was obtained from 60 and serum from another 17 patients with self‐reported food hypersensitivity. Twenty healthy volunteers served as controls, gut lavage fluid was obtained in all, serum from 11 of 20. The patients were divided into atopic and non‐atopic subgroups. BAFF was measured by ELISA in both serum and gut lavage fluid.Results  B cell‐activating factor levels in serum and gut lavage fluid were significantly higher in patients than in controls (P < 0.03 and P < 0.002 respectively). Non‐atopic patients had significantly higher levels of BAFF in serum than both atopic patients (P < 0.05) and controls (P < 0.05). There was no significant correlation between serum levels of BAFF and IgE.Conclusions  The results suggest that BAFF might be a new mediating mechanism in food hypersensitivity reactions. Significantly higher levels in non‐atopic compared with atopic patients, and no correlation between BAFF and IgE, suggest that BAFF might be involved particularly in non‐IgE‐mediated reactions.
Asynchronous independent lung ventilation
Authors: STOW P. J. , GRANT I. 
Published: July 2010

SummaryThe use of asynchronous independent lung ventilation is described in a patient presenting with acute respiratory failure due to a severe unilateral pneumonia. A polyvinyl chloride (Portex) doublelumen tube was inserted through a tracheostomy and the lungs ventilated independently using a combination of a Cape ventilator and a Servo 900 B ventilator.
Mapping and characterization of the DQ subregion of the ovine MHC
Authors: Wright H , Ballingall K T 
Published: July 2010

SummaryA map of the ovine MHC class II DQ subregion has been constructed from overlapping cosmid clones. This region consists of two loci linked on a linear tract of 130 kb DNA. Each locus consists of a DQA and a DQB gene in a tail‐to‐tail orientation. The genes in each locus are transcribed but only those designated DQ1 express class II molecules at the surface of mouse L cells following DNA‐mediated gene transfection. The DQA1 and DQB1 genes are separated by 11kb while the DQA2 and B2 genes are 25 kb apart. The loci are separated by 22 kb.
Toll-like receptor (TLR)-9 genetics and function in sarcoidosis
Authors: Veltkamp M , Van Moorsel C H M , Rijkers G T , Ruven H J T , Van Den Bosch J M M , Grutters J C 
Published: July 2010

Summary
Sarcoidosis is a systemic disorder characterized by the formation of non-caseating granulomas in variable organs. Toll-like receptor (TLR)-9 is important in the innate immune response against both Mycobacterium tuberculosis and Propionibacterium acnes, candidate causative agents in sarcoidosis. The aim of our study was to investigate possible genetic and functional differences in TLR-9 between patients and controls. TLR-9 single nucleotide polymorphisms were genotyped in 533 patients and divided into a study cohort and validation cohort and 185 healthy controls. Furthermore, part of the promotor as well as the entire coding region of the TLR-9 gene were sequenced in 20 patients in order to detect new mutations. No genetic differences were found between patients and controls. In order to test TLR-9 function, peripheral blood mononuclear cells (PBMCs) of 12 healthy controls and 12 sarcoidosis patients were stimulated with a TLR-9 agonist and the induction of interleukin (IL)-6, interferon (IFN)-γ and IL-23 was measured. Sarcoidosis patients produce significantly less IFN-γ upon stimulation with different stimuli. Regarding IL-23 production, a significant difference between patients and controls was found only after stimulation with the TLR-9 agonist. In conclusion, we did not find genetic differences in the TLR-9 gene between sarcoidosis patients and controls. Sarcoidosis patients produce less IFN-γ regardless of the stimulating agent, probably reflecting the anergic state often seen in their peripheral blood T lymphocytes. The differences in TLR-9-induced IL-23 production could indicate that functional defects in the TLR-9 pathway of sarcoidosis patients play a role in disease susceptibility or evolution.