bluuebunny/crossref_metadata_2025_split huggingface dataset:
Na+–K+–2Cl− cotransporter is implicated in gender differences in the response of the rat aorta to phenylephrine
Authors: Palacios Javier , Espinoza Francisco , Munita Carolina , Cifuentes Fredi , Michea Luis 
Published: June 2006

Inhibition of the Na+–K+–2Cl− cotransporter (NKCC1) with bumetanide reduced contractile responses to phenylephrine (PE) in male rat aortas (129±4% of 60 mM KCl‐induced contraction control vs 108±7% bumetanide; PE 10−5 M; P<0.01) but did not change equivalent responses in female rat aortas. Removal of the endothelium blunted the effect of NKCC1 inhibition on the response to PE (10−5 M) in males, whereas in denuded aorta from female rats, bumetanide reduced this response (162±5% control vs 146±3% bumetanide; P<0.05).
NKCC1 basal activity did not show gender differences in intact aortic rings, but in the presence of PE, bumetanide‐sensitive 86Rb+/K+ uptake increased more in male than female aortas (179±8 in males vs 158±5 nmol 86Rb+/K+ min−1 (g aorta)−1 in females; P<0.05). PE did not stimulate NKCC1 activity in denuded aorta from male rats. However, in female rats, PE increased NKCC1 activity similarly in both denuded (169±11 nmol 86Rb+/K+ min−1 (g aorta)−1) and intact aortas.
Ovariectomy increased the bumetanide‐sensitive 86Rb+/K+ uptake increase elicited by PE (223±17 nmol 86Rb+/K+ min−1 (g aorta)−1) and hormone replacement with 17β‐estradiol prevented this effect (159±29 nmol 86Rb+/K+ min−1 (g aorta)−1).
Na+,K+‐ATPase basal activity, measured as ouabain‐sensitive 86Rb+/K+ uptake, was similar in male and female rats, but the effect of PE was significantly less in intact male aortas (232±16 in males vs 296±25 nmol 86Rb+/K+ min−1 (g aorta)−1 in females; P<0.05).
Our results suggest that PE induced activation of NKCC1 and Na+,K+‐ATPase in the rat aorta in a gender‐dependent way.

British Journal of Pharmacology (2006) 148, 964–972. doi:10.1038/sj.bjp.0706818
The efficacy of corticosteroid therapy in inflammatory bowel disease: analysis of a 5‐year UK inception cohort
Authors: HO G.‐T. , CHIAM P. , DRUMMOND H. , LOANE J. , ARNOTT I. D. R. , SATSANGI J. 
Published: June 2006

SummaryBackgroundCorticosteroids remain the mainstay of first‐line therapy in active inflammatory bowel disease.AimsTo determine the clinical outcome after the first corticosteroid‐therapy and to identify factors which predict response/failure.Methods216 (136 ulcerative colitis and 80 Crohn's disease) patients were identified in this 5‐year inception cohort. The outcomes of early (30 days) and late (1 year) responses were used. Multivariate analyses were performed to identify factors associated with outcome.Results86 (63%) and 60 (75%) ulcerative colitis and Crohn's disease required corticosteroid therapy, respectively. In ulcerative colitis, at 30 days, 69 (51%), 42 (31%) and 25 (18%) patients demonstrated complete response, partial response and no response, respectively. For Crohn's disease, these outcomes were observed in 32 (40%), 28 (35%) and 20 (25%). After 1 year, 75 (55%), 23 (17%) and 29 (21%) patients with ulcerative colitis demonstrated prolonged response, corticosteroid‐dependence or required surgery, respectively. For Crohn's disease, these outcomes were observed in 30 (38%), 19 (24%) and 27 (35%) patients. Extensive ulcerative colitis was a predictor of surgery (P = 0.001, OR: 15.2). In Crohn's disease, inflammatory disease behaviour was negatively associated with surgery (P = 0.02, OR: 0.13).ConclusionAlthough corticosteroids are effective, dependence/resistance remains common. Patients with extensive ulcerative colitis and fistulizing/stricturing Crohn's are most at risk of failing corticosteroid therapy.
Adverse events leading to modification of therapy in a large cohort of patients with inflammatory bowel disease
Authors: HINDORF U. , LINDQVIST M. , HILDEBRAND H. , FAGERBERG U. , ALMER S. 
Published: June 2006

SummaryBackgroundAdverse events leading to discontinuation or dose reduction of thiopurine therapy occur in 9–28% of patients with inflammatory bowel disease.AimsTo evaluate the influence of thiopurine methyltransferase status and thiopurine metabolites in a large patient population for the risk of developing adverse event.MethodsThree hundred and sixty‐four patients with inflammatory bowel disease and present or previous thiopurine therapy were identified from a local database.ResultsThe adverse event observed in 124 patients (34%) were more common in adults than children (40% vs. 15%; P < 0.001) and in low to intermediate (≤9.0 U/mL red blood cell) than normal thiopurine methyltransferase activity (P = 0.02). Myelotoxicity developed later than other types of adverse event. An increased frequency of adverse event was observed in patients with tioguanine (thioguanine) nucleotide above 400 or methylated thioinosine monophosphate above 11 450 pmol/8 × 108 red blood cell. A shift to mercaptopurine was successful in 48% of azathioprine‐intolerant patients and in all cases of azathioprine‐induced myalgia or arthralgia.ConclusionsA pre‐treatment determination of thiopurine methyltransferase status might be appropriate as patients with low to intermediate thiopurine methyltransferase activity are more prone to develop an adverse event; determination of metabolite levels can be useful in the case of an adverse event. Mercaptopurine therapy should be considered in azathioprine‐intolerant patients.
Infliximab therapy in Crohn's disease: a pragmatic approach?
Authors: KEVANS D. , KEEGAN D. , MULCAHY H. E. , O'DONOGHUE D. P. 
Published: June 2006

SummaryBackgroundInfliximab is recognized as an effective therapy in unresponsive luminal and fistulating Crohn's disease. The use of maintenance or ‘on demand’ therapy thereafter is controversial.AimTo assess the need for maintenance infliximab therapy in a clinical setting where immunomodulatory agents are widely used and where episodic therapy is used in preference to maintenance therapy.MethodsNinety‐three patients with Crohn's disease receiving infliximab; 72 with unresponsive luminal disease and 21 with fistulous disease. Data collected included disease site and duration, surgical and smoking history, initial response rates, duration of response maintenance and concomitant medications.ResultsFifty‐six of 72 (78%) patients with luminal disease and 11 of 21 (52%) with fistulous disease achieved an initial response. Ten of 67 responders required conversion to maintenance infliximab infusions, while 31 remain in remission. Patients with luminal disease and those who had not taken previous surgery had higher response rates to infliximab. Younger patients and those with small bowel disease had higher relapse rates following initial response. Three patients developed allergic reactions to infliximab and one patient died of progressive pulmonary disease 6 weeks after their first infusion.ConclusionsMany patients with Crohn's disease can be maintained successfully with an episodic infliximab regimen.
Review article: moderate sedation for endoscopy: sedation regimens for non‐anaesthesiologists
Authors: REX D. K. 
Published: June 2006

SummaryBackgroundModerate sedation is a drug‐induced depression of consciousness during which patients respond purposefully to verbal commands with or without light tactile stimulation. Moderate sedation is typically accepted in the anaesthesia community as an appropriate target for sedation by non‐anaesthesiologists.AimTo describe drug regimens that can be successfully and safely targeted to moderate sedation for endoscopy by non‐anaesthesiologists.ResultsModerate sedation can be achieved using narcotics and benzodiazepines. There is interest in some countries in propofol for endoscopy, which is often viewed as an agent for deep sedation. Indeed, propofol cannot be targeted to moderate sedation for endoscopy as a single agent because of coughing during upper endoscopy and pain withdrawal responses during colonoscopy. Pre‐treatment with low doses of narcotic and/or benzodiazepine blocks these effects, allowing propofol to be targeted to moderate sedation. Fospropofol, a prodrug of propofol in clinical development, can also be targeted to moderate sedation if co‐administered with narcotic.ConclusionModerate sedation provides a safety margin when compared with deep sedation and general anaesthesia. Development of protocols that target agents such as propofol to moderate sedation will expand the sedation agents available to non‐anaesthesiologists and help ensure that this expansion occurs safely.
Oesophageal acid exposure and altered neurocardiac function in patients with GERD and idiopathic cardiac dysrhythmias
Authors: CUOMO R. , DE GIORGI F. , ADINOLFI L. , SARNELLI G. , LOFFREDO F. , EFFICIE E. , VERDE C. , SAVARESE M. F. , USAI P. , BUDILLON G. 
Published: June 2006

SummaryBackgroundOesophageal sensory stimuli alter neurocardiac function through autonomic reflexes.AimTo evaluate in patients with idiopathic supraventricular cardiac dysrhythmias and gastro‐oesophageal reflux disease (GERD) whether GE reflux alters neurocardiac function and the effect of acid suppression on cardiac symptoms.MethodsThirty‐two patients (13 females and 19 males; age: 20–69 years) with dysrhythmias plus GERD, and nine patients (five females and four males; age: 43–58 years) with GERD only, underwent simultaneous 24‐h pH‐metry and ECG monitoring. Power spectrum analysis of heart rate variability (PSHRV) was obtained with both its low frequency (LF, sympathetic modulation) and high frequency (HF, vagal modulation) components. Hourly mean oesophageal pH and LF/HF ratio were correlated. A 3 months full‐dosage PPI therapy (esomeprazole 40 mg/day) was prescribed.ResultsIn 18 (56%) of the 32 patients with dysrhythmia and in none with GERD only, a significant (P < 0.05) correlation between oesophageal pH and LF/HF ratio (oesophagus–heart correlation) was observed. A significant reduction of cardiac symptoms after PPI therapy was observed only in these patients (13/16 vs. 4/11,P < 0.01).ConclusionsThis study has identified a subgroup of dysrhythmic patients in whom the oesophageal acid stimulus elicited cardiac autonomic reflexes. In these patients acid suppression seems to improve GERD and cardiac symptoms.
Cyclophosphamide pulse therapy followed by azathioprine or methotrexate induces long‐term remission in patients with steroid‐refractory Crohn's disease
Authors: SCHMIDT C. , WITTIG B. M. , MOSER C. , ZEITZ M. , STALLMACH A. 
Published: June 2006

SummaryBackgroundIn patients with steroid‐refractory Crohn's disease, the therapeutic goal is to achieve both rapid remission and maintenance of clinical response.AimTo evaluate the long‐term benefit in patients treated with cyclophosphamide pulse therapy and azathioprine or methotrexate, a combination shown to be effective in a recent pilot study.MethodsSixteen patients with acute steroid‐refractory Crohn's disease participated in a prospective open‐labelled uncontrolled pilot study between December 1998 and June 2003. All had a median number of 4 monthly pulses of intravenous cyclophosphamide (750 mg) and were followed until relapse of the disease.ResultsThirteen of 16 patients (81%) achieved remission within 8 weeks after two pulses of cyclophosphamide in combination with azathioprine or methotrexate, with a Crohn's Disease Activity Index decrease from 294 to 111 (median). Remission sustained for 19 months (median, range: 1–45). Moreover, eight patients with pyoderma gangrenosum and erythema nodosum who responded to cyclophosphamide have maintained their remission for up to 30 months.ConclusionsIn steroid refractory patients with Crohn's disease, cyclophosphamide is highly effective to induce remission. This uncontrolled study indicates that cyclophosphamide‐induced remission is long‐lasting under standard immunosuppressive therapy.
Prevalence and management of abdominal cramping and pain: a multinational survey
Authors: QUIGLEY E. M. M. , LOCKE G. R. , MUELLER‐LISSNER S. , PAULO L. G. , TYTGAT G. N. , HELFRICH I. , SCHAEFER E. 
Published: June 2006

SummaryBackgroundThough functional gastrointestinal complaints are recognised as being common throughout the world, there have been few comparative studies of prevalence.AimTo compare the prevalence and management of abdominal cramping/pain in nine countries.MethodsIn a two‐stage community survey, approximately 1000 subjects were interviewed in each of nine countries to establish the demographics of individuals with abdominal cramping/pain (stage 1) followed by market research‐driven interviews with ≥200 sufferers per country (stage 2).Results9042 subjects were interviewed in stage 1. Mexico (46%) and Brazil (43%) had the highest prevalence of abdominal cramping/pain; Japan the lowest (10%). Abdominal cramping/pain was more common in women (12–55%) than in men (7–38%).About 1717 subjects participated in stage 2; 65% were women and the average age at symptom onset was 29 years. The frequency of episodes differed between countries, being highest in the US (61% suffered at least once in a week). Sufferers in the US and Latin America reported a higher usage of medications (around 90%) than those in Europe (around 72%). In most countries over‐the‐counter drugs were principally used. Antispasmodic drugs were most popular in Latin America and Italy, antacids in Germany and the UK. Drug therapy decreased the duration of episodes (by up to 81% in Brazil).ConclusionsThe community prevalence, severity, healthcare seeking and medication usage related to abdominal cramping/pain are high overall, but vary considerably between countries.
Systematic review: the treatment of anal fissure
Authors: STEELE S. R. , MADOFF R. D. 
Published: June 2006

SummaryBackgroundAnal fissure is one of the most common anorectal conditions encountered in clinical practice. Most patients experience anal pain with defecation and minor bright red rectal bleeding, allowing a focused history to direct the evaluation.MethodsA systematic medical literature search of NIH, Pubmed, and MEDLINE using the search terms anal fissure, sphincterotomy, anal surgery and anal fissure medical therapy. English language was not a restriction. Cited references were used to find additional studies.ResultsNo single treatment is the best choice for all patients. Because pharmacological therapy is not associated with permanent alterations in continence, a trial of either a topical sphincter relaxant or botulin toxin injection, along with adequate fluid and fibre intake, is a reasonable option. However, because pharmacological therapy has lower healing and higher relapse rates, surgery can be offered in the first instance to patients without incontinence risk factors who have severe, unrelenting pain and are willing to accept a small risk of incontinence, for the highest likelihood of prompt healing and the lowest risk of recurrence.ConclusionsBoth non‐operative and operative approaches currently exist for the management of anal fissure. Improved non‐surgical therapies may continue to lessen the role of sphincter‐dividing surgery in future.
Guidelines for capsule endoscopy: diagnoses will be missed
Authors: MAKINS R. , BLANSHARD C. 
Published: June 2006

SummaryBackgroundCapsule endoscopy represents a significant advance in the investigation of intestinal disease. National Institute of Health and Clinical Excellence, European Society of Gastrointestinal Endoscopy and American Society for Gastrointestinal Endoscopy guidelines support capsule endoscopy in obscure GI bleeding, Crohn's disease and the evaluation of non‐steroidal anti‐inflammatory drug side‐effects, polyposis syndromes and coeliac disease.AimTo determine whether the application of guidelines leads to missed diagnoses that would have been made if less stringent indications were adopted.MethodsRetrospective analysis of 100 consecutive unselected capsule endoscopy examinations at Homerton Hospital, from October 2003 to November 2005. All referrals accepted following traditional investigations. Indications and findings were recorded. Comparison made as to whether diagnoses would have been missed if guidelines had been followed and capsule endoscopy not performed.ResultsAmong the subjects 37 patients were children and 55 were male. Indications included recurrent bleeding and anaemia, assessment of Crohn's disease, ‘others’, i.e. assessment of coeliac disease, Peutz‐Jehgers syndrome, Blue Rubber Bleb syndrome or non‐specific abdominal pain. In patients with coeliac disease, widespread enteropathy was confirmed, with additional diagnoses of delayed gastric emptying and colitis. For those with abdominal pain findings included angiodysplasia, lymphoid hyperplasia and distal small bowel ulcers.ConclusionsCapsule endoscopy in patients with non‐conventional indications yielded abnormal pathology, such as ulcers and inflammation. If published guidelines had been followed such diagnoses would have been missed.
Randomized trial of rifabutin‐based triple therapy and high‐dose dual therapy for rescue treatment of Helicobacter pylori resistant to both metronidazole and clarithromycin
Authors: MIEHLKE S. , HANSKY K. , SCHNEIDER‐BRACHERT W. , KIRSCH C. , MORGNER A. , MADISCH A. , KUHLISCH E. , BÄSTLEIN E. , JACOBS E. , BAYERDÖRFFER E. , LEHN N. , STOLTE M. 
Published: June 2006

SummaryBackgroundThe clinical management of Helicobacter pylori infected patients who failed standard eradication therapies remains a challenge.AimTo investigate the efficacy of rifabutin‐based triple therapy and high‐dose dual therapy for rescue treatment of H. pylori, and the correlation between cytochrome P450 2C19 (CYP2C19) polymorphisms and treatment outcome.MethodsPatients infected with H. pylori resistant to both metronidazole and clarithromycin (n = 145) were randomized to either esomeprazole 20 mg, rifabutin 150 mg and amoxicillin 1 g, each given b.d. for 7 days (ERA), or to omeprazole 40 mg and amoxicillin 1000 mg, each given t.d.s. for 14 days (OA). Crossover therapy was offered in cases of persistent infection. CYP2C19 polymorphisms were determined by polymerase chain reaction restriction fragment length polymorphism.ResultsIntention‐to‐treat and per‐protocol eradication rates were: ERA 74% (62.4–83.6) and 78% (66.7–87.3); high‐dose OA 70% (57.5–79.7) and 75% (62.5–84.5). Crossover therapy was successful in seven of 10 patients with ERA and in eight of 10 patients with OA. Premature discontinuation of treatment occurred in 2% and 5% of patients, respectively. There was only a non‐significant trend to lower eradication rates in homozygous extensive metabolizers.ConclusionsTriple therapy with esomeprazole, rifabutin and amoxicillin and high‐dose omeprazole/amoxicillin are comparable and effective and safe for rescue therapy of H. pylori regardless of the patient's CYP2C19 genotype.
Systematic review and meta‐analysis: importance of CagA status for successful eradication of Helicobacter pylori infection
Authors: SUZUKI T. , MATSUO K. , SAWAKI A. , ITO H. , HIROSE K. , WAKAI K. , SATO S. , NAKAMURA T. , YAMAO K. , UEDA R. , TAJIMA K. 
Published: June 2006

SummaryBackgroundSome, but not all studies have provided evidence that the CagA status of Helicobacter pylori strains is a predictive factor for the outcome of eradication therapy.AimTo clarify the association between CagA status and eradication outcome.MethodsWe included studies reporting the numbers of successful and failed cases in H. pylori‐eradication therapy according to the CagA status. Fourteen studies (1529 patients) were included of 325 articles identified in the search. The pooled risk ratio for H. pylori‐eradication failure in CagA‐negative relative to CagA‐positive strains and the pooled risk difference in eradication success between the two groups were used as summary statistics. Meta‐regression was used for examining the source of heterogeneity.ResultsThe summary risk ratio for eradication failure in CagA‐negative relative to CagA‐positive was 2.0 (95% CI: 1.6–2.4, P < 0.001), corresponding with the summary risk difference for eradication success between the groups of 11% (95% CI: 3–19%, P = 0.011). Meta‐regression analysis demonstrated that usage of polymerase chain reaction examination for CagA status and a high proportion of non‐ulcer dyspepsia patients were factors for heterogeneity among studies.ConclusionsOur meta‐analysis confirmed the importance of the presence of CagA as a predictor for successful eradication of H. pylori.
Therapeutic hypothermia after cardiac arrest: a survey of practice in intensive care units in the United Kingdom
Authors: Laver S. R. , Padkin A. , Atalla A. , Nolan J. P. 
Published: June 2006

SummaryA telephone survey was carried out on the use of hypothermia as part of the management of unconscious patients following cardiac arrest admitted to United Kingdom (UK) intensive care units (ICUs). All 256 UK ICUs listed in the Critical Care Services Manual 2004 were contacted to determine how many units have implemented therapeutic hypothermia for unconscious patients admitted following cardiac arrest, how it is implemented, and the reasons for non‐implementation. Two hundred and forty‐six (98.4%) ICUs agreed to participate. Sixty‐seven (28.4%) ICUs have cooled patients after cardiac arrest, although the majority of these have treated fewer than 10 patients. The commonest reasons given for not using therapeutic hypothermia in this situation are logistical or resource issues, or the perceived lack of evidence or consensus within individual ICU teams.
Emergency Caesarean section: best practice*
Authors: Levy D. M. 
Published: June 2006

SummaryGood multidisciplinary communication is crucial to the safe management of women requiring non‐elective Caesarean section. Anaesthetists should participate actively in resuscitation of the fetus in utero; relief of aortocaval compression is paramount. Epidural top‐up with levobupivacaine 0.5% is the anaesthetic of choice for women who have been receiving labour epidural analgesia. If epidural top‐up fails to provide bilateral light touch anaesthesia from S5 – T5, a combined spinal‐epidural technique with small intrathecal dose of local anaesthetic is a useful approach. Pre‐eclampsia is not a contra‐indication to single‐shot spinal anaesthesia, which is the technique of choice for most women presenting for Caesarean section without an epidural catheter in situ. Induction and maintenance doses of drugs for general anaesthesia should not be reduced in the belief that the baby will be harmed. Early postoperative observations are geared towards the detection of overt or covert haemorrhage.
Bronchial mucus transport velocity in patients receiving anaesthesia with propofol and morphine or propofol and remifentanil
Authors: Ledowski T. , Hilmi S. , Paech M. J. 
Published: June 2006

Summary In vitro morphine does not reduce cilia beat frequency, a key factor determining bronchial mucus transport velocity. There are no reports about the effect of remifentanil on bronchial mucus transport. We compared the bronchial mucus transport velocity in patients having total intravenous anaesthesia with either propofol and morphine, or propofol and remifentanil. Twenty patients scheduled for elective surgery were randomly allocated to the two groups. Fifteen minutes after insertion of the laryngeal mask airway, bronchial mucus transport velocity was assessed by fibreoptic observation of the movement of methylene blue dye applied to the right main bronchus. Compared with morphine, bronchial mucus transport velocity was significantly reduced in patients receiving remifentanil (morphine mean (SD) 9.2 (5.8) vs remifentanil 4.2 (3.0) mm.min−1, p = 0.028). Anaesthesia with remifentanil may lead to significantly impaired bronchociliary clearance in comparison to morphine. This could have clinical implications, in particular in patients at risk.