bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low‐dose aspirin for secondary cardiovascular prevention – cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation – review and meta‐analysis
Authors: BURGER W. , CHEMNITIUS J.‐M. , KNEISSL G. D. , RÜCKER G. 
Published: April 2005

Abstract.Objectives.  Low‐dose aspirin given for secondary prevention of cardiovascular disease is frequently withdrawn prior to surgical or diagnostic procedures to reduce bleeding complications. This may expose patients to increased cardiovascular morbidity and mortality. Aim of the study was to review and quantify cardiovascular risks because of periprocedural aspirin withdrawal and bleeding risks with the continuation of aspirin.Methods.  We screened MEDLINE (January 1970–October 2004) with additional manual cross‐referencing for clinical studies, surveys on the opinions of doctors and guidelines.Results.  Studies reporting the relative risk of acute cardiovascular events after aspirin withdrawal when compared with its continuation were not found. However, retrospective investigations revealed that aspirin withdrawal precedes up to 10.2% of acute cardiovascular syndromes. The time interval between discontinuation and acute cerebral events was 14.3 ± 11.3 days, 8.5 ± 3.6 days for acute coronary syndromes, and 25.8 ± 18.1 days for acute peripheral arterial syndromes (P < 0.02 versus acute coronary syndromes). On aspirin‐related bleeding risks, we obtained 41 (12 observational retrospective, 19 observational prospective, 10 randomized) studies, reporting on 49 590 patients (14 981 on aspirin). Baseline frequency of bleeding complications varied between 0 (skin lesion excision, cataract surgery) and 75% (transrectal prostate biopsy). Whilst aspirin increased the rate of bleeding complications by factor 1.5 (median, interquartile range: 1.0–2.5), it did not lead to a higher level of the severity of bleeding complications (exception: intracranial surgery, and possibly transurethral prostatectomy). Surveys amongst doctors on the management of this problem demonstrate wide variations. Available guidelines are scarce and in part contradictory.Conclusions.  Only if low‐dose aspirin may cause bleeding risks with increased mortality or sequels comparable with the observed cardiovascular risks after aspirin withdrawal, it should be discontinued prior to an intended operation or procedure. Controlled clinical studies are urgently needed.
Prognostic value of erythrocyte sedimentation rate in ST segment elevation myocardial infarction: interaction with hyperglycaemia
Authors: TIMMER J. R. , OTTERVANGER J. P. , HOORNTJE J. C. A. , DE BOER M.‐J. , SURYAPRANATA H. , VAN'T HOF A. W. J. , ZIJLSTRA F. ,   THE ZWOLLE MYOCARDIAL INFARCTION STUDY GROUP
Published: April 2005

Abstract.Objectives. Many inflammatory markers are associated with an adverse prognosis after ST segment elevation myocardial infarction (STEMI). Hyperglycaemia may exacerbate this inflammatory response. We investigated whether the erythrocyte sedimentation rate (ESR) was associated with an adverse prognosis and whether this was mediated by glucose levels.Research design and methods. It concerns apost hocanalysis of a prospective randomised trial. In 346 patients with STEMI treated with reperfusion therapy, we investigated long‐term outcome. Patients with ESR in the upper quartile (>14 mm h−1) were compared to patients with a normal ESR. Hyperglycaemia was defined as admission glucose ≥7.8 mmol L−1. Median follow up was 7.4 years (range: 5.7–8.3).Main outcome measures. All cause mortality, cardiovascular mortality, sudden death, death as a result of heart failure.Results. Both elevated ESR and hyperglycaemia were associated with a worse prognosis and increased mortality. Elevated ESR was particularly associated with an increased risk of sudden death (OR: 3.3, 17% vs. 6%,P < 0.01) whereas hyperglycaemia was especially associated with an increased risk of death because of heart failure (OR: 6.5, 8% vs. 1%,P < 0.01). There was no association between increased ESR and elevated glucose levels. Multivariate analysis did reveal that both elevated ESR and admission glucose were independent predictors of long‐term mortality.Conclusions. Elevated ESR and admission glucose are independent predictors of mortality in STEMI patients treated with reperfusion therapy. There is no association or interaction between glucose levels and the inflammatory response as reflected by ESR.
Acute inflammatory sensorimotor polyradiculoneuropathy associated with immune thrombocytopenic purpura
Authors: SATO N. , KAMATA T. , AKIYAMA N. , KUWANA M. , KANDA T. 
Published: April 2005

Abstract.Although acute inflammatory polyneuropathy (AIP) and immune thrombocytopenic purpura (ITP) are both believed to be immune‐mediated disorders, only a few cases have been reported in which these two diseases co‐existed. We describe a case of a 67‐year‐old patient who developed quadriparesis, ophthalmoplegia and severe sensory impairment along with thrombocytopenia. Detailed examinations, including the measurement of anti‐ganglioside antibodies and anti‐glycoprotein‐IIb‐IIIa‐IgG‐producing B‐cells, revealed that he developed AIP and ITP. By reviewing past similar reports, we noticed that AIP associated with ITP tends to manifest severe sensory impairment and is often preceded by upper respiratory tract infection, but not by gastrointestinal infection.
Thermolabile methylenetetrahydrofolate reductase enzyme genotype is frequent in type 2 diabetic patients with normal fasting homocysteine levels
Authors: TUTUNCU N. B. , ERBAS T. , ALIKASIFOGLU M. , TUNCBILEK E. 
Published: April 2005

Abstract.Objective. To investigate the plasma homocysteine concentrations with regard to nutritional, metabolic and genetic factors and to find out the frequency and impact of thermolabile methylenetetrahydrofolate reductase (T‐MTHFR) polymorphism in patients with type 2 diabetes mellitus.Design. A cross‐sectional study.Subjects. A total of 94 subjects with type 2 diabetes mellitus and 91 healthy age‐ and sex‐matched nonsmoking volunteers were recruited.Main outcome measures. Age, sex, duration and complications of diabetes mellitus, metabolic variables, fasting plasma homocysteine levels, and presence of T‐MTHFR polymorphism were evaluated for all participants. Presence of T‐MTHFR polymorphism was analysed to define any possible role in diabetes progress, complications and metabolic milieu.Results. Fasting homocysteine levels were similar in diabetic patients and controls. Prevalence of homozygous polymorphism of thermolabile MTHFR gene (TT) was encountered more frequently in patients with diabetes mellitus than the healthy controls (P = 0.004). Subgrouping of the patients with respect to MTHFR genotype revealed similar metabolic variables and frequency of chronic complications of diabetes mellitus in groups. Patients withTTgenotype revealed longer diabetes duration when compared with the patients having heterozygous mutation of thermolabile MTHFR or normal homozygous MTHFR genotypes (P = 0.046).Conclusions. Type 2 diabetic patients have similar fasting plasma homocysteine levels with that of age‐ and sex‐matched healthy people. There is no correlation between diabetic complications and this amino acid metabolite. On the contrary, thermolabile variant of MTHFR genotype is found to be more frequent in diabetic patients especially in those who have experienced a longer duration of disease.
Chronic fentanyl application induces adrenocortical insufficiency
Authors: OLTMANNS K. M. , FEHM H. L. , PETERS A. 
Published: April 2005

Abstract.We report a case of a 64‐year‐old man with secondary adrenocortical insufficiency who has been on a chronic transdermal fentanyl treatment because of sciatic pain syndrome. Shortly before admission to our hospital, the patient had discontinued his hydrocortisone medication. Adrenal crisis was assumed and during therapy with hydrocortisone infusion, the patient recovered. We suspected an opiate‐induced suppression of the hypothalamus‐pituitary‐adrenal (HPA) axis. Therefore, we gradually reduced the opiate dosage. After 1 week, HPA axis function was markedly improved. We conclude that opiate medication may inhibit – in a life‐threatening way – the organism's ability to respond to physical, emotional or metabolic stressors.
Effects of atorvastatin and vitamin E on lipoproteins and oxidative stress in dialysis patients: a randomised‐controlled trial
Authors: DIEPEVEEN S. H. A. , VERHOEVEN G. W. H. E. , VAN DER PALEN J. , DIKKESCHEI L. D. , VAN TITS L. J. , KOLSTERS G. , OFFERMAN J. J. G. , BILO H. J. G. , STALENHOEF A. F. H. 
Published: April 2005

Abstract.Objectives.  The objective of this study was to examine the effects of treatment with atorvastatin, α‐tocopherol and the combination of both, on lipoproteins and oxidative stress in dialysis patients.Design and setting.  This double‐blind randomised placebo‐controlled trial was performed at the dialysis department of a non‐university hospital.Subjects, intervention and measurements.  A total of 44 clinically stable, non‐diabetic patients on dialysis therapy (23 on haemo‐ and 21 on peritoneal‐dialysis) without manifest cardiovascular disease were included in this study. They were randomised for treatment during a period of 12 weeks with 40 mg atorvastatin + placebo α‐tocopherol (group 1) once daily, 800 IU α‐tocopherol + placebo atorvastatin once daily (group 2), 40 mg atorvastatin + 800 IU α‐tocopherol once daily (group 3), or placebo atorvastatin + placebo α‐tocopherol once daily (group 4). Assessment of lipid profile and oxidative stress was performed at the start of the study and after 12 weeks of treatment.Results.  Treatment with atorvastatin reduced total cholesterol, triglycerides (TG), low‐density lipoprotein (LDL) cholesterol, apolipoprotein B (apoB) and levels of oxidised LDL (oxLDL) with 30–43%. It had no influence on LDL oxidisability. Additional supplementation with α‐tocopherol had no effect on lipid profile and oxLDL levels but decreased in vitro LDL oxidisability. No side‐effects were observed.Conclusions.  Treatment with atorvastatin is effective in lowering plasma total cholesterol, TG, LDL, apoB and oxLDL in a population of stable dialysis patients and might therefore be an effective tool in improving the poor cardiovascular outcome in these patients. Supplementation of α‐tocopherol to atorvastatin had beneficial effects on in vitro LDL oxidisability and might therefore be of additional value. Further research on the clinical effects of treatment with atorvastatin in combination with α‐tocopherol is necessary.
Incident coronary events and case fatality in relation to common carotid intima‐media thickness
Authors: ROSVALL M. , JANZON L. , BERGLUND G. , ENGSTRÖM G. , HEDBLAD B. 
Published: April 2005

Abstract.Objectives.  To evaluate the incidence of coronary events (CE) and case fatality in relation to common carotid intima‐media thickness (IMT) and carotid plaque over a median follow up of 7 years.Subjects.  A total of 5163 Swedish middle‐aged men and women with no prior myocardial infarction and/or stroke.Methods and results.  The associations amongst B‐mode ultrasound determined common carotid IMT, carotid plaque (focal IMT > 1.2 mm) and carotid stenosis (lumen reduction of >15%) and incident CE, were investigated in relation to cardiovascular risk factor levels. Age‐ and sex‐adjusted common carotid IMT, carotid plaque and carotid stenosis were significantly (P < 0.05) related to future CE. Adjustment for established risk factors generally reduced the hazard rate ratios. However, the continuous measure of common carotid IMT, carotid plaque and carotid stenosis were significantly related to incident CE, even after risk factor adjustment. The strength of the associations between common carotid IMT and CE was only to a small extent reduced after adjustment for presence of carotid plaque. There were no statistically significant associations between common carotid IMT, carotid plaque or carotid stenosis and short‐term case‐fatality rates (28‐days mortality) or long‐term case‐fatality rates (5‐years mortality).Conclusions.  The results show an association between common carotid IMT and incident CE, independently of cardiovascular risk factors and carotid plaque. However, there was no association with short‐term or long‐term mortality after a CE.
Chills in ‘early sepsis’: good for you?
Authors: VAN DISSEL J. T. , NUMAN S. C. , VAN'T WOUT J. W. 
Published: April 2005

Abstract.We evaluated the predictive value of chills, bacteraemia and endotoxaemia for in‐hospital mortality and survival at 5–10 years long‐term follow‐up in a prospective cohort of ‘early sepsis’ patients presenting with fever resulting from community‐acquired pneumonia or pyelonephritis. Febrile patients with chills had bacteraemia more often (RR 3.1, 95% CI 1.8–5.4) than those without chills. Neither chills nor bacteraemia were significantly related to in‐hospital mortality, but patients with endotoxaemia had a higher in‐hospital mortality rate than those without endotoxaemia. Patients with chills had a significantly higher survival rate at long‐term follow‐up than those without chills on admission: the estimated risk of dying was 0.644 (95% CI 0.43–0.95, P = 0.029) for an individual with chills, compared to a person without chills, adjusting for the other factors [age cohort, underlying disease and the pro‐inflammatory response in the blood, i.e. tumour necrosis factor‐α (TNF‐α) and blood leucocyte number, as scored on hospital admission] in the Cox proportional hazards model. Chills may characterize a patient subpopulation that upon pulmonary and urinary tract infection is able to raise a more rapid and/or efficient host response.
Failure of current public educational campaigns to impact on the initial response of patients with possible heart attack
Authors: Bett J. H. N. , Tonkin A. M. , Thompson P. L. , Aroney C. N. 
Published: April 2005

Abstract Aims:  The National Heart Foundation of Australia recognizes that the risk of lethal arrhythmias is greater very early after the onset of myocardial infarction and that the more promptly flow can be restored in the infarct‐related artery the greater will be the benefits for survival and preservation of heart function. The Heart Foundation has therefore conducted several public media campaigns to encourage patients to seek help more promptly and evaluated their impact.Methods:  Since 1996, we have conducted four surveys of delays preceding admission of patients to coronary care units throughout Australia to assess the impact of the Heart Foundation's media campaigns. Data were collected on 1665 patients who presented to 73 hospitals; information on patient delay was available for 1178 of them.Results:  There were no significant differences in patient delay (median 1.5–2.0 h) in the four surveys from 1996 to 2002, nor when patients were categorized by age, sex, presenting diagnosis or history of previous myocardial infarction or coronary revascularization by percutaneous or surgical techniques.Conclusion:  New approaches are needed to reduce patient‐related delay after the onset of symptoms suggesting possible myocardial infarction. (Intern Med J 2005; 35: 279–282)
Joined‐up Thomism and the ‘Second Quest’ for Trinitarian Renewal
Authors: McCosker Philip 
Published: April 2005

Book reviewed: Scripture and Metaphysics: Aquinas and the Renewal of Trinitarian Theology, Matthew Levering, Blackwell 2004 (Hb 1‐4051‐1733‐8; Pb 1‐4051‐1734‐6), pp. x + 254, Hb £55/$61.95, Pb £19.99/$32.95
Outcome at 7 years of children diagnosed with autism at age 2: predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time
Authors: Charman Tony , Taylor Emma , Drew Auriol , Cockerill Helen , Brown Jo‐Anne , Baird Gillian 
Published: April 2005

Objective:  To examine the predictive validity of symptom severity, cognitive and language measures taken at ages 2 and 3 years to outcome at age 7 in a sample of children diagnosed with autism at age 2.Method:  Twenty‐six children diagnosed with autism at age 2 were re‐assessed at ages 3 and 7 years. At each age symptom severity, cognitive and language assessments were completed.Results:  The pattern of autistic symptom severity varied over time by domain. Across time, children moved across diagnostic boundaries both in terms of clinical diagnosis and in terms of instrument diagnosis on the Autism Diagnostic Interview‐Revised (ADI‐R). On all measures group variability in scores increased with age. Although non‐verbal IQ (NVIQ) for the group as a whole was stable across the 3 assessments, this masked considerable individual instability. Standard assessments at age 2 did not predict outcome at age 7 even within the same domain of functioning. In contrast, standard assessments at age 3 did predict outcome. However, a measure of rate of non‐verbal communicative acts taken from an interactive play‐based assessment at age 2 was significantly associated with language, communication and social outcomes at age 7.Conclusions:  The trajectory of autism symptoms over time differed in different domains, suggesting that they may be, at least in part, separable. Variability in language, NVIQ and symptom severity increased over time. Caution is required when interpreting the findings from assessments of children with autism at age 2 years. At this age measures of rate of non‐verbal communication might be more informative than scores on standard psychometric tests. Predictive validity of assessments at age 3 years was greater.
How Markets in Wildlife Meat and Parts, and the Sale of Hunting Privileges, Jeopardize Wildlife Conservation
Authors: GEIST VALERIUS 
Published: April 2005

Abstract:The reintroduction of markets in wildlife meat and parts jeopardizes North America's system of wildlife conservation. This most successful of conservation systems is based on three fundamental policies: denial of economic value to dead wildlife, allocation of surplus wildlife by law, and nonfrivolous use of wildlife. These policies are being undermined by game ranching, market hunting, paid hunting and advertising of hunting as sport or competition, not harvest. Agriculture in Canada advocates raising wildlife for slaughter; in the United States it supports paid hunting. The policy of removing economic value from dead wildlife paid off in a $60 billion service and manufacturing industry based on living wildlife. Some understanding of the historical roots of American wildlife management is vital to nature conservation. Making all citizens de facto as well as de fure shareholders in wildlife deserves broad attention.
The Constancy of Leopold's Land Ethic
Authors: NORTON BRYAN G. 
Published: April 2005

Abstract:Aldo Leopold's approach to environmental management changed drastically between the early 1920s, when he advocated predator eradication, and 1944, when he drafted “Thinking Like a Mountain.” How are we to understand these changes?It is shown that, early in his career, Leopold developed the basic elements of a conservation ethic, borrowing key elements from the Russian organicist P. D. Ouspensky and from A. T. Hadley, an American pragmatist who was president of Yale University when Leopold was a student there. Hadley's pragmatism counseled that we act on the wisdom embodied in the intuitive perceptions of our forefathers. While Leopold changed the presentation of his conservation ethic over the years, he never gave up these key ideas, traces of which remain in the final version of “The Land Ethic.”The changes in Leopold's management strategies were not due to a change in metaphysical or moral views, but to his evolving experience as a forester and game manager. Leopold learned that “violent” strategies, such as monocultural planting of trees, pervasive agricultural management of fragile ecosystems and, above all predator eradication, led to unforeseen and unwelcome results. Leopold recognized that we may never have adequate information to manipulate natural systems for maximal human utility without diminishing their vitality. He therefore lost faith in “economic biology” as a guide to environmental management.Leopold's changing views on management resulted from his experience as an environmental manager, not from a conversion from utilitarian anthropocentrism to biocentric nonanthropocentrism. While Leopold was drawn to Ouspensky's organicism, and he hoped Americans would through a profound change in their perceptions of nature adopt such a view eventually, he believed throughout his career that longsighted anthropocentrism provides an adequate basis for conservation practices.
The Ecology of Extinctions in Kelp Forest Communities
Authors: ESTES JAMES A. , DUGGINS DAVID O. , RATHBUN GALEN B. 
Published: April 2005

Abstract:We recognize three levels of extinction–global, local, and ecological – and provide examples of each. The protection and recovery of sea otters (Enhydra lutris) has provided abundant evidence of the consequences of their local extinction from kelp forest communities in the North Pacifc Ocean. These consequences include release of benthic invertebrate populations from limitation by predation; deforestation of kelp beds due to increased grazing by herbivorous sea urchins, one of the otter's main prey; and various cascading effects resulting from the biological and physical importance of kelp in coastal ecosystems. These interactions probably were important agents of selection for certain species.Two other examples are discussed: Steller's sea cow (Hydrodamalis gigas), a case of global extinction, and spiny lobsters, a possible case of ecological extinction. We speculate that grazing by sea cows was an important disturbance to surface‐canopy‐forming kelps and other algae in the littoral zones, but also point out that any such interactions probably acted in concert with physical disturbances by ocean waves. The ecological and evolutionary importance of sea cow grazing probably will remain a matter of speculation and conjecture because the species is globally extinct.Predation by spiny lobsters limits a variety of littoral and sublittoral invertebrate populations, particularly mollusks In one remarkable example, the reduction or local extinction of spiny lobsters enabled predutory whelks to increase in size and abundance, ultimately resulting in a predutor‐prey role reversal. From these and other case studies we can clued that (1) the extinction of consumers may have brad and sometimes unexpected influences on kelp forest ecosystems; (2) direct or indirect interactions with now‐extinct species probably exerted important selective influences on many extant forms; (3) such ecological and evolutionary influences are best understood where local or ecological extinctions, followed by recoveries, have provided comparisons in space or time; and (4) because of various ecological and behavioral barriers, local extinctions and their ecological consequences may not be simply reversed by protecting or reintroducing depleted or locally extinct species.