bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of sequential hormone replacement therapy in the treatment of hypercholesterolemia among postmenopausal women
Authors: TONSTAD S. , OSE L. , GØRBITZ C. , DJØSELAND O. , BARD J. M. , FRUCHART J. C. 
Published: August 2009

Abstract. Objectives. To test the efficacy of hormone replacement therapy (HRT) and dietary therapy, compared to dietary therapy, in lowering LDL cholesterol levels among postmenopausal women.Design. A prospective parallel randomized study of sequential 17β‐oestradiol and norethisterone acetate or placebo for 48 weeks.Setting. A University outpatient lipid clinic.Subjects. A total of 76 postmenopausal women, aged 43–60 years, with LDL cholesterol level ≥ 4.2 mmol I−1 treated with a lipid‐lowering diet.Main outcome measures. Levels of lipids, lipoproteins, apolipoproteins, fibrinogen and glucose tolerance.Results. Adherence to the diet was similar in both groups. Total and LDL cholesterol levels were reduced by 14% (95% CI, 11–17%) and 19% (95% CI, 14–23%), respectively, in the HRT group vs. 3% (95% CI. 0–7%) and 5% (95% CI, 0–11%) in the diet group. HRT reduced the levels of apolipoprotein B and lipoprotein(a). Levels of HDL cholesterol, HDL2, HDL3, triglycerides, lipoprotein populations and apolipoproteins. AI and AII remained unchanged. No adverse effects on glucose tolerance or on fibrinogen levels were observed. The reduction in LDL cholesterol was positively correlated with initial levels of LDL cholesterol and negatively correlated with body mass index.Conclusions. HRT is effective in reducing elevated LDL cholesterol levels, and should be considered in the treatment of hyperlipidaemic postmenopausal women, in addition to dietary therapy.
The costs and effects of two different lipid intervention programmes in primary health care
Authors: TOMSON Y. , JOHANNESSON M. , ÅBERG H. 
Published: August 2009

Abstract. Objective. To compare the costs and effects of two different intervention strategies for the nonpharmacological treatment of hypercholesterolaemia.Design. Randomized, controlled trial. Subjects were randomly allocated to one of two intervention models and followed up for 1 year.Setting. Vårby Health Centre, a primary care practice located in a suburb of Stockholm.Subjects. Subjects with a total serum cholesterol in the range 7.0–7.8 mmol L−1 and no signs of ischaemic heart disease or diabetes mellitus, randomized to a low‐intensity (n = 35) or medium‐intensity (n = 41) intervention.Intervention. Two strategies were used, one labelled medium‐intensity strategy which followed national current guidelines for nonpharmacological treatment of hypercholesterolaemia, the other was a low‐intensity strategy.Main outcome measures. Total serum cholesterol and intervention costs.Results. Both intervention strategies resulted in small (mean 3.5%) decreases in total cholesterol with no significant difference between the groups. The cost per subject in the low‐intensity group was SEK 753 and in the medium‐intensity group SEK 3614.Conclusions. Because the effect of the two intervention programmes did not differ, the low‐intensity programme is to be preferred from a cost‐effectiveness point of view. If only one‐third of the population in Stockholm county with cholesterol levels ≥ 6.5 mmol L−1 are discovered by the primary health care system, and follow the treatment advice, the net savings in the low‐intensity model compared to the current guidelines here presented as the moderate‐intensity model, would be SEK 93 million.
Cardiovascular effects of prolonged growth hormone replacement in adults
Authors: BESHYAH S. A. , SHAHI M. , FOALE R. , JOHNSTON D. G. 
Published: August 2009

Abstract. Objectives. To study the cardiovascular effects of human growth hormone (GH) replacement therapy in adults.Intervention. Biosynthetic human GH given in a daily dose of 0.04 ± 0.01 IU kg−1 for 6–18 months in an open trial.Patients. Thirty‐four GH‐deficient hypopituitary patients on conventional replacement therapy, aged 19–67 years and with a body mass index of 18.0–410.0 kg/m2.Measurements. Resting blood pressure, exercise tolerance, renal function and routine blood counts were assessed every 6 months. Two‐dimensional echocardiography and Doppler ultrasound scanning were performed at 0, 6 and 12 months of GH therapy.Results. Exercise time increased significantly on GH from 9.37 ± 2.64min at the start to 10.39 ± 2.86 min (P < 0.001), 10.90 ± 2.48 min (P < 0.001) and 11.11 ± 0.70 min (P < 0.001) at 6, 12 and 18 months respectively. There was no change in the heart rate or in the blood pressure at rest nor at the peak of exercise. No significant changes were observed in measures of cardiac structure (left ventricular mass index, left ventricular posterior wall thickness and interventricular septal thickness), ejection fraction nor in cardiac output. Isovolumic relaxation time, a marker of diastolic function, decreased in 24 patients after 6 months on GH (from 98.6 ± 15.9 to 89.6 ± 15.2 ms; P < 0.03) but it was not different from baseline in the 18 patients who were restudied at 12 months. There was no significant change in the left ventricular filling neither at 6 nor at 12 months. No significant changes were observed in plasma electrolytes, creatinine nor in blood count on GH treatment.Conclusions. Growth hormone replacement therapy in hypopituitary adults for 6–18 months produced sustained increase in exercise tolerance but was not associated with changes in cardiac structure or systolic function.
Heterozygous familial hypercholesterolaemia: the influence of the mutation type of the low‐density‐lipoprotein receptor gene and PvuII polymorphism of the normal allele on serum lipid levels and response to lovastatin treatment
Authors: VUORIO A. F. , OJALA J.‐P. , SARNA S. , TURTOLA H. , TIKKANEN M. J. , KONTULA K. 
Published: August 2009

Abstract. Objectives. To study whether (i) the low‐density‐lipoprotein (LDL)‐receptor gene mutation type itself or (ii) the PvuII restriction‐fragment‐length polymorphism (RFLP) of the intact LDL‐receptor gene affects serum lipid levels and their responses to lovastatin treatment in heterozygous familial hypercholesterolaemia (FH).Design. Comparison of serum lipid levels in 149 heterozygous FH patients, including 79 patients with the FH Helsinki gene and 70 patients with the FH North Karelia gene, grouped according to the PvuII RFLP status of their nonmutated LDL‐receptor allele; studies of lovastatin responses in 23 FH patients with different mutation types.Subjects. Molecularly defined heterozygous FH patients.Interventions. DNA analysis by polymerase chain‐reaction assay (PCR) and Southern blotting, fasting serum lipid measurements in all patients, and administration of lovastatin 40–80 mg daily to 16 FH Helsinki patients and seven FH North Karelia patients.Main outcome measures. Baseline and post‐treatment serum cholesterol, LDL cholesterol, high‐density‐lipoprotein (HDL) cholesterol and triglyceride levels.Results. There were no significant differences in serum total or LDL‐cholesterol levels in FH patients with the FH Helsinki gene compared with those carrying the FH North Karelia gene. Regardless of the mutation type, patients without the PvuII site in the normal LDL‐receptor gene (P – subjects) tended to have 6–8% higher serum and LDL‐cholesterol levels than patients possessing this restriction site (P + subjects). Although not statistically significant, this difference is qualitatively and quantitatively similar to that reported in three different non‐FH populations. Treatment with lovastatin brought about similar hypolipidaemic responses in FH patients with either mutation type (FH Helsinki or FH North Karelia) or PvuII RFLP status (P + or P –).Conclusions. Two LDL‐receptor gene mutations with dissimilar phenotypic characteristics are associated with similar serum lipid levels and response to statin treatment. Our data also support the previous assumption that the PvuII RFLP of the LDL‐receptor gene locus is associated with variation of serum cholesterol levels.
Iron deficiency and iron overload in Swedish male adolescents
Authors: OLSSON K. S. , MARSELL R. , RITTER B. , OLANDER B. , ÅKERBLOM Å. , ÖSTERGÅRD H. , LARSSON O. 
Published: August 2009

Abstract.Objectives. The present study was undertaken to confirm or reject recent findings indicating a high prevalence of iron deficiency in Swedish male adolescents; a second aim was to study the prevalence of genetic iron overload.Design. The diagnostic criteria were: anaemia: Hb < 130 g L−1(a); iron deficiency: serum ferritin (SF) < 12 μg L−1+ transferrin saturation (TS) < 16% (b); iron deficiency anaemiaa + b.Iron overload: SF (90th percentile) + TS (90th percentile) in repeat tests.Setting. Central Sweden.Subjects. A total 3975 men aged 18 years studied on enrollment into military service.Results. Serum ferritin averaged 36.8 μg L−1. Anaemia was present in 0.5%, iron deficiency anaemia in 0.17% and iron deficiency in 0.4%. If iron deficiency is defined as SF < 16 μg L−1, as was recently suggested, the prevalence would be 2.8%. Such a cut‐off value would include 73% normal people (false positives). Iron overload had the same prevalence as iron deficiency, 0.4%.Conclusions. Iron stores, as measured by serum ferritin, are small in young men studied at the end of their growth spurt. However, iron deficiency is rare. Therefore, the present study has not been able to confirm the high prevalence of iron deficiency recently reported. A prevalence of genetic haemochromatosis of 0.4%, confirms earlier findings and would mean that 12.6% of the population are heterozygotic carriers of the iron‐loading genes. These findings give no support for a proposed, more effective iron‐enrichment of food. It is not needed and can be harmful.
Leucocyte doubling time is a useful predictor of progression‐free survival in chronic lymphocytic leukaemia
Authors: AXDORPH U. , NILSSON B. I. , NILSSON B. R. , BJÖRKHOLM M. 
Published: August 2009

Abstract. Objective. To assess leucocyte doubling time (LDT) in relation to progression‐free survival in patients with chronic lymphocytic leukaemia (CLL). In addition, to define the impact of a second LDT in both untreated and treated patients.Design. Retrospective study of LDT in previously untreated patients with CLL.Subjects and setting. Sixty patients diagnosed over a 13‐year period at a county hospital. In forty‐five of the 60 patients, an LDT could be defined. These patients were included in the final analysis.Main outcome measures. LDT below and above 12 months, progression‐free and overall survival.Results. Patients in Binet stages B and C had a median LDT of 4 months as compared to 26 months in stage A patients (P < 0.01). The projected progression‐free survival at 3 years was 24% in patients with an LDT of < 12 months. The corresponding figure for the remaining patients was 68% (P < 0.01). The overall 5‐year survival did not differ significantly between patients with an LDT below and above 12 months, respectively. In seven untreated patients, a second LDT could be calculated which was shorter than the first recorded LDT. A second LDT was also identified in five patients post treatment that was consistently shorter than their first LDT.Conclusions. Measurement of LDT is a simple complement in predicting progression‐free survival in patients with CLL. Thus, monitoring of LDT may add to the clinical evaluation and therapeutic decision making for the many elderly patients with this often indolent disease.
Iron status markers during pregnancy No relationship between levels at the beginning of the second trimester, prior to delivery and post partum
Authors: Milman N. , Graudal N. , Agger A. O. 
Published: August 2009

Abstract. Objective. To evaluate whether levels of iron status markers (haemoglobin, serum transferrin saturation, serum ferritin) in pregnant women, measured in the beginning of the second trimester, could be used to predict levels later in pregnancy, pre partum and post partum.Design. Randomized, double‐blind, placebo‐controlled parallel study.Setting. The Birth Clinic at the Department of Obstetrics, Herning Hospital, Herning, Denmark.Subjects. One hundred and twenty healthy pregnant women between 14 and 18 weeks of gestation.Interventions. Sixty‐three women were allocated to treatment with tablets containing 66 mg ferrous iron (as fumarate) daily, and 57 women to treatment with placebo.Main outcome measures. Haemoglobin, serum transferrin saturation, and serum ferritin were measured every 4th week during gestation, prior to delivery, and 1 and 8 weeks post partum.Results. Correlation matrices during pregnancy and post partum were calculated for each iron status marker separately in iron‐treated and placebo‐treated women. Haemoglobin, transferrin saturation and serum ferritin values at inclusion displayed steadily declining correlation coefficients with values obtained later in pregnancy. There were no clinically relevant correlations to values obtained 8 weeks or less prior to delivery, and no correlations to values post partum. Serum ferritin values at inclusion could not be used to predict values later in pregnancy or post partum.Conclusion. Haemoglobin, transferrin saturation and serum ferritin values measured in the beginning of the second trimester appear to be unsuitable as guidelines for an individual iron prophylaxis in pregnant women.
Clinical effects of octreotide compared to placebo in patients with gastrointestinal neuroendocrine tumours Report on a double‐blind, randomized trial
Authors: Jacobsen M. B. , Hanssen L. E. 
Published: August 2009

Abstract. Objectives. To compare the effect of octreotide with placebo on symptoms, tumour marker and quality of life in patients with gastrointestinal neuroendocrine tumours and liver metastases.Design. A blinded, placebo‐controlled, cross‐over study was performed. The number of flushing epidodes and diarrhoea episodes were registered for 1 week prior to the study and for the 8‐week duration of the study. Quality of life and 24‐h urinary 5‐hydroxyindoleacetic acid (5‐HIAA) excretion were measured before the start, and at 4 and 8 weeks. Quality of life was registered with the Psychosocial Adjustment to Illness Scale (PAIS) and 5‐HIAA measured by high‐performance chromatography with electrochemical detection. 5‐HIAA values exceeding 45 μmol 24 h−1 were considered to be elevated.Setting. The study was performed in a tertiary referral centre.Subjects. Twelve patients were approached; eleven patients were included, with a mean age of 56.5 (range 30–72) years. The primary tumour originated from the small intestine in nine and from the pancreas in two patients. The main symptoms were diarrhoea, flushing and nausea. The 24‐h excretion of 5‐HIAA was increased in all patients.Interventions. Patients were treated for 4 weeks with octreotide (100 μg) subcutaneously, twice daily, and for 4 weeks on placebo (octreotide vehicle) in random starting order.Main outcome measures. The main outcome measures were the number of episodes of the main clinical symptom(s) and 24‐h 5‐HIAA excretion.Results. Octreotide lowered diarrhoea and flushing frequency significantly compared to placebo. 5‐HIAA excretion was reduced during treatment with the active drug. Two domains of the PAIS were significantly improved, indicating that the reduction of tumour marker and symptoms were clinically important.Conclusions. The clinical effect of octreotide on symptoms in patients with neuroendocrine tumours was demonstrated in a controlled, prospective trial.
Predictors of mortality in hospitalized patients with secondary upper gastrointestinal haemorrhage
Authors: ZIMMERMAN J. , MEROZ Y. , ARNON R. , TSVANG E. , SIGUENCIA J. 
Published: August 2009

Abstract. Objectives. To identify clinical, laboratory and endoscopic features of prognostic implication in patients who suffer an upper gastrointestinal haemorrhage whilst hospitalized for other causes.Design/setting. A prospective longitudinal study of 125 consecutive cases (89 males, 36 females) seen during 1988–1991 in a tertiary care university hospital.Main outcome measures. The crude and adjusted relative risk of mortality associated with each of the various clinical, laboratory and endoscopic variables.Results. The rates of endoscopic haemostasis, persistent or recurrent bleeding and surgery to control bleeding were 48, 37 and 12%, respectively; the overall mortality was 28%. A significantly increased risk of mortality was associated with shock prior to onset of bleeding, sepsis, renal failure, cirrhosis, encephalopathy, presence of red blood in the nasogastric aspirate or per rectum, thrombocytopenia, hypoalbuminaemia, elevation of serum bilirubin, aminotransferases or urea levels, endoscopic evidence of active bleeding, the application of endoscopic haemostasis, rebleeding, transfusion of ≥ 6 units of blood, surgical treatment or any subsequent complication. Use of nonsteroidal anti‐inflammatory drugs (27%) was associated with a decreased mortality risk (odds ratio 0.2; P = 0.03). A multivariate analysis showed that the features at presentation which were independently associated with an increased risk of mortality were: a history of cirrhosis, sepsis, shock prior to onset of bleeding, hypoalbuminaemia and elevated serum aminotransferases.Conclusion. The prognosis of secondary upper gastrointestinal haemorrhage depends on the underlying diseases and on the general condition of the patient, rather than on the actual cause of bleeding.
The prevalence of alcoholism and its relation to cause of hospitalization and long‐term mortality in male somatic inpatients
Authors: WALLERSTEDT S. , DENISON H. , SANDSTRÖM J. , WESTIN J. 
Published: August 2009

Abstract. Objective. To investigate the prevalence of alcoholism in patients hospitalized because of somatic disorders, and to analyse morbidity, mortality, and causes of death in those alcoholics.Design. Inception cohort, 7‐year follow‐up.Setting. Primary and secondary care clinics at a community hospital in Göteborg, Sweden.Patients and controls. A convenience sample of all 205 men hospitalized at a medical, surgical, and orthopaedic clinic at a random time‐point. The diagnosis of alcoholism was stated or rejected by means of structured interviews about drinking habits and by scrutiny of records from the hospital, psychiatric clinics, and social authorities. In the study of morbidity pattern and mortality in the alcoholics (n = 52), age‐matched, non‐alcoholic controls were recruited from the same sample.Main outcome measures. Prevalence of alcoholism; distribution of somatic disorders as cause of hospitalization at inclusion; mortality and risk ratio of death using the death hazard function of the groups compared with that of men of the same age‐distribution in the Swedish population; causes of death during a 7‐year follow‐up.Main results. Fifty‐two of the 205 hospitalized men (25%) were alcoholics and 16 of these men (31%) were treated for an alcohol‐related disorder. During follow‐up, the mortality rate was about 50% both in the alcoholic and in the control groups. The risk of death ratio was 5.0 [95% confidence interval (CI), 2.9 to 8.3] in the alcoholics and 3.9 (95% CI, 2.2 to 6.4) in the controls. Death from trauma, intoxication, and liver failure occurred exclusively in the alcoholics and accounted for almost one‐third of the deaths after discharge.Conclusions. Alcoholism was found in every fourth male somatic inpatient, and an alcohol‐related disorder was the cause of hospitalization in one‐third of these men. The long‐term prognosis did not differ from that in non‐alcoholic patients. In the treatment of alcoholics with somatic disorders, it is important to take measures against alcoholism as well.
The role of potassium in postural hypotension: electrolytes and neurohumoral factors in elderly hypertensive patients using diuretics
Authors: Luutonen Sinikka , NEUVONEN P. , RUSKOAHO H. , RÄIHÄ I. , RAJALA T. , ANTILA K. , SOURANDER L. 
Published: August 2009

Abstract. Objective. To study the association between postural hypotension and (i) electrolyte levels and (ii) neurohumoral factors in elderly hypertensive patients using diuretics.Design. Cross‐sectional study of patients and controls.Setting. The subjects were gathered from senior citizen clubs or they were referred to the study by general practitioners. The subjects were examined on a geriatric ward in Turku City Hospital.Subjects. Seven subjects with postural hypotension and 13 controls.Measurements. Plasma electrolyte levels and neurohumoral response to head‐up tilt.Results. There were significantly more hypokalemic subjects in the postural hypotension group (5/7) than in the control group (1/13) (P < 0.01). The plasma potassium level was negatively correlated to plasma aldosterone (r = –0.57; P < 0.01) and renin activity (r = –0.69; P < 0.001). Subjects with postural hypotension had higher levels of noradrenaline, both supine (P < 0.05) and during tilt (P < 0.05). There were no significant differences in supine or tilt levels of plasma adrenaline, vasopressin, atrial natriuretic peptide, aldosterone and renin activity between the groups.Conclusion. The results suggest that potassium depletion is associated with postural hypotension in elderly hypertensive patients using diuretics. However, it is unclear whether there is a causative link between potassium depletion and postural hypotension or whether they are both caused by some other factor, e.g. volume contraction.
Genetic analysis of xenocoumacin antibiotic production in the mutualistic bacterium Xenorhabdus nematophila
Authors: Park Dongjin , Ciezki Kristin , Van Der Hoeven Ransome , Singh Swati , Reimer Daniela , Bode Helge B. , Forst Steven 
Published: August 2009

SummaryXenocoumacin 1 (Xcn1) and xenocoumacin 2 (Xcn2) are the major antimicrobial compounds produced by Xenorhabdus nematophila. To study the role of Xcn1 and Xcn2 in the life cycle of X. nematophila the 14 gene cluster (xcnA–N) required for their synthesis was identified. Overlap RT‐PCR analysis identified six major xcn transcripts. Individual inactivation of the non‐ribosomal peptide synthetase genes, xcnA and xcnK, and polyketide synthetase genes, xcnF, xcnH and xcnL, eliminated Xcn1 production. Xcn1 levels and expression of xcnA–L were increased in an ompR strain while Xcn2 levels and xcnMN expression were reduced. Xcn1 production was also increased in a strain lacking acetyl‐phosphate that can donate phosphate groups to OmpR. Together these findings suggest that OmpR‐phosphate negatively regulates xcnA–L gene expression while positively regulating xcnMN expression. HPLC‐MS analysis revealed that Xcn1 was produced first and was subsequently converted to Xcn2. Inactivation of xcnM and xcnN eliminated conversion of Xcn1 to Xcn2 resulting in elevated Xcn1 production. The viability of the xcnM strain was reduced 20‐fold relative to the wild‐type strain supporting the idea that conversion of Xcn1 to Xcn2 provides a mechanism to avoid self‐toxicity. Interestingly, inactivation of ompR enhanced cell viability during prolonged culturing.