bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abnormality of the hepatic vein waveforms in cirrhotic patients with portal hypertension and its prognostic implications
Authors: Kawanaka Hirofumi , Kinjo Nao , Anegawa Go , Yoshida Daisuke , Migoh Shinichi , Konishi Kozou , Ohta Masayuki , Yamaguchi Shohei , Tomikawa Morimasa , Hashizume Makoto , Maehara Yoshihiko 
Published: July 2008

AbstractBackground and Aim: We investigated the prognostic significance of changes in the Doppler hepatic vein (HV) waveforms in cirrhotic patients with portal hypertension and the mechanisms of these changes.Methods: A total of 103 consecutive patients were included in this study and their HV waveforms were classified into four types: type I, triphasic waveform; type II, biphasic waveform; type III, biphasic waveform with reduced phasic oscillations; and type IV, a flat waveform.Results: Type I was observed in 34, type II in 40, type III in 23, and type IV in six patients. The 5‐year survival rates were 90%, 89%, 41%, and 0% in type I, II, III, and IV, respectively. Five variables including the Child–Pugh score, albumin, bilirubin, ascites, and HV waveform significantly correlated with the survival in a univariate analysis. A multivariate analysis only identified the HV waveform (type III and IV) to be an independent prognostic value. Even in Child–Pugh class B patients, the 5‐year survival rate for type III or IV was as poor as 26% in comparison to 92% for type I or II. In contrast, in Child–Pugh class C patients, the 5‐year survival rate for type I or II was as good as 63% in comparison to 25% for type III or IV. Furthermore, the changes in HV waveforms correlated with the extent of hepatic fibrosis, the increase in portal perfusion per liver volume, or the decrease in portal vascular resistance.Conclusions: Analyzing the HV waveforms was thus found to be a simple method for accurately assessing the prognosis in cirrhotic patients with portal hypertension.
Cerebral diffusion tensor imaging and in vivo proton magnetic resonance spectroscopy in patients with fulminant hepatic failure
Authors: Saksena Sona , Rai Vijan , Saraswat Vivek Anand , Rathore Ramkishore Singh , Purwar Ankur , Kumar Manoj , Thomas M Albert , Gupta Rakesh Kumar 
Published: July 2008

AbstractBackground and Aim:  Cerebral edema is a major complication in patients with fulminant hepatic failure (FHF). The aim of this study was to evaluate the metabolite alterations and cerebral edema in patients with FHF using in vivo proton magnetic resonance spectroscopy (MRS) and diffusion tensor imaging, and to look for its reversibility in survivors.Methods:  Ten FHF patients along with 10 controls were studied. Five of the 10 patients who recovered had a repeat imaging after three weeks. N‐acetylaspartate, choline (Cho), glutamine (Gln), glutamine/glutamate (Glx), and myoinositol ratios were calculated with respect to creatine (Cr). Mean diffusivity (MD) and fractional anisotropy (FA) were calculated in different brain regions.Results:  Patients exhibited significantly increased Gln/Cr and Glx/Cr, and reduced Cho/Cr ratios, compared to controls. In the follow‐up study, all metabolite ratios were normalized except Glx/Cr. Significantly decreased Cho/Cr were observed in deceased patients compared to controls. In patients, significantly decreased MD and FA values were observed in most topographical locations of the brain compared to controls. MD and FA values showed insignificant increase in the follow‐up study compared to their first study.Conclusions:  We conclude that the Cho/Cr ratio appears to be an in vivo marker of prognosis in FHF. Decreased MD values suggest predominant cytotoxic edema may be present. Persistence of imaging and MRS abnormalities at three weeks' clinical recovery suggests that metabolic recovery may take longer than clinical recovery in FHF patients.
Eosinophilic esophagitis in children with celiac disease
Authors: Ooi Chee Y , Day Andrew S , Jackson Reuben , Bohane Tim D , Tobias Vivienne , Lemberg Daniel A 
Published: July 2008

AbstractBackground and Aims:  Eosinophilic esophagitis and celiac disease are distinct gastrointestinal disorders. The present study in children highlights the possible coexistence of these two conditions. This study also analyzes the epidemiological and clinical profiles of these patients.Methods:  The medical records of patients diagnosed with celiac disease from 1 April 1999 to 31 March 2007 were reviewed. Patients with coincident histological diagnosis of eosinophilic esophagitis were retrospectively identified. The presenting symptoms, laboratory evaluations, endoscopic and histopathological findings, and treatment and follow‐up outcomes of these patients were analyzed.Results:  Of the 221 patients with celiac disease, seven (3.2%) were also diagnosed with eosinophilic esophagitis. A majority (6/7) presented with periumbilical pain and diarrhea. None had dysphagia. Each patient had abnormal celiac screening tests. Three patients had peripheral blood eosinophilia and elevated eosinophil cationic protein. Endoscopic changes of eosinophilic esophagitis and celiac disease were apparent in the majority of patients (6/7). A gluten‐free diet was instituted in every patient. Topical corticosteroid therapy was started in one patient at diagnosis and in another patient after repeat endoscopic and histopathological evaluations.Conclusions:  Awareness of the potential coexistence of eosinophilic esophagitis and celiac disease should promote optimal diagnosis of these conditions. Routine esophageal biopsies may be warranted when investigating for celiac disease.
Plasma lipid alterations after total splenectomy, subtotal splenectomy and splenic auto‐implants in rats
Authors: Petroianu Andy , Veloso Denny FM , Alberti Luiz R , De Souza Vasconcellos Leonardo 
Published: July 2008

AbstractBackground and Aim:  The relation between the spleen and lipid metabolism has not been properly studied. In order to contribute to the filling of this gap, in the present investigation we experimentally assessed the lipidogram of rats in the presence of the spleen, in asplenia, and after conservative spleen surgeries.Methods:  Fifty female Wistar rats of similar weight and age were divided into five groups submitted to the following procedures: group 1: control, with an intact spleen; group 2: sham operation; group 3: total splenectomy; group 4: subtotal splenectomy; and group 5: total splenectomy complemented with autogenous spleen tissue implants. Four months after the interventions, serum triglycerides, total cholesterol and fractions (very‐low‐density lipoprotein [VLDL]‐cholesterol, low‐density lipoprotein [LDL]‐cholesterol, high‐density lipoprotein [HDL]‐cholesterol) were determined. The results for the four groups were compared by analysis of variance followed by the Tukey–Kramer test, with the level of significance set at P < 0.05.Results:  There were no differences between groups 1, 2, 4 and 5. In the animals submitted to total splenectomy, total cholesterol (P = 0.0151) and LDL‐cholesterol fraction concentrations (P < 0.0001) were higher, whereas HDL‐cholesterol fraction concentrations were lower (P = 0.0026) than those detected in the other groups. There was no difference in triglycerides (P = 0.1571) or VLDL‐cholesterol (P = 0.2527) between groups.Conclusion:  The spleen probably plays an important role in the lipid metabolism of female rats and total splenectomy may be related to changes in cholesterol control. It is possible that preservation of spleen tissue prevents such metabolic disorders.
Microbiological monitoring of endoscopes: 5‐year review
Authors: Gillespie Elizabeth E , Kotsanas Despina , Stuart Rhonda L 
Published: July 2008

AbstractPeriodic microbiological monitoring of endoscopes is a recommendation of the Gastroenterological Society of Australia (GENSA). The aim of monitoring has been to provide quality assurance of the cleaning and disinfection of endoscopes; however, there is controversy regarding its frequency. This lack of consensus stimulated a review of the experience within our health service. At Southern Health, routine microbiological sampling has involved 4‐weekly monitoring of bronchoscopes, duodenoscopes and automated flexible endoscope reprocessors (AFER), and 3‐monthly monitoring of all other gastrointestinal endoscopes. Records of testing were reviewed from 1 January 2002 until 31 December 2006. A literature review was conducted, cost analysis performed and positive cultures investigated. There were 2374 screening tests performed during the 5‐year period, including 287 AFER, 631 bronchoscopes for mycobacteria and 1456 endoscope bacterial screens. There were no positive results of the AFER or bronchoscopes for mycobacteria. Of the 1456 endoscopic bacterial samples, six were positive; however, retesting resulted in no growth. The overall cost of tests performed and cost in time for nursing staff to collect the samples was estimated at $AUD 100 400. Periodic monitoring of endoscopes is both time‐consuming and costly. Our review demonstrates that AFER (Soluscope) perform well in cleaning endoscopes. Based on our 5‐year experience, assurance of quality for endoscopic use could be achieved through process control as opposed to product control. Maintenance of endoscopes and AFER should be in accordance with the manufacturer's instructions and microbiological testing performed on commissioning, annually and following repair. Initial prompt manual leak testing and manual cleaning followed by mechanical leak testing, cleaning and disinfection should be the minimum standard in reprocessing of endoscopes.
Improving outcomes for operable pancreatic cancer: Is access to safer surgery the problem?
Authors: Chang David K , Merrett Neil D , Biankin Andrew V ,   NSW Pancreatic Cancer Network
Published: July 2008

AbstractDespite advances in the understanding and treatment of pancreatic cancer in the last two decades, there is a persisting nihilistic attitude among clinicians. An alarmingly high rate of under‐utilization of surgical management for operable pancreatic cancer was recently reported in the USA, where more than half of patients with stage 1 operable disease and no other contraindications were not offered surgery as therapy, denying this group of patients a 20% chance of long‐term survival. These data indicate that a nihilistic attitude among clinicians may be a significant and reversible cause of the persisting high mortality of patients with pancreatic cancer. This article examines the modern management of pancreatic cancer, in particular, the advances in surgical care that have reduced the mortality of pancreatectomy to almost that of colonic resection, and outlines a strategy for improving outcomes for patients with pancreatic cancer now and in the future.
Hepatic steatosis in chronic hepatitis B patients is associated with metabolic factors more than viral factors
Authors: Peng Dandan , Han Ying , Ding Huiguo , Wei Lai 
Published: July 2008

AbstractBackground and Aims:  Hepatic steatosis is commonly seen in chronic hepatitis C (CHC) patients. It has been reported to be associated with both metabolic factors and viral factors, and affects the severity of fibrosis in CHC. However, the relationship between hepatic steatosis and chronic hepatitis B (CHB) is unclear. The aims of this study were to investigate the frequency of hepatic steatosis in CHB patients, to identify the factors associated with its presence, and assess the relationship between the stage of steatosis and the severity of fibrosis.Methods:  Medical records of 153 adult patients with CHB who had undergone a liver biopsy within the past 4 years were included in the study.Results:  Body mass index (BMI) and age of CHB patients with steatosis was significantly higher than the patients without steatosis (P < 0.05), as determined by the univariate analysis. Steatosis was found to correlate with the BMI values and alanine aminotransferase (ALT) levels, and ALT levels were associated with hepatitis B virus (HBV)–DNA levels and histology activity index (HAI) scores, stages of fibrosis were associated with the HAI score and HBV–DNA, as determined by the multivariate analysis. In contrast, there was no significant association between advanced stages of fibrosis and steatosis.Conclusion:  Our data indicate that hepatic steatosis is more frequently present in CHB patients than in the general population. We hypothesize that steatosis in CHB patients may be due to metabolic factors and the ability of HBV to indirectly facilitate the development of steatosis. In the present study, steatosis in CHB patients was not found to be associated with the severity of fibrosis.
HIV and hepatitis C coinfection
Authors: Matthews Gail V , Dore Gregory J 
Published: July 2008

AbstractThe significant burden of HIV/hepatitis C virus (HCV) coinfection is increasingly recognized worldwide, and in particular within the Asia–Pacific region. Individuals who are coinfected with both viruses are at risk from accelerated liver disease and consequently cirrhosis, liver failure, and hepatocellular carcinoma. In addition, coinfected individuals may have altered immunological responses to HAART and are at increased risk of highly active antiretroviral therapy (HAART)–related hepatotoxicity. Treatment for HCV infection in HIV‐infected individuals is with standard pegylated interferon and ribavirin therapy, and all HIV/HCV coinfected subjects should undergo suitability for HCV treatment assessment. Response rates to HCV therapy are generally 10–15% lower than in HCV monoinfection, and therapy may be complicated by issues of drug interactions and significant toxicity. However, greater understanding of baseline factors can contribute to better prediction of treatment outcome, and monitoring of on‐treatment virological responses increasingly allows individualization of therapy. Where possible, treatment of HCV is often advisable before HAART is required to avoid the issues of drug interactions on HCV therapy and the risk of HAART‐related hepatotoxicity. Early diagnosis of both HIV and HCV infection is essential to most effectively manage HIV‐HCV‐coinfected individuals. New therapies, including HCV protease and polymerase inhibitors, are in development and may widen therapeutic options for HIV‐HCV‐coinfected individuals into the future.
Profiting from Being Pirated by ‘Pirating’ the Pirates
Authors: Harbi Sana El , Grolleau Gilles 
Published: July 2008

SUMMARYPirates are not only copiers, they can also be innovators. They possess skills and a creative capital that allow them to explore new directions. Their innovations can be freely and profitably re‐appropriated by the high‐end designers of the pirated firms. Creative pirates are engaged in a kind of tacit reciprocity, where they appropriate illegally creations of high end designers and launch modified or new versions that can in return inspire in a profitable way, the designers of the original fashion houses. Moreover, pirates can create a pro‐competitive environment that stimulates the innovative abilities of the pirated firm at unexpected levels without piracy.
Mutual Recognition Revisited: Misunderstandings, Inconsistencies, and a Suggested Reinterpretation
Authors: Kerber Wolfgang , Van den Bergh Roger 
Published: July 2008

SUMMARYThe principle of mutual recognition is almost universally acclaimed for removing barriers to trade, for enabling regulatory competition, and for preserving scope for regulatory autonomy instead of embarking on a path to harmonisation and centralisation. By using economic theories of legal federalism and regulatory competition, this paper shows that mutual recognition leads to a number of inconsistencies, which question its suitability as a conflict of law rule that guarantees a stable allocation of regulatory powers within a two‐level system of regulations. Mutual recognition should be understood more as a dynamic principle, which triggers a reallocation of regulatory powers between different jurisdictional levels. It leads either back to the country of destination principle, to a free market for regulations, or to harmonisation. The European experience suggests that a regime of mutual recognition is primarily another path to convergence and harmonisation, instead of being an instrument that preserves decentralised regulatory powers or even regulatory competition. The welfare gains from achieving market integration should be balanced against the welfare losses of an inefficient allocation of regulatory powers.
ALTERNATIVE CONSENT MODELS FOR BIOBANKS: THE NEW SPANISH LAW ON BIOMEDICAL RESEARCH
Authors: DA ROCHA ANTONIO CASADO , SEOANE JOSÉ ANTONIO 
Published: July 2008

ABSTRACTThis article provides an overview of recent contributions to the debate on the ethical use of previously collected biobank samples, as well as a country report about how this issue has been regulated in Spain by means of the new Biomedical Research Act, enacted in the summer of 2007. By contrasting the Spanish legal situation with the wider discourse of international bioethics, we identify and discuss a general trend moving from the traditional requirements of informed consent towards new models more favourable to research in a post‐genomic context.
Secure antiretroviral therapy delivery in a resource‐limited setting: streamlined to minimize drug resistance and expense
Authors: Kitkungvan D , Apisarnthanarak A , Laowansiri P , Mundy LM 
Published: July 2008

BackgroundWe report the design and analysis of a streamlined approach to the delivery of antiretroviral therapy (ART) that minimized risk for emergence of ART drug resistance (ART‐DR) in a resource‐limited setting.MethodsThe algorithm of care for persons with HIV comprised generic, fixed‐dose, twice‐daily stavudine, lamivudine and nevirapine (GPO‐VIR), scheduled and unannounced pill counts and measurement of viral load at months 6 and 18 after initiation of ART. We evaluated adherence as measured by pill counts, HIV suppression and programmatic costs.ResultsOver a 4‐year period, 214 of 330 patients (64.8%) were enrolled; baseline median CD4 count was 84 cells/μL. At month 1, nine patients (4.2%) discontinued GPO‐VIR because of skin rash. At month 6, 199 patients (93%) achieved viral load ≤400 HIV‐1 RNA copies/mL, with current alcohol use the sole predictor of treatment failure [adjusted Relative Risk (aRR)=1.67; 95% confidence interval=1.05–2.48; P<0.001]. Most patients (97%) with HIV suppression at month 6 had viral loads ≤50 copies/mL at month 18; all had ≥75% visit compliance and 192 (98%) had ≥75% adherence measured by pill counts. The estimated annual costs were $111.92 per patient for the pill counts, home visits and viral load measurement.ConclusionsSecure ART delivery, while minimizing risk for non‐adherence and ART‐DR, is clinically and economically feasible in this resource‐limited setting.
Effect of haematological alterations on thalassaemia investigation in HIV‐1‐infected Thai patients receiving antiretroviral therapy
Authors: Pornprasert S , Leechanachai P , Klinbuayaem V , Leenasirimakul P , Sukunthamala K , Thunjai B , Phusua A , Saetung R , Sanguansermsri T 
Published: July 2008

ObjectivesTo evaluate the effect of haematological alterations resulting from antiretroviral therapy (ART) on the diagnosis of thalassaemia carriers in HIV‐1‐infected Thai patients.MethodsComplete blood cell counts, osmotic fragility (OF) test and haemoglobin (Hb)‐A2 values were measured in blood samples of 52 antiretroviral‐treated and 14 untreated HIV‐1‐infected patients. Data were analysed according to thalassaemia type and ART.ResultsSixteen patients carried at least one of the investigated thalassaemia types and most of them (87.5%) received ART. Their red cell indices [mean corpuscular Hb (MCH), mean corpuscular Hb concentration (MCHC) and red blood cell distribution width (RDW)], OF test and Hb‐A2 values were observed within the critical criteria of each thalassaemia type. Normocytic red cells were observed in α‐thalassaemia and Hb‐E trait. Among HIV‐1‐infected patients who are non‐thalassaemia carriers, higher values of Hb‐A2, MCH, macrocytosis and lower red cell counts were observed in the treated group. Values of RDW, MCHC and OF test for treated and untreated groups were in the normal range. Five treated patients had Hb‐A2 values within the critical criteria of β‐thalassaemia carriers but β‐thalassaemia gene mutations were not observed by polymerase chain reaction analysis.ConclusionsART can alter many haematological figures. Therefore, diagnosis of thalassaemia should be evaluated carefully in combination with those parameters.
P–T–t–D paths of Everest Series schist, Nepal
Authors: JESSUP M. J. , COTTLE J. M. , SEARLE M. P. , LAW R. D. , NEWELL D. L. , TRACY R. J. , WATERS D. J. 
Published: July 2008

AbstractU(–Th)–Pb geochronology, geothermobarometric estimates and macro‐ and micro‐structural analysis, quantify the pressure–temperature–time–deformation (P–T–t–D) history of Everest Series schist and calcsilicate preserved in the highest structural levels of the Everest region. Pristine staurolite schist from the Everest Series contains garnet with prograde compositional zoning and yields a P–T estimate of 649 ± 21 °C, 6.2 ± 0.7 kbar. Other samples of the Everest Series contain garnet with prograde zoning and staurolite with cordierite overgrowths that yield a P–T estimate of 607 ± 25 °C, 2.9 ± 0.6 kbar. The Lhotse detachment (LD) marks the base of the Everest Series. Structurally beneath the LD, within the Greater Himalayan Sequence (GHS), garnet zoning is homogenized, contains resorption rinds and yields peak temperature estimates of ∼650 ± 50 °C. P–T estimates record a decrease in pressure from ∼6 to 3 kbar and equivalent temperatures from structurally higher positions in the overlying Everest Series, through the LD and into GHS. This transition is interpreted to result from the juxtaposition of the Everest Series in the hangingwall with the GHS footwall rocks during southward extrusion and decompression along the LD system. An age constraint for movement on the LD is provided by the crystallization age of the Nuptse granite (23.6 ± 0.7 Ma), a body that was emplaced syn‐ to post‐solid‐state fabric development. Microstructural evidence suggests that deformation in the LD progressed from a distributed ductile shear zone into the structurally higher Qomolangma detachment during the final stages of exhumation. When combined with existing geochronological, thermobarometric and structural data from the GHS and Main Central thrust zone, these results form the basis for a more complete model for the P–T–t–D evolution of rocks exposed in the Mount Everest region.