bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transjugular liver biopsy is a safe and effective intervention to guide management for patients with a congenital bleeding disorder infected with hepatitis C
Authors: Dawson M. A. , McCarthy P. H. , Walsh M. E. , McLean C. A. , Thomson K. , Roberts S. , Street A. M. 
Published: August 2005

AbstractThe prevalence of hepatitis C virus (HCV) infection in adult patients with a congenital bleeding disorder (CBD) approaches 95% and is a major cause of morbidity and mortality. Histological examination of the liver remains the cornerstone of management decisions in patients without a CBD. The reluctance to perform liver biopsies in patients with a CBD has been a major limitation in the management of these patients. We are currently the only haemophilia centre in Australasia performing liver biopsies in patients with a CBD for the purpose of guiding prognostic and therapeutic decisions. We report here the results of our centre's experience with transjugular liver biopsy (TJLB) in patients with a CBD. An adequate specimen for histological assessment was attained from all of the patients. There were no major complications recorded. Patients were hospitalized for ≤ 48 h for haemostasis prophylaxis. The diagnostic specimen obtained from patients was integral in guiding their future management. We suggest that with a coordinated multidisciplinary approach, TJLB can be performed in patients with a CBD. (Intern Med J 2005; 35: 556–559)
Effects of opioids and sedatives on survival in an Australian inpatient palliative care population
Authors: Good P. D. , Ravenscroft P. J. , Cavenagh J. 
Published: August 2005

Abstract Aims: To assess whether opioid and sedative medication use affects survival (from hospice admission to death) of patients in an Australian inpatient palliative care unit.Background: Retrospective audit. Newcastle Mercy Hospice – a tertiary referral palliative care unit. All patients who died in the hospice between 1 February and 31 December 2000.Methods: Length of survival from hospice admission to death, and the median and mean doses of opioids and sedatives used in the last 24 h of life. Comparison of these with published studies outside of Australia.Results: In this study, the use of opioids, benzodiazepines and haloperidol did not have an association with shortened survival and the only statistical significant finding was an increased survival in patients who were on 300 mg/day or more of oral morphine equivalent (OME). The proportion of patients requiring greater than or equal to 300 mg OME/day (at 28%) was higher than published studies, but the mean dose of 371 mg OME/day was within the range of other studies. The proportion of patients receiving sedatives (94%) was higher than other studies, but the median dose of parenteral midazolam equivalent of 12.5 mg per 24 h was lower than other studies from outside Australia.Conclusions: There was no association between the doses of opioids and sedatives on the last day of life and survival (from hospice admission to death) in this population of palliative care patients. (Intern Med J 2005; 35: 512–517)
Randomized double‐blind trial of sotalol versus lignocaine in out‐of‐hospital refractory cardiac arrest due to ventricular tachyarrhythmia
Authors: Kovoor P. , Love A. , Hall J. , Kruit R. , Sadick N. , Ho D. , Adelstein B.‐A. , Ross D. L. 
Published: August 2005

Abstract Aim: We aimed to compare the efficacy of sotalol versus lignocaine for the treatment of patients with out‐of‐hospital ventricular fibrillation refractory to ≥4 defibrillatory shocks.Background: The outcome of patients in ventricular fibrillation refractory to ≥4 defibrillatory shocks is poor. In a previous randomized trial, sotalol was superior to lignocaine for acute termination of ventricular tachycardia not causing loss of consciousness.Methods: Patients of the Ambulance Service of New South Wales treated by paramedics with continued ventricular fibrillation despite standard resuscitation and ≥4 defibrillatory monophasic shocks were eligible. Drug doses were sotalol 100 mg or lignocaine 100 mg, given as i.v. boluses. A further 2 min of cardiopulmonary resuscitation was given and then defibrillation was repeated twice. If this failed, half the initial dose of the trial drug was repeated and a further ≥2 shocks were given.Results: Sixty patients were randomized to sotalol and 69 randomized to lignocaine. There was no significant difference between the two groups in the clinical characteristics of the patients or in the number of shocks received. Outcomes in the sotalol and lignocaine groups were survival to hospital admission in 7 (12%) and 16 (23%), respectively (P = 0.09), and survival to hospital discharge in 2 (3%) and 5 (7%), respectively (P = 0.33).Conclusions: Sotalol is not superior to lignocaine for treatment of ventricular fibrillation refractory to multiple shocks. The overall outcome of this group of patients is poor regardless of the pharmacological intervention (lignocaine or sotalol). (Intern Med J 2005; 35: 518–525)
Use of a quantitative point‐of‐care test for the detection of serum cardiac troponin T in patients with suspected acute coronary syndromes
Authors: Hallani H. , Leung D. Y. , Newland E. , Juergens C. P. 
Published: August 2005

Abstract We compared a third generation quantitative cardiac troponin T (cTnT) point‐of‐care testing (POCT) from Roche Diagnostics with the laboratory assay (Roche Elecsys 2010 immunoassay analyser). Heparin‐treated blood and serum were collected simultaneously in 133 unselected patients (mean age 62 ± 14 years, 38% females) presenting to our hospital with possible cardiac chest pain. Results of the POCT were measured against the laboratory‐based assay considered as the gold standard. There were 18 POCT positive versus 24 laboratory assay positive (≥0.03 ng/mL) patients. POCT was falsely negative in six patients, with values between 0.03 and 0.1 ng/mL. The POCT had a sensitivity of 75%, specificity of 100%, positive predictive value of 100%, negative predictive value of 95% and a total accuracy of 95%; kappa = 0.831 (P < 0.001). There was good correlation between the values of POCT and the laboratory assay: Y = 1.195X + 0.002, r2 = 0.94 (P < 0.0001). Whereas cTnT levels >0.1 mg/mL were reliably detected with this current generation of POCT, cTnT levels between 0.03 and 0.10 ng/mL were not. Future generations of devices will need to improve sensitivity to reliably risk stratify patients with suspected acute coronary syndromes. (Intern Med J 2005; 35: 560–562)
Stool antigen testing for the diagnosis and confirmation of eradication of Helicobacter pylori infection: a prospective blinded trial
Authors: Islam S. , Weilert F. , Babington R. , Dickson G. , Smith A. C. 
Published: August 2005

Abstract Background and aims:  Helicobacter pylori is an established pathogen for a wide spectrum of gastroduodenal diseases. We investigated the usefulness of H. pylori stool antigen test (HpSA) before and after eradication therapy on patients referred for gastroscopy.Methods:  Over a 12‐month period, 127 adult patients (47% males) underwent HpSA and gastroscopy with dual biopsies from the antrum and proximal body of the stomach for urease and histology. The positive patients (histology, urease or combined positive) received triple therapy consisting of clarithromycin 500 mg, amoxycillin 1 g and omeprazole 20 mg, each given twice daily for 7 days. Six weeks post‐therapy, eradication was verified with the 13C‐urea breath test (UBT) and the HpSA results compared on a second stool sample.Results:  Pre‐therapy, 23/113 patients were positive by urease test, 22/112 by histology and 22/112 were combined positive. For the HpSA, compared to combined urease and histology as the reference standards, the sensitivity and specificity were 79 and 92% while the positive and negative predictive values (PPV and NPV) were 68 and 96%, respectively. Post‐therapy, UBT was adopted as the reference standard and 18 paired samples were available for analysis: three were positive and 15 were negative. Sensitivity and specificity were 67 and 100% while the PPV and NPV were 100 and 94%, respectively.Conclusions:  In this prospective study, HpSA was found to be a reasonably useful diagnostic test for H. pylori infection. Post‐eradication, it was highly specific and similar to UBT in terms of PPV and NPV. The test is non‐invasive and cheaper than the urease test or the UBT, making it a candidate in the investigation of dyspepsia. (Intern Med J 2005; 35: 526–529)
Aging per se does not influence postprandial glucose levels in type 2 diabetes
Authors: Magata Yumiko , Oba Kenzo , Inuzuka Yuki , Nakano Hiroshi 
Published: August 2005

Background:  It is well known that postprandial glucose increases with aging in non‐diabetic subjects. The question we addressed is whether elderly type 2 diabetic patients with definite fasting hyperglycemia (≥ 126 mg/dL) also display increased postprandial hyperglycemia relative to their younger counterparts.Methods:  Diurnal plasma glucose profiles were measured in 162 overt type 2 diabetic patients treated by diet alone (diet group) or with sulfonylureas as monotherapy (SU group). Plasma glucose concentrations were measured at 08.00 hours (before breakfast), 10.00, 12.00 (before lunch), 14.00, 18.00 (before dinner), 20.00, 24.00, 03.00, 06.00 and 08.00 hours the next morning. The postprandial glucose area under the curve (AUC) from 08.00 to 24.00 hours was calculated above the baseline level equal to the 08.00‐hours plasma glucose value, and the relationships with clinical variables, including age, were assessed.Results:  There were no differences in diurnal plasma glucose profiles between the middle‐aged (< 65 years) and elderly (≥ 65 years) groups either the diet group or the SU group. Univariate analysis showed that the postprandial glucose area under the curve was related to the 08:00‐hours plasma glucose value (R = 0.583, P < 0.001) in the diet alone group and to the duration of diabetes (R = 0.220, P < 0.05), SU dose (R = 0.330, P = 0.001) and urine CPR (R = −0.229, P < 0.05) in the SU group. In multivariate analysis, postprandial glucose area under the curve was only related to 08.00 hours plasma glucose value in the diet group (R2 of the model = 0.340, P < 0.001) and to the SU dose in SU group (R2 of the model = 0.145, P < 0.001).Conclusion:  These results suggest that aging, per se, does not influence postprandial glucose levels in overt type 2 diabetic patients.
Influence of living alone on emotional well‐being in community‐dwelling elderly persons
Authors: Kawamoto Ryuichi , Yoshida Osamu , Oka Yuichiro , Kodama Akihiro 
Published: August 2005

Background:  Elderly persons living alone might be an at‐risk group for high levels of mortality and morbidity, making high demands on health and social services. However, the effect of living alone on the physical and mental health of the elderly has not been sufficiently investigated. This study investigated the relationship between living alone and well‐being, and determined the characteristics, physical health status, mental health status, social support and health needs of community‐dwelling elderly people who are living alone.Methods:  The study subjects were 877 persons living with others and 86 persons living alone at the baseline. The final outcome regarding emotional well‐being was based on four criteria: the subjects’ perceptions regarding the statements, ‘I feel I am as good as other people’, ‘I am hopeful about the future’, ‘I am happy’ and ‘I enjoy life. Stepwise multiple regression analysis was performed for findings regarding subjects’ emotional well‐being.Results:  The mean age ± standard deviation was 72 ± 5.4 years, and 461 subjects (47.9%) were men. Significantly independent explanatory variables included financial status (β, 0.070; P = 0.028), participation in community events (β, 0.138; P < 0.001), everyday alcohol use (β, 0.103; P = 0.001) and self‐rated health (β, 0.153; P < 0.001). Living alone did not remain in the final model, however, when testing its interaction with confounding factors, the interactions between living alone and work activity status (F = 5.41; P = 0.0120) and prescription medication use (F = 5.77; P = 0.017) were significant independent explanatory variables.Conclusion:  The interactions between living alone and work activity status and prescription medication influence the emotional well‐being of elderly subjects.
Relationships among impairment, disability, handicap, burden of care, economic expenses, event‐related potentials and regional cerebral blood flow in Parkinson's disease
Authors: Takeda Yoshiko , Kuroiwa Yoshiyuki , Watabe Setsuko , Gokita Kazue , Chuman Taeko , Wang Lihong , Li Mei , Toda Hiroyuki , Kamitani Toshiaki , Omoto Shu , Ikegami Tadashi , Matsubara Sho , Suzuki Yume 
Published: August 2005

Background:  Relationships between impairment, disability and handicap in neurological diseases such as stroke and spinal cord injury have been studied using the framework of the international classification of impairment, disability and handicap, defined by World Health Organization. Those relationships in Parkinson's disease have rarely been studied on a statistical basis.Methods:  In order to identify relationships between impairment, disability, handicap, burden of care, economic expenses and neurophysiological dysfunction in patients with Parkinson's disease, we made quantitative evaluations of these parameters in 24 patients and 14 care‐givers. Impairment was measured by symptomatic assessment for motor and autonomic impairments and neuropsychological assessment using the revised version of Hasegawa's dementia scale, the mini‐mental state examination, and the self‐rating depression scale. Disability was measured by Hoehn and Yahr scale, Barthel index, and the comprehensive activities of daily living index for the elderly. Handicap was measured by the Craig handicap assessment and reporting technique. Scores for burdens of care on principal care‐givers had physical and psychosocial aspects. Neurophysiological dysfunction was studied by measuring visual event‐related potentials and regional cerebral blood flow.Results:  Motor and cognitive impairments, disability and handicap significantly correlated to each other. In particular, disability and handicap were strongly correlated. The burden of care on care‐givers, economic expenses, visual event‐related potentials and regional cerebral blood flow were significantly correlated with impairment, disability and handicap.Conclusion:  Further investigations are anticipated to confirm practical values of symptomatic, neuropsychological, electrophysiological and neuroimaging evaluations to predict burden of care on families and economic expenses for patients with Parkinson's disease.
Species pool size and invasibility of island communities: a null model of sampling effects
Authors: Herben Tomáš 
Published: August 2005

AbstractThe success of alien species on oceanic islands is considered to be one of the classic observed patterns in ecology. Explanations for this pattern are based on lower species richness on islands and the lower resistance of species‐poor communities to invaders, but this argument needs re‐examination. The important difference between islands and mainland is in the size of species pools, not in local species richness; invasibility of islands should therefore be addressed in terms of differences in species pools. Here I examine whether differences in species pools can affect invasibility in a lottery model with pools of identical native and exotic species. While in a neutral model with all species identical, invasibility does not depend on the species pool, a model with non‐zero variation in population growth rates predicts higher invasibility of communities of smaller pools. This is because of species sampling; drawing species from larger pools increases the probability that an assemblage will include fast growing species. Such assemblages are more likely to exclude random invaders. This constitutes a mechanism through which smaller species pools (such as those of isolated islands) can directly underlie differences in invasibility.
Intraspecific application of the mid‐domain effect model: spatial and temporal nest distributions of green turtles, Chelonia mydas, at Tortuguero, Costa Rica
Authors: Tiwari Manjula , Bjorndal Karen A. , Bolten Alan B. , Bolker Benjamin M. 
Published: August 2005

AbstractThe mid‐domain effect (MDE) model was developed to evaluate patterns of species richness. We applied the MDE model to intraspecific distribution patterns – the spatial and temporal nest distributions of green turtles, Chelonia mydas, at Tortuguero, Costa Rica, from 1972 to 2000. Spatial and temporal distributions of green turtle nests at Tortuguero did not exhibit significant annual variation over this time period. The spatial and temporal distribution of nests largely conformed to the predictions of the MDE model, although the spatial model has a better fit. Environmental factors that may cause deviations from the MDE model are discussed. The model also indirectly provided a first estimate of the mean spatial nesting range of individual green turtles at Tortuguero: 10.1 km (SD 8.7 km). The MDE model provides insight into intraspecific as well as interspecific distribution patterns.
Neutral drift and polymorphism in gene‐for‐gene systems
Authors: Salathé Marcel , Scherer Almut , Bonhoeffer Sebastian 
Published: August 2005

AbstractPathogens are a main driving force of the evolution of plants and animals. Being resistant to diseases confers a high selective advantage to hosts, yet many host–pathogen systems show a remarkable degree of polymorphism of host resistance and pathogen virulence. The most common explanation of this phenomenon is that both resistance and virulence genes are costly and that there is selection against those genes when they are unnecessary. Here, we use stochastic multi‐locus simulations to show that the origin and the maintenance of genetic polymorphism in plant–pathogen systems can be explained without costs. In multi‐locus gene‐for‐gene systems, temporal domination of a super pathogen can cause polymorphism in resistance through neutral drift. With an increasing number of susceptible alleles in the host population, pathogen types other than the super race are able to cause infections and invade the population, leading to higher pathogen diversity and in turn to higher host diversity.
Running to stand still: adaptation and the response of plants to rapid climate change
Authors: Jump Alistair S. , Peñuelas Josep 
Published: August 2005

AbstractClimate is a potent selective force in natural populations, yet the importance of adaptation in the response of plant species to past climate change has been questioned. As many species are unlikely to migrate fast enough to track the rapidly changing climate of the future, adaptation must play an increasingly important role in their response. In this paper we review recent work that has documented climate‐related genetic diversity within populations or on the microgeographical scale. We then describe studies that have looked at the potential evolutionary responses of plant populations to future climate change. We argue that in fragmented landscapes, rapid climate change has the potential to overwhelm the capacity for adaptation in many plant populations and dramatically alter their genetic composition. The consequences are likely to include unpredictable changes in the presence and abundance of species within communities and a reduction in their ability to resist and recover from further environmental perturbations, such as pest and disease outbreaks and extreme climatic events. Overall, a range‐wide increase in extinction risk is likely to result. We call for further research into understanding the causes and consequences of the maintenance and loss of climate‐related genetic diversity within populations.
And the beak shall inherit – evolution in response to invasion
Authors: Carroll Scott P. , Loye Jenella E. , Dingle Hugh , Mathieson Michael , Famula Thomas R. , Zalucki Myron P. 
Published: August 2005

AbstractThe increased demographic performance of biological invaders may often depend on their escape from specifically adapted enemies. Here we report that native taxa in colonized regions may swiftly evolve to exploit such emancipated exotic species because of selection caused by invaders. A native Australian true bug has expanded it host range to include a vine imported from tropical America that has become a serious environmental weed. Based on field comparisons and historical museum specimens, we show that over the past 30–40 years, seed feeding soapberry bugs have evolved 5–10% longer mouthparts, better suited to attack the forest‐invading balloon vines, which have large fruits. Laboratory experiments show that these differences are genetically based, and result in a near‐doubling of the rate at which seeds are attacked. Thus a native biota that initially permits invasion may rapidly respond in ways that ultimately facilitate control.
Prospective study on the role of the CT scan in patients with an acute abdomen
Authors: Salem T. A. , Molloy R. G. , O'Dwyer P. J. 
Published: August 2005

AbstractObjectives  Recent reports indicate that early CT scan (within 24 h) increases diagnostic accuracy, reduces hospital stay and mortality in patients with an acute abdomen. The aim of this study was to assess the surgeons' use of CT in patients with an acute abdomen and the impact of this on diagnostic accuracy and mortality.Patients and methods  Patients older than 25 years admitted as an emergency with acute abdominal pain were prospectively evaluated.Results  Two hundred and eleven patients fulfilled the inclusion criteria including 129 women and 82 men with a mean age of 62.4 years (range 27–92 years). The correct diagnosis on admission was made in 99 (47%) patients. CT was performed in 81 (38%), including 24 who had the scan performed within 24 h of admission. The sensitivity, specificity and accuracy of CT were 86%, 79% and 84%. CT was considered to have changed clinical management in 40 patients. Fifteen patients died, and one death may have been prevented by an early CT. Five had a delay in diagnosis of a serious condition; all could have been prevented by early CT.Conclusion  Selective use of CT increases diagnostic accuracy and improves the management of patients with an acute abdomen. Clinical trials are necessary to assess outcome following selective vs routine use of CT in this group of patients.
Staged mucosal advancement flap for the treatment of complex anal fistulas: pretreatment with noncutting Setons and in case of recurrent multiple abscesses a diverting stoma
Authors: Van Der Hagen S. J. , Baeten C. G. , Soeters P. B. , Beets‐Tan R. G. , Russel M. G. V. M. , Van Gemert W. G. 
Published: August 2005

AbstractObjective  To assess the efficacy of a staged strategy for the treatment of complex perianal fistula.Methods  Between January 1999 and April 2003 all consecutive patients with complex perianal fistulas were treated according to a staged strategy. Fistula tracks originating from the middle third or upper part of the anal sphincter were included. Patients were examined for recurrent fistulas and complaints of incontinence and soiling. Initial treatment consisted of a noncutting seton with or without a diverting stoma. Definitive surgical treatment consisted of an advancement flap or fistulotomy.Results  Thirty patients were included (median age; 42 years, range 22–68 years). Seven had Crohn's disease without signs of rectal and anal involvement other than the fistula. At a median follow up of 22 months (range 8–52 months) in 29 (97%) patients, the wounds had healed completely; 7 (22%) patients subsequently developed a recurrent fistula and minor soiling occurred in 7 (23%) patients.Conclusion  Initial treatment with a seton with and without a diverting stoma minimizing inflammatory activity at the fistula site before definitive surgical treatment gave good results in this difficult group of patients.