bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post‐operative analgesic requirements: a prospective, randomized, double‐blind, controlled trial in patients undergoing major orthopedic surgery
Authors: Arcioni R. , Palmisani S. , Tigano S. , Santorsola C. , Sauli V. , Romanò S. , Mercieri M. , Masciangelo R. , De Blasi R. A. , Pinto G. 
Published: March 2007

Background:  New ways of decreasing post‐operative analgesic drug requirements are of special interest after major surgery. Magnesium sulfate (MgSO4) alters pain processing and reduces the induction and maintenance of central sensitization by blocking the N‐methyl‐d‐aspartate (NMDA) receptor in the spinal cord. We investigated whether supplementation of spinal anesthesia with combined intrathecally and epidurally infused MgSO4 reduced patients’ post‐operative analgesia requirements.Methods:  In a randomized, prospective, double‐blind, placebo‐controlled trial, we enrolled 120 consecutive patients undergoing orthopedic surgery during spinal anesthesia (levobupivacaine and sufentanil). Patients were randomly assigned to receive intrathecal MgSO4 (94.5 mg, 6.3%), epidural MgSO4 (2%, 100 mg/h), intrathecal and epidural MgSO4 combined or spinal anesthesia alone (controls). Post‐operative morphine consumption was assessed in all groups by patient‐controlled analgesia (PCA).Results:  Of the 120 patients enrolled, 103 (86%) completed the study. Morphine consumption at 36 h after surgery was 38% lower in patients receiving spinal anesthesia plus epidural MgSO4 [– 14.963 mg; 95% confidence interval (CI), – 1.44 to – 28.49 mg], 49% lower in those receiving spinal anesthesia plus intrathecal MgSO4 (– 18.963 mg; 95% CI, – 5.27 to – 32.65 mg) and 69% lower in the intrathecal–epidural combined group (– 26.963 mg; 95% CI, – 13.73 to – 40.19 mg) relative to control patients receiving spinal anesthesia alone. No complications developed during the post‐operative course or at 1 month after surgery.Conclusion:  In patients undergoing orthopedic surgery, supplementation of spinal anesthesia with combined intrathecal and epidural MgSO4 significantly reduces patients’ post‐operative analgesic requirements.
Intrathecal betamethasone pain relief in cancer patients with vertebral metastasis: a pilot study*
Authors: Inada T. , Kushida A. , Sakamoto S. , Taguchi H. , Shingu K. 
Published: March 2007

Background:  We have reported previously the usefulness of intrathecal betamethasone for pain relief in cancer patients who suffer from intractable pain caused by vertebral metastasis. The mechanism by which betamethasone relieves pain may be related to alterations in cerebrospinal fluid (CSF) concentrations of pro‐inflammatory cytokines and prostanoids.Methods:  Thirteen cancer patients with intractable pain caused by vertebral metastasis received 2–3 mg betamethasone in the lumbar subarachnoid space. CSF concentrations of tumor necrosis factor‐α (TNF‐α), interleukin‐1β (IL‐1β), IL‐6, IL‐8 and prostaglandin E2 (PGE2) were measured with an enzyme‐linked immunosorbent assay (ELISA) and a chemiluminescence enzyme immunoassay. Pain was measured using a numerical pain score (range, 0–10; 0, no pain; 10, worst pain imaginable).Results:  Intrathecal betamethasone was associated with a significant decrease in the pain score in six patients. In these cases, the pain score decreased from 6.7 ± 0.5 (mean ± standard error of the mean) to 3.3 ± 0.3 (P < 0.05), and the CSF concentrations of IL‐8 and PGE2 decreased significantly compared with pre‐treatment levels (IL‐8, 183.3 ± 21.2 to 116.5 ± 10.6 pg/ml; PGE2, 43.8 ± 10.3 to 14.7 ± 3.0 pg/ml). There were no significant changes in the CSF concentrations of cytokines and PGE2 in the remaining seven patients.Conclusion:  Pain relief with intrathecal betamethasone is related to decreases in the CSF concentration of IL‐8 and PGE2.
Neurogenic pulmonary edema
Authors: Baumann A. , Audibert G. , McDonnell J. , Mertes P. M. 
Published: March 2007

Neurogenic pulmonary edema (NPE) is usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. It has been reported regularly for a long time in numerous and various injuries of the central nervous system in both adults and children, but remains poorly understood because of the complexity of its pathophysiologic mechanisms involving hemodynamic and inflammatory aspects.NPE seems to be under‐diagnosed in acute neurologic injuries, partly because the prevention and detection of non‐neurologic complications of acute cerebral insults are not at the forefront of the strategy of physicians. The presence of NPE should be high on the list of diagnoses when patients with central neurologic injury suddenly become dyspneic or present with a decreased Pao2/Fio2 ratio.The associated mortality rate is high, but recovery is usually rapid with early and appropriate management.The treatment of NPE should aim to meet the oxygenation needs without impairing cerebral hemodynamics, to avoid pulmonary worsening and to treat possible associated myocardial dysfunction.During brain death, NPE may worsen myocardial dysfunction, preventing heart harvesting.
Real‐time multiplex allele‐specific polymerase chain reaction for genotyping of the Duffy antigen, the Plasmodium vivax invasion receptor
Authors: Sousa T. N. , Sanchez B. A. M. , Cerávolo I. P. , Carvalho L. H. , Brito C. F. A. 
Published: March 2007

Background and Objectives  Duffy blood group is of major interest in clinical medicine as it is not only involved in blood‐transfusion risks and occasionally in neonatal haemolytic disease, but it is also the receptor for the human malaria parasite Plasmodium vivax in the erythrocyte invasion. The aim of this study was to develop a rapid and inexpensive approach for high‐throughput Duffy genotyping.Materials and methods  This paper reported the development of a Duffy genotyping assay based on multiplex real‐time polymerase chain reaction (PCR) using SYBR Green I fluorescent dye.Results  By using this approach for Duffy genotyping we obtained the same results as that for the conventional allele‐specific PCR, however, in a high‐throughput assay. The Duffy genotyping of field samples demonstrated that P. vivax‐infected individuals showed a significantly higher prevalence of two functional alleles than Plasmodium falciparum‐infected and non‐infected individuals. This finding corroborates the hypothesis that the presence of two functional alleles increases the risk of P. vivax infection.Conclusion  This methodology may be suitable for epidemiological studies, particularly for exploring the relationship between Duffy alleles and malaria susceptibility, and also for identification of transfusional incompatibility in blood banks.
Growth and parameters of microflora in intestinal and faecal samples of piglets due to application of a phytogenic feed additive
Authors: Muhl A. , Liebert F. 
Published: March 2007

SummaryA commercial phytogenic feed additive (PFA), containing the fructopolysaccharide inulin, an essential oil mix (carvacrol, thymol), chestnut meal (tannins) and cellulose powder as carrier substance, was examined for effects on growth and faecal and intestinal microflora of piglets. Two experiments (35 days) were conducted, each with 40 male castrated weaned piglets. In experiment 1, graded levels of the PFA were supplied (A1: control; B1: 0.05% PFA; C1: 0.1% PFA; D1: 0.15% PFA) in diets based on wheat, barley, soybean meal and fish meal with lysine as the limiting amino acid. In experiment 2, a similar diet with 0.1% of the PFA (A2: control; B2: 0.1% PFA; C2: +0.35% lysine; D2: 0.1% PFA + 0.35% lysine) and lysine supplementation was utilized. During experiment 1, no significant effect of the PFA on growth, feed intake and feed conversion rate was observed (p > 0.05). Lysine supplementation in experiment 2 improved growth performance significantly, but no significant effect of the PFA was detected. Microbial counts in faeces (aerobes, Gram negatives, anaerobes and lactobacilli) during the first and fifth week did not indicate any significant PFA effect (p > 0.05). In addition, microflora in intestinal samples was not significantly modified by supplementing the PFA (p > 0.05). Lysine supplementation indicated lysine as limiting amino acid in the basal diet, but did not influence the microbial counts in faeces and small intestine respectively.
In vitro fermentation of different starches by mixed micro‐organisms from the sheep rumen
Authors: Ataşoğlu C. , Yurtman ı. Y. 
Published: March 2007

SummaryFermentation characteristics of wheat, rye, maize and triticale starches by mixed micro‐organisms from the sheep rumen were determined in an in vitro experiment. Starch was incubated with ruminal fluid for 2, 4, 6, 8, 10 and 12 h and various fermentation variables were determined. The rates of fermentation of the starches were not different (p > 0.05) from each other except for 2 and 4 h of incubation. Likewise, net ammonia production, sugar utilization, microbial biomass and the efficiency of microbial protein synthesis did not differ between the starches (p > 0.05). The proportions of sugar utilized were similar between the starches and approximately 75% of the starches were fermented during the 12‐h incubation. The 12‐h net concentrations of individual and total volatile fatty acids (VFA) were affected (p < 0.05) by the type of starch. The concentrations of acetate, propionate and butyrate and that of total VFA from wheat, maize and triticale incubations were higher (p < 0.05) than those from rye incubation. The results suggest that the type of starch subject to investigation had no measurable effects on fermentation variables determined in this study except for individual and total VFA concentrations.
Effects of rosuvastatin on lipids, lipoproteins and apolipoproteins in the dyslipidaemia of diabetes
Authors: Betteridge D. J. , Gibson J. M. 
Published: March 2007

AbstractAims  To compare the effects of rosuvastatin and atorvastatin 10 and 20 mg on plasma lipid and lipoprotein profiles in patients with Type 2 diabetes mellitus and triglycerides ≤ 6.0 mmol/l.Methods  A double‐blind, randomized, multicentre study to assess the effect of rosuvastatin and atorvastatin, at 10 mg/day for 8 weeks followed by 20 mg/day for a further 8 weeks, on low‐density lipoprotein cholesterol (LDL‐C), together with a range of secondary lipid and lipoprotein end points.Results  Rosuvastatin reduced mean LDL‐C levels from baseline over 16 weeks by 57.4%, while atorvastatin reduced mean LDL‐C levels by 46.0% over the same period. The difference in LDL‐C reduction between treatments was statistically significant (P < 0.001). Rosuvastatin also produced statistically significantly greater mean reductions from baseline in levels of total cholesterol, non‐high‐density lipoprotein cholesterol, apolipoprotein B and lipid ratios. More patients achieved European LDL‐C (< 2.5 mmol/l) and total cholesterol (< 4.5 mmol/l) goals with rosuvastatin than with atorvastatin. Rosuvastatin was associated with a significantly (P < 0.049) greater mean percentage increase in glycated haemoglobin (HbA1c) from baseline compared with atorvastatin; however, patients in both treatment groups maintained good glycaemic control. Both rosuvastatin and atorvastatin were well tolerated.Conclusions  Greater reductions in LDL‐C were achieved with rosuvastatin compared with equal doses of atorvastatin, enabling more patients with Type 2 diabetes to achieve European LDL‐C goals.
Type 1 diabetes and prolonged fasting
Authors: Reiter J. , Wexler I. D. , Shehadeh N. , Tzur A. , Zangen D. 
Published: March 2007

AbstractAims  Fasting is common in several religions. The aims of this study were to determine if prolonged fasting (> 25 h) is safe for individuals with Type 1 diabetes and to identify factors associated with success.Methods  Patients intending to fast were instructed on insulin dose adjustments, frequent glucose monitoring and when to terminate the fast using a standard protocol. Clinical and epidemiological factors were recorded and a comparison was made between successful and unsuccessful fasters.Results  Of 56 subjects who intended to fast, 37 (65%) were successful. Individuals terminated their fast in the presence of either hypoglycaemia or hyperglycaemia and adherence to the protocol was high. There were no serious side‐effects of fasting. Successful fasters had greater reductions in insulin dosage and higher HbA1c. There were no differences between individuals taking intermittent insulin injections and those with continuous infusion pumps.Conclusions  Persons with Type 1 diabetes can participate safely in prolonged fasts provided they reduce their usual insulin dose significantly and adhere to guidelines regarding glucose monitoring and indications for terminating fasting.
Persistent social disparities in the risk of hospital admission of paediatric diabetic patients in Germany—prospective data from 1277 diabetic children and adolescents
Authors: Icks A. , Rosenbauer J. , Strassburger K. , Grabert M. , Giani G. , Holl R. W. 
Published: March 2007

AbstractBackground  Reduction of social inequality in health care is a major target in many countries. The risk of hospital admission is thought to be higher in diabetic children from socially deprived families but actual data are lacking.Methods  Based on a nationwide prospective computer‐based documentation program (DPV), we determined the association between three social parameters (parental professional education, one‐parent family vs. complete family, migration background) and the risk for post‐onset hospital admission, as well as the number of hospital admission days in children and adolescents < 20 years of age with diabetes onset in 2002–2005 [n = 1277, 56% male, mean age at onset 8.5 (4.1) years]. We estimated relative risks with 95% confidence intervals, adjusting for age, sex, and diabetes centre (cluster), using random effect models.Results  Forty‐two per cent of the study subjects were admitted to hospital at least once during follow‐up. The incidence of hospital admissions was 0.46 (0.43–0.49) per person year, and there were 2.72 (2.65–2.80) hospital days per person year. Hospital admissions and hospital days were higher in girls than in boys (significant for hospital days, P < 0.05), and significantly lower in adolescents aged 15–19 compared with children aged 0–4 years (P < 0.05 in all models). Hospital admission rates were significantly higher in children from lower‐educated parents, single‐parent families, and families with a migration background (all P < 0.05).Discussion  We found post‐onset hospital admission rates to be higher in diabetic children and adolescents from socially deprived families. In comparison with an analysis in the 1990s, no decrease in social disparity in hospital admission risk was found.
HbA1c as a screening tool for detection of Type 2 diabetes: a systematic review
Authors: Bennett C. M. , Guo M. , Dharmage S. C. 
Published: March 2007

AbstractAim  To assess the validity of glycated haemoglobin A1c (HbA1c) as a screening tool for early detection of Type 2 diabetes.Methods  Systematic review of primary cross‐sectional studies of the accuracy of HbA1c for the detection of Type 2 diabetes using the oral glucose tolerance test as the reference standard and fasting plasma glucose as a comparison.Results  Nine studies met the inclusion criteria. At certain cut‐off points, HbA1c has slightly lower sensitivity than fasting plasma glucose (FPG) in detecting diabetes, but slightly higher specificity. For HbA1c at a Diabetes Control and Complications Trial and UK Prospective Diabetes Study comparable cut‐off point of ≥ 6.1%, the sensitivity ranged from 78 to 81% and specificity 79 to 84%. For FPG at a cut‐off point of ≥ 6.1 mmol/l, the sensitivity ranged from 48 to 64% and specificity from 94 to 98%. Both HbA1c and FPG have low sensitivity for the detection of impaired glucose tolerance (around 50%).Conclusions  HbA1c and FPG are equally effective screening tools for the detection of Type 2 diabetes. The HbA1c cut‐off point of > 6.1% was the recommended optimum cut‐off point for HbA1c in most reviewed studies; however, there is an argument for population‐specific cut‐off points as optimum cut‐offs vary by ethnic group, age, gender and population prevalence of diabetes. Previous studies have demonstrated that HbA1c has less intra‐individual variation and better predicts both micro‐ and macrovascular complications. Although the current cost of HbA1c is higher than FPG, the additional benefits in predicting costly preventable clinical complications may make this a cost‐effective choice.
Introducing estimated glomerular filtration rate (eGFR) into clinical practice in the UK: implications for the use of metformin
Authors: Warren R. E. , Strachan M. W. J. , Wild S. , McKnight J. A. 
Published: March 2007

AbstractAims  The reporting of estimated glomerular filtration rate (eGFR) will identify people with diabetes who have previously undiagnosed renal impairment. Our current guideline recommends discontinuation of metformin when serum creatinine > 150 µmol/l. We examined the implications of replacing this with a criterion based on eGFR.Methods  The Lothian diabetes register was used to identify patients with Type 2 diabetes for whom age, sex and creatinine measurements within the last 15 months were available. eGFR was calculated using the abbreviated Modification of Diet in Renal Disease (MDRD) equation.Results  Of 19 981 patients with Type 2 diabetes, 11 297 were taking metformin in accordance with our current guideline. Of these, 9259 (82.0%) had at least stage 2 renal impairment (eGFR < 90 ml/min per 1.73 m2) and 2880 (25.5%) had at least stage 3 renal impairment (eGFR < 60 ml/min per 1.73 m2). Changing to an eGFR threshold of 36 ml/min per 1.73 m2 would have a neutral effect on the number of patients eligible for metformin therapy and would permit its use in patients with creatinine concentrations as high as 179 µmol/l. An eGFR threshold of 40 ml/min per 1.73 m2 would result in 312 (2.8%) patients discontinuing metformin and would permit metformin to be used with creatinine concentrations as high as 163 µmol/l.Conclusions  The introduction of eGFR reporting could have a major effect on prescription of metformin. A threshold eGFR of 36–40 ml/min per 1.73 m2 is approximately consistent with our current practice. If our current practice is considered safe, this would be a useful recommendation.
High‐level expression of secreted complex glycosylated recombinant human erythropoietin in the Physcomitrella Δ‐fuc‐t Δ‐xyl‐t mutant
Authors: Weise Andreas , Altmann Friedrich , Rodriguez‐Franco Marta , Sjoberg Eric R. , Bäumer Wolfgang , Launhardt Heike , Kietzmann Manfred , Gorr Gilbert 
Published: March 2007

SummaryThe highly glycosylated peptide hormone erythropoietin (EPO) plays a key role in the regulation of erythrocyte maturation. Currently, marketed EPO is produced by recombinant technology in mammalian cell cultures. The complementary DNA (cDNA) for human EPO (hEPO) was transiently and stably expressed in the moss Physcomitrella patens wild‐type and Δ‐fuc‐t Δ‐xyl‐t mutant, the latter containing N‐glycans lacking the plant‐specific, core‐bound α1,3‐fucose and β1,2‐xylose. New expression vectors were designed based on a Physcomitrella ubiquitin gene‐derived promoter for the expression of hEPO cDNA. Transient expression in protoplasts was much stronger at 10 than at 20 °C. In Western blot analysis, the molecular size of moss‐produced recombinant human EPO (rhEPO) was identified to be 30 kDa, and it accumulated in the medium of transiently transformed protoplasts to high levels around 0.5 µg/mL. Transgenic Physcomitrella Δ‐fuc‐t Δ‐xyl‐t mutant lines expressing EPO cDNA showed secretion of rhEPO through the cell wall to the culture medium. In 5‐ and 10‐L photobioreactor cultures, secreted rhEPO accumulated to high levels above 250 µg/g dry weight of moss material after 6 days. Silver staining of rhEPO on sodium dodecylsulphate‐polyacrylamide gel electrophoresis (SDS‐PAGE) taken from the bioreactor culture demonstrated a high purity of the over‐expressed secreted rhEPO, with a very low background of endogenous moss proteins. Peptide mapping of rhEPO produced by the Physcomitrella Δ‐fuc‐t Δ‐xyl‐t mutant indicated correct processing of the plant‐derived signal peptide. All three N‐glycosylation sites of rhEPO were occupied by complex‐type N‐glycans completely devoid of the plant‐specific core sugar residues fucose and xylose.
Low self‐esteem: group cognitive behaviour therapy
Authors: Whelan Anne , Haywood Pennie , Galloway Scott 
Published: March 2007

Accessible summary

This article will describe a group to help improve self‐esteem in adults with learning disabilities.
The group was based on a cognitive behavioural therapy model.
The article will show how this particular group was organized and run.
Relevant research and theory will be discussed and an outline of the group itself will be given.

SummaryThis article will describe a self‐esteem cognitive behavioural therapy group run with adults with learning disabilities. The aim is to show how a group of this nature can be organized and run, using theory to inform practice. An introduction to the concept of self esteem will be given and then explored in relation to adults with learning disabilities. Details of the group, including how people were selected, will then be discussed. Some basic background information on group members and a cognitive behavioural formulation will follow. Then contents of sessions and the use of an adapted outcome measure will be mentioned, followed by some final reflections on the group.
Managing chronic pain in people with learning disabilities: a case study
Authors: Lewis Sarah , Bell Dorothy , Gillanders David 
Published: March 2007

Accessible summaryMany people with learning disabilities have pain that never goes away. This is called chronic pain.Lots of work has been done on chronic pain for people without learning disabilities, but not much is known about how to help people who have learning disabilities and chronic pain.This paper looked at what helped people without learning disabilities to live with chronic pain and adapted it to be used for people with learning disabilities and chronic pain.This paper found that it helped one woman and so it describes what was done so other people can use the same ideas in the future.SummaryChronic pain is a prevalent, under‐diagnosed problem in the learning disability population. This is in part due to communication problems, unrecognized pain behaviours and the effects of medication. As a consequence, chronic pain often goes untreated and causes ongoing distress. This paper initially describes the main research that has been carried out into learning disabilities and chronic pain management and then goes on to detail the case of a 32‐year‐old woman with mild–moderate learning disabilities who has been suffering from chronic pain for 16 months. A multi‐modal and multidisciplinary assessment was carried out to explore the physical and psychological underpinnings of her pain and its impact on her quality of life. A cognitive‐behavioural pain management intervention was developed by adapting a manual for non‐learning disabled adults to meet the physical, social and cognitive needs of the client. Sessions were carried out once a week for 4 months and improvements were reported in the level of pain intensity, levels of anxiety and depression and the range of activities she took part in.