bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous closure of patent foramen ovale
Authors: Bijl J. M. , Ruygrok P. N. , Hornung T. S. , Wilson N. J. , West T. 
Published: November 2005

Abstract Aim: To review the safety and efficacy of percutaneous closure of patent foramen ovale (PFO) in symptomatic patients without the use of general anaesthesia or echocardiographic guidance.Method: All patients accepted for percutaneous PFO closure by our service from August 2002 to August 2004 were included. Patient demographics and clinical information were obtained from clinical records and by telephone interview. Follow‐up outcomes recorded were recurrence of systemic thromboembolism, residual shunt, and change in pattern of migraines.Results: Forty consecutive adult patients, of whom 19 (48%) had an atrial septal aneurysm (ASA), underwent PFO closure using the Amplatzer occluder device with fluoroscopic guidance alone. Their mean age was 45 ± 10 years (range 23–63 years) and 24 (60%) were male. The indications for closure were ischaemic stroke (n = 26), transient ischaemic attack (TIA) (n = 8), both stroke and TIA (n = 2), refractory hypoxia (n = 2), platypnoea‐orthodeoxia (n = 1) and severe migraine with seizures (n = 1). Twenty patients suffered a single neurological event and 16 suffered >1 event, including six with only radiographic evidence of >1 event. Mean procedure time was 17.7 ± 9.6 min and fluoroscopy time was 6.7 ± 7.3 min. Implanted device sizes were 18 mm (n = 1), 25 mm (n = 37) and 35 mm (n = 2). In 33 patients, the procedure was performed as a day‐case. No complications were encountered. No further neurological events occurred in 39 patients at a mean follow‐up time of 11 ± 7 months (3–25 months) nor was a significant shunt detected in the 34 who underwent follow‐up echocardiography.Conclusions: Percutaneous closure of PFO with or without ASA, under local anaesthesia and without echocardiographic guidance, is a safe and effective procedure which can be performed as a day‐case. This has now become our standard clinical practice. (Intern Med J 2005; 35: 706–710)
Symptomatic hypocalcaemia and renal impairment associated with bisphosphonate treatment in patients with multiple myeloma
Authors: Henley D. , Kaye J. , Walsh J. , Cull G. 
Published: November 2005

Abstract We report three cases of severe hypocalcaemia associated with i.v. bisphosphonate treatment in patients with multiple myeloma. All patients had symptomatic hypocalcaemia, including a tonic‐clonic seizure and tachyarrhythmia in one case. Two cases were associated with the development of acute renal failure, whereas the third patient had pre‐existing renal impairment. We recommend that bisphosphonates be used with caution in patients with myeloma and renal impairment, that vitamin D deficiency be corrected prior to treatment (to reduce the risk of hypocalcaemia) and that serum calcium and renal function be monitored during treatment. (Intern Med J 2005; 35: 726–728)
Printed patient education interventions to facilitate shared management of chronic disease: a literature review
Authors: Harris M. , Smith B. , Veale A. 
Published: November 2005

Abstract Background: Printed materials for patient self‐education are a comparatively low cost, flexible and potentially useful aid for dealing with the growing burden of chronic disease in our society. A comprehensive review of existing trials is required.Aims:  We conducted a comprehensive review which aimed to (i) evaluate the evidence for effectiveness of print‐only interventions in increasing patient participation in chronic disease management and (ii) identify disease or intervention characteristics associated with success.Methods:  Medline, the Cochrane Central Register of Controlled Trials, EMBASE and CINAHL were searched for the period 1992 to January 2005 for reports of controlled trials of printed patient materials in chronic disease. The quality of both studies and interventions was assessed.Results:  Seven studies were found. They focussed on inflammatory bowel disease, arthritis, asthma and diabetes. Few studies named primary outcomes, continued beyond 6 months or included process evaluations. Few reports gave the behaviour‐change rationale of the intervention. Few interventions were reported as having been designed using testing and improvement, psychosocial theory, checks of patient understanding or other patient input. A variety of outcomes was measured. Statistically significant change was found for few. Knowledge improved in three studies, adherence improved in two and quality of life declined in one.Conclusions:  We found that printed interventions as currently designed appear to produce, at best, modest benefits. The design of interventions, studies and study reports all need improvement before decisions can be made about effectiveness and characteristics associated with success. (Intern Med J 2005; 35: 711–715)
Severe community‐acquired pneumonia: an Australian perspective
Authors: Wilson P. A. , Ferguson J. 
Published: November 2005

Abstract Background:  Severe community‐acquired pneumonia (CAP) is a common disease with a relatively high mortality. The initial treatment is empirical, based on a broad range of potential pathogens. There are minimal published data describing microbiological causes of pneumonia in Australia.Aims:  To describe the aetiology and characteristics of severe CAP in patients requiring intensive care unit (ICU) admission, to identify factors predicting mortality and to audit current practices of investigation and antibiotic management of these patients from an Australian perspective.Methods:  A retrospective analysis of patient case notes was performed for 96 consecutive patients admitted to two ICU with severe CAP. Data recorded included patient demographics, comorbidities, antimicrobial treatment, investigations and outcome (mortality, length of stay).Results:  Overall, mortality was 32%. A microbiological diagnosis was made in 46% of patients. The most frequent causative organisms were Streptococcus pneumoniae (13 cases), influenza A (9), Haemophilus influenzae (5) and Staphylococcus aureus (4); aerobic Gram‐negative bacilli collectively accounted for five cases. Blood cultures were positive in 20% of patients. Seventy patients (73%) required mechanical ventilation and 61 patients (63%) required inotropic support. Laboratory abnormalities including acute renal failure, metabolic acidosis and coagulopathy were frequent. Factors associated with mortality on multivariate analysis were age, antibiotic administration prior to hospital presentation, delay in hospital antibiotic administration of more than 4 h, and presence of multilobar or bilateral consolidation on chest X‐ray.Conclusions:  Severe CAP requiring ICU admission was associated with a mortality rate of 32%, despite appropriate antimicrobial therapy including a beta‐lactam and a macrolide antibiotic in most cases. Causative organisms identified were similar to those found in previous studies. High rates of viral causes (28% of identified pathogens) were noted. Low rates of legionellosis and other atypical causes were found, most probably due to a lack of systematic testing for these agents. (Intern Med J 2005; 35: 000–000)
Doubling daily inhaled corticosteroid dose is ineffective in mild to moderately severe attacks of asthma in adults
Authors: Rice‐McDonald G. , Bowler S. , Staines G. , Mitchell C. 
Published: November 2005

Abstract Background:  Asthma guidelines recommend increasing or doubling inhaled corticosteroid (ICS) dose to treat mild and moderate exacerbations of asthma in adults.Aim:  To: (i) compare the effectiveness of doubling existing daily ICS dose (fluticasone) with maintaining usual ICS dose and usual daily ICS dose accompanied by oral steroids (OS) (dexamethasone) during mild and moderately severe exacerbations of asthma in adults; (ii) examine determinants of success and failure; and (iii) compare side‐effect profiles.Methods:  A randomized, double‐blind, placebo‐controlled (double‐dummy), triple crossover trial. Participants acted as their own control. Outcome measures included treatment success/failure, peak expiratory flow (PEF) after 7 days therapy or at treatment failure, and side‐effects.Results:  From 22 participants (nine males and 13 females), 18 pairs of data were available for maintaining usual ICS versus doubling ICS and doubling ICS versus OS, and 19 for maintaining usual ICS versus OS. Median (fifth–95th percentile) age was 46.5 (32–64) years and forced expiratory volume in one second (FEV1) 73% (29–97%) predicted. The outcome after doubling ICS was not superior to maintaining usual ICS, with 11 (61%) failures in both arms (P = 0.66). OS, with only 5 (26%) failures, was superior to maintaining usual ICS with 12 (63%) failures (P = 0.04), and to doubling ICS with 5 (28%) versus 11 (61%) failures (P = 0.07). Median PEF (as percentage of run‐in best) at end‐points were 90.5% (57.1–177.1) for OS, 78.3% (39.5–103.1) for maintaining usual ICS and 77.9 (27.7–110.3) for doubling ICS. Neither gender nor PEF at exacerbation were predictive of failure. Although doubling ICS was not an effective therapy overall, ICS dose at exacerbation were predictive of success in the doubling ICS arm (P = 0.04). Treatment failures when doubling daily ICS dose were more common if achieved fluticasone dose was less than 2000 µg (three of 11, 73%) compared to 2000 µg or greater (eight of eight, 37.5%). Increasing age and the presence of an upper respiratory tract infection (URTI) were predictive of failure with OS. Side‐effects were more commonly reported with OS (52.6%) than doubling ICS (42.1%) or maintaining usual ICS (19.1%) with the most common being mood changes (36.8%), sleep disturbance (31.6%) and changes in appetite (26.3%).Conclusions:  Doubling daily ICS dose per se is not effective for the treatment of mild to moderately severe exacerbations of asthma in adults. Success may depend on achieved ICS dose. Oral steroids are effective, but side‐effects are common. A review of current guidelines may be warranted. (Intern Med J 2005; 35: 693–698)
Warfarin induction at 5 mg daily is safe with a low risk of anticoagulant overdose: results of an audit of patients with deep vein thrombosis commencing warfarin
Authors: Harper P. , Monahan K. , Baker B. 
Published: November 2005

Abstract Background:  Conventionally warfarin therapy is initiated using a loading dose given over several days. Daily international normalised ratio (INR) monitoring is recommended to prevent overdose; however, with a large proportion of patients with deep vein thrombosis now receiving treatment out of hospital daily blood tests are inconvenient. We introduced a low‐dose protocol for starting anticoagulant therapy that only required INR testing on days 4 and 6 and audited the results to assess safety and efficacy.Methods: Two‐hundred and forty‐eight patients with confirmed deep vein thrombosis were started on warfarin therapy at 5 mg daily for 3 days. INR measurements were taken at day 4 and day 6.Results:  Of these patients, 21% had an INR within the therapeutic range on day 4 and 52% had a therapeutic INR on day 6. The risk of overdose was small with only one case with an INR above 4.0 on day 4 and nine cases on day 6. There were no reported cases of bleeding.Conclusion: The low‐dose protocol with infrequent testing is safe and convenient for outpatient management. However, our results suggest that patients on this protocol take between 6–10 days to achieve a stable INR. (Intern Med J 2005; 35: 717–720)
Attention deficit disorder: not just for children
Authors: Clarke S. , Heussler H. , Kohn M. R. 
Published: November 2005

Abstract Attention deficit/hyperactivity disorder (ADHD) has long been described in children who demonstrate developmentally inappropriate symptoms of inattention, impulsivity and motor restlessness. In adults, symptoms are known to persist and the validity of adult ADHD as an entity is now recognized. There is an associated high proportion of other serious psychiatric comorbidities, especially substance abuse, mood and anxiety disorders. Advances have been made into the aetiology and management of ADHD. Many of these focus on the dopamine and noradrenaline pathways. (Intern Med J 2005; 35: 721–725)
Effect of copper and zinc supplementation on peripheral leukocytes in neutropenia due to copper deficiency
Authors: Kikuchi Motoo , Inagaki Toshiaki , Hanaki Hidekazu 
Published: November 2005

Background:  Recent quantitative and qualitative studies in animals suggest that copper deficiency causes immunological impairment and a decrease in leukocytes. We investigated the effect of copper supplementation in remedying these effects of its deficiency and whether zinc, a trace element that is significant to the immune status modifies such effects.Methods:  In the present investigation, the effects of copper supplementation on circulating lymphocyte levels of 18 patients (aged 61–98 years, mean 85 years) with severe copper deficiency, elicited by a long‐term low copper diet, were examined in comparison with six age and sex‐matched healthy elderly subjects. Every day for 28 days, 2 mg of copper sulfate was added to the diets of 12 of the copper‐deficient subjects. The remaining copper‐deficient subjects received 2 mg of copper sulfate daily in their diets and were also given 17.3 mg of zinc sulfate every day by intravenous infusion, both supplements were also given for 28 days. Two‐color flow‐cytometry was conducted and the blastogenesis of circulating lymphocytes was examined.Results:  Copper supplementation increased the number of circulating CD2+, CD4+, CD20+ cells without affecting numbers of NK‐type CD8+ T cells (CD11b+ and CD57+ lymphocytes). The percentage of monocytes to total leukocytes decreased after copper supplementation. Zinc supplementation, however, did not augment these effects and did not increase the total number of CD57+ cells. The ratio of pokeweed mitogen reactivity to concanavalin‐A reactivity was diminished by copper supplementation but not additional zinc. There was no change in the immunological colloid reaction in the zinc sulfate turbidity test.Conclusion:  Our results suggest that copper depletion has a deleterious effect on the immune system, with a decrease in circulating lymphocytes numbers. Monocytes seemed to be more resistant to copper deficiency than neutrophils, and to play a significant role in lymphocyte activation. Despite this, however, it seems unlikely that there is any synergy between copper supplementation and zinc supplementation.
β‐amyloid inhibition of long‐term potentiation is mediated via tumor necrosis factor
Authors: Wang Qinwen , Wu Jinqun , Rowan Michael J. , Anwyl Roger 
Published: November 2005

AbstractA number of recent studies have shown that β‐amyloid (Aβ) inhibits the induction of long‐term potentiation (LTP) in the hippocampus. However, little is known about the mechanisms underlying such inhibition of LTP. In the present study, we present evidence that the cytokine tumor necrosis factor (TNF) α has a key role in the Aβ inhibition of LTP. The suppression of LTP by Aβ was absent in mutant mice null for TNF receptor type 1 (TNF‐R1) and was prevented by the inhibitors of TNFα, infliximab and TNF peptide antagonist, and by the inhibitor of TNFα production, thalidomide. In addition, exogenous TNFα inhibited LTP induction, an action mediated via TNF‐R1 as such inhibition was absent in mutant mice null for TNF‐R1. The inhibition of LTP by TNFα involved activation of group I metabotropic glutamate receptor and p38 MAP kinase, identical to that for the Aβ‐mediated inhibition of LTP induction.
Increased discharge threshold after an interictal spike in human focal epilepsy
Authors: de Curtis Marco , Tassi Laura , Lo Russo Giorgio , Mai Roberto , Cossu Massimo , Francione Stefano 
Published: November 2005

AbstractIt is commonly assumed that interictal spikes (ISs) in focal epilepsies set off a period of inhibition that transiently reduces tissue excitability. Post‐spike inhibition was described in experimental models but was never demonstrated in the human epileptic cortex. In the present study post‐spike excitability was retrospectively evaluated on intracerebral stereo‐electroencephalographic recordings performed in the epileptogenic cortex of five patients suffering from drug‐resistant focal epilepsy secondary to Taylor‐type neocortical dysplasias. Patients typically presented with highly periodic interictal spiking activity at 2.33 ± 0.87 Hz (mean ± SD) in the dysplastic region. During the stereo‐electroencephalographic procedure, low‐frequency stimulation at 1 Hz was systematically performed for diagnostic purposes to identify the epileptogenic zone. The probability of evoking an IS during the interspike period in response to 1‐Hz stimuli delivered close to the ictal‐onset zone was examined. Stimuli that occurred early after a spontaneous IS (within 70% of the inter‐IS period) had a very low probability of generating a further IS. On the contrary, stimuli delivered during the late inter‐IS period had the highest probability of evoking a further IS. The generation of stimulus‐evoked ISs is occluded for several hundred milliseconds after the occurrence of a preceding spike discharge. As previously shown in animal models, these findings suggest that, during focal, periodic interictal spiking, human neocortical excitability is phasically controlled by post‐spike inhibition.
Activation and desensitization of neuronal nicotinic receptors modulate glutamatergic transmission on neonatal rat hypoglossal motoneurons
Authors: Quitadamo Costanza , Fabbretti Elsa , Lamanauskas Nerijus , Nistri Andrea 
Published: November 2005

AbstractIn the neonate the muscles of the tongue, which are exclusively innervated by the XII cranial nerves originating from the brainstem nucleus hypoglossus, must contract rhythmically in coincidence with breathing, suckling and swallowing. These motor commands are generated by hypoglossal motoneurons excited by glutamatergic inputs. Because in forebrain areas the efficiency of glutamatergic transmission is modulated by neuronal nicotinic receptors (nAChRs), the role and identity of nAChRs within the nucleus hypoglossus of the neonatal rat were explored using anin vitrobrainstem slice preparation. This area expressed immunoreactivity for α4, α7 and β2 nAChR subunits. Whole‐cell patch‐clamp recording from hypoglossal motoneurons showed lack of spontaneous cholinergic events mediated by nAChRs even in the presence of a cholinesterase inhibitor. However, pharmacological antagonism of α7‐ or β2‐containing receptors depressed glutamatergic currents arising either spontaneously or by electrical stimulation of the reticular formation. Hypoglossal motoneurons expressed functional nAChRs with characteristics of α4β2 and α7 receptor subunits. Such receptors underwent fast desensitization (time constant of 200 ms) with full recovery within 1 min. Low (0.5 µm) concentration of nicotine first facilitated glutamatergic transmission on motoneurons and later depressed it through receptor desensitization. When 0.1 µmnicotine was used, only depression of synaptic transmission occurred, in keeping with the suggestion that nAChRs can be desensitized without prior activation. These results highlight the role of tonic nAChR activity in shaping excitatory inputs to hypoglossal motoneurons, and suggest that nAChR desensitization by ambient nicotine could contribute to disorders of tongue muscle movements.
A daily palatable meal without food deprivation entrains the suprachiasmatic nucleus of rats
Authors: Mendoza Jorge , Angeles‐Castellanos Manuel , Escobar Carolina 
Published: November 2005

AbstractFood is considered a potent Zeitgeber for peripheral oscillators but not for the suprachiasmatic nucleus (SCN), which is entrained principally by the light–dark cycle. However, when food attains relevant properties in quantity and quality, it can be a potent Zeitgeber even for the SCN. Here we evaluated the entrainment influence of a daily palatable meal, without regular food deprivation, on the circadian rhythm of locomotor activity and the c‐Fos and PER‐1 protein expression in the SCN. Rats fed ad libitum, in constant darkness, received a palatable meal for 6 weeks starting in the middle of the subjective day. Locomotor activity showed entrainment when the offset of activity coincided with the palatable meal‐time. In the SCN, the peak expression of c‐Fos was observed at palatable meal‐time and PER‐1 showed a peak during the onset of subjective night, as predicted according to the behavioural entrained pattern. In addition, c‐Fos and PER‐1 expression in the paraventricular thalamic nucleus (PVT) showed increased expression at palatable meal‐time, while the intergeniculate leaflet did not, suggesting that the PVT may be involved as an input pathway of palatable food‐entrainment to the SCN. These results demonstrate that daily access to a palatable meal can entrain the SCN; several stimuli can be implicated in this process, including motivation and arousal.
Heteromodal connections supporting multisensory integration at low levels of cortical processing in the monkey
Authors: Cappe Céline , Barone Pascal 
Published: November 2005

AbstractWhile multisensory integration is thought to occur in higher hierarchical cortical areas, recent studies in man and monkey have revealed plurisensory modulations of activity in areas previously thought to be unimodal. To determine the cortical network involved in multisensory interactions, we performed multiple injections of different retrograde tracers in unimodal auditory (core), somatosensory (1/3b) and visual (V2 and MT) cortical areas of the marmoset. We found three types of heteromodal connections linking unimodal sensory areas. Visuo‐somatosensory projections were observed originating from visual areas [probably the ventral and dorsal fundus of the superior temporal area (FSTv and FSTd), and middle temporal crescent (MTc)] toward areas 1/3b. Somatosensory projections to the auditory cortex were present from S2 and the anterior bank of the lateral sulcus. Finally, a visuo‐auditory projection arises from an area anterior to the superior temporal sulcus (STS) toward the auditory core. Injections in different sensory regions allow us to define the frontal convexity and the temporal opercular caudal cortex as putative polysensory areas. A quantitative analysis of the laminar distribution of projecting neurons showed that heteromodal connections could be either feedback or feedforward. Taken together, our results provide the anatomical pathway for multisensory integration at low levels of information processing in the primate and argue against a strict hierarchical model.