bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fatty fish and supplements are the greatest modifiable contributors to the serum 25‐hydroxyvitamin D concentration in a multiethnic population
Authors: Van Der Meer Irene M. , Boeke A. Joan P. , Lips Paul , Grootjans‐Geerts Ilse , Wuister Jan D. , Devillé Walter L. J. M. , Wielders Jos P. M. , Bouter Lex M. , Middelkoop Barend J. C. 
Published: September 2010

SummaryObjective  Because vitamin D synthesis is lower in a heavily pigmented skin than in a lighter skin, the relative contribution of determinants to the vitamin D concentration might differ between ethnic groups. The aim of this study was to assess the prevalence of vitamin D deficiency and the relative contribution of vitamin D consumption and exposure to sunlight to the vitamin D concentration in a multiethnic population.Design  Cross‐sectional study.Patients  A total of 613 adults aged 18–65 years from a random sample from general practices in the Netherlands (52°N, 2003–05), stratified according to gender and ethnic group.Measurements  Serum 25‐hydroxyvitamin D [25(OH)D], PTH, ethnic group, sunlight exposure, consumption of foods and supplements rich in vitamin D.Results  The prevalence (95% confidence interval) of vitamin D deficiency [serum 25(OH)D < 25 nmol/l] was higher in Turkish (41·3%; 32·5–50·1), Moroccan (36·5%; 26·9–46·1), Surinam South Asian (51·4%; 41·9–60·9), Surinam Creole (45·3%; 34·0–56·6), sub‐Saharan African (19·3%; 9·1–29·5) and other adults (29·1%; 17·1–41·1) compared to the indigenous Dutch (5·9%; 1·3–10·5). Modifiable, significant determinants (standardized regression coefficients) for serum 25(OH)D concentration were: consumption of fatty fish (0·160), use of vitamin D supplements (0·142), area of uncovered skin (highest category 0·136; middle category 0·028), use of tanning bed (0·103), consumption of margarine (0·093) and preference for sun (0·089). We found no significant modification of ethnic group on the effect of sunlight determinants.Conclusion  Of the modifiable determinants, fatty fish and supplements are the greatest contributors to the serum 25(OH)D concentration in a multiethnic population.
Elevated liver enzymes in Turner syndrome during a 5‐year follow‐up study
Authors: El‐Mansoury Mostafa , Berntorp Kerstin , Bryman Inger , Hanson Charles , Innala Eva , Karlsson Anders , Landin‐Wilhelmsen Kerstin 
Published: September 2010

SummaryObjectives  To study the prevalence and incidence of elevated liver enzymes and their relationship with body weight, metabolic factors and other diseases in Turner syndrome (TS).Design  Five‐year follow‐up.Patients  Women with TS (n = 218, mean age 33 ± 13, range 16–71 years) from outpatient clinics at university hospitals in Sweden.Measurements  Fasting blood samples for aspartate (AST) and alanine aminotransferase (ALT), bilirubin, alkaline phosphatase (ALP), γ‐glutamyl transferase (GT), viral hepatitis serology and hepatic auto‐antibodies, vitamin B12, blood glucose, lipids and hormones.Results  Seventy‐nine subjects (36%) had one or more liver enzyme levels higher than the reference level, the most prevalent being GT. Karyotype 45,X was present in 51% of all TS women and in 48% of those with elevated liver enzymes. Body weight, body mass index (BMI), total cholesterol, triglycerides, and apolipoproteins A and B at start were higher in TS women with elevated liver enzymes than in TS women with normal levels. At 5 years, AST, ALT and GT were increased and another 23% of patients had developed elevated liver enzymes, that is, 59% in total (36% + 23%), while in 6%, the elevated liver enzymes had been normalized and all 6% also had lowered cholesterol levels. Multivariate analysis showed that GT was correlated with total cholesterol; P = 0·0032 at start and P = 0·0005 at 5 years, independently of other factors. Liver biopsy in six TS women showed one cholangitis, one hepatitis C, two steatosis and two normal biopsies. Withdrawal of oestrogen substitution did not influence the liver enzymes.Conclusions  Pathological liver enzymes were common in TS women, with a prevalence of 36% at 33 years of age, an annual incidence over 5 years of 3·4%. There was no relation to karyotype, alcohol, viral hepatitis, E2 or autoimmunity, but a connection with total serum cholesterol.
Decision modelling of economic evaluation of intervention programme of breast cancer
Authors: Chang Jung‐Chen , Chen Tony H‐H. , Duffy Stephen W. , Yen Amy M‐F. , Chen Sam L‐S. 
Published: September 2010

AbstractObjectives Economic appraisal of an intervention is a complex and multivariable problem, with probabilistic issues related not only to clinical outcomes but also to costs and willingness to pay.Methods We provide a comprehensive framework for economic appraisal of a health intervention to prevent beast cancer mortality, involving probabilistic model of costs as well as of aspects of the disease process. The economic appraisal can give a range of probabilities of cost‐effectiveness depending on willingness or ability to pay.Results We apply the method to the example of polychemotherapy for early breast cancer. Results indicate a 30% probability of cost‐effectiveness for a willingness to pay of $60 000 per quality‐adjusted life‐year and around 50% for a threshold of $100 000.Conclusion The comprehensive economic appraisal model is a powerful tool for decision making over a range of economic environments.
Mokken scaling of the Myocardial Infarction Dimensional Assessment Scale (MIDAS)
Authors: Thompson David R. , Watson Roger 
Published: September 2010

AbstractAims  The purpose of this study was to examine the hierarchical and cumulative nature of the 35 items of the Myocardial Infarction Dimensional Assessment Scale (MIDAS), a disease‐specific health‐related quality of life measure.Method  Data from 668 participants who completed the MIDAS were analysed using the Mokken Scaling Procedure, which is a computer program that searches polychotomous data for hierarchical and cumulative scales on the basis of a range of diagnostic criteria.Results  Fourteen MIDAS items were retained in a Mokken scale and these items included physical activity, insecurity, emotional reaction and dependency items but excluded items related to diet, medication or side‐effects. Item difficulty, in item response theory terms, ran from physical activity items (low difficulty) to insecurity, suggesting that the most severe quality of life effect of myocardial infarction is loneliness and isolation.Conclusions  Items from the MIDAS form a strong and reliable Mokken scale, which provides new insight into the relationship between items in the MIDAS and the measurement of quality of life after myocardial infarction.
Causal diagrams and change variables
Authors: Shahar Eyal , Shahar Doron J. 
Published: September 2010

AbstractBackground  The true change in the value of a variable between two time points is often assumed to be a cause or an effect of interest. To our knowledge, this assumption is based on intuition, rather than on any formal theoretical justification.Methods  We used causal directed acyclic graphs to explore the causal properties of a change variable, and critically examined competing structures.Results  Based on the proposed causal structure, a change variable (true change) is no more than a derived variable. It does not cause anything and is not of causal interest.Conclusions  A true change is not a variable in the physical world. Therefore, modelling the change between two time points is justified only in a few situations.
The importance of communication in collaborative decision making: facilitating shared mind and the management of uncertainty
Authors: Politi Mary C. , Street Richard L. 
Published: September 2010

AbstractRationale  Quality medical decision making requires that clinicians and patients incorporate the best available clinical evidence with the patients' values and preferences to develop a mutually agreed upon treatment plan. The interactive process involved in medical decision making is complex and requires patients and clinicians to use both cognitive and communicative skills to reach a shared understanding of the decision.Aims and objectives  The purpose of this paper is to present a communication model to help better understand quality medical decision making, and how patient‐centered, collaborative communication enhances the decision‐making process.Methods  We present research on shared mind and cognitive and communicative skills to highlight how they can facilitate the management of uncertainty during the interactive process involved in medical decision making. We provide simple examples about how to frame messages to achieve shared mind and foster uncertainty tolerance.Conclusions  Strategies such as providing clear explanations, checking for understanding, eliciting the patient's values, concerns, needs, finding common ground, reaching consensus on a treatment plan, and establishing a mutually acceptable follow‐up plan can facilitate collaborative decision making. Future research should explore ways to implement collaborative decision‐making processes in existing health care systems.
Rapid tryptophan depletion as a treatment for acute mania: a double‐blind, pilot‐controlled study
Authors: Applebaum Julia , Bersudsky Yuly , Klein Ehud 
Published: September 2010

Objectives:  Rapid reduction of up to 80% in plasma tryptophan level can be accomplished by administering an oral tryptophan‐free amino acid solution, which induces hepatic protein synthesis and thereby depletes available plasma tryptophan. Rapid tryptophan depletion (RTD) has been shown to induce transient depressive symptoms in patients with remitted major depression. The effect of RTD in acutely manic patients has not been studied.Methods:  We carried out a double‐blind, placebo‐controlled pilot study of RTD in acutely manic patients. Patients were randomized to the treatment groups. Sodium valproate treatment was started at a dose of 1000 mg/day and continued throughout the 7‐day study. On days 1‐7, patients received a daily tryptophan‐free amino acid drink or a placebo drink. The tryptophan‐free amino acid drink contained a mix of amino acids without tryptophan. The placebo drink contained the additives and constituents of the real mixture to provide identical flavor and texture without the amino acids. Ratings were administered at baseline and then repeated on days 3, 5, and 7. All ratings were carried out by an experienced rater who was blind to the group assignment of patients.Results:  A total of 23 patients entered the study and 17 completed the 7‐day treatment protocol. The patients who received the amino acid drink showed greater improvement in mania ratings. The differences in Young Mania Rating Scale (YMRS) and Clinical Global Impression (GCI) scores were significant. However, the intolerance rate was high (23%) and the findings in this pilot study are based only on results from those patients who were able to tolerate the drink.Conclusions:  Rapid tryptophan depletion may have an antimanic effect.
Mood‐stabilizing pharmacological treatment in bipolar disorders and risk of suicide
Authors: Søndergård Lars , Lopez Ana Garcia , Andersen Per Kragh , Kessing Lars Vedel 
Published: September 2010

Objectives:  This study investigated the association between continued mood‐stabilizing treatment (lithium and anticonvulsants) in bipolar disorder (BD) and the risk of suicide.Methods:  Using linkage of national registers, the association between continued mood‐stabilizing treatment and suicide was investigated among all patients discharged nationwide from hospital psychiatry as an in‐ or outpatient in a period from 1995 to 2000 in Denmark with a diagnosis of BD.Results:  A total of 5,926 patients were included in the study and among these 51 patients committed suicide eventually during the study period. Although the rate of suicide was higher during periods when patients purchased anticonvulsants (293 suicides per 100,000 person‐years) than during periods with lithium (136 suicides per 100,000 person‐years), the suicide rate decreased with the number of prescriptions in a rather similar way for patients first treated with lithium and patients first treated with anticonvulsants: patients who continued treatment with mood‐stabilizing drugs had a decreased rate of suicide compared to patients who purchased mood stabilizers once only [rate ratio for anticonvulsants = 0.28, 95% confidence interval (CI) = 0.19–0.41; rate ratio for lithium = 0.20, 95% CI = 0.10–0.38]. Further, the rate of suicide decreased consistently with the number of additional prescriptions. Switch to or augmentation with lithium to patients initiated on anticonvulsants was associated with a significantly reduced rate of suicide (rate ratio = 0.28, 95% CI = 0.20–0.40), whereas a switch to or augmentation with anticonvulsants to patients first started on lithium showed no additional effect on the suicide rate.Conclusions:  Although continued treatment with anticonvulsants and continued treatment with lithium was associated with a rather similar reduction in the rate of suicide, the results suggest that treatment with lithium may have some superiority in relation to prevention of suicide.
Further support for association of the mitochondrial complex I subunit gene NDUFV2 with bipolar disorder
Authors: Xu Chun , Li Peter P , Kennedy James L , Green Marty , Hughes Bronwen , Cooke Robert G , Parikh Sagar V , Warsh Jerry J 
Published: September 2010

Background:  The nuclear‐encoded mitochondrial complex I subunit gene, NDUFV2, has been implicated in the pathogenesis of bipolar disorder (BD) in Japanese by virtue of association of variants in its promoter with BD and decreased NDUFV2 messenger ribonucleic acid (mRNA) levels in B lymphoblasts (BLCL) in BD patients compared to controls. We sought to determine if these same changes occur in non‐Japanese populations and, if so, their relationship to altered basal intracellular Ca2+ ([Ca2+]B) in BLCL from BD patients.Methods:  Bipolar disorder patients and healthy subjects included 298 subjects of European Caucasian descent. The 5′‐nuclease allelic discrimination TaqMan assay was used to detect selected single nucleotide polymorphisms (SNPs) in promoter, introns and 3′UTR regions, spanning the NDUFV2 gene. NDUFV2 mRNA levels and [Ca2+]B in BLCLs were determined.Results:  The A allele of the NDUFV2 SNP rs1156044 was significantly associated (Bonferroni‐corrected) with BD (p = 0.013) but differed in allele (rs1156044 G allele) from that previously reported as associated with BD. There was a trend for elevated BLCL [Ca2+]B associated with SNP rs977581 in BD patients, but NDUFV2 mRNA levels in BLCLs did not differ between patients and controls, nor represented genotypes.Conclusions:  While genetic variants of NDUFV2 may increase risk for BD, the role of its altered expression and the link to intracellular Ca2+ abnormalities in BD remains equivocal.
Proceedings of the Symposium ‘Angiotensin AT1Receptors: From Molecular Physiology to Therapeutics’: ENDOGENOUS ANGIOTENSIN II LEVELS AND THE MECHANISM OF ACTION OF ANGIOTENSIN‐CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN RECEPTOR TYPE 1 ANTAGONISTS
Authors: Campbell Duncan J 
Published: September 2010

SUMMARYModification of endogenous angiotensin II (AngII)‐mediated processes by inhibitors of the angiotensin‐converting enzyme (ACE) and antagonists of the angiotensin type 1 (AT1) receptor is dependent upon both the levels of each agent in the plasma and tissues and on the concomitant changes in plasma and tissue AngII levels.Both ACE inhibitors and AT1receptor antagonists increase renin secretion and angiotensin peptide formation in plasma and extrarenal tissues. Clinical doses of ACE inhibitors produce incomplete inhibition of ACE and the increased AngI levels act to restore AngII towards basal levels. Clinical doses of AT1receptor antagonists produce incomplete blockade of AT1receptors and the increased AngII levels in plasma and extrarenal tissues counteract (to an unknown degree) the effects of the antagonist.The effects of ACE inhibitors and AT1receptor antagonists on AngII levels show tissue specificity. Angiotensin II‐mediated processes in the kidney are most sensitive to inhibition by these agents. ACE inhibitors reduce renal AngII levels at doses much less than those required to reduce AngII levels in plasma and other tissues. Moreover, in contrast to increased AngII levels in plasma and extrarenal tissues, renal AngII levels do not increase in response to AT1receptor antagonists. The inhibition of AngII‐mediated processes in the kidney may, therefore, play a primary role in mediating the effects of ACE inhibitors and AT1receptor antagonists on blood pressure and other aspects of cardiovascular function and structure.Combination of an ACE inhibitor with an AT1receptor antagonist prevents the rise in plasma AngII levels that occurs with AT1receptor antagonism alone. This combination would, therefore, be predicted to produce more effective inhibition of endogenous AngII‐mediated processes than either agent alone. We must await further studies to determine whether the combination of ACE inhibition and AT1receptor antagonism results in superior clinical outcomes.
Proceedings of the Symposium ‘Angiotensin AT1 Receptors: From Molecular Physiology to Therapeutics’: CYTOKINES AND CARDIAC HYPERTROPHY: ROLES OF ANGIOTENSIN II AND BASIC FIBROBLAST GROWTH FACTOR
Authors: Kaye David M , Kelly Ralph A , Smith Thomas W 
Published: September 2010

SUMMARY

While the haemodynamic influences that cause cardiac hypertrophy are well known, the cellular and molecular mechanisms by which a mechanical stimulus is translated into a growth response by cardiac muscle have remained uncertain.
Current evidence suggests that a number of trophic factors may be released by cellular constituents of the heart, acting in an autocrine or paracrine manner to influence the growth response and phenotype of neighbouring cells.
Angiotensin II, acting via the AT1 receptor subtype, and both basic fibroblast growth factor and heparin‐binding epidermal growth factor have been shown to exert hypertrophic actions in vivo and in vitro. Studies also indicate that cardiac myocytes themselves are capable of releasing all of these cytokines in response to increased mechanical load.
LACK OF INOTROPIC EFFECT OF NITRIC OXIDE ON THE RAT MYOCARDIUM
Authors: Worthley Matthew I , Horowitz John D , Zeitz Christopher J 
Published: September 2010

SUMMARY1. Nitric oxide (NO) is an important mediator of contractile function in the heart. However, isolated papillary muscle preparations appear to lack NO responsiveness in certain animal species. Although cat, guinea‐pig and ferret models have been NO responsive, there have been mixed results in the rat papillary muscle. In null form, we tested three separate hypotheses in rat papillary muscle, specifically that the NO donor sodium nitroprusside (SNP) would not affect the contractility of: (i) the isolated papillary muscle; (ii) papillary muscle prestimulated with the β‐adrenoceptor agonist isoprenaline; and (iii) papillary muscle subjected to 15 min anoxia followed by 45 min reoxygenation.2. Male Sprague‐Dawley rats were used. The left ventricular papillary muscle was mounted and maintained at 30°C and was stimulated at 10 b.p.m. Each experiment was performed in parallel with a control papillary muscle from the same animal. Papillary muscles were exposed to increasing concentrations of SNP (10−9to 10−5 mol/L) either alone or following pretreatment with 10−7 mol/L isoprenaline. Anoxia/reoxygenation was simulated by 15 min anoxia followed by 60 min reoxygenation in the presence or absence of 10−7 mol/L SNP.3. Both isometric and isotonic parameters were assessed. As expected, isoprenaline had a significant positive inotropic response. Similarly, contractility was impaired during anoxia and partially recovered during reoxygenation. Nitric oxide did not alter either isotonic or isometric parameters in the three experimental protocols.4. The rat isolated papillary muscle has no measurable response to exogenous NO. The inotropic effects of β‐adrenoceptor stimulation and anoxia/reoxygenation are NO independent.
BLOOD PRESSURE VARIABILITY, CARDIAC BAROREFLEX SENSITIVITY and ORGAN DAMAGE IN EXPERIMENTALLY HYPERTENSIVE RATS
Authors: Wang Di‐Song , Xie He‐Hui , Shen Fu‐Ming , Cai Guo‐Jun , Su Ding‐Feng 
Published: September 2010

SUMMARY1. The present study was designed to investigate the haemodynamic features and morphological changes in experimentally hypertensive rat models.2. Sprague‐Dawley rats were used to prepare the experimentally hypertensive models, including two‐kidney, one‐clip renovascular hypertensive (2K1C) rats, deoxycorticosterone acetate salt hypertensive (DOCA) rats and NG‐nitro‐l‐arginine methyl ester‐induced hypertensive (l‐NAME) rats. Six weeks after the induction of hypertension, 24 h blood pressure was recorded and blood pressure variability (BPV) expressed by 24 h (or 12 h in the daytime and night‐time study) standard deviation of the variables was calculated. Then, cardiac baroreflex sensitivity (BRS) was determined and four endogenous factors (tumour necrosis factor‐α, interleukin‐1β, angiotensin II and endothelin‐1) were measured. Finally, morphological changes were examined.3. It was found that an increase in BPV and a decrease in BRS were accompanied by an elevation of blood pressure in all three hypertensive models. The DOCA rats had the highest BPV, whereas the l‐NAME rats had the lowest BRS.4. Morphological changes were similar in DOCA and l‐NAME rats and the cardiac changes were relatively slight in 2K1C rats. Tumour necrosis factor‐α was increased in all the three models, especially in DOCA rats. Endothelin‐1 was higher in DOCA rats and angiotensin II was increased in 2K1C rats and decreased in DOCA rats.5. In conclusion, increased BPV and decreased BRS accompanied the elevation of blood pressure in all three hypertensive models. The DOCA rats had the highest BPV and the l‐NAME rats had the lowest BRS. Obvious organ damage was seen in all three hypertensive models 6 weeks after the induction of hypertension.
WAGNER‐NELSON METHOD FOR ANALYSING THE ATYPICAL DOUBLE‐PEAKED [13CO2] EXCRETION CURVE IN THE [13C]‐OCTANOATE GASTRIC EMPTYING BREATH TEST IN HUMANS
Authors: Sanaka Masaki , Yamamoto Takatsugu , Tsutsumi Hiroko , Abe Koichiro , Kuyama Yasushi 
Published: September 2010

SUMMARY1. In the [13C]‐octanoic acid breath test, the time versus pulmonary [13CO2] excretion rate curve is analysed using mathematical curve‐fitting techniques to calculate gastric emptying parameters. Thus, the goodness‐of‐fit highly influences the accuracy of the breath test. However, a double‐peaked [13CO2] excretion curve, which occasionally develops owing to the presence of an interval of quiescent gastric emptying (the plateau phase), is likely to be fitted poorly.2. In pharmacokinetics, the Wagner‐Nelson method has been used to describe precisely the absorption kinetics of orally administered drugs and its reliability is independent of the nature of gastric emptying. A recent study has shown the potential of the Wagner‐Nelson method to generate a realistic gastric emptying flow curve from [13CO2] excretion data. In the present report, we have demonstrated that the Wagner‐Nelson method can visualize the plateau emptying phase responsible for the cases of double peaks.3. Wagner‐Nelson analysis applied to the breath test described precisely the characteristic emptying pattern of the two emptying phases being interrupted by the plateau phase. Conventional analysis for the breath test failed to detect the plateau phase.4. The Wagner‐Nelson method is a useful tool for analysing atypical double‐peaking [13CO2] excretion curves.