bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term Result of Total versus Partial Fundoplication after Esophagomyotomy for Primary Esophageal Motor Disorders
Authors: Zhu Zi‐Jiang , Chen Long‐Qi , Duranceau Andre 
Published: January 2008

AbstractBackgroundThe selection of the type of fundoplication or the necessity for an added fundoplication after esophagomyotomy (Heller’s operation) for the treatment of achalasia remains controversial. The present retrospective study was designed to compare the long‐term results of total and partial fundoplication on the myotomized esophagus.MethodsBetween 1978 and 1998, a total of 64 consecutive patients with achalasia or diffuse esophageal spasm underwent esophagomyotomy and an antireflux operation via a left thoracotomy approach. Twenty‐one had a total fundoplication (Nissen Group) during the period 1978–1983. After 1984 and until 1998, the remaining 43 patients were treated with addition of a Belsey Mark IV partial fundoplication (Belsey Group) to protect the myotomized esophagus. Clinical, radiologic, radionuclide transit, manometric, 24–h pH monitoring, and endoscopic assessments were obtained before and after the operation.ResultsThere were no operative deaths or major complications in either group. After 6 years of follow‐up the Belsey group was compared to the Nissen group. A higher frequency of dysphagia (7/18 versus 3/31; p = 0.025), more barium stasis (9/13 versus 10/27; p = 0.056), and increased radionuclide material retention (52.4% versus 29.2%; p = 0.044) were observed in the Nissen group. These findings were confirmed by endoscopy, which showed increased esophageal lumen dilation (10/15 versus 8/26; p = 0.026) and more frequent food retention (11/15 versus 6/26; p = 0.002). Functionally, both operations successfully reduced the lower esophageal sphincter pressure gradient (from 23.8 to 7.7 mmHg for the Nissen group, and from 27.4 to 8.2 mmHg for the Belsey group; p = 0.656). In the Nissen group, the esophageal diameter observed on radiology increased from 3.9 cm preoperatively to 5.5 cm postoperatively (p = 0.012), whereas it remained identical for the Belsey group (ranging from 5.4 cm to 5.3 cm; p = 0.695). Reoperation to relieve recurrent dysphagia and esophageal retention was necessary in 8 patients from the Nissen group and in 1 patient from the Belsey group (p < 0.001).ConclusionsWhen treating achalasia or diffuse esophageal spasm by esophageal myotomy and an antireflux operation, a total fundoplication adds too much resistance to allow esophageal emptying and is considered as inappropriate. A partial fundoplication provides proper antireflux effects without causing significant esophageal emptying difficulties.
Surgery for Cushing’s Syndrome: An Historical Review and Recent Ten‐year Experience
Authors: Porterfield John R. , Thompson Geoffrey B. , Young William F. , Chow John T. , Fryrear Raymond S. , van Heerden Jon A. , Farley David R. , Atkinson John L. D. , Meyer Fredric B. , Abboud Charles F. , Nippoldt Todd B. , Natt Neena , Erickson Dana , Vella Adrian , Carpenter Paul C. , Richards Melanie , Carney J. Aidan , Larson Dirk , Schleck Cathy , Churchward Marilyn , Grant Clive S. 
Published: January 2008

AbstractBackgroundCushing’s syndrome (CS), due to multiple etiologies, is a disorder associated with the ravages of cortisol excess. The purpose of this review article is to provide a historical synopsis of surgery for CS, review a recent 10‐year period of operative management at a tertiary care facility, and to outline a practical approach to diagnosis and management.Materials and MethodsFrom 1996 to 2005, 298 patients underwent 322 operative procedures for CS at Mayo Clinic, Rochester, Minnesota. A retrospective chart review was carried out. Data was gathered regarding demographics, preoperative assessment, procedures performed, and outcomes. Data are presented as counts and percentages. Five‐year survival rates were calculated where applicable by the Kaplan‐Meier method. Statistical analysis was carried out with SAS, version 9 (SAS Institute, Inc., Cary, NC).ResultsTwo‐hundred thirty‐one patients (78%) had ACTH‐dependent CS and 67 patients (22%) had ACTH‐independent CS. One‐hundred ninety‐six patients (66%) had pituitary‐dependent CS and 35 patients (12%) had ectopic ACTH syndrome. Fifty‐four patients (18%) had cortisol‐secreting adenomas, 10 patients (3%) had cortisol‐producing adrenocortical carcinomas, and 1% had other causes. Cure rates for first time pituitary operations (transsphenoidal, sublabial, and endonasal) were 80% and 55% for reoperations. Most benign adrenal processes could be managed laparoscopically. Five‐year survival rates (all causes) were 90%, 51%, and 23% for adrenocortical adenomas, ectopic ACTH syndrome, and adrenocortical carcinomas, respectively.ConclusionsSurgery for CS is highly successful for pituitary‐dependent CS and most ACTH‐independent adrenal causes. Bilateral total adrenalectomy can also provide effective palliation from the ravages of hypercortisolism in patients with ectopic ACTH syndrome and for those who have failed transsphenoidal surgery. Unfortunately, to date, adrenocortical carcinomas are rarely cured. Future successes with this disease will likely depend on a better understanding of tumor biology, more effective adjuvant therapies and earlier detection. Clearly, IPSS, advances in cross‐sectional imaging, along with developments in transsphenoidal and laparoscopic surgery, have had the greatest impact on today’s management of the complex patient with CS.
Prediction of Response to Splenectomy in Patients with Idiopathic Thrombocytopenic Purpura
Authors: Shojaiefard A. , Mousavi S. A. , Faghihi S. H. , Abdollahzade S. 
Published: January 2008

AbstractBackgroundChronic immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by destruction of opsonized platelets in the reticuloendothelial system, particularly the spleen, and by resulting low platelet counts. Splenectomy is the standard second‐line treatment for patients with ITP who do not respond to corticosteroids. In the present study we determined predictive factors for the response of patients with ITP to splenectomy.Materials and MethodsFor thirty‐one patients with ITP referred from the Hematology Department of Shariati Hospital, open surgical splenectomy was performed between February 2002 and December 2004. All potentially important variables of response were collected and analyzed to determine predictive parameters.ResultsOlder patients (>52) responded less positively than younger patients (<52) to splenectomy (p < 0.01). Likewise, patients with a sustained remission after splenectomy had a significantly shorter interval of diagnosis of ITP to splenectomy (p < 0.05) and shorter duration of corticosteroid therapy before splenectomy (p < 0.05).ConclusionsThis study confirms that splenectomy is an effective treatment for patients with ITP. Our findings highlight age as the major predictive factor of long‐term response to splenectomy in patients with ITP.
Myopathy in Gaucher disease
Authors: Tsai Li‐Kai , Chien Yin‐Hsiu , Yang Chih‐Chao , Hwu Wuh‐Liang 
Published: January 2008

SummaryGaucher disease is a recessively inherited lysosomal storage disorder, caused by deficiency of glucocerebrosidase activity. Affected individuals usually present with hepatosplenomegaly, anaemia, thrombocytopenia, and skeletal diseases. A wide range of neurological manifestations have also been recognized in Gaucher patients including acute neurological deterioration in infancy, mental retardation, ocular motor apraxia, seizure, and parkinsonism. Although muscle weakness is not an uncommon finding in patients with Gaucher disease, the aetiology of weakness is not well understood. We prospectively investigated seven Gaucher patients and found that four of them (patients 1–4) had mild to moderate degree of proximal‐predominant symmetrical muscle weakness in four limbs. By history, three patients (patients 1–3) developed insidious onset of nonprogressive muscle weakness in four limbs with easy muscle fatigue from adolescence. A needle electromyographic study detected some small, brief polyphasic waves in these four patients. Muscle biopsy in one patient (patient 1) showed a few atrophic type II muscle fibres without infiltration of Gaucher cells. Three patients (patients 1–3) continuously received enzyme replacement therapy with imiglucerase and their muscle strength seemed improved after two years. We concluded that Gaucher disease may be associated with myopathy.
Specialized host‐plant performance of the cotton aphid is altered by experience
Authors: Liu Xiang Dong , Zhai Bao Ping , Zhang Xiao Xi 
Published: January 2008

AbstractAlthough distinct host specialization is observed for the cotton‐melon aphid (Aphis gossypii Glover) on cotton and cucurbit plants, it is still ambiguous whether the specialization is altered by experience on a novel host plant. Here the performance of cotton and cucurbit‐specialized aphids, A. gossypii on novel host plants was studied by a host‐selection test and by the life‐table method. The two host‐specialized aphids cannot survive and establish populations after reciprocal host transfers. They have ability to recognize the host plants on which they were reared, and escape behavior from novel hosts was observed. Interestingly, the cotton and cucurbit‐specialized aphids survive and reproduce normally on hibiscus (Hibiscus syriacus), a main overwintering host plant, and host‐fidelity of A. gossypii to cucurbit plants is altered by feeding and living experience on hibiscus, which confers the same capacity to use cotton and cucumber on to the cucurbit‐specialized population, but host‐fidelity to cotton is not altered and the fitness of the cotton specialized population to cucumber is still poorer. A. gossypii from hibiscus has a significant preference for cotton to cucumber in the host‐selection process, and none stays on cucumber more than 20 h after transfer. The results presented imply that cucurbit‐specialized aphids might not return to an overwintering host plant (hibiscus) in wild fields, so host conservatism to cucurbit plants is maintained. The potential of cucurbit‐specialized aphids of A. gossypii to use cotton plants, intermediated by experience on hibiscus, suggests that the specialized host‐plant performance of phytophagous insects is not wholly conservative.
Microwave Synthesis of Cationic Fatty Imidazolines and their Characterization
Authors: Bajpai Divya , Tyagi V. K. 
Published: January 2008

AbstractThis paper describes an efficient method for the synthesis of long chain dialkyldiamido imidazolines by the reaction of diethylenetriamine and several fatty acids under non‐solvent microwave irradiation using calcium oxide as support This synthesis required much less time in comparison to conventional thermal condensation and is carried out in an open vessel and the products obtained by this method were found to be in good yields and of high purity. Fatty imidazolines were then quaternized by using dimethyl sulfate as a quaternizing agent and isopropanol as a solvent, to produce cationic imidazolinium salts which were evaluated for yield and cationic content. The instrumental techniques, viz. FT‐IR and 1H NMR verified the formation of imidazolines and its subsequent quaternization. This method produced imidazolines in the very low time of 5–10 min and gave a yield of 89–91% as compared to a very long time of 8–10 h and a lower yield of 75–80% by the conventional thermal condensation method.
A high resolution SEM study of the effects of RU486, used as a postcoital contraceptive, on the rat uterus during early pregnancy
Authors: Scholtz Kathrine E. , Penny Clem B. , Hosie Margot J. 
Published: January 2008

AbstractDuring the window of receptivity, a narrow range of time under the control of the ovarian hormones progesterone and oestrogen, when a blastocyst can attach to the uterine surface, the plasma membrane of the uterine epithelial cells undergoes a remarkable change in structure, known as ‘the plasma membrane transformation’ of early pregnancy. RU486, the controversial abortion drug (Mifegyne™), acts as a progesterone receptor antagonist, resulting in transcriptionally inactive progesterone receptors. In view of this, a change in the well‐documented sequences of the plasma membrane transformation is postulated. This study therefore aims to investigate the effects of RU486 on this sequence of events in the implantation and non‐implantation sites of the rat uterus. In both RU486 treated and control animals, on days 4.5, 5.5 and 6.5 of pregnancy, scanning electron microscopy revealed a distinct pattern of folding of the uterine surface in non‐implantation sites. In contrast, folding was not observed within the implantation sites. These results indicate that surface alterations are probably not under the control of progesterone signalling. The lack of folding at the implantation sites possibly ensures maximum close contact between the blastocyst and the maternal tissue thus promoting implantation. During early pregnancy, specifically on day 5.5, the microvilli of the uterine epithelial cells in the treated animals were more dense than those in the untreated animals. Such microvilli are characteristic of the uterine epithelial cells of a uterus under‐stimulated by hormones. Flattening of the apical cell borders usually seen at the time of blastocyst attachment and implantation was not observed following RU486 treatment. Large apical protrusions were observed in the RU486 treated animals only, possibly linked in someway to apoptosis. The antiprogestin properties of RU486 may further elucidate the progesterone effects associated with early pregnancy.
Differentiation of embryonic stem cells towards pancreatic progenitor cells and their transplantation into streptozotocin‐induced diabetic mice
Authors: Chen Chunhua , Zhang Yuebo , Sheng Xiaoyan , Huang Cheng , Zang Ying Qin 
Published: January 2008

AbstractType I diabetes is characterized by the deficiency of endocrine β cells in the pancreatic islets of Langerhans and transplantation of islet cells can be an effective therapeutic approach. Embryonic stem cells can be differentiated into any cell type, and therefore represent an unlimited source of islet cells for the transplantation and treatment for type I diabetes. We have adopted an easy and reproducible in vitro differentiation system with a reduced serum concentration plus nicotinamide to generate early pancreatic progenitor cells from embryonic stem cells. Gene expression analysis indicated that the differentiated cells expressed not only endoderm markers such as GATA‐4, HNF‐3β, but also early markers of pancreatic development including key transcription factors PDX‐1 and IAPP. Some pancreatic specific markers, such as insulin I, insulin II, Glu‐2 and glucagon, were also expressed to some extent at the mRNA level. Differentiated ES cells showed low level immunoreactivity for insulin. However, transplantation of these early pancreatic progenitor clusters into STZ‐induced diabetic mice failed to reverse the hyperglycemic state of the disease as reported previously. The results suggest that culture manipulation can direct ES cells to differentiate into early pancreatic progenitor cells committing to pancreatic islet cell fate, but these cells cannot function normally to reduce blood glucose of diabetic mice at this stage.
Behavioral effects of current Alzheimer's disease treatments: A descriptive review
Authors: Cummings Jeffrey L. , Mackell Joan , Kaufer Daniel 
Published: January 2008

BackgroundBehavioral abnormalities and neuropsychiatric symptoms are common manifestations of Alzheimer's disease (AD). Many clinical trials of cholinesterase inhibitors (ChE‐Is) and memantine have included behavioral measures as primary or secondary outcomes, and most have observed behavioral benefits in conjunction with treatment. The purpose of this review was to determine the frequency of positive behavioral outcomes in AD clinical trials and clinical reports, to determine the symptoms most responsive to antidementia agents, and to explore factors that correlate with negative outcomes in clinical trials of antidementia agents with regard to behavioral measures.MethodsWe performed a computerized search of randomized clinical trials and open‐label studies of ChE‐Is and memantine for AD including a behavioral outcome measure. Studies involving 10 or more patients using therapeutic doses of the target agents and including a behavioral measure as a primary or secondary outcome were included in this review.ResultsOne hundred fifty‐seven peer‐reviewed articles and 68 publicly presented abstracts were identified in the literature search. Subsequent review established that 15 publications arising from 13 randomized, double‐blind, placebo‐controlled AD trials met the review inclusion criteria. Positive outcomes on behavioral measures were reported in 8 of 15 publications as a primary or secondary outcome. In most blinded AD clinical trials, behavioral measures were secondary outcomes. Mood symptoms and apathy have most commonly responded to ChE‐Is, whereas memantine has been associated with a reduction in irritability and agitation. However, there is substantial variability among trials in terms of behavioral outcomes. Studies that assessed patients with more severe dementia, included patients with less severe behavioral disturbances at baseline, involved institutionalized patients, or were international in scope tended to have negative outcomes. In institutionalized patients there is commonly an improvement in the placebo group that confounds the observation of any drug‐placebo difference.ConclusionsAntidementia agents have been associated with beneficial behavioral outcomes in many randomized clinical trials and open‐label studies. Most studies are not designed to test the psychotropic properties of antidementia drugs. Trials with negative behavioral outcomes are most likely to involve patients who are institutionalized and have few behavioral disturbances at baseline. Clinical trials designed to assess behavioral effects of antidementia agents should anticipate these factors.
Differentiating Alzheimer's disease from dementia with Lewy bodies and Parkinson's disease with (+)‐[11C]dihydrotetrabenazine positron emission tomography
Authors: Koeppe Robert A. , Gilman Sid , Junck Larry , Wernette Kris , Frey Kirk A. 
Published: January 2008

BackgroundSeveral progressive neurologic disorders begin with cognitive decline or parkinsonism, notably Alzheimer's disease (AD), Parkinson's disease (PD), and dementia with Lewy bodies (DLB). We used positron emission tomography (PET) in attempts to differentiate these disorders.MethodsWe performed PET with (+)‐[11C]dihydrotetrabenazine ([11C]DTBZ) to examine blood‐to‐brain ligand transport (K1) and striatal monoaminergic presynaptic binding (distribution volume [DV]) in 25 DLB, 30 PD, and 25 AD patients and 57 elderly controls (NC).Results[11C]DTBZ DV was decreased significantly in caudate nucleus, anterior putamen, and posterior putamen in DLB and PD compared with AD and NC. DLB and PD groups showed an anterior‐to‐posterior gradient of binding loss relative to NC, least in caudate nucleus and largest in posterior putamen. The gradient was significantly steeper in PD than DLB. Both PD and DLB showed significantly greater interhemispheric striatal binding asymmetry than NC, and PD had greater asymmetry than DLB. Cerebral cortical [11C]DTBZ K1 was decreased diffusely by 4% to 8% in PD. Larger K1 deficits occurred in AD and DLB temporoparietal and prefrontal association cortices and posterior cingulate cortex. Greater reduction of K1 occurred in occipital cortex in DLB than AD. Receiver operating characteristic curve analyses distinguished DLB from AD more effectively on the basis of striatal DV than occipital K1 and distinguished DLB from PD more effectively on the basis of cerebral cortical K1 than striatal DV patterns. Overall, 90% of cases were properly classified by combining these measures.ConclusionsPET with [11C]DTBZ can differentiate DLB from both PD and AD in a single neuroimaging study.
The pre–mild cognitive impairment, subjective cognitive impairment stage of Alzheimer's disease
Authors: Reisberg Barry , Prichep Leslie , Mosconi Lisa , John E. Roy , Glodzik‐Sobanska Lidia , Boksay Istvan , Monteiro Isabel , Torossian Carol , Vedvyas Alok , Ashraf Nauman , Jamil Imran A. , de Leon Mony J. 
Published: January 2008

BackgroundSubjective cognitive impairment (SCI) has been a common, but poorly understood condition, frequently occurring in older persons.MethodsThe past and the emerging literature on SCI and synonymously named conditions is reviewed.ResultsFindings include: (1) There is support from at least one longitudinal study for a long‐standing concept of SCI as a pre–mild cognitive impairment (MCI) condition lasting ∼15years. (2) There are complex relationships between SCI and depression and anxiety. (3) Differences in SCI subjects from age‐matched non‐SCI persons are being published in terms of cognitive tests, hippocampal gray matter density, hippocampal volumes, cerebral metabolism, and urinary cortisol levels. Psychometric and dementia test score differences between SCI and MCI subjects have long been evident. (4) Predictive electrophysiologic features of subsequent decline in SCI subjects are being published.ConclusionsStudies of therapeutic agents in SCI treatment and resultant Alzheimer's disease prevention appear to be feasible. These trials are also necessary from a public health perspective.
The association between dietary macronutrient intake and the prevalence of the metabolic syndrome
Authors: Skilton Michael R. , Laville Martine , Cust Anne E. , Moulin Philippe , Bonnet Fabrice 
Published: January 2008

We examined the association of dietary carbohydrates, protein, fat (including fatty acid subtypes) and alcohol with the metabolic syndrome and its components, in a cross-sectional study of 1626 patients with at least one cardiovascular risk factor. Multivariate nutrient density substitution models were used to examine the associations between macronutrients (assessed by 24 h dietary recall) and the metabolic syndrome. These models express the effects of ‘substituting’ one macronutrient for another without altering total energy intake. Increases in carbohydrates offset by isoenergetic decreases in either fat or protein were associated with a decrease in the prevalence of the metabolic syndrome (OR 0·87 (95 % CI 0·81, 0·93), P < 0·0001; OR 0·70 (95 % CI 0·61, 0·79), P < 0·0001, per 5 % energy intake respectively). Increased intake of dietary fat at the expense of dietary protein was also associated with a decreased prevalence of the metabolic syndrome (OR 0·80 (95 % CI 0·70, 0·92), P = 0·002 per 5 % energy intake). There were no statistically significant differences between fatty acid subtypes (P>0·10). Consumption of up to one standard alcoholic drink per d was associated with a lower prevalence of the metabolic syndrome when compared with non-drinkers (OR 0·67 (95 % CI 0·50, 0·89), P = 0·006); however, these benefits were weakened with higher levels of alcohol intake (P = 0·10 for one to three drinks and P = 0·29 for >three drinks). Thus, a diet high in carbohydrates, low in fat and protein, with low-to-moderate alcohol intake, is associated with a reduced prevalence of the metabolic syndrome.