bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bronchodilator reversibility, airway eosinophilia and anti‐inflammatory effects of inhaled fluticasone in COPD are not related
Authors: REID David W. , WEN Yudong , JOHNS David P. , WILLIAMS Trevor J. , WARD Chris , WALTERS E. Haydn 
Published: September 2008

Background and objective:  Bronchodilator reversibility (BDR) is common in smoking‐related COPD, but the airway pathology underlying this has not been described. In particular, it is not known whether BDR is associated with underlying airway eosinophilia and whether BDR is predictive of a better response to inhaled corticosteroid (ICS) treatment.Methods:  A double‐blind, placebo‐controlled, randomized 2 : 1 study of fluticasone propionate (FP), 500 µg twice daily versus placebo over 6 months was performed in subjects with mild to moderate COPD. Subjects with a clinical history of asthma were excluded, but not on BDR criteria alone. Induced sputum, BAL and endobronchial biopsies (EBB) were performed in 36 subjects at baseline, and 30 of these provided a second full set of samples (FP, n = 19; placebo, n = 11).Results:  Baseline BDR was not related to airway eosinophilia and did not predict response to ICS. Post‐bronchodilator FEV1 increased in the FP group compared with the placebo group (P = 0.05), and there were within‐treatment group reductions in total symptom scores with FP (P < 0.05). Compared with placebo, FP reduced macrophage numbers but increased neutrophil numbers in EBB (P = 0.01 and P = 0.003, respectively). BAL neutrophil and epithelial cell numbers were also reduced with FP (P = 0.03 for both). There were within‐treatment group reductions in the numbers of EBB mast cells and CD8+ve lymphocytes with FP (P = 0.007).Conclusions:  BDR was not related to any particular inflammatory phenotype or any clinical or anti‐inflammatory response to ICS in these subjects with mild to moderate COPD.
Epidemiology of primary systemic vasculitis in the Australian Capital Territory and south‐eastern New South Wales
Authors: Ormerod A. S. , Cook M. C. 
Published: September 2008

AbstractBackground:  The aim of the study was to determine the epidemiology of primary systemic vasculitis in the Australian Capital Territory and the surrounding rural region between 1995 and 2005.Methods:  Cases were ascertained by a medical record search according to international consensus classification criteria. For antineutrophil cytoplasmic antibody‐associated vasculitides, ascertainment was corroborated by a search of all positive antineutrophil cytoplasmic antibody serology during the study period. Denominators were obtained from region‐specific census data collected during the study period. Prevalence, incidence and patient characteristics for primary systemic vasculitides were determined for two 5‐year periods, 1995–1999 and 2000–2004.Results:  We identified 41 cases of primary systemic vasculitides (Wegener’s granulomatosis (WG), microscopic polyangiitis (MPA), Churg–Strauss syndrome or polyarteritis nodosa) between 1995 and 1999 and 67 between 2000 and 2004, giving prevalences of 95/million (95% confidence interval (CI) 76.9–116.1) and 148/million (95%CI 125.1–173.9), respectively. Annual incidence was similar in both periods (approximately 17/year per million adult population). Disease‐specific incidences (per million per year) for each of the two periods were 8.8 and 8.4 for WG, 2.3 and 5.0 for MPA, 2.3 and 2.2 for Churg–Strauss syndrome and 2.3 and 1.1 for polyarteritis nodosa. The rural incidence of MPA was 13.9 (95%CI 7.7–23.5) compared with 1.6 (95%CI 0.2–7.2) in the city and there was a trend towards a higher incidence of WG in rural than urban areas.Conclusion:  The overall incidence of primary systemic vasculitides is similar to that reported from other developed countries. WG is more common in south‐eastern Australia than in southern Europe, whereas MPA is less common. There was a trend towards higher incidence of antineutrophil cytoplasmic antibody‐associated vasculitides in rural than urban areas.
Cardiac magnetic resonance imaging in the evaluation of cardiac sarcoidosis: an Australian single‐centre experience
Authors: Manins V. , Habersberger J. , Pfluger H. , Taylor A. J. 
Published: September 2008

AbstractBackground:  Cardiac involvement in systemic sarcoidosis is common; however, current diagnostic tools are imprecise. Recognition of cardiac sarcoidosis (CS) is important as it has a relatively poor prognosis. Gadolinium‐enhanced cardiac magnetic resonance imaging (Gad‐CMR) is emerging as an excellent technique in determining the presence of and extent to which cardiac muscle is affected by sarcoidosis.Methods:  A retrospective analysis was performed on all patients with biopsy‐proven systemic sarcoidosis referred for Gad‐CMR scanning to evaluate potential cardiac involvement. All patients also underwent an electrocardiogram, Holter monitor and echocardiography. Gallium‐67 radionuclide investigation, positron emission tomography and cardiac biopsy were ordered at the discretion of the treating physician.Results:  Eleven of the 20 patients had Gad‐CMR images supportive of the diagnosis of CS. Eight of these 11 patients met the Japanese Ministry of Health and Welfare (JMHW) criteria for the diagnosis of CS; three abnormal Gad‐CME scans consistent with diagnosis of CS were seen in patients who did not meet JMHW criteria. No patients with normal Gad‐CMR scan met JMHW criteria for CS.Conclusion:  These findings suggest that Gad‐CMR is potentially superior to the JMHW criteria in the diagnosis of cardiac sarcoidosis.
Nephrotoxic effects of iodixanol and iopromide in patients with abnormal renal function receiving N‐acetylcysteine and hydration before coronary angiography and intervention: a randomized trial
Authors: Juergens C. P. , Winter J. P. , Nguyen‐Do P. , Lo S. , French J. K. , Hallani H. , Fernandes C. , Jepson N. , Leung D. Y. C. 
Published: September 2008

AbstractBackground:  The use of contrast agents during coronary intervention can result in nephropathy, particularly in patients with renal dysfunction. We aimed to determine whether the use of iso‐osmolar iodixanol is less nephrotoxic than that of low‐osmolar iopromide when patients are adequately prehydrated and have received N‐acetylcysteine.Methods:  We conducted a randomized, double‐blind, multicentre study of patients with impaired renal function undergoing a coronary interventional procedure. Primary end‐point was the incidence of contrast‐induced nephropathy (CIN) on day 2, defined as an increase in serum creatinine concentration of ≥44 μmol/L (0.5 mg/dL) or by a relative increase of ≥25% from baseline. Secondary end‐points included peak increase in serum creatinine between baseline and day 7.Results:  Of 191 patients recruited, 15% (95% CI: 8–22) of the patients receiving iopromide and 12% (95% CI: 5–19) of the patients receiving iodixanol developed CIN (95% CI of the difference: 13 to −7, P = 0.56). When including peak serum creatinine on day 7, CIN developed in 23% of patients receiving iopromide and in 27% of patients receiving iodixanol (95% CI of the difference: 8 to −16, P = 0.48). The peak increase in serum creatinine concentration at day 7 was similar in both groups (patients receiving iopromide, 18.4 ± 24.4 μmol/L, vs patients receiving iodixanol, 21.9 ± 24.2 μmol/L; P = 0.33).Conclusion:  There remains a high incidence of CIN despite prehydration and routine use of N‐acetylcysteine in patients with pre‐existing renal dysfunction undergoing coronary interventional procedures. Although our study is underpowered, iodixanol was not associated with a statistically significant lower incidence of CIN when compared with iopromide.
An opportunity to reinforce ethical values: declarations made by graduating medical students in Australia and New Zealand
Authors: Macneill P. U. , May A. N. , Dowton S. B. 
Published: September 2008

AbstractBackground:  The aim of the study was to ascertain the use of declarations of ethical commitment made by medical students graduating from the final‐year class of 2006 in Australia and New Zealand, the extent of student contribution to the process and the manner in which those declarations were declared.Methods:  Information was obtained, by telephone interview and email, from officers or responsible academic staff of faculties of medicine (or medicine and health sciences) in Australia and New Zealand.Results:  Of 20 medical faculties in Australia and New Zealand, seven were established recently and are yet to graduate students. Thirteen faculties graduated medical students in 2006 and students in 10 of those faculties made declarations on graduating. Of those, six faculties consulted with students in formulating and/or in deciding on the declaration and four gave students major responsibility for writing the declaration. Three faculties invited graduating students to modify the declaration each year. Students in two of those faculties had done so on occasion and, in the third, they had rewritten the declaration each year.Conclusion:  An increasing proportion of faculties of medicine in Australia and New Zealand provide for a declaration of ethical values on graduating. We emphasize educational opportunities for reinforcing these values by encouraging students to formulate their ‘own’ declaration, modify the declaration each year, read the declaration in a formal ceremony and by presenting graduating students with a plaque or printed declaration suitable for framing, which is signed by the Dean and graduating student.
Assessment and management of hypertension in patients with type 2 diabetes
Authors: Thomas M. C. , Atkins R. 
Published: September 2008

AbstractBackground:  Hypertension is a major risk factor for adverse outcomes in type 2 diabetes and an important target for intervention. Despite this, the management of blood pressure (BP) remains suboptimal, particularly in patients at increased risk for cardiovascular and chronic kidney disease. The aim of this study was to estimate the frequency of hypertension and its management in consecutive clinic‐based samples of patients with type 2 diabetes in Australian primary care.Methods:  BP levels and antihypertensive management strategies were compared in patients with type 2 diabetes recruited as part of the Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes (DEMAND) study in 2003 (n = 1831) and the National Evaluation of the Frequency of Renal impairment cO‐existing with Non‐insulin‐dependent diabetes (NEFRON) study in 2005 (n = 3893). Systolic BP levels and the use of antihypertensive therapies were examined in patients with and without chronic kidney disease.Results:  The patient characteristics in both studies were similar in that more than 80% of patients in both studies were hypertensive. Systolic BP targets of ≤130 mmHg were achieved in approximately half of all treated patients in both studies. However, the use of antihypertensive therapy either alone or in combination increased from 70.4% in DEMAND to 79.5% in NEFRON 2 years later (P < 0.001). Despite this, antihypertensive therapy continued to be underutilized in high‐risk groups, including in those with established chronic kidney disease.Conclusion:  The DEMAND and NEFRON studies both show that BP control is achievable in Australian general practice, with more than half of all patients seeing their general practitioners achieving a target systolic BP ≤130 mmHg. However, more needs to be done to further reduce BP levels, particularly in patients at high risk of adverse outcomes.
Are children just small adults? The differences between paediatric and adult sleep medicine
Authors: Robinson P. D. , Waters K. 
Published: September 2008

AbstractSeveral important physiological and maturational changes occur in sleep development during the paediatric age range, particularly during infancy and in early childhood. As the pathology of sleep apnoea is superimposed onto a developing and often plastic physiological system, children often show a different pathophysiology to their adult counterparts. These factors need to be incorporated into the evaluation of a child’s sleep problems. Particular attention should be paid to the developmental stage of the child. Investigation, interpretation and subsequent management provide further unique challenges and during successive reviews predicted normal changes must also be taken into account. This review article discusses the important physiological and maturational changes that occur in sleep during childhood, some common paediatric sleep conditions and their presentation and the appropriate evaluation and management of these conditions. In the course of the discussion, we have stressed important differences between paediatric and adult sleep medicine.
Safe general anesthesia in a hyperkalemic infant
Authors: SHUKRY MOHANAD , DE ARMENDI ALBERTO J. 
Published: September 2008

SummaryA 10‐day‐old boy treated in the intensive care unit and operating room due to hyperkalemia and renal failure. After admission to the intensive care unit and treatment for hyperkalemia, the patient required insertion of dialysis catheter in the operating room. Treatment for hyperkalemia continued while the patient was under general anesthesia. The operation was carried out successfully and cardiac signs and symptoms of hyperkalemia did not occur despite of potassium blood levels of 8.1 mEq·l−1. General anesthesia could be safe in hyperkalemic patients as long as the treatment for hyperkalemia is initiated before and during the surgery and hyperkalemia inducing agents are avoided.
Alteration of anion gap and strong ion difference caused by hydroxyethyl starch 6% (130/0.42) and gelatin 4% in children
Authors: WITT LARS , OSTHAUS WILHELM ALEXANDER , JÜTTNER BJÖRN , HEIMBUCHER CHRISTIAN , SÜMPELMANN ROBERT 
Published: September 2008

SummaryBackground:  Synthetic colloid administration is a common practice for preventing perioperative hypovolemia and consecutive circulatory failure in children. This prospective, randomized study was conducted to investigate the effects of two different unbalanced synthetic colloid solutions on acid–base equilibrium in children.Methods:  Fifty pediatric patients (aged 0–12 years) scheduled for major pediatric surgery were randomized to receive either 10 ml·kg−1 of 6% hydroxyethyl starch solution 130/0.42 (HES) or 4% modified fluid gelatin (GEL) to maintain adequate systemic hemodynamics. Before and after colloid administration, a blood sample was collected to analyze hemoglobin, hematocrit, electrolytes, and acid–base parameters. The anion gap and the strong ion difference (SID) were calculated using standard formulas.Results:  Both HES and GEL administration caused a significant increase in plasma chloride concentration (P < 0.01) and an accompanying decrease in SID (P < 0.01). In the HES group, the anion gap decreased significantly (P < 0.01) whereas the anion gap remained stable in the GEL group. In both groups, initial actual base excess and pH did not change significantly after colloid administration.Conclusions:  Moderate intraoperative plasma replacement with unbalanced synthetic colloids HES and GEL leads to a decrease in SID and, in the case of HES, to a significant decrease in the anion gap in children. These alterations may result in a possible misinterpretation when the anion gap and SID are used for differential diagnosis of metabolic disturbances during major pediatric surgery.
Paracetamol (Acetaminophen): mechanisms of action
Authors: ANDERSON BRIAN J. 
Published: September 2008

SummaryParacetamol has a central analgesic effect that is mediated through activation of descending serotonergic pathways. Debate exists about its primary site of action, which may be inhibition of prostaglandin (PG) synthesis or through an active metabolite influencing cannabinoid receptors. Prostaglandin H2synthetase (PGHS) is the enzyme responsible for metabolism of arachidonic acid to the unstable PGH2. The two major forms of this enzyme are the constitutive PGHS‐1 and the inducible PGHS‐2. PGHS comprises of two sites: a cyclooxygenase (COX) site and a peroxidase (POX) site. The conversion of arachidonic acid to PGG2is dependent on a tyrosine‐385 radical at the COX site. Formation of a ferryl protoporphyrin IX radical cation from the reducing agent Fe3+at the POX site is essential for conversion of tyrosine‐385 to its radical form. Paracetamol acts as a reducing cosubstrate on the POX site and lessens availability of the ferryl protoporphyrin IX radical cation. This effect can be reduced in the presence of hydroperoxide‐generating lipoxygenase enzymes within the cell (peroxide tone) or by swamping the POX site with substrate such as PGG2. Peroxide tone and swamping explain lack of peripheral analgesic effect, platelet effect, and anti‐inflammatory effect by paracetamol. Alternatively, paracetamol effects may be mediated by an active metabolite (p‐aminophenol).p‐Aminophenol is conjugated with arachidonic acid by fatty acid amide hydrolase to form AM404. AM404 exerts effect through cannabinoid receptors. It may also work through PGHS, particularly in areas of the brain with high concentrations of fatty acid amide hydrolase.
Urodynamic evaluation of sacral neuromodulation for urge urinary incontinence
Authors: Groenendijk Pieter M. , Lycklama à Nyeholt August A.B. , Heesakkers John P.F.A. , Van Kerrebroeck Philip E.V. , Hassouna Magdy M. , Gajewski Jerzy B. , Cappellano Francesco , Siegel Steven W. , Fall Magnus , Dijkema Hero E. , Jonas Udo , Van Den Hombergh Ubi ,   Representing the Sacral Nerve Stimulation Study Group
Published: September 2008

OBJECTIVETo evaluate the urodynamic data before and 6 months after implantation of sacral neuromodulation (SNM, an established treatment for voiding dysfunction, including refractory urge urinary incontinence, UI) and to assess the correlation between the urodynamic data and clinical efficacy in patients with UI.PATIENTS AND METHODSIn all, 111 patients with a >50% reduction in UI symptoms during a percutaneous nerve evaluation test qualified for surgical implantation of SNM. Patients were categorized in two subgroups, i.e. those with UI with or without confirmed detrusor overactivity (DO) at baseline. At the 6‐month follow‐up all patients had a second urodynamic investigation, with the stimulator switched on.RESULTSAt baseline, there was urodynamically confirmed DO in 67 patients, while 44 showed no DO. A review of filling cystometry variables showed a statistically significant improvement in bladder volumes at first sensation of filling (FSF) and at maximum fill volume (MFV) before voiding for both UI subgroups, compared with baseline. In 51% of the patients with UI and DO at baseline, the DO resolved during the follow‐up. However, those patients were no more clinically successful than those who still had DO (P = 0.73). At the 6‐month follow‐up, 55 of 84 implanted patients showed clinical benefit, having a ≥50% improvement in primary voiding diary variables. Patients with UI but no DO had a higher rate of clinical success (73%) than patients with UI and DO (61%), but the difference was not statistically significant.CONCLUSIONThese urodynamic results show a statistically significant improvement in FSF and MFV in patients with UI with or with no DO after SNM. Although there was a urodynamic and clinical improvement in both groups, patients with UI but no DO are at least as successful as patients with UI and DO. Therefore in patients with UI, DO should not be a prerequisite selection criterion for using SNM.
Adeno‐associated viral vector transduction of green fluorescent protein in kidney: effect of unilateral ureteric obstruction
Authors: Ito Keiichi , Chen Jie , Khodadadian Jonathan J. , Vaughan E. Darracott , Lipkowitz Michael , Poppas Dix P. , Felsen Diane 
Published: September 2008

OBJECTIVETo evaluate adeno‐associated virus (AAV) mediated renal gene transfer, by examining the localization and time course of gene expression in the kidneys of mice with unilateral ureteric obstruction (UUO) and controls. AAV is a replication‐defective virus that has the potential to deliver genes into the kidney to improve renal damage after UUO.MATERIALS AND METHODSAn AAV vector carrying a green fluorescent protein (GFP) reporter gene (rAAV‐GFP) was used. In control mice, GFP expression was evaluated at 4, 7, 14 and 28 days after intrapelvic injection of rAAV or phosphate‐buffered saline (PBS). In mice with UUO, the left ureter was obstructed, and 24 h later either rAAV or PBS was injected; GFP expression was evaluated 4, 7 and 14 days later by direct fluorescence.RESULTSIn the control mice, at least 7 days was required to detect GFP expression, whereas after UUO, GFP expression was already evident at 4 days after injection. GFP was localized mainly to the medullary tubules.CONCLUSIONSThis study shows successful transduction of GFP into mouse kidney using an AAV vector; GFP was expressed sooner in UUO kidneys than in the controls. These results show the feasibility of using AAV to transduce GFP into the obstructed kidney, and suggest that it might be useful in transducing therapeutically active agents.
Inhibitory effects of nicorandil, a KATPchannel opener and a nitric oxide donor, on overactive bladder in animal models
Authors: Kamiyama Yutaka , Muto Satoru , Masuda Hitoshi , Ide Hisamitsu , Ishizuka Nobuhiko , Saito Keiji , Horie Shigeo 
Published: September 2008

OBJECTIVESTo investigate the effects of nicorandil, an ATP‐sensitive potassium (KATP) channel opener with a nitric oxide (NO) donor property, on overactive bladder (OAB) in animal models. Nicorandil is currently used clinically to treat ischaemic heart disease.MATERIALS AND METHODSThree animal OAB models were used: (i) C‐fibre mediated bladder overactivity by infusion of a low concentration of acetic acid (AA) into the bladder in female Wistar rats; (ii) bladder outlet obstruction (BOO) created by partial urethral obstruction in female Wistar rats; and (iii) neuronal NO synthase (nNOS) knockout (KO) mice with urinary frequency. The effects of nicorandil and KRN2391, both of which act as KATPchannel openers and NO donors, on the OAB models were examined.RESULTSCystometry showed that intravesical instillation of nicorandil and KRN2391 successfully inhibited OAB induced by intravesical instillation of AA. In the BOO model compared with untreated BOO rats, both nicorandil (1 and 3 mg/kg, orally) and KRN2391 (1 mg/kg, orally) significantly reduced the voiding frequency. Compared with wild‐type mice, nNOS KO mice had urinary frequency with no change in the total urine volume. Nicorandil (3 mg/kg, orally) and KRN2391 (1 mg/kg, orally) significantly reduced the voiding frequency in nNOS KO mice.CONCLUSIONSOurin vivoresults show that nicorandil, a KATPchannel opener with a NO donor property, can suppress OAB from both neurogenic and myogenic causes. Nicorandil appears to be a promising candidate for clinical use in patients with OAB.