bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bone demineralization in adult thalassaemic patients: contribution of GH and IGF‐I at different skeletal sites
Authors: Scacchi Massimo , Danesi Leila , Cattaneo Agnese , Valassi Elena , Giraldi Francesca Pecori , Argento Crocetta , D’Angelo Emanuela , Mirra Nadia , Carnelli Vittorio , Zanaboni Laura , Tampieri Benedetta , Cappellini Maria Domenica , Cavagnini Francesco 
Published: July 2008

SummaryBackground and objective  GH and IGF‐I exert an important role in the control of bone formation, as shown by decreased bone mineral density and increased fracture risk in adult hypopituitary patients untreated for GH deficiency (GHD). Different degrees of bone demineralization are frequently reported in patients affected by β‐thalassaemia. Considering the high prevalence of GHD recently observed by our group among adult thalassaemic patients, we elected to study the possible role of GH–IGF‐I abnormalities in the pathogenesis of the osteopenia/osteoporosis of this disease.Design  Sixty‐four adult thalassaemic patients (49 with thalassaemia major and 15 with thalassaemia intermedia, 23 men and 41 women, aged 31·4 ± 6·8 years) were studied.Methods  Bone mineral density was assessed by dual energy X‐ray absorptiometry at lumbar spine in 62 patients and at proximal femur in 58. All patients underwent GHRH (1 µg/kg as an i.v. bolus) plus arginine (0·5 g/kg as a 30‐min i.v. infusion) testing. Severe GHD was defined by GH peaks < 9 µg/l, whereas partial GHD was defined by GH peaks ranging from 9 to 16·5 µg/l. Blood samples for IGF‐I measurement were collected.Results  Lumbar osteoporosis and osteopenia were demonstrated in 46/62 (74·1%) and 14/62 (22·5%) patients, respectively. Femoral osteoporosis and osteopenia were documented in 22/58 (37·9%) and 32/58 (55·1%) patients, respectively. Severe GHD was demonstrated in 16/64 patients (25%), while 11 additional patients (17·1%) displayed partial GHD. IGF‐I standard deviation score (SDS) was low, that is, below –1·88, in the majority (54·6%) of patients. Lumbar T‐score values were not correlated with either GH peaks or IGF‐I SDS values. Femoral T‐score values were positively correlated with GH peaks (r = 0·38, P < 0·005) and IGF‐I SDS values (r = 0·39, P < 0·005). Multiple regression analysis pointed to both GH peak and IGF‐I SDS as predictors of femoral T‐score. Furthermore, mean femoral T‐score was significantly lower in patients with severe GHD than in those with normal GH secretion (–2·94 ± 0·25 vs.–2·15 ± 0·12, P < 0·01).Conclusion  This study, while confirming the high prevalence of both osteopenia/osteoporosis and somatotropin–somatomedin deficiency in adult thalassaemic patients, indicates that defective GH secretion and diminished serum IGF‐I levels may contribute to femoral demineralization in these patients. Further studies are worth carrying out to evaluate the efficacy of biosynthetic GH administration on bone abnormalities of GH‐deficient thalassaemic adults.
Severe hypomagnesaemia in long‐term users of proton‐pump inhibitors
Authors: Cundy T. , Dissanayake A. 
Published: July 2008

SummaryObjective  To explore the mechanism underlying severe hypomagnesaemia in long‐term users of proton‐pump inhibitors (PPIs).Patients  Two cases of severe hypomagnesaemia in adult long‐term users of the PPI omeprazole, presenting with hypocalcaemic seizures.Measurements  We studied renal magnesium handling during an incremental intravenous magnesium infusion, and assessed total body magnesium status by the 24‐h retention of the parenteral load. We also observed the effects of oral magnesium supplements whilst continuing the PPI, and the effect of withdrawal of the PPI.Results  Both patients were severely magnesium‐depleted and had avid renal magnesium retention, implicating a failure of intestinal magnesium absorption. There was no evidence of generalized malabsorption. The hypomagnesaemia could be partially corrected by high dose oral magnesium supplementation, and resolved on withdrawal of PPIs.Conclusions  PPI use can inhibit active magnesium transport in the intestine, though it is not clear if this is an idiosyncratic effect. Long‐term PPI users who are highly adherent to treatment can eventually deplete total body magnesium stores and present with severe complications of hypomagnesaemia.
Thyroid function in short children born small‐for‐gestational age (SGA) before and during GH treatment
Authors: De Kort S. W. K. , Willemsen R. H. , Van Der Kaay D. C. M. , Van Dijk M. , Visser T. J. , Hokken‐Koelega A. C. S. 
Published: July 2008

SummaryContext  Disturbances in thyroid function have been described in small‐for‐gestational age (SGA) children but the influence of prematurity is unclear. In addition, the effect of GH treatment on thyroid function has not been studied in short SGA children.Objectives  To determine whether short SGA children have higher TSH levels compared to age‐matched controls and evaluate the influence of gestational age. To investigate whether GH treatment alters thyroid function.Patients  A total of 264 short SGA children (116 preterm), prepubertal and non‐GH deficient.Measurements  Serum FT4 and TSH at baseline and after 6, 12 and 24 months of GH treatment.Results  Baseline mean TSH was higher in preterm short SGA children than in age‐matched controls (P < 0·05). Mean FT4 was not significantly different between short SGA children and controls. Baseline FT4 or TSH did not correlate with gestational age, or SDS for birth weight, birth length, height, body mass index, IGF‐I or IGFBP‐3. Mean FT4 decreased significantly during the first 6 months of GH treatment, but remained within the normal range. TSH did not change during treatment. The change in FT4 did not correlate with the change in height SDS during 24 months of GH treatment.Conclusion  Preterm short SGA children have higher, although within the normal range, TSH levels than controls. The level of TSH does not correlate with gestational age, birth weight SDS or birth length SDS. FT4 decreases during GH treatment, but is neither associated with an increase in TSH nor does it affect the response to GH treatment. As these mild alterations in thyroid function do not appear clinically relevant, frequent monitoring of thyroid function during GH therapy is not warranted in short SGA children.
Endometrial intraepithelial neoplasia is associated with polyps and frequently has metaplastic change
Authors: Carlson J W , Mutter G L 
Published: July 2008

Aims:  Endometrial intraepithelial neoplasia (EIN) is a monoclonal precursor to endometrioid endometrial adenocarcinoma characterized by a geographic cluster of crowded glands with epithelial cytology altered relative to the background. It may demonstrate epithelial metaplastic changes, or arise within polyps, but the frequencies of these features as encountered in practice is unknown. The aim was to report the epithelial differentiation state and polyp context of 83 sequential EIN lesions diagnosed over a 2‐year period.Methods and results:  EIN is a rare lesion, seen in only 1.4% of endometrial biopsy specimens in a busy hospital‐based practice. Of 83 EIN cases, 39 contained metaplastic changes (18% squamous morular, 14% tubal secretory and 5% each of secretory, mucinous or ciliated change). Endometrial polyps were more likely (odds ratio 5.2, P < 0.001) to occur in the endometrial biopsy specimens of women with EIN lesions (43.3%), compared with the background polyp rate (12.9%) of comparable specimens from the same patient population.Conclusions:  Non‐endometrioid differentiation and occurrence within polyps are frequent presentations of EIN lesions. Possible mechanisms of polyp association with EIN include: non‐shedding of polyp tissue creating a shelter for persistence of pre‐existing neoplastic glands, or promotion of premalignant glandular clones by unique polyp stroma.
Unexpectedly high 20th century floristic losses in a rural landscape in northern France
Authors: Van Calster H. , Vandenberghe R. , Ruysen M. , Verheyen K. , Hermy M. , Decocq G. 
Published: July 2008

Summary

Resurveys of regional floras allow assessment of long‐term floristic change and to pinpoint driving forces behind these changes. Causes of floristic decline derived from such resurveys depend on the considered landscape, but are often associated with human activities especially in urbanized areas. Much could be learned from comparisons of contrasting landscapes.
Vascular plant abundance categories from a detailed, late 19th century flora were matched with distribution data from a late 20th century plant database in a rural area (Thiérache; 1673 km2) in northern France. Floristic change was characterized both in absolute numbers of extinct and extant species and by a measure for relative change in range size. Knowledge of land use changes and ecological correlates of floristic change permitted the causes for species change to be inferred and to identify which traits are associated with species vulnerability. Extinction rates were compared with similar studies from contrasting landscapes, taking into account the negative relationship between standardized extinction rates and log‐transformed size of the study area.
Of the 959 species from the historical list, 186 (19.4%) may be considered regionally extinct. Most extinct species were already rare historically. Differences among habitats indicated strong declines for aquatic species and arable weeds and least change for forest species. Percentage species loss per year in Thiérache equalled 0.22, which was higher than two other similar sized predominantly rural landscapes.
Across the main habitat groups, relative species decline was always associated with relatively higher stress tolerance and lower competitiveness and biased towards therophytes. The main causes of species decline were management intensification, eutrophication, secondary succession in semi‐natural open habitats and land use change.
Synthesis. Rural landscapes with no population density increase, no urbanization and a stable landscape configuration are believed to be less vulnerable; yet, on a relatively short time scale, without nature conservation measures, these landscapes may suffer strong species loss comparable to that in urbanized landscapes. Effective management of landscapes for biodiversity conservation whether they are urbanized or rural requires the development of a network of nature reserves.
Attitudes of patients and nurses towards diarrhoea during enteral tube feeding
Authors: Majid H.A. , Emery P.W. , Whelan K. 
Published: July 2008

Background:  Diarrhoea is a common complication during enteral tube feeding (ETF) and, despite little empirical evidence, is said to be unpleasant for both patients and nurses (Whelan et al., 2007). The aspects of diarrhoea considered to be unpleasant among patients receiving ETF or among nurses caring for these patients has not previously been investigated. Therefore, the aim of the study was to investigate patients’ and nurses’ attitudes towards diarrhoea during ETF.Methods:  A questionnaire was developed following an extensive literature review and was pre‐tested for clarity. An interviewer‐administered questionnaire survey was then conducted by the same interviewer, in patients receiving ETF and in nurses caring for patients receiving ETF. Seven different characteristics of diarrhoea (faecal colour, consistency, frequency, quantity, incontinence, odour, need to change underwear) were rated for their unpleasantness using a four‐point Likert scale. Ratings were then ranked and a mean rank calculated for each group to determine the most and least unpleasant characteristic. Ranks were then compared within patients and within nurses using a Friedman test. Ethical approval was obtained from an NHS Research Ethics Committee.Results:  In total, 22 patients (16 male, six female; mean age 58.5 ± 15.2 years) receiving ETF due to dysphagia, post‐surgery, tracheostomy and inadequate nutritional intake and 57 nurses (16 male, 41 female) from respiratory, intensive therapy, elderly care and renal units were interviewed. There were differences in the rankings of the seven characteristics among patients (P < 0.001) and among nurses (P < 0.001). Patients rated incontinence and frequency as the most unpleasant characteristic of diarrhoea, whereas nurses rated odour and changing underwear as the most unpleasant characteristic of caring for patients with diarrhoea during ETF (Table 1).

Mean ranking of attitude towards diarrhoea during ETF within nurses and patients (Rank 1 = least unpleasant, 7 = most unpleasant)

Characteristics
Patient (n = 22)
Nurses (n = 57)

Incontinence
5.5
4.0

Frequency
4.8
4.0

Consistency
4.4
4.1

Odour
4.2
5.3

Quantity
3.8
3.7

Colour
2.8
2.4

Changing underwear
2.5
4.5

P‐value (Friedman test)
<0.001
<0.001

Discussion:  The characteristics of diarrhoea considered to be unpleasant by patients are not the same as for nurses. The importance of understanding the patient perspective of symptoms is increasingly recognised in practice and research.Conclusion:  Faecal incontinence and frequency are considered to be the most unpleasant characteristics of diarrhoea by patients. These characteristics should be monitored by healthcare professionals and strategies developed to minimize their occurrence in hospitalised patients receiving ETF.Reference  Whelan, K. (2007) Enteral‐tube‐feeding diarrhoea: manipulating the colonic microbiota with probiotics and prebiotics. Proc. Nutr Soc. 66, 299–306.
Dietary management of orofacial granulomatosis: quantification of benzoates in foods and cosmetics
Authors: Nagarajah R. , Campbell H. , Sanderson J.D. , Lomer M.C.E. 
Published: July 2008

Background:  Orofacial granulomatosis (OFG) is a chronic inflammatory disorder of unknown aetiology that typically presents with lip swelling, although a number of intra‐oral sites may also be affected. Management is challenging but recent evidence implicates dietary antigens. Benzoates are used as preservatives and occur naturally in some foods, particularly spices, some fruit and vegetables. A strict cinnamon and benzoate free diet is used as first line treatment with a clinical response in 68% patients (White et al., 2006). The benzoate free dietary treatment was recently extended to avoid cosmetics and toiletries containing benzoates. The aim of the current study is to quantify the level of added benzoates in food, cosmetics and toiletries for the development of education material to minimise benzoate exposure in long term management of OFG.Methods:  Food, drink, cosmetic and toiletry manufacturers (n = 174) were identified by visiting local supermarkets and chemists. They were contacted by letter for information about whether benzoates were used in their products and, if so, at what levels. Companies that did not respond within 4 weeks were then contacted by telephone for information. An updateable database of benzoates in food, drinks, cosmetics and toiletries was developed for analysis of data and development of patient information.Results:  Ninety manufacturers (51%) responded to the request for information on benzoates in their products. Sixteen manufacturers confirmed that some of their products (2–534) contained added benzoates. Of these, two food/drink and seven cosmetic/toiletry manufacturers provided quantitative data relating to the levels of benzoates in their products. A total of 136 products contained benzoates (foods 0.54–0.8 mg kg−1, non alcoholic drinks 140 mg L−, cosmetics 5.2–11 511 mg kg−1, pharmaceuticals 0.001–0.25 mg/100 mL), while all other products were free from added benzoates.Discussion:  Obtaining quantitative data on the level of benzoates in the diet, cosmetics and toiletries is difficult due to manufacturers’ unwillingness to disclose information. Further research using an analytical technique may be the way forward to further quantify benzoates added to food, drinks, cosmetics and toiletries. It would also help to establish the levels at which benzoates occur naturally in some foods.Conclusions:  Identification of the amount of benzoates in the diet, cosmetics and toiletries is not easy and using an analytical method to measure benzoates in products directly may help to increase quantitative information.Reference  White, A., Nunes, C., Escudier, M., Lomer, M.C.E., Barnard, K., Shirlaw, P., Challacombe, S.J. & Sanderson, J.D. (2006) Improvement in oro‐facial granulomatosis on a cinnamon and benzoate free diet. Inflamm. Bowel Dis.12, 508–514.
A nutritional screening audit of new adult out‐patients with HIV
Authors: Pribram V. , Childs K. , Poulton M. 
Published: July 2008

Background:  National guidelines state nutrition screening should be done on all out‐patients at first appointment as malnutrition is known to contribute to morbidity and mortality (NICE, 2006). Implementation of nutritional screening for adult out‐patients newly diagnosed with HIV was audited at the Caldecot Centre, King's College Hospital.Methods:  Sixty patients were included by selecting every third patient from list of 142 patients attending new patient clinic between 1 April 2006 and 28 February 2007. A doctor and dietitian collected all data from integrated care pathway (ICP) forms and descriptive statistical analyses were performed.Results:  Information was available for 50 patients with a mean age of 35. Of these, height and weight were recorded in 49 (SD 8.0) but body mass index (BMI) calculated in only 28. The number of patients reporting symptoms to nurses were; weight loss = 34%, appetite loss = 38%, diarrhoea = 12%, vomiting = 10%. Amount and duration of weight loss were recorded for only eight patients (range 2–12.7 kg) and seven patients, respectively. Referral to dietitian was indicated for 23 patients but only 10 patients had evidence of a planned appointment. Patients were seen within the following time period: 1 week = 3; 2 weeks = 2; 3 weeks = 5. Median BMI was 24.5 kg m−2 (range 17.7–36.4). Seven patients had BMI of 20 or less, 15 were in over‐weight range of which four were obese. One‐third of patients had a low CD4 (<200 cells mm−3) indicating increased risk of opportunistic infection. Symptoms related to HIV and malnutrition (e.g. diarrhoea, candidiasis, TB, pneumonia) were recorded by physician for 22% of patients.Discussion:  Essential data were not collected or calculated in the majority of cases perhaps because patients newly diagnosed with HIV often have other urgent social and medical problems. There is clearly a need for nutritional screening in this population as large numbers (33%) presented with advanced infection and HIV and malnutrition related symptoms were widely reported.Conclusion:  Nutritional screening of new HIV positive patients is inadequate. Training and education, repeat screening, redesign of screening form, and/or improved care pathways may help improve the implementation of nutritional screening for adult out‐patients with HIV.Reference  National Institute for Health and Clinical Excellence (NICE). (2006) Nutritional Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. Clinical Guideline 32. London: National Institute for Health and Clinical Excellence.
An evaluation of the integration of theory and practice during practice education: Placement A
Authors: Reidlinger D. , Croxford S. , Illingworth S. 
Published: July 2008

Background:  The need to increase student placement capacity resulted in a new model for the delivery of Placement A by the Scottish Stakeholder Partnership (Transition Team Implementation Programme, 2007). A number of initiatives to increase capacity have also been implemented in London, including a pilot building on the Scottish experience where Placement A is delivered in two parts: a series of integrated ‘day placements’, followed by a 2‐week block placement at an approved placement setting. The delivery of the 4 week model for Placement A was evaluated to obtain baseline data and to ensure students’ ability to integrate campus‐based learning with placement learning was considered in the design of an alternative delivery model.Methods:  A questionnaire was completed by 35 third year undergraduate students at King's College London and 14 second year undergraduate students at London Metropolitan University, after they had returned to university after a 4‐week Placement A. Using a five‐point Likert scale, students were asked to indicate the level of agreement with 29 statements, including nine relating to the tasks and integration of learning between campus and placement. Other questions related to student enjoyment, motivation, range of experiences and student perception of Placement A's impact on their preparation for Placement B.Results:  The results showed that 38 of the 53 (72%) students felt that the 4‐week placement duplicated learning at university, but the same number also felt that the tasks undertaken helped them to apply what they had learned at university. Whilst the majority of students (43/53) agreed that the placement was enjoyable, 26 students responded they were bored at times during their placement. Four students indicated that after Placement A they were rethinking their decision to study dietetics.Discussion:  Students’ responses reflected the role of the placement in the application of theory, and the duplication of tasks between practice and university is likely to be necessary to fulfil this role. The integration of theory and practice is an important educational outcome of practice placements, and the finding that some students’ are unable to relate placement tasks to campus‐based learning raises a concern that the theory‐practice gap could be better addressed. Improved integration may benefit the student experience and enjoyment of Placement A.Conclusions:  The results from this evaluation will inform the pilot of the new delivery model for Placement A in London.Reference  Transition Team Implementation Programme. (2007) Working In Partnership Towards Local Allocation of Dietetic Practice Placements – TTIP Progress Report, February 2007. Available at http://www.lmu.ac.uk/health/ttip/documents/progressreport.pdf (accessed on 18 January 2008).