bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre‐ and post‐treatment predictors of the early achievement of HBeAg loss in lamivudine‐resistant patients receiving adefovir therapy
Authors: Jang Jeong Won , Kim Min Soo , Lee So Yeon , Kim Chang Wook , Bae Si Hyun , Choi Jong Young , Cha Sang Bok , Yoon Seung Kew 
Published: June 2006

AbstractBackground and Aim:  This study investigated the clinical variables that predict hepatitis B e antigen (HBeAg) loss in lamivudine‐resistant patients receiving adefovir therapy.Methods:  Fifty‐six consecutive HBeAg‐positive patients treated with adefovir for at least 12 months were enrolled in this study. All had serum alanine aminotransferase (ALT) levels over twice the upper limit of normal (ULN) as a result of lamivudine resistance. Predictors of HBeAg loss after switching from lamivudine to adefovir were examined.Results:  During the follow‐up period, 18 (32.1%) of 56 patients showed a loss of HBeAg. The estimated rates of HBeAg loss at 6, 12, and 18 months were 11.5%, 26.8%, and 42.9%, respectively. Univariate analysis revealed that pretreatment ALT levels >10 × ULN (P = 0.029), a viral load at 3 months of therapy (P = 0.017), and viral decline by >3 log10 from baseline at 3 months (P < 0.001) were significantly associated with the loss of HBeAg within 12 months of therapy. With multivariate analysis using the stepwise logistic regression model, pretreatment ALT > 10 × ULN (odds ratio [OR], 4.22; 95% confidence interval [CI], 1.09–19.44; P = 0.044) and viral suppression >3 log10 at 3 months (OR, 10.39; 95% CI, 1.86–58.07; P = 0.008) were identified as the two independent predictors of HBeAg loss.Conclusions:  Pretreatment ALT levels and the initial pattern of post‐treatment viral decline are the strongest predictors of the early achievement of HBeAg loss following treatment with adefovir in lamivudine‐resistant patients. These results may provide useful information for the optimal timing of adefovir rescue as well as for better monitoring after treatment.
Mild zinc deficiency and dietary phytic acid accelerates the development of fulminant hepatitis in LEC rats
Authors: Saito Akiko , Nakayama Kenji , Hara Hiroshi 
Published: June 2006

AbstractBackground and Aim:  Restriction of copper intake delays hepatic copper accumulation in Long–Evans Cinnamon (LEC) rats, which are animal models of Wilson’s disease. Involvement of zinc is suggested to develop hepatitis in the disease; however, this has not been clarified. The aims of this study were to investigate the effects of mild zinc deficiency on the development of hepatitis and to determine the relationship between the absorption and hepatic levels of copper, zinc and iron.Methods:  Male LEC and F344 (wild type atp7b) rats were fed a low zinc, phytate‐containing or control diet. The onset of hepatitis (Experiment 1), and absorptive rates of copper, zinc and iron and hepatitis indices in 4 weeks (Experiment 2) were observed.Results:  The onset of fulminant hepatitis in LEC rats was much earlier in the low zinc and phytate groups (mean 94.6 ± 2.74 days and 82.8 ± 3.56 days old, respectively) than in the control group (136 ± 2.11 days old) with worse hepatitis indices. Hepatic copper levels were much higher in LEC rats than F344 rats, but were not largely different among the diet groups without prominent changes in copper absorption. Hepatic levels and intestinal absorption of zinc and iron were lower in the phytate group than in the control group.Conclusion:  Mild zinc deficiencies caused by a low zinc or phytate‐containing diet accelerate the onset of hepatitis in LEC rats without increasing copper absorption, and zinc and iron metabolism may be involved in the earlier onset of jaundice of LEC rats.
PROVIDERS AND CONSUMERS SUPPORT THE WESTERN AUSTRALIAN AUDIT OF SURGICAL MORTALITY
Authors: Semmens James B. , Mountain Jenny A. , Sanfilippo Frank M. , Barraclough Jenny Y. , McKenzie Anne , Mukhtar S. Aqif , Haynes Natasha S. , Aitken R. James 
Published: June 2006

Background:  The Western Australian Audit of Surgical Mortality (WAASM) was established in June 2001 to independently peer‐review all surgical deaths in Western Australia. The objectives of this study were (i) to evaluate whether participation in the WAASM has influenced clinical and hospital practice; and (ii) to ascertain the support and relevance of the WAASM to surgeons, hospitals and consumers.Methods:  Three qualitative questionnaires were designed to evaluate the response of surgeons, hospital administrators and consumers to the WAASM. The outcomes measured included audit participation, value and use of feedback provided, changes to clinical and hospital practice and the future role of the WAASM.Results:  The key findings were that 138 (73%) of 190 surgeons participating in the WAASM had changed their clinical practice in at least one way, 44 (24%) were aware of changes in hospital practice and 21 (11%) were aware of changes in a colleague’s practice. Particular areas where changes in surgical practice had occurred included attention to deep vein thrombosis prophylaxis (81, 44%), increased constructive discussion among peers (78, 42%) and quality of documentation in case notes (68, 37%). All groups supported the continuation of the WAASM. Hospital executives and consumers recommended that the WAASM be included in accreditation.Conclusion:  Surgeons, hospitals and consumers supported the concept of independent peer review of surgical care. They confirmed the ability of audit to influence and change surgical and hospital practice. It strengthens the intention of the Royal Australasian College of Surgeons to extend the WAASM project throughout Australia and New Zealand.
PERITONEAL CARCINOMATOSIS FROM COLORECTAL CANCER AND SMALL BOWEL CANCER TREATED WITH PERITONECTOMY
Authors: Shehata Mena , Chu Frank , Saunders Vanessa , Kam Peter C. A. , Links Matthew , Morris David L 
Published: June 2006

Background:  This study aims to assess the survival of patients who underwent peritonectomy, to assess the morbidity and mortality associated with the procedure and to review the published reports on the survival of patients with peritoneal spread of colorectal cancer (CRC).Methods:  Peritonectomy involves resection of all visible peritoneal tumour and is followed by heated intraperitoneal chemotherapy. Peritonectomy with heated intraperitoneal chemotherapy is associated with a 3‐year survival of 30–50% in patients with low peritoneal cancer index (PCI) with peritoneal carcinomatosis from CRC. There are approximately 1000 patients in phase 2 studies and a large survival advantage was shown in a randomized control trial. We have carried out over 100 peritonectomy procedures. This study describes 22 patients with peritoneal spread of gastrointestinal cancer treated with peritonectomy between 1996 and March 2005. Twenty of these patients had primary colorectal cancer and two patients had primary small bowel cancer.Results:  Of the 22 patients who underwent peritonectomy, 8 patients are now deceased. The median follow up is now 16.1 months. At 12 months, the survival was 61.5% and at 24 months the survival was 46.1%, which are creditable results comparable with the world published reports. We found that those patients with all macroscopic residual tumour removed at the end of the procedure (completeness of cancer resection, CCR O) had improved 24‐month survival compared with patients in whom there was incomplete tumour resection (53.3% survival vs 22.2%, respectively, P = 0.024). Patients with a PCI score less than 13 had better survival (P = 0.0003).Conclusions:  Peritonectomy for peritoneal carcinomatosis from CRC offers patients improved survival. Our results are consistent with the published data with respect to improved survival in patients with low PCI and complete cytoreduction.
FACTORS AFFECTING EARLY MORTALITY IN SPONTANEOUS RUPTURE OF HEPATOCELLULAR CARCINOMA
Authors: Tan Felicia L.‐S. , Tan Yu‐Meng , Chung Alexander Y.‐F. , Cheow Peng C. , Chow Pierce K.‐H. , Ooi London L. 
Published: June 2006

Background:  Spontaneous rupture of hepatocellular carcinoma (HCC) is a catastrophic surgical emergency with high mortality rates. The aim of this study is to determine the factors associated with the prognosis and to assess the outcome of different management strategies.Methods:  A retrospective study of 34 consecutive patients with spontaneous rupture of HCC was conducted from January 1996 to January 2004. Clinical, biochemical and operative factors influencing 30‐day mortality were analysed.Results:  In our study, 30‐day mortality rate was 32% (n = 11). Presence of cirrhosis, Child’s C status, shock on admission, higher blood transfusion requirement, raised α‐fetoprotein, raised alkaline phosphatase, raised aspartate transaminase, and raised indocyanine green at 15 min were all associated with increased risk of 30‐day mortality on univariate analysis (P < 0.05). On multivariate analysis, only shock on admission (P = 0.001) and higher blood transfusion requirement (P = 0.01) were significant independent factors affecting early mortality. Surgical intervention was associated with a better 30‐day survival as compared with medical therapy or transarterial embolization. The median survival time of patients undergoing curative resection was significantly longer than that of patients who had surgery for haemostasis only (420 vs 205 days). The overall median survival was 161 days.Conclusions:  Spontaneous rupture of HCC is a potentially salvageable complication of HCC. Poor prognosis is associated with poor liver reserve, advanced disease and severity of haemorrhage. Shock and blood transfusion requirement are the only independent factors affecting early mortality.
OPTIMAL NUMBER OF SENTINEL NODES AFTER INTRADERMAL INJECTION ISOTOPE AND BLUE DYE
Authors: Low Kenny S.‐S. , Littlejohn David R. G. 
Published: June 2006

Background:  Sentinel node (SN) biopsy for breast cancer is becoming more common owing to its lower morbidity when compared with full axillary dissection. However, the optimal method of finding and the number of SN to be dissected are still subject to conjecture. The aim of this study was to determine the optimal number of SN required to accurately stage an axilla after the i.d. injection of isotope and blue dye.Method:  Prospective data from all patients undergoing SN biopsy from April 2000 to September 2004 were analysed. For positive SN, the order in which they became positive was then tabulated.Results:  During the 4 years, 113 patients who fulfilled the selection criteria had undergone SN biopsy with 216 SN harvested. Of these, 33 patients had positive SN results. If only the first SN was analysed, 87.9% of those positive biopsies would have been discovered. Two SN raised the predictive value to 97.0%.Conclusion:  Two SN would seem to be the optimal number to harvest after i.d. injection of both isotope and blue dye.
EARLY PROSTHETIC COMPLICATIONS AFTER UNIPOLAR HEMIARTHROPLASTY
Authors: Weinrauch Patrick C. L. , Moore William R. , Shooter David R. , Wilkinson Matthew P. R. , Bonrath Esther M. , Dedy Nicolas J. , McMeniman Timothy J. , Jabur Majid K. A. , Whitehouse Sarah L. , Crawford Ross W. 
Published: June 2006

Background:  In Australia, the most frequently used hemiarthroplasty prosthesis for the management of displaced intracapsular femoral neck fractures is the Uncemented Austin Moore (UAM). Despite concerns regarding poor functional outcomes and increased early revision rates associated with the UAM prosthesis, apprehension regarding the systemic side‐effects of polymethylmethacrylate cement implantation in the elderly patient continues to influence prosthesis selection. This study examines the incidence of early prosthesis related complications after UAM and Cemented Thompson (CT) hemiarthroplasty procedures for the management of femoral neck fractures.Methods:  A multicentre retrospective review of charts and radiographs was conducted in 1118 unipolar hemiarthroplasty implantations to determine early complications associated with the CT and UAM prostheses over a 6‐year period in five Queensland public hospitals.Results:  Intraoperative periprosthetic fractures were sustained in 11.8% of UAM and 1.8% of CT implantations (P < 0.0001). Intraoperative periprosthetic fractures were associated with an increased requirement for reoperation within 1 month of the index procedure (P = 0.05). No statistical difference in the incidence of intraoperative periprosthetic fractures could be observed between the hospitals participating, regardless of the proportional use of each prosthesis. Early dislocation rates were similar for the UAM and CT prostheses. The intraoperative mortality rate attributable to the use of polymethylmethacrylate cement during hip hemiarthroplasty was 1/738 (0.14%).Conclusions:  The results of this study support the use of the CT prosthesis for the management of femoral neck fractures to reduce the high incidence of intraoperative periprosthetic fractures and associated requirements for early reoperation experienced with the UAM.
CRITICAL COURSE OF THE ANTERIOR LARYNGEAL BRANCH OF THE INFERIOR LARYNGEAL NERVE
Authors: Yalçin Bülent , Tuğcu Harun , Cantürk Nergis , Kurt Bülent , Ozan Hasan 
Published: June 2006

Background:  Although in the past few authors stated that the nerve penetrated the ligament of Berry, many new authors have not confirmed this assertion. Because of the clinical importance and indefiniteness of this subject, we aimed to present an anatomical study concerning the course of the inferior laryngeal nerve.Method:  In 60 specimens, 102 sides were examined for this project, including 41 male and 19 female cadavers between the ages of 40 and 89 years at death.Results:  In two sides (one on the right and the other on the left), we found that the anterior (motor) laryngeal branch of the inferior laryngeal nerve penetrated the ligament unilaterally. The branch entered the ligament 5.6, 7.2 mm above its lower border and 3.3, 1.9 mm below its upper border. Distances from the entrance point of the branch to the trachea and thyroid were 9.5, 8.2 mm and 3.1, 2.2 mm, respectively.Conclusion:  We found two anterior laryngeal branches penetrating the ligament of Berry. This subject is very important during the thyroid surgery, particularly during the division of the ligament for total lobectomy.
DRIVING PLASTERED: WHO DOES IT, IS IT SAFE AND WHAT TO TELL PATIENTS
Authors: Kalamaras Michael A. , Rando Angelo , Pitchford Donald G. K. 
Published: June 2006

Background:  The number and safety of patients who drive in an upper limb fracture cast has been largely untested. This study investigates the proportion of persons who drive in their casts and the capability of a casted persons driving is also assessed. The stance of government and insurance bodies is reviewed. The aim is to provide a guide for when a doctor should advise a patient not to drive while wearing an upper limb fracture cast.Methods:  Patients attending fracture clinic in upper limb casts were anonymously surveyed and asked (along with demographics) if they drove while in a cast and if they believed it illegal or covered by insurance to drive. Driving tests of the author wearing upper limb fracture casts were undertaken. The Queensland police traffic branch, the Queensland Department of Transport and the RACQ insurance company were contacted to review the legal and insurance issues involved.Results:  Two‐thirds of male and one‐third of female patients (half overall) were found to drive while in an upper limb cast. The author failed driving instructor tests in all casts and occupational therapist driving assessments while wearing long arm casts. The author passed occupational therapy driving assessments in left and right short arm casts.Conclusions:  According to these results, a doctor’s advice should be to patients not to drive in a long arm upper limb fracture cast and to consider concomitant patient factors when advising patients in short arm casts. Although we do not suggest that patients drive while wearing any cast, we have found a large proportion do. Our limited study has found that a young, fit and pain‐free person may be able to drive well enough to pass a driving test while wearing a short arm cast.
Association of beta‐2‐adrenoceptor polymorphisms and pulmonary function in patients with chronic obstructive pulmonary disease
Authors: Ruse Charlotte E , Hill Maureen C , Wheatley Amanda P , Burton Paul B , Connolly Martin J , Parker Stuart G , Wardlaw Andrew J 
Published: June 2006

Aims:  The Dutch Hypothesis suggests that asthma and chronic obstructive pulmonary disease may share some pathogenic mechanisms. There is considerable evidence that polymorphisms of the β2 adrenoceptor have disease‐modifying roles in juvenile onset asthma, determining severity and response to β agonists, but not determining disease susceptibility. There is evidence from family and twin studies to suggest that chronic obstructive pulmonary disease (COPD) also has a significant genetic component. We therefore hypothesized that β2 adrenoceptor polymorphisms would have similar disease modifying roles in patients with COPD.Methods:  One hundred and ninety‐five COPD subjects and 142 matched controls were recruited. All had detailed clinical phenotyping. Subjects were genotyped for the Agr → Gly polymorphism at codon 16, the Gln → Glu polymorphism at codon 27, and the SNPC/T‐47 promoter polymorphism.Results:  In patients with COPD (mean age 67, 57% male), individuals with the homozygous Gly16/homozygous Glu27/homozygous SNP −47*C genotype had significantly worse lung function as measured by forced expiratory volume 1, expressed as a percentage of its predicted value (39.2 compared with 45.8, P = 0.004), and for forced vital capacity (FVC) percent predicted (77.2 compared with 70.4, P = 0.02). The polymorphisms had no effect on disease susceptibility.Conclusion:  The Arg16, Gln27, SNPC/T‐47 β2 adrenoceptor polymorphisms may have disease modifying roles in patients with COPD.
Dental status and mortality in institutionalized elderly people
Authors: Ohrui Takahashi , Matsui Toshifumi , Yoshida Mitsuyoshi , Yoneyama Takeyoshi , Adachi Mieko , Akagawa Yasumasa , He Mei , Yamaya Mutsuo , Arai Hiroyuki , Sasaki Hidetada ,   Members of the Oral Care Working Group
Published: June 2006

Background: Inadequate dentition for mastication is one of the major issues associated with systemic health for institutionalized elderly people, but its prognostic value and related deaths have not been fully examined.Methods: Four hundred and three patients aged 65 and older were recruited from nine nursing homes and were prospectively followed up for morbidity and mortality for 5 years in Japan. These patients were classified into three groups according to dental status: patients who had adequate dentition with natural teeth only or natural teeth with partial dentures (Group A); those who were edentulous but wearing full dentures (Group B); and those who had inadequate dentition without dentures (Group C).Results: Dental status was strongly related to age, cognitive function and activities of daily living. After allowing for confounding effects, the 2‐year risk of mortality among those in Group C was 1.84 times that of Group A (95% confidence interval 1.01–3.36,P = 0.047). Furthermore, the 5‐year mortality rate in Group C was higher than that in Group A, whereas that was not significant with a hazard ratio of 1.30 (0.90–1.88,P = 0.168). The main causes of death were respiratory infections, which explained 14.1% of all causes of death in Group A, 14.3% in Group B and 18.3% in Group C. Any associations between a specific cause of death and the different dental status did not reach a significant level.Conclusion: Inadequate dental status is associated with high overall mortality. Our findings suggest that systemic attention to dental status should be recommended in institutionalized elderly people.
Treatment with HMG‐CoA reductase inhibitors (statins) attenuates the progression of aortic valve stenosis in the elderly
Authors: Kuwabara Masanori , Kitaoka Hiroaki , Okawa Makoto , Furuno Takashi , Nishinaga Masanori , Doi Yoshinori 
Published: June 2006

Aim:  Recent studies have shown that degenerative aortic stenosis (AS) relates to the process of atherosclerosis. The purpose of this study was to determine whether the use of 3‐hydroxy‐3‐methygulutaryl coenzyme A (HMG‐CoA) reductase inhibitor (statin) delays progression of AS in the elderly.Methods:  Thirty‐three elderly patients (> 65 years; mean age, 75 ± 6 years) with mild to moderate degenerative AS underwent two consecutive echocardiograms at least 6 months apart.Results:  Thirteen patients were treated with statin and the remaining 20 were not treated with statin. The two groups were similar in age (74 ± 5 vs 75 ± 6 years) and initial peak pressure gradient (45 ± 27 vs 40 ± 31 mmHg). The annual increase in peak pressure gradient in statin group was smaller than that in the non‐statin group (1.25 ± 5.3 mmHg/year vs 6.04 ± 6.12 mmHg/year, P < 0.05). In multiple regression analysis, statin usage was an independent predictor of a smaller increase in peak gradient after adjusting for age, initial peak gradient, diabetes mellitus and hypertension.Conclusions:  Statin‐treated patients had delayed AS progression compared with those not treated with statin. In the elderly, statin treatment may delay the rate of progression of degenerative AS.
Predictors of functional status in Japanese community‐dwelling older persons during a 2‐year follow up
Authors: Kawamoto Ryuichi , Tomita Hitomi , Oka Yuichiro , Ohtsuka Nobuyuki 
Published: June 2006

Aims:  To clarify baseline sociodemographic and health characteristics that predict subsequent functional outcome in community‐dwelling Japanese older persons.Methods:  All subjects were enrolled from the April 2001 resident registry of Nomura‐cho, Seiyo‐city in Ehime prefecture. Of 1392 community‐dwelling persons aged 65 and older who could provide complete responses to questionnaires including functional status in the first survey, 1105 subjects were also able to provide complete answers in the second survey. Functional status was categorized according to a hierarchical scale as: completely functional; with functional limitations; and with disabilities in instrumental activities of daily living (IADL). A multivariate logistic regression model was used to estimate the ability of selected 2001 sociodemographic and health status variables to predict 2003 functional status.Results:  Subjects consisted of 470 men (mean age ± standard deviation, 72 ± 5.9 years) and 635 women (73 ± 7.1 years). During the 2‐year follow up, significant independent predictors of future functional status by multiple logistic regression analysis included: (i) age (odds ratio: 0.511, 95% confidence interval [CI]: 0.329–0.791); (ii) spouse (1.655, 1.044–2.621); (iii) activities of daily living (3.231, 2.008–5.199); (iv) baseline instrumental self‐maintenance (14.62, 9.065–23.57); and (v) social role (2.176, 1.419–3.337) after controlling for baseline functional status.Conclusion:  These results indicate that many background factors are predictive of subsequent physical function in community‐dwelling older persons. Thus, early prevention and intervention regarding these background factors might be critical to promote and maintain functional status.