bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glycaemic and nonglycaemic effects of pioglitazone in triple oral therapy of patients with type 2 diabetes
Authors: DORKHAN M. , MAGNUSSON M. , FRID A. , GRUBB A. , GROOP L. , JOVINGE S. 
Published: June 2006

Abstract.Objectives.  To examine pioglitazone as add‐on to metformin and insulin secretagogues in patients with type 2 diabetes and inadequate glycaemic control and its effect on glycaemic control, surrogate measures of insulin sensitivity (adiponectin) and β‐cell function (proinsulin/insulin) and fluid retention.Design and setting.  Prospective open‐label study of 54 patients with type 2 diabetes and HbA1c≥6.5% admitted to outpatient unit at Malmö University Hospital. The patients received 30–45 mg pioglitazone daily during 26 weeks in addition to their existing antidiabetic medication. After 26 weeks, one‐third of patients were followed for 3 months without pioglitazone.Results.  HbA1c decreased (7.8 ± 0.9–6.3 ± 0.9%, P < 0.001) with 61% of patients achieving levels <6.5%. However, in the group followed for another 3 months HbA1c increased (6.1 ± 0.73–7.1 ± 0.9, n = 18, P < 0.001) after pioglitazone withdrawal. Adiponectin increased (6.1 ± 2.8–13.2 ±5.8 μg mL−1, P < 0.001) and the proinsulin to insulin ratio decreased (0.89 ± 0.66–0.66 ± 0.53, P < 0.001). Nt‐proBNP increased from 487.3 ± 252.2 to 657.8 ± 392.1 pmol L−1 (P < 0.001).Conclusions.  Pioglitazone is effective in achieving glycaemic targets and reducing risk factors involved in atherosclerosis and improving β‐cell function when used as part of triple oral therapy in patients with type 2 diabetes and secondary drug failure. Nt‐proBNP increase with concomitant decrease in haemoglobin suggests a subclinical sign of fluid retention.
Clinical and angiographic follow‐up after coronary drug‐eluting and bare metal stent implantation. Do drug‐eluting stents hold the promise?
Authors: JENSEN J. , LAGERQVIST B. , AASA M. , SÄREV T. , NILSSON T. , TORNVALL P. 
Published: June 2006

Abstract.Objectives.  To investigate the influence of drug‐eluting stent (DES) implantation on clinical and angiographic restenosis.Design.  Registry study of data from the Swedish Coronary Angiography and Angioplasty Registry with a coronary angiographic substudy.Setting.  Multi‐centre study.Subjects.  During October 2002 to May 2004 a total of 23 590 percutaneous coronary intervention (PCI) procedures were performed at 25 hospitals. After selection, to achieve comparable groups, a total of 5068 patients of whom 4111 had a bare metal stent (BMS) implanted and 957 had a DES implanted, remained. End‐point in the registry follow‐up was >50% diameter restenosis at clinically driven reangiography within 12 months after index PCI. The primary end‐point in the angiographic substudy was late loss in patients’ DES at 6‐month angiographic follow‐up.Results.  The rate of clinically driven restenosis, within 12 months, in patients receiving DES was less (3.9%) compared with those who received BMS (7.0%). In multivariate analysis the risk of clinical restenosis was one‐third for DES compared with BMS (HR 0.36, 95% CI 0.25–0.52). In the angiographic substudy late loss was 0.07 ± 0.53 mm (range −0.88 to 1.62). The amount of late loss was related to the presence of diabetes mellitus or not (0.19 ± 0.45 mm vs. −0.12 ± 0.58 mm), and lack of postdilatation of the stent or not (0.23 ± 0.51 mm vs. −0.09 ± 0.50 mm).Conclusions.  The use of DES in the Swedish ‘real world’ is effective in reducing the clinically driven restenosis rate, when compared with patients with BMS treatment. In the angiographic follow‐up the average late loss was as low as observed in recent randomized multi‐centre trials.
Population‐attributable risk of coronary heart disease risk factors during long‐term follow‐up: the Malmö Preventive Project
Authors: NILSSON P. M. , NILSSON J.‐Å , BERGLUND G. 
Published: June 2006

Abstract.Aims.  To calculate the population‐attributable risk (PAR) of coronary events (CE) from 10 risk factors, during long‐term follow‐up.Methods.  We used both case–cohort and case–control analyses for calculation of PAR in relation to 10 baseline risk factors. First CE (fatal or nonfatal, n = 3072) in 22 444 males and 10 902 females was recorded during a mean follow‐up of 20 years by use of national registers.Results.  Using a Cox regression analysis in a case–cohort design, smoking (prevalence in men 49%, women 37%) was the strongest risk factor, RR 2.29 (95% CI 2.09–2.52; PAR 39%), followed by hypercholesterolaemia, RR 1.70 (95% CI 1.56–1.86; PAR 18%), and diabetes, RR 1.67 (95% CI 1.41–1.99; PAR 3%). For women the strongest risk factors were smoking, RR 3.16 (95% CI 2.50–3.98; PAR 44%), diabetes, RR 2.59 (95% CI 1.78–3.76; PAR 6%), and hypertension, RR 2.47 (95% CI 1.94–3.14; PAR 23%). In men, smoking was the strongest predictor both after 10 years [RR 2.69 (95% CI 2.23–3.24)] and 20 years [RR 2.45 (95% CI 2.15–2.79)], followed by hypercholesterolaemia (RR 2.16–1.63), hypertension (RR 2.04–1.51), and diabetes (RR 1.85 –1.47). The case–control design gave very similar results. Total PAR varied from 74% (fully adjusted Cox regression, case–control, in men) to 116% in women (case–cohort).Conclusion.  Smoking is the most important long‐term risk factor for CE in both genders, based on data from a population with a high proportion of smokers. Ten measured variables explained almost all variation in risk and could be used as a basis for intervention programmes.
Spinal tuberculosis: overlooked?
Authors: ABOU‐RAYA S. , ABOU‐RAYA A. 
Published: June 2006

Abstract.Objective.  The aim of the present study was to ascertain the degree of occurrence of tuberculous infection in patients presenting with low back pain (LBP).Methods.  Forty consecutive patients seeking primary medical attention for the main symptom of LBP and presenting to the Rheumatology Outpatient Clinic of our institution from January 2004 to June 2005, were recruited in this cohort study. All patients were thoroughly interrogated (occupational, trauma, infection, diabetes mellitus and medication history), subjected to a rigorous clinical examination and a battery of investigationsResults.  Twelve of the 40 patients (33%) proved to have spinal TB as the cause of backache. Eight of these patients were above the age of 65. Five of the 12 patients with spinal TB also had concomitant osteoarthritic changes of the spine and two patients had concomitant disc prolapse. Eleven of the 12 patients with spinal TB had a completely normal chest X‐ray and in 10 of these patients the plain X‐ray of the lumbosacral region failed to show any significant lesion. In all 12 patients, sputum analysis failed to reveal acid‐fast bacilli.Conclusions.  The findings of this study indicate that TB is a common cause of LBP that is liable to be overlooked in the differential diagnosis of LBP. Furthermore, evidence of concurrent active intrathoracic TB may be lacking and consequently a high level of suspicion is required. The need for prompt diagnosis and treatment of skeletal TB is of utmost importance to prevent serious bone and joint destruction and severe neurological sequelae. A reliable imaging modality for diagnosing spinal TB seems to be magnetic resonance imaging.
Intravenous immunoglobulin‐associated cranial pachymeningitis
Authors: MARIE I. , HERVÉ F. , LAHAXE L. , ROBADAY S. , GERARDIN E. , LEVESQUE H. 
Published: June 2006

Abstract.To date, intravenous immunoglobulin (IvIg) has more often been considered as a safe medication. However, with the wider use of IvIg, severe side effects have also been reported to occur in IvIg‐treated patients, notably aseptic meningitis. Other neurological complications have more rarely been described in patients receiving IvIg therapy, e.g. stroke or acute encephalopathy. We recently observed a case which is of particular interest, as the patient with steroid‐refractory polyarteritis nodosa developed cranial pachymeningitis related to IvIg therapy. To our knowledge, this is the first reported case of cranial pachymeningitis complicating IvIg therapy. Our findings emphasize the importance of recognizing IvIg‐related neurological complications in IvIg‐treated patients. As cranial pachymeningitis is a fibrosing process, both recognition and management at an early stage are required to prevent definite neurological impairment in patients.
Assessing cognition and psychomotor function under long‐term treatment with controlled release oxycodone in non‐cancer pain patients
Authors: Gaertner J , Radbruch L , Giesecke T , Gerbershagen H , Petzke F , Ostgathe C , Elsner F , Sabatowski R 
Published: June 2006

Background:  The therapeutic use of opioids can be associated with altered cognition and impaired psychomotor function. Several studies have demonstrated the impact of opioid therapy on psychomotor performance and cognition, but no data exist about the effect of long‐term treatment with controlled release oxycodone (CRO) on driving ability.Methods:  Thirty patients suffering from chronic non‐cancer pain who had been treated with stable doses of CRO where included in a prospective trial and compared with 90 healthy volunteers (matched pairs). A computerized test battery that was developed to assess the driving ability of traffic delinquents in Germany was employed. Attention reaction, visual orientation, motor coordination and vigilance were evaluated. The data from a total of 11 parameters were assessed and for each test a relevant score was defined. As the primary endpoint the sum score of the three relevant scores was determined. A weaker statistical means to assess the patients’ performance is to compare the test results with an age‐independent control group. Individuals performing worse than the 16th percentile of this control group are considered to be unable to drive according to German legislation.Results:  Significant non‐inferiority could not be demonstrated for the primary endpoint. However, driving ability as defined as a result above the 16th percentile did not differ significantly between the patients receiving CRO and the age‐independent control group.Conclusion:  The use of CRO does not prohibit driving, but individual assessment is necessary.
Acupuncture stimulation of ST‐36 (Zusanli) significantly mitigates acute lung injury in lipopolysaccharide‐stimulated rats
Authors: Huang C.‐L , Huang C.‐J , Tsai P.‐S , Yan L.‐P , Xu H.‐Z 
Published: June 2006

Background:  We sought to investigate the potential therapeutic effects of acupuncture stimulation of ST‐36 (Zusanli) on endotoxemia‐induced acute lung injury in lipopolysaccharide (LPS)‐stimulated rats.Methods:  Sixty rats were randomized into six groups (n= 10): (i) lipopolysaccharide (LPS) control group, (ii) normal saline (N/S) control group, (iii) LPS plus ST‐36 group, (iv) N/S plus ST‐36 group, (v) LPS plus sham point (Sham) group, and (vi) N/S plus Sham group. Manual acupuncture stimulation of ST‐36 (designated as ‘ST‐36’) or a ‘non‐acupoint’ (designated as ‘Sham’) was performed in lightly immobilized rats for 30 min. Then, LPS injection was employed to induce sepsis. Rats were killed at 6 h after LPS injection and lung injury, nitric oxide (NO) biosynthesis and inducible NO synthase (iNOS) expression were assayed.Results:  Significant lung injury, pulmonary iNOS expression and systemic and pulmonary NO biosynthesis were noted in the LPS groups. Rats in the LPS plus Sham group had lung injury, pulmonary iNOS expression, systemic and pulmonary NO biosynthesis similar to those observed in the LPS group. However, the degree of lung injury, pulmonary iNOS expression and pulmonary NO biosynthesis, but not systemic NO biosynthesis, were significantly attenuated in the LPS plus ST‐36 group as compared with those in both the LPS group and the LPS plus Sham group.Conclusion:  Acupuncture stimulation of ST‐36 may be effective as a prophylaxis measure against sepsis. However, results from this study do not support the use of acupuncture for the treatment of sepsis.
GABAmimetic intravenous anaesthetics inhibit spontaneous Ca2+‐oscillations in cultured hippocampal neurons
Authors: Sinner B. , Friedrich O. , Zink W. , Fink R. H. A. , Graf B. M. 
Published: June 2006

Background:  Spontaneous Ca2+‐oscillations are a possible mechanism of Ca2+‐mediated signal transduction in neurons. They develop by a periodical interplay of Ca2+, which enters the neuron from the extracellular medium and triggers Ca2+ release from the endoplasmic reticulum (ER). Ca2+‐oscillations are terminated by reuptake into the ER or plasmalemmal extrusion. Spontaneous Ca2+‐oscillations are glutamate dependent and appear to be responsible for neuronal plasticity and integration of information. Here, we examined the role of the gamma‐aminobutyric acid (GABAA) receptor on spontaneous Ca2+‐oscillations and studied the effects of the anaesthetics midazolam, thiopental and the non‐anesthetic barbituric acid on spontaneous Ca2+‐oscillations.Methods:  Hippocampal neuronal cell cultures of 19‐day‐old embryonic Wistar rats 17–18 days in culture were loaded with the Ca2+‐sensitive dye Fura‐2AM. Experiments were performed using dual wave‐length excitation fluorescence microscopy and calibration constants were obtained from in situ calibration.Results:  Spontaneous Ca2+‐oscillations are influenced by the GABAA receptor. The intravenous anaesthetics midazolam and thiopental suppressed the amplitude and frequency reversibly in a dose‐dependent manner with EC50 in clinically relevant concentrations. This effect was mediated via the GABAA receptor as it could be reversed by the GABAA receptor antagonist bicuculline. In contrast, the application of barbituric acid had no effects on the spontaneous Ca2+‐oscillations.Conclusion:  Spontaneous Ca2+‐oscillations are influenced by the GABAA receptor. Spontaneous Ca2+‐oscillations might represent an interesting model system to study anaesthetic mechanisms on neuronal information processing.
Allocation of tasks between anesthesiologists and anesthesia nurses in Finland
Authors: Vakkuri A. , Niskanen M. , Meretoja O. A. , Alahuhta S. 
Published: June 2006

Background:  The shortage of anesthesiologists in Finland is worsening. A survey was carried out in 2003 among head anesthesiologists and head nurses to clarify current practice and the potentials for reorganizing tasks between anesthesiologists and anesthesia nurses. A national working group analyzed the results.Methods:  A questionnaire concerning doctor and nurse resources in anesthesiology, current allocation of tasks, and opinions on how these tasks could be reallocated was sent to 87 head anesthesiologists and 32 head nurses in 45 different hospitals. The answers from the doctors and nurses were compared.Results:  The response rate of doctors and nurses was 87% and 100%, respectively. In the enrolled hospitals there were 64 unoccupied positions for specialists in anesthesiology. The ratio of anesthesiologists to operation rooms (OR) they attended varied between 0.3 and 1.5. Doctors and nurses reported the allocation of tasks quite similarly. The great majority of respondents considered spinal, epidural, and interscalene brachial plexus blocks, and the induction of general anesthesia to be tasks that should be performed by an anesthesiologist. Very few respondents of either profession were willing to reallocate tasks so that nurses could deliver general anesthesia, including endotracheal intubation, even in low‐risk patients.Conclusion:  Nurses could be trained nationwide to perform procedures already performed by locally trained nurses in some hospitals. To cope with the shortage of anesthesiologists, other strategies must be adopted in addition to transferring part of their work load to nurses.
Ultrasound guidance improves the success rate of a perivascular axillary plexus block
Authors: Sites B. D. , Beach M. L. , Spence B. C. , Wiley C. W. , Shiffrin J. , Hartman G. S. , Gallagher J. D. 
Published: June 2006

Background:  Traditional approaches to performing brachial plexus blocks via the axillary approach have varying success rates. The main objective of this study was to evaluate if a specific technique of ultrasound guidance could improve the success of axillary blocks in comparison to a two injection transarterial technique.Methods:  Fifty‐six ASA physical status I–III patients presenting for elective hand surgery were prospectively randomized to receive an axillary block performed by either a transarterial technique (Group TA) or an ultrasound‐guided perivascular approach (Group US). Both groups received a total of 30 ml of 1.5% lidocaine (225 mg) with 5 μg/ml epinephrine. Patients were then evaluated for block onset in specific nerve distributions and whether or not the block acted as a surgical anesthetic.Results:  Group TA sustained more failures defined as conversion to general anesthesia or the inability to localize the artery [Group TA eight patients (29%) vs. Group US in which 0 patients required conversion to general anesthesia (0%) P < 0.01]. Group US demonstrated a reduction in performance times vs. Group TA (7.9 ± 3.9 min vs. 11.1 ± 5.7 min, P < 0.05). By 30 min post‐injection, there were no significant differences between groups TA and US in terms of the proportion of patients demonstrating a complete motor or sensory loss.Conclusion:  Ultrasonographic guidance improves the overall success rate of axillary blocks in comparison to a transarterial technique.
Plasma concentrations following repeated rectal or intravenous administration of paracetamol after heart surgery
Authors: Holmér Pettersson P. , Jakobsson J. , ÖWall A. 
Published: June 2006

Background:  Paracetamol is commonly used for post‐operative pain management in combination with more potent analgesics. The best route of paracetamol administration after major surgery, when oral intake may not be optimal, is not known. Our primary purpose was to study plasma concentrations after the 1st and 4th dose of 1 g of paracetamol given either rectally or intravenously (i.v.) after major surgery.Methods:  In this prospective, randomized study, 48 patients undergoing heart surgery were randomized upon arrival to the intensive care unit (ICU) to receive paracetamol every 6th hour either as suppositories or intravenous injections. In half the patients (n= 24), blood samples for paracetamol concentration were obtained before and 20, 40 and 80 min after the first dose. In the other patients (n= 24), additional samples were taken prior to, and at 20, 40, 80 min and 4 and 6 h after, the 4th dose.Results:  Plasma paracetamol concentration peaked (95 ± 36 μmol/l) within 40 min after initial i.v. administration but did not increase within 80 min after the 1st suppository. Plasma concentration before the 4th dose was 74 ± 51 and 50 ± 27 in the rectal and i.v. groups, respectively. Paracetamol concentration peaked 20 min after the 4th dose for the i.v. patients (210 ± 84 μmol/l) and declined to 99 ± 27 μmol/l at 80 min as compared with the rectal patients 69 ± 44 to 77 ± 48 μmol/l.Conclusion:  Both time course and peak plasma concentrations of paracetamol given rectally differ from the one seen after intravenous administration. The clinical impact of these differences needs further investigation.
Etoricoxib pre‐medication for post‐operative pain after laparoscopic cholecystectomy
Authors: Puura A. , Puolakka P. , Rorarius M. , Salmelin R. , Lindgren L. 
Published: June 2006

Background:  Etoricoxib alleviates and prevents acute pain. The hypothesis of our study was that the pre‐operative use of etoricoxib would reduce the post‐operative need for additional pain treatment.Methods:  In this double‐blind, randomized and active placebo‐controlled study, 75 patients were pre‐medicated 1.5 h before elective laparoscopic cholecystectomy with 120 mg of etoricoxib (E120 group), the same dose of etoricoxib combined with 1 g of paracetamol (E + P group) or placebo (Pla group). To alleviate post‐operative pain, a patient‐controlled analgesia (PCA) device was programmed to deliver 50 μg of fentanyl intravenously (lockout time, 5 min). The pain intensity and nausea were assessed using a visual analogue scale (VAS). The number of patients with post‐operative nausea and vomiting was recorded. Blood loss was compared between the groups. Because the operations are almost blood‐less, the operation time was also recorded to compare the possible effect on bleeding time.Results:  Pre‐medication with etoricoxib or etoricoxib plus paracetamol had a statistically significant fentanyl‐sparing effect 2–20 h post‐operatively compared with placebo (P= 0.001). No significant differences were demonstrated in fentanyl‐sparing effect between the E120 and E + P groups. No significant differences in pain intensity were found between the three study groups. No significant differences were observed between the groups with regard to nausea, blood loss, duration of anaesthesia or duration of surgery.Conclusion:  Etoricoxib is suitable for pre‐medication before laparoscopic cholecystectomy as it reduces the need for post‐operative opioids. Opioid‐related side‐effects, however, were not reduced in the present study, despite the observed opioid‐sparing effect of etoricoxib and combined etoricoxib and paracetamol.
Continuous peripheral nerve block catheter tip adhesion in a rat model
Authors: Buckenmaier C. C. , Auton A. A. , Flournoy W. S. 
Published: June 2006

Background:  Continuous peripheral nerve block (CPNB) has been used effectively in combat casualties from Iraq and Afghanistan to provide surgical anesthesia and extended duration analgesia during evacuation and convalescence. Little information is available concerning catheter tip tissue reaction with prolonged use.Methods:  Forty‐eight male Sprague‐Dawley rats were assigned (12 per group) to one of four catheter tip designs provided by Arrow International: group A, 20‐gauge catheter with three side‐holes and a bullet‐shaped tip; group B, 19‐gauge StimuCath™ catheter with coiled omni‐port end with hemispherical distal tip; group C, 19‐gauge catheter with single end‐hole in conducting tip; group D, 19‐gauge catheter with closed conducting tip with four side‐holes. Following laparotomy, a randomly assigned catheter tip was sutured to the parietal peritoneal wall with the tip extending between experimental injuries created on the abdominal wall and cecum. After 7 days in situ, the catheter tips were removed from the adhesion mass using a force gauge, and the grams of force needed for removal were recorded.Results:  The mean force ± standard deviation values were 1.09 ± 1.21 g for group A, 21.20 ± 30.15 g for group B, 0.88 ± 1.47 g for group C and 1.60 ± 2.50 g for group D. The variation of each catheter group mean force compared with that of group B was significant (P < 0.05). There was no significant difference in adhesion force between groups A, C and D.Conclusions:  These results suggest that the manufactured design of a CPNB catheter tip can contribute to the adhesion of the tip in an intense inflammatory environment. This finding may have important clinical implications for CPNB catheters left in place for extended periods of time.
Influence of developmental environment on male‐ and female‐mediated sperm precedence in Drosophila melanogaster
Authors: AMITIN E. G. , PITNICK S. 
Published: June 2006

AbstractLength of the sperm flagellum and of the female's primary sperm‐storage organ, the seminal receptacle (SR), exhibit a pattern of rapid correlated evolution in Drosophila and other lineages. Experimental evolution studies with Drosophila melanogaster indicate that these traits have coevolved through sexual selection, with length of the SR representing the proximal basis of female sire discrimination, biasing paternity according to sperm length. Here, we examine the impact of experimentally varying the developmental environment, including larval density and larval and adult nutrition, on sperm length, SR length and on the pattern of sperm precedence. Expression of SR length was far more sensitive to variation among developmental environments than was sperm length. Nevertheless, there was striking co‐variation in sperm and SR length. The developmental environment of both females and second males, but not first males, significantly contributed to variation in male competitive fertilization success.