bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital Variation in Episiotomy Use and the Risk of Perineal Trauma During Childbirth
Authors: Webb David A. , Culhane Jennifer 
Published: March 2003

Background: Episiotomies are the most frequently performed surgical procedure among United States women, but there are no published epidemiological studies of the extent of variation in episiotomy use among different obstetrical providers, or the outcomes associated with different levels of use. The objective of this study was to assess the extent of hospital variation in the use of episiotomy and the relationship between hospital episiotomy use and the incidence and risk of perineal trauma among women residing in a large urban area in the United States.Methods: Linked birth certificate and hospital discharge data pertaining to births to nulliparous women without prolonged labor or obstructed deliveries, and with infants weighing between 2500 and 4000 g, were analyzed for 18 major maternity hospitals. The relationship between episiotomy use and perineal trauma at the hospital level was examined using regression analysis.Results: Hospital episiotomy rates ranged from approximately 20 to 73 percent. The rate of third or fourth degree perineal lacerations varied from a low of 4 percent to a high of more than 13 percent among hospitals. Rates of episiotomy were significantly correlated with rates of a third or fourth degree perineal laceration (r = 0.70; p < 0.01), and with the hospital‐specific, adjusted odds ratios for such lacerations (r = 0.65; p < 0.01).Conclusions: Findings from the analysis of epidemiological data for this study population were consistent with those from clinical studies, indicating that liberal as opposed to restrictive use of episiotomy is unwarranted, and probably even harmful. Hospital episiotomy rates exceeded 20 percent in all cases, but such rates appear difficult to justify in face of the evidence. (BIRTH 29:2 June 2002)
Both Empowered and Powerless: Mothers’ Experiences of Professional Care When Their Newborn Dies
Authors: Lundqvist Anita , Nilstun Tore , Dykes Anna‐Karin 
Published: March 2003

ABSTRACT: Background: The death of a newborn is a complex and tragic situation, the uncertain and stressful nature of which places emotional burdens on the parents. The aim of this study was to examine and illuminate mothers’ experiences and perceptions of the care given to them at neonatal clinics while facing the threat and the reality of losing their baby.Method: Interviews were performed, in the form of conversations, with 16 mothers approximately 2 years after the death of their newborns. The interviews were analyzed using a hermeneutic phenomenological method.Results: The primary themes identified were feeling empowered and feeling powerless. Three related themes to feeling empowered were a sense of nearness—supporting confidence; a sense of encouragement—supporting self‐esteem; and a sense of empathy—supporting comfort. Three related themes to feeling powerless were a sense of distance—leading to strength or adjustment; a sense of violation—leading to helplessness and despondency; and a sense of disconnection—leading to insecurity and discouragement. All mothers felt both empowered and powerless. When experiencing empowering care, they had a feeling of encountering benevolence, with respect to their individual desires. Experiencing competent care without humane treatment madethemfeel powerless, and they were neither respected as a mother nor a person.Conclusions: Feelings of empowerment emerged when the health care professionals not only saw the mother as an individual but also ‘‘saw through the mothers’ eyes’’ and ‘‘felt with the mother's feelings’’.Feelings of powerlessness emerged when the similarity in the lifeworld (i.e., the world of lived experiences) differed, and the perspectives of the mothers and the health care professionals did not correspond. (BIRTH 29:3 September 2002)
Colloidal Bismuth Pectin: An Alternative to Bismuth Subcitrate for the Treatment of Helicobacter pylori– Positive Duodenal Ulcer
Authors: Nie Yuqiang , Li Yuyuan , Wu Huisheng , Sha Weihong , Du Hong , Dai Shoujun , Wang Hong , Li Qinglin 
Published: March 2003

Background. Bismuth triple therapy provides consistently good results in Helicobacter pylori eradication worldwide, whereas quadruple therapy using a combination of omeprazole and bismuth triple regimen has produced cure rates in excess of 90%. The prevalence of metronidazole‐resistant strains was 26.8% in our area. Colloidal bismuth pectin (CBP) is a new, lower‐priced bismuth salt made in China. The purpose of this study was to investigate the efficacy and safety of CBP triple and quadruple regimens in the treatment of H. pylori–positive duodenal ulcer.Materials and Methods. In this prospective trial, 205 patients with H. pylori–positive duodenal ulcer were allocated randomly to receive one of four regimens: metronidazole, 200 mg; amoxicillin, 250 mg; and colloidal bismuth subcitrate (CBS), 120 mg (group 1), or CBP, 100 mg qid (group 2) for 2 weeks, then continued CBS, 240 mg, or CBP, 200 mg bid for a further 2 weeks. A quadruple regimen using a combination of omeprazole, 20 mg bid, and CBS triple therapy (group 3) or CBP triple therapy (group 4), respectively, was given to patients for 1 week, followed by omeprazole, 20 mg once daily for a further 3 weeks. Further endoscopy was performed at least 4 weeks after cessation of the treatment. H. pylori status was determined by histology, a 14C urea breath test, and a urease test.Results. The per‐protocol H. pylori cure rates were 85% (22 of 26 patients), 90% (35 of 39), 96% (46 of 48), and 95% (75 of 79) for groups 1 through 4. In the intention‐to‐treat analysis, cure rates were 79% (22 of 28), 83% (35 of 42), 90% (46 of 51), and 89% (75 of 84), respectively. The cure rates of quadruple therapy were higher than those of triple therapy; an 8.2% difference was not statistically significant (95% confidence interval [CI], 2.3–18.7%). The ulcer‐healing rates were 88%, 87%, 98%, and 97%, respectively, for groups 1 through 4. The ulcer pain was relieved more rapidly in quadruple‐ than in triple‐therapy regimens. Two patients discontinued treatment prematurely owing to drug‐related side effects.Conclusion. One‐week quadruple therapy is highly effective and safe in H. pylori eradication in Chinese patients. CBP is as effective as CBS.
Invasiveness of Helicobacter pylori into Human Gastric Mucosa
Authors: Ko Gyung Hyuck , Kang Soo Min , Kim You Kyung , Lee Jeong Hee , Park Cheol Keun , Youn Hee Shang , Baik Seung Chul , Cho Myung Je , Lee Woo Kon , Rhee Kwang Ho 
Published: March 2003

Background. Helicobacter pylori has generally been observed only in the gastric mucous layer or in the spaces between gastric mucus‐secreting cells and not in the gastric epithelial cells or in the lamina propria. The purpose of this study is to determine whether H. pylori invades the gastric mucosa, using an immunoelectron microscopical examination of human gastric mucosa infected with H. pylori.Materials and Methods. Five hundred gastric antral biopsy specimens were fixed in a periodate‐lysin‐paraformaldehyde solution, embedded in Lowicryl, sectioned, and examined with a light microscope. One hundred specimens moderately or severely infected with H. pylori were selected and were incubated with polyclonal rabbit anti–H. pylori antibody. The specimens were washed, incubated with 20 nm of colloidal gold–conjugated goat anti–rabbit IgG, stained with uranyl acetate and lead citrate, and observed with a transmission electron microscope.Results. In one case, a bacterium was observed within the cytoplasm of a gastric mucus‐secreting cell; in another case, a few bacteria were observed within the cytoplasm of a stromal cell in the lamina propria. The bacteria could be differentiated from degenerated intracellular organelles by gold particles attached to the bacteria.Conclusion. H. pylori rarely invade the lamina propria and gastric cells.
Negative Association Between Helicobacter pylori Infection and Reflux Esophagitis in Older Patients: Case‐Control Study in Japan
Authors: Haruma Ken , Hamada Hiroshige , Mihara Mitsuhiro , Kamada Tomoari , Yoshihara Masaharu , Sumii Koji , Kajiyama Goro , Kawanishi Masahiro 
Published: March 2003

Background. Recent studies have clarified a close association between H. pylori infection and gastritis, peptic ulcer disease, and gastric cancer, but there is little information concerning the relationship between H. pylori infection and reflux esophagitis (RE). We investigated the relationship between H. pylori, RE, and corpus gastritis.Subjects and Methods. Ninety‐five patients with RE and 190 sex‐ and age‐matched asymptomatic healthy controls demonstrating no localized lesions in the upper GI tract were studied and evaluated for H. pylori infection, histologic gastritis, serum gastrin, and pepsinogens (PGs).Results. H. pylori infection was significantly lower in RE patients than in asymptomatic controls (41% vs. 76%, p < .01). Histologic gastritis of both the antrum and corpus was significantly less frequent (antrum; p < .01, corpus; p < .01), and serum levels of PGI and the PG I/II ratio were significantly higher in RE patients than in controls (PGI; p < .05, PG I/II ratio; p < .01). When the subjects were divided into two age groups (59 years of age and younger and 60 years of age and older), a significant difference was found only among patients over 60 years of age (29% vs. 85%, p < .01). Among subjects in this age group, gastritis in both the antrum and corpus were significantly milder in RE patients than in controls. Although the prevalence of H. pylori infection was similar between the two groups of patients under 59 years of age, corpus gastritis was significantly milder in patients than in controls (p < .05).Conclusions. A significantly low prevalence of H. pylori infection was found in RE patients over 60 years of age but not in those under 59 in comparison with sex‐ and age‐matched controls. The relative lack of corpus gastritis might play a role in the pathogenesis of RE in our population through preservation of the acid secretion area.
13C Urea Breath Test with Nondispersive Isotope‐Selective Infrared Spectrometry: Reproducibility and Importance of the Fasting Status
Authors: Mana Fazia , Franken Philippe R. , Ham Hamphrey R. , Reynaert Hendrik , Urbain Daniel 
Published: March 2003

Background. The 13C urea breath test (13C‐UBT) is the most convenient method for diagnosing Helicobacter pylori infection noninvasively. Nondispersive isotope‐selective infrared spectrometry (NDIRS) is an inexpensive and easy alternative to mass spectrometry. The objective of this study was to evaluate: (1) the reproducibility of the 13C‐UBT as performed by using the NDIRS method; (2) the repeatability of bags analysis and the impact of delayed analysis; and (3) the need for fasting status for the 13C‐UBT.Methods. The 13C‐UBT was performed with 75 mg urea labeled with 13C, with breath samples collected at times 0 and 30 minutes. Results are expressed as delta over baseline (0/00). Fifty‐three patients underwent two successive 13C‐UBTs with an interval of 48 to 72 hours. The 106 collected bags were randomly reanalyzed immediately or 72 hours later. In 26 volunteer subjects, the 13C‐UBT was performed both in a fasting condition and after a nonstandardized meal. The reproducibility was assessed by the method of Bland and Altman.Results. The mean of difference between two successive tests was 0.14 0/00 (standard deviation, 0.90), and the coefficient of repeatability was 1.80 (confidence interval, 95%). The difference between two successive analyses was always less than 2.2% of the initial value. The coefficient of variation between two successive tests for the influence of a meal was 11.24.Conclusion. The 13C‐UBT as performed by using NDIRS is reproducible, analyses can be delayed up to 72 hours, and the test must be performed in fasting conditions.
Double‐Blind Comparison of Absorbable Colloidal Bismuth Subcitrate and Nonabsorbable Bismuth Subnitrate in the Eradication of Helicobacter pylori and the Relief of Nonulcer Dyspepsia
Authors: Whitehead Mark W. , Phillips Rosemary H. , Sieniawska Christine E. , Delves H. Trevor , Seed Paul T. , Thompson Richard P.H. , Powell Jonathan J. 
Published: March 2003

Background. Bismuth is widely used for the eradication of H. pylori, especially in developing countries, although there are concerns over its neurotoxicity. Whether bismuth has to be absorbed in humans to act against H. pylori is not known. In this study, we compared “absorbable” (colloidal bismuth subcitrate) and “nonabsorbable” (bismuth subnitrate) bismuth as part of triple therapy in the eradication of H. pylori.Materials and Methods. A double‐blind, randomized, placebo‐controlled trial was carried out with 120 H. pylori–positive patients with nonulcer dyspepsia. Group CBS + Ab (n = 35) received colloidal bismuth subcitrate (one tablet qds), amoxicillin (500 mg qds), and metronidazole (400 mg tds). Group BSN + Ab (n = 35) received bismuth subnitrate (two tablets tds) and the same antibiotics. Group Ab (n = 35) received placebo bismuth (two tablets tds) and the antibiotics. Group BSN (n = 15) received bismuth subnitrate (two tablets tds) and placebo antibiotics. Bismuth was taken for 4 weeks and the antibiotics for the first 2 weeks. H. pylori eradication, side effects, compliance, pre‐ and post‐treatment symptom scores, and bismuth absorption were assessed.Results. H. pylori eradication was 69%, 83%, 31%, and 0% in CBS + Ab, BSN + Ab, Ab, and BSN, respectively. Side effects, compliance, and symptom relief were similar in all groups, but blood bismuth levels were significantly greater in CBS + Ab than the other three groups.Conclusion. The efficacy of bismuth‐based therapies as part of triple therapy in the eradication of H. pylori is unrelated to absorption. Hence, the use of effective but poorly absorbed bismuth preparations should be encouraged for bismuth‐based eradication therapies.
pH‐Dependent Protein Profiles of Helicobacter pylori Analyzed by Two‐Dimensional Gels
Authors: Slonczewski Joan L. , McGee David J. , Phillips Judith , Kirkpatrick Christopher , Mobley Harry L. T. 
Published: March 2003

Background. Helicobacter pylori survives transient exposure to extreme acid prior to adherence and growth on the gastric epithelium at neutral pH.Materials and Methods. The effect of pH stress on protein profiles of H. pylori was observed using two‐dimensional gel electrophoresis (2‐D gels). H. pylori 26695 was grown microaerobically in tryptone‐yeast extract broth, 3% fetal bovine serum. Growth in acid alkalinized the medium, whereas growth in base caused acidification. For 2‐D gel analysis of protein profiles, cultures were grown in media buffered at pH 5.7 and at pH 7.5.Results. Under all pH conditions, the most abundant proteins observed were the urease structural subunit UreB and the chaperonin GroEL. Growth in acid significantly increased the abundance of UreB. Thus, urease expression is not completely constitutive, as reported previously, but shows regulation by pH. Another protein observed only at low pH was identified as mammalian apolipoprotein A‐I, possibly taken up by H. pylori from bovine serum in the growth medium. This finding, if confirmed, suggests that uptake of high‐density lipoprotein from the human host may facilitate acquisition of cholesterol, required for formation of the unique cholesteryl glucosides in the membrane of H. pylori. In growth above pH 7, three stress proteins were induced: GroES (HspA), GroEL (HspB), and the antioxidant AhpC homolog TsaA. In addition, N‐terminal sequence analysis identified five additional proteins that had not previously been reported on 2‐D gels of H. pylori (FMN, SodB, TrxB, TsaA, and Tsr).Conclusions. In summary, our 2‐D gel study reveals expression of several proteins dependent on growth pH.
High Efficacy of Ranitidine Bismuth Citrate, Amoxicillin, Clarithromycin and Metronidazole Twice Daily for Only Five Days in Helicobacter pylori Eradication
Authors: Gisbert Javier P. , Marcos Santiago , Gisbert Jose Luis , Pajares Jose Maria 
Published: March 2003

ABSTRACTAim.The combination of a proton pump inhibitor (PPI) or ranitidine‐bismuth‐citrate (Rbc) and two antibiotics for 7–10 days are, at present, the preferred treatments in Helicobacter pylori eradication. However, therapies for fewer than 7 days have been scarcely evaluated and it is unknown whether the length of treatment can be shortened, without a lost of efficacy, if three instead of two antibiotics are used. The aim of our study was to evaluate the efficacy of Rbc plus three antibiotics for only 5 days in H. pylori eradication.Methods.We prospectively studied 80 patients (34% duodenal ulcer, 66% functional dyspepsia) infected by H. pylori. At endoscopy, biopsies were obtained for histological study and rapid urease test, and a 13C‐urea breath test was carried out. Urea breath test was repeated 4 weeks after completing eradication treatment with Rbc [400 mg twice a day (bid)], amoxicillin (1 g bid), clarithromycin (500 mg bid) and metronidazole (500 mg bid). All drugs were administered together after breakfast and dinner for 5 days only, and no treatment was administered thereafter. Compliance with therapy was determined from the interrogatory and the recovery of empty envelopes of medications.Results.In 79 out of the 80 patients, H. pylori eradication success or failure was assessed after therapy (one patient was lost from follow‐up). All but one of these 79 patients took all the medications (one patient stopped treatment on the day 3 due to nausea/vomiting). Per protocol eradication was achieved in 72/78 (92%; 95% CI, 84–96%) and in 72/80 (90%; 81–95%) by intention‐to‐treat. Therapy was more effective in patients with duodenal ulcer than in those with functional dyspepsia [100% (87–100%) vs. 85% (73–92%) by intention‐to‐treat; p < .05]. Adverse effects were described in ten patients (12%), and included the perception of a metallic taste (eight patients), nausea/vomiting (two patients, one of them abandoned the treatment due to this), and diarrhea (two patients).Conclusion.The combination of Rbc, amoxicillin, clarithromycin and metronidazole for only 5 days represents a promising therapy for H. pylori infection, due to its high efficacy, simple posology, low cost and excellent tolerance.
Helicobacter pyloriInfection and Recurrent Abdominal Pain in Turkish Children
Authors: Özen Hasan , Dinler Gönül , Akyön Yakut , Koçak Nurten , Yüce Aysel , Gürakan Figen 
Published: March 2003

AbstractBackground.Helicobacter pyloriinfection is primarily acquired in childhood. However, the association betweenH. pyloriinfection and recurrent abdominal pain (RAP) remains unclear.Materials and methods.One hundred and forty‐one children with and 21 without RAP underwent upper gastrointestinal endoscopy. At least five antral gastric biopsies were obtained from each patient and the presence ofH. pyloriinfection was accepted when at least two out of four tests (histology, direct antral smear, culture, and rapid urease test) were positive. Patients withH. pyloriinfection underwent triple therapy with omeprazole, clarithromycin, and metronidazole.Results.Eighty‐five out of 141 (60.3%) patients with RAP wereH. pyloripositive whereas 5 out of 21 (20.8%) patients without RAP were (p = .0037). Symptoms were disappeared in 87% of children whoseH. pyloriinfection was eradicated compared with 41% of those in whom the infection was not eradicated (p = .0035).Conclusions.It was concluded that children with RAP andH. pyloriinfection appear to benefit from eradication therapy in Turkey.
Helicobacter pylori Infection is Associated with a Decreased Risk of Developing Oesophageal Neoplasms
Authors: Henrik Simán J. , Forsgren Arne , Berglund Göran , Florén Claes‐Henrik 
Published: March 2003

ABSTRACTBackground.The role of Helicobacter pylori infection in the development of oesophageal malignancies was investigated through a multivariate conditional logistic regression analysis in a nested case‐control study.Methods.Blood samples and a questionnaire on smoking and alcohol habits were collected from a cohort of 32,906 city residents during a health‐screening programme between 1974 and 1992. Forty‐four cases of oesophageal cancer and 149 matched controls were selected. The mean interval between screening and cancer diagnosis was 11.9 years. H. pylori seropositivity was determined by an enzyme‐linked immunosorbant assay measuring IgG. Occupation was included in the statistical analysis as an indicator of socio‐economic status.Results. Helicobacter pylori seropositivity was present in 10 of the cases (22.7%) and 67 of the controls (45.0%). In a multivariate model, with adjustment for occupation, tobacco and alcohol consumption, the odds ratio for developing an oesophageal malignancy when infected with H. pylori was 0.29 (95% confidence interval (CI): 0.12–0.67). Current smokers had an odds ratio of 17.3 (95% CI: 3.0–99.4) and the odds ratio for ex‐smokers was 5.9 (95% CI: 1.15–29.9). High alcohol consumption was no longer significantly associated with oesophageal neoplasms after tobacco smoking was included into the model, odds ratio 1.22 (95% CI: 0.46–3.2). The protective effect of H. pylori was more pronounced for oesophageal adenocarcinoma (seven cases, odds ratio 0.16, 95% CI: 0.00–1.06) than for squamous‐cell carcinoma (29 cases, odds ratio 0.41, 95% CI: 0.14–1.2).Conclusions. Helicobacter pylori infection is associated with a decreased risk of developing an oesophageal malignancy. Current smokers and ex‐smokers have instead a definite increased risk of oesophageal neoplasms.
Proteome Analysis of Highly Immunoreactive Proteins of Helicobacter pylori
Authors: Lock Robert A. , Coombs Geoffrey W. , McWilliams Tracy M. , Pearman John W. , Grubb Warren B. , Melrose Graham J. H. , Forbes Geoffrey M. 
Published: March 2003

AbstractBackground. Identification of the immunoreactive proteins of Helicobacter pylori is important for the development of both diagnostic tests and vaccines relating to the organism. Our aim was to determine whether there are significant differences between human IgG and IgA reactivities to individual H. pylori proteins, and whether patterns of immunoreactivity are sustained across different strains of H. pylori.Method. The total complement of protein from seven strains of H. pylori was resolved by two‐dimensional polyacrylamide gel electrophoresis (2D‐PAGE). Proteins were transferred electrophoretically onto polyvinylene difluoride (PVDF) membranes, which were probed with sera pooled either from H. pylori‐infected patients, or noninfected (control) patients. Highly immunoreactive proteins were detected using chromogenic enzyme‐antibody conjugates recognising either serum IgG or IgA. These proteins were then characterised by tryptic peptide‐mass fingerprinting using matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry (MALDI‐TOF MS).Results. Highly immunoreactive proteins were detected which were common to all seven strains, and recognised by both immunoglobulin subclasses. The proteins appear to be localised in five groups. Protein analysis established that these groups encompass multiple isoforms of chaperonin HspB (two subgroups); urease β‐subunit UreB; elongation factor EF‐Tu; and flagellin FlaA. The pattern of highly immunoreactive proteins was strongly conserved across the seven strains.Conclusion. These results suggest that within a tightly defined region on the H. pylori proteome map there are five groups of proteins that are highly reactive to both IgG and IgA. Our analysis suggests it is unlikely that the highly immunoreactive clusters harbour any significant proteins other than isoforms of HspB, UreB, EF‐Tu and FlaA, and that, with the partial exception of FlaA, these clusters are strongly conserved across all seven strains.