bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic value of self‐reported symptoms in Danish outpatients referred with symptoms consistent with colorectal cancer
Authors: Bjerregaard N. C. , Tøttrup A. , Sørensen H. T. , Laurberg S. 
Published: January 2007

AbstractObjective  To assess the association between self‐reported symptoms and a diagnosis of colorectal cancer (CRC) in symptomatic outpatients without CRC risk factors, defined by a Danish expert group.Method  A cross‐sectional study of patients aged 40 years and older referred by general practitioners to two Danish surgical outpatient clinics for symptoms consistent with CRC during a 16‐month period. CRC was diagnosed at endoscopy and through follow up. Before their first appointment, participants completed a questionnaire about symptoms.Results  The study included 2172 patients. Of these, 122 were diagnosed with CRC (5.6%). Median age was 61 years (range: 40–97) and 44.0% were men. All symptoms had high (93.4–96.8%) negative predictive values for CRC. The highest positive predictive values (PPV) were found for dark rectal bleeding (PPV: 20.6%) and CRC was diagnosed in a first‐degree relative over the age of 50 years (PPV: 11.2%). At multiple logistic regression analysis dark rectal blood was the most important predictor of CRC (OR: 7.4). Other predictors were age 60 years or older (OR: 3.0), change in frequency of bowel movements (OR: 2.5), CRC diagnosed in a first‐degree relative over the age of 50 years (OR: 2.6), male gender (OR: 2.2) and mono‐symptomatic fresh rectal blood (OR: 1.7).Conclusion  No self‐reported symptoms presented by outpatients without CRC risk factors can be used accurately to identify patients with CRC with certainty. For clinical purposes self‐reported symptoms seems thus not to be a useful accurate tool to distinguish between symptomatic outpatients with and without CRC.
Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer
Authors: Doornebosch P. G. , Tollenaar R. A. E. M. , Gosselink M. P. , Stassen L. P. , Dijkhuis C. M. , Schouten W. R. , Van De Velde C. J. , De Graaf E. J. R. 
Published: January 2007

AbstractObjective  Total mesorectal excision (TME) is the gold standard in rectal cancer, if curation is intended. Transanal endoscopic microsurgery (TEM) is a much safer technique and seems to have comparable survival in early rectal cancer. The impact of both procedures on quality of life has never been compared. In this study we compared quality of life after TEM and TME.Method  Fifty‐four patients underwent TEM for a T1 carcinoma. Only patients without known locoregional or distant recurrences were included, resulting in 36 eligible patients in whom quality of life after TEM was studied. The questionnaires used included the EuroQol EQ‐5D, EQ‐VAS, EORTC QLQ‐C30 and EORTC QLQ‐CR38. The results were compared with a sex‐and age‐matched sample of T+N0 rectal cancer patients who had undergone sphincter saving surgery by TME and a sex‐ and age matched community‐based sample of healthy persons.Results  Thirty‐one patients after TEM returned completed questionnaires (overall response rate 86%). Quality of life was compared with 31 TME patients and 31 healthy controls. From the patients’ and social perspective quality of life did not differ between the three groups. Compared with TEM, significant defecation problems were seen after TME (P < 0.05). A trend towards better sexual functioning after TEM, compared with TME, was seen, especially in male patients, although it did not reach statistical significance.Conclusion  Transanal endoscopic microsurgery and TME do not seem to differ in quality of life postoperatively, but defecation disorders are more frequently encountered after TME. This difference could play a role in the choice of surgical therapy in (early) rectal cancer. Further prospective studies are needed to confirm our conclusions.
Laparoscopic colorectal surgery – results from 200 patients
Authors: Scala A. , Huang A. , Dowson H. M. P. , Rockall T. A. 
Published: January 2007

AbstractObjective  Laparoscopic surgery is increasingly being performed for benign and malignant colorectal disease. This study examines the short‐term results in a consecutive series of laparoscopic colorectal procedures performed over 2 years.Method  A prospective database was established for all elective patients undergoing laparoscopic colorectal surgery by one surgeon. The main outcome measures assessed were operative duration, conversion rate, length of hospital stay, morbidity and mortality and lymph node harvest.Results  Two hundred and thirty‐one consecutive patients were referred for elective colorectal surgery, with 18 patients excluded from laparoscopic surgery. Thirteen patients had nonresective laparoscopic colorectal procedures for endometriosis and have been excluded from the series. Of 200 patients who underwent a laparoscopic colorectal procedure, 114 (57%) were female, the median age was 67 years (inter‐quartile range (IQR) 57–76), and there were 116 malignancies. The most common operations were anterior resection and sigmoid colectomy (n = 82), right hemicolectomy (n = 62) and left hemicolectomy (n = 12). The median operating time was 120 min (IQR 90–150) and 10 patients (5%) required conversion to open surgery. The median lymph node harvest in malignancies was 21 nodes (IQR 15–30) and no positive resection margins were found. There were two deaths and 29 significant complications (14.5%), with seven patients requiring re‐operations because of postoperative complications. The median postoperative hospital stay was 4 days (IQR 3–6) and 13 patients (6.5%) were re‐admitted within 30 days of hospital discharge.Conclusion  Laparoscopic colorectal surgery is possible for most benign and malignant conditions, with low conversion and complication rates, as well as short hospital stay.
Inter general practice variability in use of referral guidelines for colorectal cancer
Authors: John S. K. P. , Jones O. M. , Horseman N. , Thomas P. , Howell R. D. , Fozard J. B. J. 
Published: January 2007

AbstractObjective  The Two‐Week Wait (TWW) referral system for suspected colorectal cancers has a low yield. To examine this, we assessed the referral pattern of general practices within four primary care trusts and looked at the variability of yield of colorectal cancer amongst all TWW referrals and assessed the reasons for variability.Method  A prospectively collected database of all colorectal cancers was examined for new cases diagnosed in the 12 months from April 1st 2004. Patients were cross‐referenced via general practitioner (GP) codes to identify the referral origin. Reasons for the variability in referral patterns from each general practice were assessed in relation to TWW referrals, population demographics and through postal questionnaire of GPs.Results  A total of 175 patients diagnosed with colorectal cancer were referred from 49 general practices. Whilst there was a positive correlation between the number of TWW referrals and colorectal cancer per 1000‐practice population (P = 0.001; Spearman correlation coefficient rs=0.447, two‐tailed), there was a big discrepancy between referrals and cancer diagnosed in many general practices. Twenty‐six general practices (53%) had no colorectal cancer diagnosed via the TWW route and these practices had significantly lower utilization of the TWW referral pathway. In the postal survey, 22% of GPs were unaware of TWW clinics or colorectal cancer referral guidelines and only 8% of GPs knew the number of referral criteria.Conclusion  This study demonstrates wide variability within primary care, in the appropriate use of colorectal cancer referral guidelines. General practices should be targeted for education.
The positive correlation between avian species richness and human population density in Britain is not attributable to sampling bias
Authors: Evans Karl L. , Greenwood Jeremy J.D. , Gaston Kevin J. 
Published: January 2007

ABSTRACTAim  To assess whether spatial variation in sampling effort drives positive correlations between human population density and species richness.Location  British 10 × 10 km squares.Methods  We calculated three measures of species richness from atlas data of breeding birds in Britain: total species richness, species richness standardised for sampling effort, and the number of species only recorded in supplementary casual records in a manner not standardised for survey effort. We then assessed the form of the relationship between these richness estimates and human population density, both with and without taking spatial autocorrelation into account.Results  Both total and standardised species richness exhibit similar species richness–human population density relationships; species richness generally increases with human population density, but decreases at the very highest densities. Supplementary species richness is very weakly correlated with human population density.Main conclusions  In this example, sampling effort only slightly influences the form of species richness–human population density relationships. The positive correlation between species richness and human population density and any resultant conservation conflicts are thus not artefactual patterns generated by confounding human density and sampling effort.
A human‐induced downward‐skewed elevational abundance distribution of pteridophytes in the Bolivian Andes
Authors: Jácome Jorge , Kessler Michael , Smith Alan R. 
Published: January 2007

ABSTRACTAim  To search for differences in the spatial variability of upper and lower elevational distribution limits of tropical ferns, based on the assumption that these are determined to different degrees by biotic and abiotic factors.Location  The Yungas biogeographical region, in the Bolivian Andes.Methods  From a data base of > 25,000 herbarium records, we analysed the skewness of the elevational distribution of 220 montane pteridophyte species, each with 15 records. Additionally, we compared the spatial variability of upper and lower elevational range limits of ferns in 351 plots of 400 m2 each along four elevational transects separated by 15–450 km.Results  Individual species showed variable elevational distribution patterns, ranging from symmetric to asymmetric, i.e. downward and upward skewed, but overall there was a statistically significant trend towards asymmetric distributions with abrupt upper limits and diffuse lower limits. This trend, however, was almost exclusively due to terrestrial species occurring at and above the current timberline. The analysis of the elevational transects revealed no significant trends.Main conclusions  The downward‐skewed distributional abundance of terrestrial, open‐country ferns near the timberline appears to be a result of the extensive forest destruction that has lowered the timberline in the high Andes by 500–800 m, opening up habitats for a restricted suite of species. Our study shows that a limited number of species can cause a general trend in the overall data set, and that failure to extract these data may result in unsupported conclusions, in our case to assign a greater importance to biotic and abiotic factors in the elevational limitation of plants at lower and upper elevations, respectively.
Cervical lipomatosis in HIV‐infected patients: a case–control study
Authors: Palacios R , Galindo MJ , Arranz JA , Lozano F , Estrada V , Rivero A , Morales D , Asensi V , Del Arco A , Muñoz A , Santos J ,   for the Grupo de Estudio de Alteraciones Metabólicas (GEAM)
Published: January 2007

ObjectivesThe aim of the study was to analyse the prevalence of cervical lipomatosis (CL) in HIV‐infected patients on highly active antiretroviral therapy (HAART) and the factors associated with its development.MethodsThis was a multicentre, observational, 1:1 case–control study. HIV‐infected patients with CL (cases) and HIV‐infected patients from the same cohort, controlled for age (±5 years), sex and body mass index (±2.5 kg/m2) (controls), were included in the study, and a multiple conditional logistic regression was performed to identify factors related to CL.ResultsCL was reported in 80 patients (1.8%) from a cohort of 4214 patients on HAART followed up in 10 Spanish hospitals. CL was associated with time of exposure to stavudine [for each 6‐month increase, odds ratio (OR) 5.82, 95% confidence interval (CI) 5.70–5.94, P=0.0073] and lipoatrophy (OR 8.04, 95% CI 2.93–22.02, P=0.00001).ConclusionsAlthough lipodystrophy is very frequent among HIV‐infected patients on HAART, CL is an uncommon type of fat redistribution in this population, and in our cohort it was related to time of exposure to stavudine and lipoatrophy.
No association between HIV disease and its treatment and thyroid function
Authors: Madge S , Smith CJ , Lampe FC , Thomas M , Johnson MA , Youle M , Vanderpump M 
Published: January 2007

ObjectivesThe aims of the study were (i) to investigate the prevalence of overt and subclinical thyroid disease in HIV‐positive patients in a London teaching hospital; (ii) to determine risk factors associated with the development of thyroid dysfunction, including highly active antiretroviral therapy (HAART) and individual antivirals, and (iii) to determine the occurrence of thyroid dysfunction longitudinally over 3 years.MethodsThe study consisted of retrospective analyses of thyroid function tests (TFT) in HIV‐positive patients. The period prevalence of and factors associated with clinical and subclinical thyroid dysfunction were investigated. Patients with normal TFT but previous thyroid disease were identified from pharmacy records and included in the overt category.ResultsA total of 1565 patients (73% of the clinic population) had at least one TFT taken since 2001. Overall, 3584 samples were analysed. Of the patients included in the study, 1233 (79%) were male, 1043 (66%) were white and 365 (23%) were black African, and in 969 (62%) the main risk for HIV was homosexual sex. Median age at baseline was 37 years. Nine hundred patients (58%) were on HAART at the start of the study. Thirty‐nine (2.5%) were found to have overt hypothyroidism, and eight (<1%) had overt hyperthyroidism. Sixty‐one (4%) had subclinical hypothyroidism, five (<1%) had subclinical hyperthyroidism and 263 (17%) had a nonthyroidal illness. A normal TFT was obtained for 1118 patients (75.5%). Multivariate analysis suggested that no independent variables were significantly associated with overt hypothyroidism, including HAART and stavudine use specifically. Repeated measurements over 3 years were available for 825 patients and only eight new cases (1%) of overt thyroid disease occurred.ConclusionsThe prevalence of overt thyroid disease was low in this cohort, suggesting that screening is not warranted.
Community‐based rapid HIV testing in homeless and marginally housed adults in San Francisco
Authors: Buchér JB , Thomas KM , Guzman D , Riley E , Dela Cruz N , Bangsberg DR 
Published: January 2007

BackgroundStandard two‐step HIV testing is limited by poor return‐for‐results rates and misses high‐risk individuals who do not access conventional testing facilities.MethodsWe describe a community‐based rapid HIV testing programme in which homeless and marginally housed adults recruited from shelters, free meal programmes and single room occupancy hotels in San Francisco received OraQuick Rapid HIV‐1 Antibody testing (OraSure Technologies, Bethlehem, PA, USA).ResultsOver 8 months, 1614 adults were invited to participate and 1213 (75.2%) underwent testing. HIV seroprevalence was 15.4% (187 of 1213 individuals) overall and 3.5% (37 of 1063) amongst high‐risk individuals reporting no previous testing, a prior negative test, or previous testing without result disclosure. All 1213 participants received their results. Of 30 newly diagnosed persons who received confirmatory results, 26 (86.7%) reported at least one contact with a primary healthcare provider in the 6 months following diagnosis.ConclusionsWe conclude that community‐based rapid testing is feasible, acceptable and effective based on the numbers of high‐risk persons tested over a short period, the participation rate, the prevalence of new infection, the rate of result disclosure, and the proportion linked to care.
Treatment outcomes amongst previously antiretroviral‐naïve HIV‐infected patients starting lopinavir/ritonavir‐containing antiretroviral regimens at the Royal Free Hospital*
Authors: Smith CJ , Phillips AN , Youle MS , Sabin CA , Lampe FC , Tsintas R , Tyrer M , Johnson MA 
Published: January 2007

ObjectiveTo describe outcomes in patients starting first‐line antiretroviral regimens including lopinavir/ritonavir (LPV/r) in a routine clinic setting.MethodsPreviously naïve patients starting LPV/r‐containing antiretroviral therapy were included in the study. Virological failure was defined as the first of two viral loads >500 HIV‐1 RNA copies/mL more than 6 months after starting LPV/r. Cumulative percentages experiencing virological failure were calculated using Kaplan–Meier methods.ResultsA total of 195 individuals had a median follow‐up time of 1.7 years. At 48 weeks, 87.9, 77.4 and 71.6% of patients with pretreatment CD4 counts of <50, 50–200 and >200 cells/μL, respectively, remained on LPV/r. By 48, 72 and 96 weeks, 2.2, 3.0 and 5.0% of patients, respectively, had experienced virological failure, ignoring treatment changes but censoring follow‐up at discontinuation of all antiretrovirals; these percentages became 24.0, 33.7 and 42.3% when LPV/r discontinuation was considered as virological failure. Censoring those who stopped LPV/r with a viral load <50 copies/mL and considering as virological failures those who stopped LPV/r with a viral load >50 copies/mL gave 12.1, 14.6 and 17.0% virological failure at 48, 72 and 96 weeks, respectively. Median CD4 count increases at 24, 48 and 72 weeks were 167, 230 and 253 cells/μL, respectively.ConclusionsFew patients experienced virological failure whilst on a LPV/r‐based regimen, although it was not uncommon for patients in our clinic with higher baseline CD4 counts to discontinue LPV/r.
Safety of nevirapine in pregnancy
Authors: Natarajan U , Pym A , McDonald C , Velisetty P , Edwards SG , Hay P , Welch J , De Ruiter A , Taylor GP , Anderson J 
Published: January 2007

BackgroundNevirapine has been widely used in pregnancy for its efficacy, low pill burden, bioavailability and rapid transplacental transfer. Concern about nevirapine toxicity during pregnancy has emerged over recent years.ObjectivesThe aims of the study were to document the frequency of cutaneous and hepatic toxicity secondary to nevirapine use during pregnancy and to compare rates in women starting nevirapine during the current pregnancy with those in women who had commenced nevirapine prior to the current pregnancy.DesignThis was a retrospective, comparative, five‐centre study carried out in London, UK, in 1997–2003.MethodsAll HIV‐1‐infected women who received nevirapine as part of combination antiretroviral therapy (ART) during pregnancy were included in the study. Data on demographics, HIV infection risk, Centers for Disease Control and Prevention (CDC) status, surrogate markers at initiation of therapy, other medications hepatitis B and C virus coinfection and clinical data relating to potential toxicity were collated and analysed.ResultsFifteen of 235 eligible women (6.4%) developed rash and eight (3.4%) developed hepatotoxicity, including four with coexistent rash, giving a combined incidence of 19 potential cases of nevirapine toxicity during pregnancy (8.1%). Alternative causes of rash/hepatotoxicity were suspected in seven cases and only 10 mothers (5.8%) discontinued nevirapine. Of the 170 women who commenced nevirapine during this pregnancy, 13 (7.6%) developed rash and eight (4.7%) hepatotoxicity, a combined incidence of 10%. Only two of 65 women with nevirapine exposure prior to this pregnancy developed rash (3.1%).ConclusionsNevirapine‐containing ART was well tolerated in this cohort of pregnant women. Although pregnancy did not appear to increase the risk of nevirapine‐associated toxicity compared to published adult data, CD4 count may be less predictive of toxicity in pregnancy.
Haemoglobin and albumin as markers of HIV disease progression in the highly active antiretrovial therapy era: relationships with gender*
Authors: Shah S , Smith CJ , Lampe F , Youle M , Johnson MA , Phillips AN , Sabin CA 
Published: January 2007

ObjectivesThe aims of the study were to describe gender differences in haemoglobin and albumin and to investigate the prognostic value of these measurements in relation to highly active antiretroviral therapy (HAART).MethodsAnaemia was defined as haemoglobin <13.5 g/dL for men and <11.5 g/dL for women. Albumin <35 g/L was defined as hypoalbuminaemia. Proportional hazards models were used to describe relationships between these markers and HIV progression and death.ResultsA total of 291 patients had pre‐HAART and 1‐year measurements. Mean haemoglobin and albumin levels pre‐HAART were lower in women than in men (haemoglobin: 11.2 vs 13.2 g/dL, respectively, P<0.0001; albumin: 37.4 vs 40.2 g/L, respectively, P<0.0001), and a higher proportion of women were anaemic and hypoalbuminaemic compared with men. Despite a rise in both markers in the first year on HAART, mean haemoglobin levels remained lower by 2.08 g/dL (P<0.0001) and albumin by 2.88 g/L (P<0.0001) in women. In the 495 patients included in this analysis, haemoglobin and albumin levels were both significantly related to short‐term risk of AIDS and death independently of CD4 count [hazards ratio (HR)=0.73/g/dL higher haemoglobin, 95% confidence interval (CI) 0.55–0.82, P<0.0001 and HR=0.87/g/L higher albumin, 95% CI 0.83–0.91, P<0.0001]. The prognostic value did not differ by gender.ConclusionsWomen were more likely to be anaemic and/or hypoalbuminaemic pre‐HAART, but post‐HAART increases were similar to those in men. Both haemoglobin and albumin were strong independent prognostic factors for risk of AIDS and death, regardless of gender.
Identification and characterization of eight microsatellite loci in Aster amellus L. (Asteraceae)
Authors: MAYOR R. , NACIRI Y. 
Published: January 2007

AbstractEight polymorphic microsatellites were developed in the perennial herbaceous Aster amellus L. (Asteraceae) and characterized on three populations from France and Switzerland. The number of alleles ranged between four and 30 depending on the locus, and the mean number of effective alleles was 5.8. The average gene diversity equalled 0.744 (range: 0.419–0.957) and the overall differentiation was found significant (θ = 0.092, P < 0.01). Three loci displayed significant heterozygote deficiencies, which might indicate the presence of null alleles. Amplifications were detected on eight loci in Aster alpinus L.