bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renal failure after liver transplantation: outcome after calcineurin inhibitor withdrawal
Authors: Neau‐Cransac Martine , Morel Delphine , Bernard Pierre‐Henri , Merville Pierre , Revel Philippe , Potaux Luc , Saric Jean 
Published: March 2003

Neau‐Cransac M, Morel D, Bernard P‐H, Merville P, Revel P, Potaux L, Saric J. Renal failure after liver transplantation. Outcome after calcineurin inhibitor withdrawal. Clin Transplant 2002: 16: 368–373. © Blackwell Munksgaard, 2002Chronic nephrotoxicity is one of the most serious side‐effects of calcineurin inhibitor treatment and a factor in mortality and morbidity after liver transplantation. In our transplant centre, among patients who underwent a liver transplantation between January 1989 and December 2000, 14 liver graft recipients (6.86%) developed de novo severe renal dysfunction as defined by a serum creatinine concentration above 200 micromol/L. Renal biopsy was performed in nine cases and evidenced histological lesions compatible with chronic nephrotoxicity related to calcineurin inhibitor treatment. For nine patients, we report the results of a prospective non‐randomized study consisting of cyclosporine or tacrolimus withdrawal associated with administration of mycophenolate mofetil or azathioprine. Despite this therapeutic modification, we did not observe a significant renal function improvement but on the other hand, there was no graft rejection.
Risk factors for slow graft function after kidney transplants: a multivariate analysis
Authors: Humar A , Ramcharan T , Kandaswamy R , Gillingham K , Payne WD , Matas AJ 
Published: March 2003

Humar A, Ramcharan T, Kandaswamy R, Gillingham K, Payne WD, Matas AJ. Risk factors for slow graft function after kidney transplants: a multivariate analysis. Clin Transplant 2002: 16: 425–429. © Blackwell Munksgaard, 2002Background: We previously defined an intermediate group of cadaver kidney transplant recipients who do not have immediate graft function (IGF), but do not have sufficient graft dysfunction to be classified as having delayed graft function (DGF). We showed that this group with slow graft function (SGF) had an increased risk of rejection and inferior long‐term results vs. recipients with IGF. The aim of our current study was to determine risk factors for SGF, which have not been well defined (in contrast to risk factors for DGF).Methods: Between January 1, 1984 and September 30, 1999, we performed 896 adult cadaver kidney transplants at the University of Minnesota. Recipients were analysed in three groups based on initial graft function: IGF [creatinine (Cr) < 3 mg/dL by post‐operative day (POD) no. 5], SGF (Cr > 3 mg/dL on POD no. 5, but no need for dialysis), and DGF (need for dialysis in the first week post‐transplant). A multivariate analysis looked specifically at risk factors for SGF, as compared with risk factors for DGF. Outcomes with regard to graft survival and acute rejection (AR) rates were determined for the three groups.Results: Of the 896 recipients, 425 had IGF, 238 had SGF, and 233 had DGF. A multivariate analysis of risk factors for SGF showed donor age >50 yr (RR=3.3, p=0.0001) and kidney preservation time >24 h (RR=1.6, p=0.01) to be the most significant risk factors. A multivariate analysis of risk factors for DGF showed similar findings, although high panel‐reactive antibodies (PRA) and donor Cr >1.7 mg/dL were also significant risk factors for DGF. Initial function of the graft significantly influenced the subsequent risk of AR: at 12 months post‐transplant, the incidence of AR was 28% for those with IGF, 38% for those with SGF, and 44% for those with DGF (p=0.04 for SGF vs. DGF). Initial graft function also significantly influenced graft survival: the 5‐yr death‐censored graft survival rate was 89% for recipients with IGF, 72% for those with SGF, and 67% for those with DGF (p=0.01 for IGF vs. SGF; p=0.03 for SGF vs. DGF).Conclusions: SGF represents part of the spectrum of graft injury and post‐transplant graft dysfunction. Risk factors for SGF are similar to those seen for DGF. Even mild to moderate graft dysfunction post‐transplant can have a negative impact on long‐term graft survival.
The impact of impaired insulin release and insulin resistance on glucose intolerance after renal transplantation*
Authors: Hjelmesæth Jøran , Hagen Monica , Hartmann Anders , Midtvedt Karsten , Egeland Thore , Jenssen Trond 
Published: March 2003

Abstract: The current knowledge of the pathogenesis of post‐transplant glucose intolerance is sparse. This study was undertaken to assess the relative importance of insulin secretion (ISec) and insulin sensitivity (IS) in the pathogenesis of post‐transplant diabetes mellitus (PTDM), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) after renal transplantation.An oral glucose tolerance test (OGTT) was performed in 167 non‐diabetic recipients 10 wk after renal transplantation. Fasting, 1‐h and 2‐h insulin and glucose levels were used to estimate the insulin secretory response and IS. One year after transplantation 89 patients were re‐examined with an OGTT including measurements of fasting and 2 h glucose.Ten weeks after transplantation the PTDM‐patients had significantly lower ISec and IS than patients with IGT/IFG, who again had lower ISec and IS than those with normal glucose tolerance (NGT). One year later, a similar difference in baseline ISec was observed between the three groups, whereas baseline IS did not differ significantly. Patients who improved their glucose tolerance during the first year, were mainly characterized by a significantly greater baseline ISec, and they received a significantly higher median prednisolone dose at baseline with a subsequent larger dose reduction during the first year, than the patients who had their glucose tolerance unchanged or worsened.In conclusion, both impaired ISec and IS characterize patients with PTDM and IGT/IFG in the early course after renal transplantation. The presence of defects in insulin release, rather than insulin action, indicates a poor prognosis regarding later normalization of glucose tolerance.
The changes in serum leptin, body fat mass and insulin resistance after renal transplantation
Authors: Kayacan S Mehmet , Yildiz Alaattin , Kazancioglu Rumeyza , Sahin Sevgi , Sever M Sükrü , Ark Ergin 
Published: March 2003

Abstract: Background:  In this prospective‐controlled study, we aimed to investigate the effect of changes in insulin resistance and anthropometrical parameters on serum leptin levels (SLL) after renal transplantation (Tx).Patients and methods:  Thirty‐four patients (M/F: 19/15, mean age: 29 ± 9 yr) and 30 age and sex‐matched healthy controls (C) were included. Body weight, subscapular, suprailiac, periumbilical, biceps and triceps skinfold thicknesses, neck, wrist, hip and waist circumferences, as well as body mass index and body fat mass were measured as anthropometrical parameters. In order to measure the serum glucose, insulin and SLL, blood samples were obtained before and 1 wk, 1 and 6 months after Tx. Homeostasis Model Assessment (HOMA) values were calculated as an index of insulin resistance.Results:  Serum leptin levels (SLL) of the patients at pre‐Tx were significantly higher than C (21.5 ± 3.5 vs. 7.8 ± 0.9 ng/mL, p = 0.002) and decreased at first week after Tx (from 21.5 ± 3.5 to 8.4 ± 1.5 ng/mL, p < 0.001). Thereafter, it gradually increased to 12.8 ± 2.1 ng/mL in the first month and to 14.4 ± 2.1 ng/mL in the sixth month after Tx. Serum leptin levels at sixth month were significantly higher than C (p = 0.005). Serum insulin and HOMA values changed similar to SLL after Tx. Correlations between SLL and HOMA persisted during the study period [pre‐Tx (r: 0.40) and at first (r: 0.38) and sixth (r: 0.47) months]. In linear regression analysis, HOMA and fat mass were found as independent variables for predicting SLL at the sixth month after Tx.Conclusion:  Serum leptin levels dramatically decreased immediately after Tx and significantly correlated with serum insulin levels and HOMA during the entire study. Increase in SLL at sixth months was probably because of increase in fat mass, insulin resistance and steroid use in renal transplant recipients.
Gabapentin in bipolar disorder: a placebo‐controlled trial of adjunctive therapy1
Authors: Pande Atul C , Crockatt Jerri G , Janney Carol A , Werth John L , Tsaroucha Georgia ,   Gabapentin Bipolar Disorder Study Group
Published: March 2003

Objectives:

To assess efficacy and safety of gabapentin in the treatment of bipolar disorder.

Methods: This was a double‐blind, placebo‐controlled trial of adjunctive gabapentin (dosed flexibly between 900 and 3600 mg/day). Patients with a lifetime diagnosis of bipolar disorder (type I), and who were currently suffering from symptoms of either mania, hypomania or a mixed state despite ongoing therapy with lithium, valproate, or lithium and valproate in combination were eligible for inclusion. The primary efficacy measures were the baseline to endpoint change in total score on the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HAM‐D).

Results: Both treatment groups had a decrease in total YMRS from baseline to endpoint, but this decrease was significantly greater in the placebo group (−9) than the gabapentin group (−6) (p<0.05). No difference between treatments was found for the total score on the HAM‐D. Secondary efficacy measures were not different between treatment groups. More patients in the placebo group had changes made to their ongoing lithium therapy (n=12) compared to the gabapentin group (n=4). When these patients are removed from the efficacy analysis, the YMRS treatment difference still favors placebo, but is no longer statistically significant. Based on gabapentin plasma levels at termination, some patients did not take the study drug as prescribed.

Conclusions: The findings of this study did not demonstrate that gabapentin is an effective adjunctive treatment when administered to outpatients with bipolar disorder.
Bipolar disorder during adolescence and young adulthood in a community sample
Authors: Lewinsohn Peter M , Klein Daniel N , Seeley John R 
Published: March 2003

Objectives:

To compare the incidence and prevalence of bipolar disorder (BD) between adolescence and young adulthood; to explore the stability and consequences of adolescent BD in young adulthood; to determine the rate of switching from major depressive disorder (MDD) to BD; and to evaluate the significance of subsyndromal BD (SUB).

Methods: A large, randomly selected community sample (n=1507) received diagnostic assessments twice during adolescence, and a stratified subset (n=893) was assessed again at 24years of age. In addition, direct interviews were conducted with all available first‐degree relatives. Five mutually exclusive groups, based on diagnoses in adolescence, were compared: BD (n=17), SUB (n=48), MDD (n=275), disruptive behavior disorder (n=49), and no‐disorder (ND) controls (n=307).

Results: Lifetime prevalence of BD was approximately 1% during adolescence and 2% during young adulthood. Lifetime prevalence for SUB was approximately 5%. Less than 1% of adolescents with MDD ‘switched’ to BD by age 24. Adolescents with BD had an elevated incidence of BD from 19 to 23 years, while adolescents with SUB exhibited elevated rates of MDD and anxiety disorders in young adulthood. BD and SUB groups both had elevated rates of antisocial symptoms and borderline personality symptoms. Compared to the ND group, adolescents with BD and SUB both showed significant impairment in psychosocial functioning and had higher mental‐health treatment utilization at age 24 years of age. The relatives of adolescents with BD and SUB had elevated rates of MDD and anxiety disorders. The relatives of SUB probands had elevated BD, while the relatives of BD had elevated rates of SUB and borderline symptoms.

Conclusions: Adolescent BD showed significant continuity across developmental periods and was associated with adverse outcomes during young adulthood. Adolescent SUB was also associated with adverse outcomes in young adulthood, but was not associated with an increased incidence of BD. Due to high rates of comorbidity with other disorders, definitive conclusions regarding the specific clinical significance of SUB must await studies with larger numbers of ‘pure’ SUB cases.
Coping and its correlates among caregivers of patients with bipolar disorder: a preliminary study
Authors: Chakrabarti Subho , Gill Sapna 
Published: March 2003

Objectives:
In contrast to schizophrenia, coping patterns of caregivers of bipolar patients have not received much attention. Previous evidence suggests that demographic factors, illness variables, caregiver burden, appraisal, etc can significantly influence coping styles. This study thus attempted to examine coping and its correlates in caregivers of bipolar patients, in comparison with schizophrenia.
Method:
Structured assessments of dysfunction, burden, appraisal, social support available, and coping styles were carried out in caregivers of 38 bipolar patients and 20 patients with schizophrenia (ICD – 10 diagnoses).
Results:
Caregivers used a wide variety of coping strategies, both problem and emotion‐focused. In bipolar disorder, demographic parameters, illness duration, levels of dysfunction, burden and social support, and appraisal by caregivers demonstrated significant associations with coping styles of caregivers. Problem‐focused coping strategies were more common in caregivers of bipolar patients and emotion‐focused strategies in caregivers of schizophrenic patients. These differences appeared to be linked to differences in caregiver‐burden and appraisal between the two groups.
Conclusions:
Appraisal by, and burden on caregivers play a major role in determining their style of coping. These factors largely accounted for the differences in coping observed between caregivers of patients of bipolar disorder and schizophrenia, in this study. Reducing burden on caregivers and enhancing their awareness of illness could lead to adoption of more adaptive coping styles by them.
Topiramate versus Bupropion SR when added to mood stabilizer therapy for the depressive phase of bipolar disorder: a preliminary single‐blind study
Authors: McIntyre Roger S , Mancini Deborah A , McCann Sonia , Srinivasan Janaki , Sagman Doron , Kennedy Sidney H 
Published: March 2003

Objective:
Antiepileptic drugs (AEDs) are commonly employed in the treatment of bipolar disorder. The efficacy and tolerability of topiramate, a novel anticonvulsant, and bupropion SR when added to mood stabilizer therapy were compared under single‐blind conditions (rater‐blinded) in patients meeting DSM‐IV criteria for bipolar I/II depression.
Methods:
A total of 36 out‐patients with Hamilton Depression Rating Scale (HDRS‐17) scores ≥16 were randomized to receive escalating doses of either topiramate (50–300 mg/day) or bupropion SR (100–400 mg/day) for 8 weeks. Data were analyzed on an intent‐to‐treat basis using the last observation carried forward method.
Results:
The percentage of patients meeting a priori response criteria (≥50% decrease from baseline in mean HDRS‐17 total score) was significant for both topiramate (56%) and bupropion SR (59%) [t(17)=2.542, p=0.04 and t(17)=2.661, p=0.03, respectively]. Baseline demographic and clinical parameters were comparable between the two treatment groups. The mean doses of study medication were 176 mg/day (SD=102 mg/day) for the topiramate‐treated group and 250 mg/day (SD=133 mg/day) for the bupropion SR‐treated group. A significant and comparable reduction in depressive symptoms was observed from baseline to endpoint following topiramate and bupropion SR treatment, according to a ≥ 50% reduction in the HDRS‐17. Total mean HDRS‐17 scores significantly decreased from baseline to endpoint in both groups (p=0.001), however, differences between the topiramate‐treated group and the bupropion SR‐treated group were not significant [t(36)=1.754, p=0.097]. Both topiramate and bupropion SR were generally well tolerated. Thirteen patients discontinued the study: 2 because of lack of efficacy, 1 due to withdrawal of consent and 10 following side‐effects (six in the topiramate and four in the bupropion SR‐treated group). There were no cases of affective switch in either arm. Weight loss was experienced by patients in both groups (mean weight loss at endpoint was 1.2 kg in bupropion SR and 5.8 kg in topiramate) [t(17)=2.325, p=0.061 and t(17)=2.481, p=0.043, respectively].
Conclusions:
These preliminary data suggest that adjunctive topiramate may reduce depressive symptom severity in acute bipolar depression. The antidepressant efficacy of this compound requires confirmation via double‐blind placebo controlled investigation.
Clinical indicators for the use of antidepressants in the treatment of bipolar I depression
Authors: Fagiolini A , Frank E , Cherry CR , Houck PR , Novick DM , Buysse DJ , Kupfer DJ 
Published: March 2003

Objectives:  Current guidelines provide little practical information on the clinical characteristics of bipolar I patients who are likely to benefit from the combination of a mood stabilizer and an antidepressant. Rather, guidelines simply state that an adjunctive antidepressant is recommended in cases of ‘severe’ depression. Our objective was to evaluate the clinical and demographic differences between patients who remitted on a mood stabilizer alone and patients who subsequently required an adjunctive antidepressant to achieve stabilization.Methods:  We retrospectively compared the pharmacological treatment strategies of 39 patients with bipolar I disorder who were in a current depressive episode. Patients who did not respond to mood stabilizer monotherapy were prescribed an adjunctive antidepressant. We evaluated the clinical differences at baseline and week 1, 2 and 3 of treatment between patients stabilizing on a mood stabilizer alone and patients that did not remit until they subsequently received an adjunctive antidepressant.Results:  Patients who required an adjunctive antidepressant had significantly higher total Hamilton Depression Rating (HRS‐D) scores at week 1, 2 and 3 of treatment, but not at baseline. Patients who remitted on mood stabilizer monotherapy were more likely to be married, achieved stabilization in less time, presented with higher Young Mania Rating Scale (YMRS) scores, and experienced the previous episode of depression more recently than patients who required an antidepressant.Conclusions:  Our findings suggest that rapid improvement after achieving a therapeutic dose of a mood stabilizer is clinically significant and represents a surrogate endpoint in the treatment of bipolar I depression. Larger, prospective, and controlled studies are needed to verify our results and to identify additional indicators for a mood stabilizer and antidepressant combination treatment strategy.
Frontal lobe differences in bipolar disorder as determined by proton MR spectroscopy
Authors: Cecil Kim M , DelBello Melissa P , Morey Rachel , Strakowski Stephen M 
Published: March 2003

Objectives: Proton magnetic resonance spectroscopy (MRS) provides insight into neurochemical processes. Imaging and postmortem studies have implicated abnormalities of structure and function within the frontal lobe. Patients with bipolar disorder having a manic or mixed episode were hypothesized to demonstrate metabolic abnormalities within the frontal lobe.Methods: Seventeen patients with bipolar disorder type I (ages 16–35 years, mean 22 ± 7.3 years) hospitalized for a manic (n = 9) or mixed (n = 8) episode and 21 healthy subjects (ages 16–35 years, mean 21.7 ± 5.2 years) were evaluated with proton MRS. The gray matter medially and white matter laterally within the frontal lobe were sampled. Metabolite concentrations were calculated for each voxel, corrected for cerebral spinal fluid (CSF) contributions to the voxel, and compared between study populations.Results: Patients demonstrated with multivariate analyses of variance (MANOVA) a significant overall difference in gray matter metabolite concentrations compared with healthy subjects. The largest effect sizes for group differences were found with reductions of N‐acetyl aspartate (NAA) and Choline (Cho) concentrations (f = 0.41 and 0.37, respectively). A significant group difference with MANOVA in white matter metabolite concentrations was also observed with the largest effect size at f = 0.44 for elevation of the composite amino acid (AA) concentration.Conclusions: A reduction of NAA within the gray matter of patients suggests neuronal dysfunction. Altered phospholipid metabolism suggestive of a trend toward decreased volume is implicated with a reduction of Cho concentrations. Within white matter, composite concentrations of AAs were elevated in patients indicating altered neurotransmission.
Hemoglobin and erythrocyte indices during normal pregnancy and postpartum in 206 women with and without iron supplementation
Authors: MILMAN NILS , BYG KELD‐ERIK , AGGER ANDERS OLE 
Published: March 2003

Background. The aim was to define reference values for hemoglobin, hematocrit and erythrocyte indices, i.e. erythrocyte count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), in normal pregnancy and after a normal delivery in non‐iron‐supplemented and iron supplemented women.Methods. Two hundred and six healthy Danish women included at 9–18 weeks of gestation were allocated to treatment with placebo tablets (n=107) or tablets containing 66 mg iron (n=99). Blood samples were obtained at inclusion, every fourth week during gestation, and 8 weeks postpartum.Results. All hematologic indices were significantly lower in placebo‐treated than in iron‐treated women. In placebo‐treated women, the 5th percentile for hemoglobin was 110 g/L in the 1st trimester; in the 2nd trimester it was 105 g/L in the first and the second, and 103 g/L in the last third; in the 3rd trimester, it was 102 g/L in the first, 100 g/L in the second, and 101 g/L in the last third; postpartum it was 113 g/L. In iron‐treated women, the 5th percentile for hemoglobin was 111 g/L in the 1st trimester; in the 2nd trimester it was 109 g/L in the first, 106 g/L in the second, and 103 g/L in the last third; in the 3rd trimester, it was 105 g/L in the first and second, and 110 g/L in the last third; postpartum it was 123 g/L.Conclusions. Hematologic reference values should be derived from iron replete women.We suggest that the lowest critical hemoglobin value in iron‐treated pregnant women should be 110 g/l (6.8 mmol/L) in the 1st trimester, and 105 g/L (6.5 mmol/L) in the 2nd and 3rd trimester.