bluuebunny/crossref_metadata_2025_split huggingface dataset:
Supporting medication adherence in renal transplantation (SMART): a pilot RCT to improve adherence to immunosuppressive regimens
Authors: De Geest Sabina , Schäfer‐Keller Petra , Denhaerynck Kris , Thannberger Nicole , Köfer Susanne , Bock Andreas , Surber Christian , Steiger Jürg 
Published: June 2006

Abstract:  Background:  Although non‐adherence to an immunosuppressive regimen (NAH) is a major risk factor for poor outcome after renal transplantation (RTx), very few studies have examined non‐adherence intervention in this context. This pilot randomized controlled trial (RCT) tested the efficacy of an educational–behavioural intervention to increase adherence in non‐adherent RTx patients. We also assessed how NAH evolves over time.Methods:  Eighteen RTx non‐adherent patients (age: 45.6±1.2 yr; 78.6% male) were randomly assigned to either an intervention group (IG) (n=6) or an enhanced usual care group (EUCG) (n=12), the latter receiving the usual clinical care. The IG received one home visit and three telephone interviews. We assessed NAH through electronic monitoring (EM) of medication intake during a nine‐month period (three months intervention, six months follow‐up).Results:  Five of 18 patients withdrew. Inclusion in the study resulted in a remarkable decrease in NAH in both groups over the first three months (IG χ2=3.97, df=1, p=0.04; EUCG χ2=3.40, df=1, p=0.06). The IG showed the greatest decrease in NAH after three months, although this did not reach statistical significance (at 90 d, χ2=1.05, df=1, p=0.31). Thereafter, NAH increased gradually in both groups, reaching comparable levels at the end of the six‐month follow‐up (i.e. at nine months).Conclusion:  Our findings suggest an inclusion effect. Although the intervention in this pilot RCT appeared to add further benefit in medication compliance, a lack of statistical power prevented us from making a strong statistical statement.
Infectious complications after kidney transplantation: current epidemiology and associated risk factors
Authors: Alangaden George J , Thyagarajan Rama , Gruber Scott A. , Morawski Katherina , Garnick James , El‐Amm Jose M. , West Miguel S. , Sillix Dale H. , Chandrasekar Pranatharthi H. , Haririan Abdolreza 
Published: June 2006

Abstract: Background: The impact of newer immunosuppressive and antimicrobial prophylactic agents on the pattern of infectious complications following kidney transplantation has not been well studied.Methods: This is an observational study in 127 adult recipients transplanted from 2001 to 2004. Patients received thymoglobulin (ATG) (50%) or basiliximab (50%) for induction and were maintained on mycophenolate mofetil, either tacrolimus (73%) or sirolimus (SRL) (27%), and prednisone (79%). Antimicrobial prophylaxis included perioperative cefazolin, trimethoprim/sulfamethaxazole for six months, valganciclovir for three months and nystatin for two months. Regression models were used to examine the association of various factors with infections.Results: We observed 127 infections in 65 patients, consisting of urinary tract infection (UTI) (47%), viral infections (17%), pneumonia (8%) and surgical wound infections (7%). UTI was the most common infection in all post‐transplant periods.Enterococcusspp. (33%) andEscherichia coli(21%) were the most prevalent uropathogens. Of six patients with cytomegalovirus infection, none had tissue‐invasive disease. There were no cases of pneumocystis pneumonia or BK nephropathy. Six patients developed fungal infections. Two deaths due to disseminatedRhizopusandCandida albicansaccounted for a 1.5% infection‐related mortality. Retransplantation and ureteral stents were independently associated with UTI (OR = 4.5 and 2.9, p = 0.06 and 0.03, respectively), as were ATG and SRL with bacterial infections (OR = 3.3 and 2.5, p = 0.009 and 0.047, respectively).Conclusion: This study suggests that the use of newer immunosuppressive agents in recent years is associated with some changes in the epidemiology of post‐transplant infections. Enterococci have become the predominant uropathogen. Invasive fungal infections, although rare, are often fatal.
Body mass index as a predictive factor for long‐term renal transplant outcomes in Asians
Authors: Chow Kai Ming , Szeto Cheuk Chun , Leung Chi Bon , Lui Siu Fai , Tong Yuen Fan , Li Philip Kam‐Tao 
Published: June 2006

Abstract:  Background:  There is substantial evidence that renal transplant recipients with obesity or body mass index >30 kg/m2 have increased risk of graft loss. However, few data exist for Asian population; clinicians have to rely upon indirect evidence by extrapolating the results from Caucasians to Asian recipients.Study:  Using data from a study population of 150 consecutive cadaveric or living related Chinese renal transplant recipients at our center between 1985 and 2002, we examined the effect of baseline body mass index cut‐off 25 kg/m2 on the transplant outcomes using Kaplan–Meier analysis and Cox proportional hazards analysis. Primary study end point was overall graft survival.Results:  The mean body mass index was 22.9 ± 4.0 kg/m2. Thirty‐seven (25%) patients were classified as overweight and 113 patients as non‐overweight, using the cut‐off of 25 kg/m2. After median follow up period of nine yr, 15 graft losses (41%) occurred in the overweight group, as compared with 14 graft losses (12%) in the non‐overweight group. Kaplan–Meier estimates of cumulative graft survival at five yr were significantly worse for the overweight group than non‐overweight group (83.6% versus 92.7%, p = 0.0041). By multivariate Cox proportional hazards analysis, baseline body mass index ≥25 kg/m2 conferred a significantly higher risk of graft loss (with relative risk of 4.78, 95% CI = 1.52–15.2) and doubling of serum creatinine (relative risk 3.19, 95% CI = 1.22–8.40). Death with a functioning graft occurred in 11% of overweight recipients, compared with 3% among the non‐overweight group (p = 0.041).Conclusion:  Our results draw attention to a recipient body mass index cut‐off value ≥25 kg/m2, which might confer an increased risk of graft loss in Asian kidney transplant populations.
Revival of effective and safe high‐dose mizoribine for the kidney transplantation*
Authors: Sugitani Atsushi , Kitada Hidehisa , Ota Morihito , Yoshida Junichi , Doi Atsushi , Hirakata Hideki , Tanaka Masao 
Published: June 2006

Abstract:  We investigated whether high‐dose Mizoribine (MIZ: a water‐soluble anti‐metabolite), 4–6 mg/kg/d was as effective and safe as mycophenolate mofetil (MMF) for patients after kidney transplantation. Between January 2001 and December 2005, 36 recipients at a stable phase more than one month passed after transplantation underwent conversion from MMF to MIZ, two from Azathioprine to MIZ, and two cases on MIZ from the beginning. There were 24‐male and 16‐female patients whose average age was 43.3 yr old and average weight was 54.0 kg. The types of transplantations were living donor renal transplantation 25, cadaveric renal transplantation 11, and simultaneous pancreas–kidney transplantation four examples. Of these, 33 patients were on Tacrolimus‐based triple regimen and seven patients on Cyclosporine A base. The drugs used together with MIZ were basically the same as those before conversion. The reasons for conversion to MIZ were infection in 18 cases (45.0%), bone marrow suppression in nine cases (22.5%) and diarrhea in eight cases (20.0%), and post‐transplant lymphoproliferative disorder in one case (2.5%). We initiated 4–6 mg/kg/d of MIZ divided twice a day depending on the serum creatinine (sCr) value of each patient.There was no big difference in the sCr value before and after MIZ administration in each individual patient, 1.79 ± 1.37 and 1.65 ± 1.30 mg/dL, respectively. A 12 h pharmaco‐kinetic study of MIZ revealed that a peak value reached 2.87 μg/mL on average at three h (C3) followed by a slow decrease afterward. Acute rejection occurred in two cases and adverse effects were seen in five cases. The results of analysis of 349 points divided into three groups by renal function were as follows; poor renal function Group A revealed a trough level of 2.21 ± 0.99 μg/mL and dosage 2.20 ± 1.06 mg/kg, good renal function Group B had a trough level of 1.06 ± 0.82 μg/mL and dosage 4.40 ± 1.72 mg/kg, and excellent function Group C had a trough level of 0.92 ± 0.55 μg/mL and dosage of 4.36 ± 1.08 mg/kg.High‐dose MIZ 4–6 mg/kg/d is an anti‐metabolite having an equivalent immunosuppressive effect, fewer serious adverse events and good cost‐effectiveness as MMF even for patients with prolonged hemodialysis period and declined digestive function in Japan.
Effect of concurrent elemental diet on infliximab treatment for Crohn’s disease
Authors: Tanaka Torao , Takahama Kazuya , Kimura Tomomi , Mizuno Tamaki , Nagasaka Mitsuo , Iwata Katsumi , Nakano Hiroshi , Muramatsu Masaaki , Takazoe Masakazu 
Published: June 2006

AbstractBackground:  Infliximab and elemental diet (ED) have been shown to be effective in the management of Crohn’s disease. However, few experiences have been reported regarding their combination therapy. The aim of the present study was to investigate the efficacy and safety of infliximab in Japanese patients, the first such study in Asia, as well as the effect of concomitant ED.Methods:  One hundred and ten consecutive patients receiving infliximab were followed up to week 16 after the last infusion, and clinical response and primary outcome were collected. A response was defined as a reduction in Harvey–Bradshaw Index for inflammatory disease and closure of fistula in fistulizing disease.Results:  Out of 75 inflammatory and 35 fistulizing disease patients, 68 (90.7%) and 25 (71.4%) responded at week 4, and 38 (50.7%) and 14 (40.0%) continued to respond until week 16, respectively. Interestingly, inflammatory disease patients with concurrent ED had a significantly higher response rate at week 16 (68.4%) than those without ED (32.4%, P = 0.0026). The effects of ED were independent of the usage of azathioprine and smoking habit.Conclusions:  Infliximab was clinically useful in the treatment of Crohn’s disease in Japanese patients as well as in those in Western countries. The efficacy of concurrent ED was suggestive and should be confirmed in a randomized controlled study.
Mutation of keratin 8 in patients with liver disease
Authors: Schöniger‐Hekele Maximilian , Petermann Dagmar , Müller Christian 
Published: June 2006

AbstractBackground:  Epithelial tissues of the gastrointestinal tract and the liver express predominantly cytokeratin 8 and cytokeratin 18. In vitro experiments and animal studies have demonstrated a protective influence of keratin 8 and keratin 18 against toxic damage of hepatocytes. A specific mutation of keratin 8 (G61C) was found to be a genetic risk factor for the development of cryptogenic liver cirrhosis. The purpose of the present paper was therefore to determine the prevalence of cytokeratin 8 (G61C) and cytokeratin 18 mutations (Y53H) in patients with liver disease.Methods:  Overall 152 patients (male, n = 93, 61%; female, n = 59, 39%) were included in the present study. The 152 patients consisted of 107 patients with liver disease (70.4%; male, n = 71, 66.4%; female, n = 36, 33.6%) and 45 control patients (29.6%; male, n = 22, 48,9%; female, n = 23, 51,1%) without liver disease. Of the patients with liver disease 46 had alcoholic liver disease; 25, chronic hepatitis C; 15, cryptogenic liver disease; and 21, other liver diseases of various etiologies. Cytokeratin 8 and 18 genotypes were specified by polymerase chain reaction (PCR) amplification and direct sequence analysis was used to detect the previously described mutations in cytokeratin 8 (G61C) and in cytokeratin 18 (Y53H).Results:  Four out of 152 patients (male n = 2, female n = 2) with a mutation (G61C) in cytokeratin 8 were found. The etiology was alcoholic liver disease (n = 1), cryptogenic liver disease (n = 1) and idiopathic liver disease with minimal changes in liver biopsy (n = 1). Also, one out 45 disease control patients with an adenoma of the colon but without liver disease was found to carry the mutation G61C of cytokeratin 8. Therefore, the mutation G61C in cytokeratin 8 was found in 2.8% of patients with liver disease and in 2.2% of control patients without liver disease. Two of 15 patients (13.3%) with cryptogenic liver disease had the mutation G61C in cytokeratin 8 (P = 0.069 vs patients with non‐cryptogenic liver disease). In the 152 patients studied, no mutation in cytokeratin 18 was found.Discussion:  The mutation G61C in the cytokeratin 8 gene was found in one patient with alcoholic liver disease and in two patients with liver disease of unknown etiology. Also, one patient without liver disease had the cytokeratin 8 G61C mutation. In summary, the cytokeratin 8 mutation G61C, which has been found to be associated with cryptogenic liver cirrhosis, was also found in the present patient population. However, the clinical relevance is yet to be determined in further investigations.
Colonic amoebiasis and spirochetosis: Morphological, ultrastructural and microbiological evaluation
Authors: Calderaro Adriana , Villanacci Vincenzo , Bommezzadri Simona , Gorrini Chiara , Piccolo Giovanna , Aquilano Maria Costanza , Incaprera Marina , Viviani Giovanni , Dettori Giuseppe , Chezzi Carlo 
Published: June 2006

AbstractBackground:  The present study reports on a prompt diagnosis of colonic amoebiasis with colonic spirochetosis by Brachyspira aalborgi and B. pilosicoli; such diagnosis allowed exclusion of other diseases and resolution of the case after specific treatment.Methods and Results:  A 37‐year‐old Italian man with a history of several months’ mucosal diarrhea travelled to Greece, Romania and Tunisia. After his last trip he presented with an increase of up to 3–5 discharges daily, associated with bloody diarrhea, supporting the clinical suspect of inflammatory bowel disease. Colonoscopy revealed erosions from the cecum to the rectum, and ulcers both in the descending and sigmoid colon. Structures resembling amoebic trophozoites and sinusoidal microorganisms were observed in the colonic biopsies at histopathology and electron microscopy. Entamoeba histolytica DNA was detected by small‐subunit rDNA polymerase chain reaction (PCR) from feces, rectal biopsies and isolated trophozoites. Spirochetes were identified from feces, colonic biopsies and cultures using a 16S rDNA restriction fragment length polymorphism‐PCR specific for the detection of B. aalborgi and B. pilosicoli. After therapy, the patient was restored to health.Conclusions:  The rapid identification of E. histolytica, B. aalborgi and B. pilosicoli using traditional and specific and sensitive molecular methods permitted an accurate diagnosis and a specific therapy. It is suggested that mixed infection by parasites and spirochetes might occur more frequently than expected: it would be of extreme interest and importance to intensify clinical findings, and one infection should not prompt the pathologist/clinician to stop looking.
What are the risk factors for aggravation of esophageal varices in patients with hepatocellular carcinoma?
Authors: Kadouchi Kaori , Higuchi Kazuhide , Shiba Masatsugu , Okazaki Hirotoshi , Yamamori Kazuki , Sasaki Eiji , Tominaga Kazunari , Watanabe Toshio , Fujiwara Yasuhiro , Oshitani Nobuhide , Arakawa Tetsuo 
Published: June 2006

AbstractBackground and Aim:  The risk factors for aggravation of esophageal varices (EV) in patients with hepatocellular carcinoma (HCC) are poorly understood. The aim of this study was to evaluate the effects of HCC on the appearance of the red color (RC) sign on EV and also investigate whether risk factors for the appearance of the RC sign differed between patients with and without HCC.Methods:  A total of 243 patients with cirrhosis (127 with HCC, 116 without HCC) without the RC sign, with no previous variceal hemorrhage, and not on prophylactic treatment for EV were enrolled. The endpoint was defined as being either when the RC sign was first noted, or when variceal bleeding occurred. In patients without HCC, follow‐up was discontinued if HCC was discovered. The risk factors were analyzed by Cox proportional hazards regression.Results:  In patients with HCC, portal vein tumor thrombus was a statistically independent risk factor (risk ratio [RR] 4.58, 95% confidence interval [CI] 1.32–15.86), although the presence of HCC was not. A large HCC (≥50 mm) tended to be a risk factor, but this was not statistically significant (RR 2.50, 95%CI 0.98–6.39). Child–Pugh classification and low platelet count were common risk factors regardless of whether HCC was present or not.Conclusions:  Portal vein tumor thrombus, but not the presence of HCC, was a significant risk factor for aggravation of EV in patients with HCC. Cirrhotic patients with portal vein tumor thrombus should receive more aggressive management of portal hypertension to prevent aggravation of EV.
Cytochrome P450 2C19 polymorphism influences the preventive effect of lansoprazole on the recurrence of erosive reflux esophagitis
Authors: Kawamura Masashi , Ohara Shuichi , Koike Tomoyuki , Iijima Katsunori , Suzuki Hitoshi , Kayaba Shoichi , Noguchi Kenji , Abe Shinya , Noguchi Mitsunori , Shimosegawa Toru 
Published: June 2006

AbstractBackground:  The efficacy of lansoprazole (LPZ) at inhibiting gastric acid secretion is influenced by cytochrome P450 2C19 (CYP2C19) polymorphism. The purpose of the present study was to investigate whether CYP2C19 polymorphism had an influence on the remission of erosive reflux esophagitis (RE) during maintenance therapy with LPZ.Methods:  Eighty‐two Japanese patients with initial healing of erosive RE by 8 weeks of LPZ therapy were enrolled. As maintenance therapy, the patients were treated with LPZ (15 mg/day) for 6 months. The CYP2C19 genotype, Helicobacter pylori infection status, and serum pepsinogen (PG) I/II ratio were assessed before treatment. The patients were investigated for relapse by endoscopy at 6 months or when symptoms recurred.Results:  The proportion of patients in remission after 6 months was 61.5%, 78.0%, and 100% among homozygous extensive metabolizers (homo‐EM), heterozygous EM (hetero‐EM), and poor metabolizers (PM), respectively. The percentage of PM patients who remained in remission was significantly higher than that of homo‐EM or hetero‐EM.Conclusions:  The efficacy of LPZ (15 mg/day) as maintenance therapy for erosive RE is influenced by CYP2C19 polymorphism.
Hyaluronic acid levels can predict severe fibrosis and platelet counts can predict cirrhosis in patients with nonalcoholic fatty liver disease
Authors: Kaneda Hiroyuki , Hashimoto Etsuko , Yatsuji Satoru , Tokushige Katsutoshi , Shiratori Keiko 
Published: June 2006

AbstractBackground and Aim:  Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of liver disease from simple steatosis to cirrhosis. Therefore, markers for predicting NAFLD with advanced fibrosis are needed. The aim of this study was to establish non‐invasive predictive markers of liver fibrosis in NAFLD.Methods:  One hundred and forty‐eight patients were diagnosed as having biopsy‐proven NAFLD. In order to separately identify severe fibrosis (bridging fibrosis plus cirrhosis) and cirrhosis, the patients were analyzed twice: first, as mild fibrosis versus severe fibrosis; and second, as non‐cirrhosis versus cirrhosis. Univariate and multivariate analyses were conducted. The diagnostic ability to detect severe fibrosis and cirrhosis was assessed by the area under the receiver operating characteristic curve. The cut‐off values of serum markers to detect severe fibrosis and cirrhosis were determined.Results:  Hyaluronic acid was selected as a predictive marker for severe fibrosis. A cut‐off value of 42 ng/mL of hyaluronic acid had a 100% predictive value for patients free of severe fibrosis and was associated with an optimal combination of sensitivity (100%, 95% confidence interval [CI] 90–100%) and specificity (89%, 95%CI 80–94%). The platelet count was found to be an independent predictor of cirrhosis. A cut‐off value of 16 × 104/µL for the platelet count was associated with an optimal combination of sensitivity (100%, 95%CI 82–100%) and specificity (95%, 95%CI 90–98%).Conclusions:  Hyaluronic acid levels can accurately identify NAFLD patients with severe fibrosis, and the platelet count can identify NAFLD patients with cirrhosis. Thus, these markers offer a good guideline for the assessment of hepatic fibrosis in the many patients with NAFLD.
Role of cell‐cycle turnover and oxidative stress in telomere shortening and cellular senescence in patients with chronic hepatitis C
Authors: Sekoguchi Satoru , Nakajima Tomoki , Moriguchi Michihisa , Jo Masayasu , Nishikawa Taichiro , Katagishi Tatsuo , Kimura Hiroyuki , Minami Masahito , Itoh Yoshito , Kagawa Keizo , Tani Yoichi , Okanoue Takeshi 
Published: June 2006

AbstractBackground:  In addition to the telomere shortening that occurs with cell division, oxidative stress can damage or shorten telomeres and induce a condition termed premature senescence, possibly before telomeres become critically short. We investigated the effects of cell‐cycle turnover and oxidative stress on cellular senescence in hepatitis C virus (HCV)‐related chronic liver injury.Method:  Using quantitative fluorescence in situ hybridization, the telomere lengths of hepatocytes in biopsy specimens from HCV‐positive patients were estimated. We assessed clinicopathological parameters that reflect cell‐cycle turnover, including Ki‐67 positive index, serum alanine aminotransferase (ALT) level and degree of fibrosis, and also oxidative stress‐related parameters, such as 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG) expression. Nuclear size and DNA content of hepatocytes were measured as morphological features of senescence.Results:  Telomere shortening correlated with the degree of cell turnover, hepatic fibrosis and morphological features of aging cells. Furthermore, the rate of telomere shortening per year was positively correlated with fibrosis progression. In cases of no or mild fibrosis, telomere lengths of positive patients were generally shorter than those of 8‐OHdG‐negative patients, and this trend achieved statistical significance in advanced‐stage fibrosis. HCV carriers with persistently normal serum ALT level (PNAL) showed significantly longer telomeres than patients with active hepatitis and mild fibrosis. There was no significant difference in telomere lengths between HCV carriers with PNAL and normal controls.Conclusions:  Cell‐cycle turnover is the primary mechanism of telomere shortening, and can induce fibrosis progression and cellular senescence. However, oxidative stress can be an accelerator of senescence, especially in advanced‐stage fibrosis.