bluuebunny/crossref_metadata_2025_split huggingface dataset:
Full-term, peri-urban South African infants under 6 months of age are at risk for early-onset anaemia
Authors: Sibeko LN , Dhansay MA , Charlton KE , Johns T , Van Stuijvenberg ME , Gray-Donald K 
Published: September 2004

AbstractObjective:There is a paucity of data on the micronutrient status of low-income, lactating South African women and their infants under 6 months of age. The aim of this study was to elucidate the level of anaemia and vitamin A deficiency (VAD) in peri-urban breast-feeding women and their young infants.Design:Cross-sectional study including anthropometric, biochemical and infant feeding data.Setting:Peri-urban settlement in Cape Town, South Africa.Subjects:Breast-feeding women (n= 113) and their infants (aged 1–6 months) attending a peri-urban clinic.Results:Mean (standard deviation (SD)) haemoglobin (Hb) of the lactating mothers was 12.4 (1.3) gdl−1, with 32% found to be anaemic (Hb < 12 g dl−1). Maternal serum retinol was 49.8 (SD 13.3) μg dl−1, with 4.5% VAD. Using breast milk, mean (SD) retinol concentration was found to be 70.6 (24.6) μg dl−1and 15.7 (8.3) μg/g milk fat, with 13% below the cut-off level of <8μg/g fat. There was no correlation found between breast milk retinol and infant serum retinol.Z-scores (SD) of height-for-age, weight-for-age and weight-for-height were –0.69 (0.81), 0.89 (1.01) and 1.78 (0.83), respectively. Mean (SD) infant Hb was 10.9 (1.1) g dl−1, with the prevalence of anaemia being 50%, 33% and 12% using Hb cut-offs below 11 g dl−1, 10.5 g dl−1and 9.5 g dl−1, respectively. Mean (SD) infant serum retinol was 26.9 (7.2) μg dl−1, with 10% being VAD. None of the infants was exclusively breast-fed, 22% were predominantly breast-fed and 787percnt; received complementary (mixed) breast-feeding. Thirty-two per cent of infants received weaning foods at an exceptionally young age (≤1 month old).Conclusion:A high rate of anaemia is present in lactating women residing in resource-poor settings. Moreover, their seemingly healthy infants under 6 months of age are at an elevated risk of developing early-onset anaemia and at lower risk of VAD.
An efficient Monte Carlo approach to assessing statistical significance in genomic studies
Authors: Lin D. Y. 
Published: September 2004

AbstractMotivation: Multiple hypothesis testing is a common problem in genome research, particularly in microarray experiments and genomewide association studies. Failure to account for the effects of multiple comparisons would result in an abundance of false positive results. The Bonferroni correction and Holm's step-down procedure are overly conservative, whereas the permutation test is time-consuming and is restricted to simple problems.Results: We developed an efficient Monte Carlo approach to approximating the joint distribution of the test statistics along the genome. We then used the Monte Carlo distribution to evaluate the commonly used criteria for error control, such as familywise error rates and positive false discovery rates. This approach is applicable to any data structures and test statistics. Applications to simulated and real data demonstrate that the proposed approach provides accurate error control, and can be substantially more powerful than the Bonferroni and Holm methods, especially when the test statistics are highly correlated.Contact: lin@bios.unc.edu
Worsening of Seizures by Oxcarbazepine in Juvenile Idiopathic Generalized Epilepsies
Authors: Gelisse Philippe , Genton Pierre , Kuate Callixte , Pesenti Aurélie , Baldy‐Moulinier Michel , Crespel Arielle 
Published: September 2004

Summary:  Purpose: Several studies have shown that carbamazepine (CBZ) may aggravate idiopathic generalized epilepsy (IGE). Oxcarbazepine (OXC) is a new drug chemically related to CBZ. We report six cases of juvenile IGE with a clear aggravation by OXC. Methods: We retrospectively studied all patients with IGE first referred to our epilepsy department between January 2001 and June 2003 and treated with OXC. Results: During this period, six patients were identified. All had an aggravation of their epilepsy in both clinical and EEG activities. OXC had been used because of an incorrect diagnosis of focal epilepsy or generalized tonic–clonic seizures (GTCSs) of undetermined origin (no syndromic classification of the epilepsy). Before OXC, only one patient had experienced a worsening of seizures with an inadequate drug (CBZ). Four had juvenile myoclonic epilepsy, one had juvenile absence epilepsy, and one had IGE that could not be classified into a precise syndrome. OXC (dosage range, 300–1,200 mg/day) was used in monotherapy in all of them except for one patient. Aggravation consisted of a clear aggravation of myoclonic jerks (five cases) or de novo myoclonic jerks (one case). Three patients had exacerbation of absence seizures. One patient had worsened dramatically and had absence status, and one had de novo absences after OXC treatment. The effects of OXC on GTCSs were less dramatic, with no worsening in frequency in three and a slight increase in three. Conclusions: OXC can be added to the list of antiepileptic drugs that can exacerbate myoclonic and absence seizures in IGE.
fMRI of Generalized Absence Status Epilepticus in Conscious Marmoset Monkeys Reveals Corticothalamic Activation
Authors: Tenney Jeffrey R. , Marshall Paul C. , King Jean A. , Ferris Craig F. 
Published: September 2004

Summary:  Purpose: A nonhuman primate model of generalized absence status epilepticus was developed for use in functional magnetic resonance imaging (fMRI) experiments to elucidate the brain mechanisms underlying this disorder. Methods: Adult male marmoset monkeys (Callithrix jacchus) were treated with γ‐butyrolactone (GBL) to induce prolonged absence seizures, and the resulting spike–wave discharges (SWDs) were analyzed to determine the similarity to the 3‐Hz SWDs that characterize the disorder. In addition, blood‐oxygenation‐level–dependent (BOLD) fMRI was measured at 4.7 Tesla after absence seizure induction with GBL. Results: Electroencephalographic recordings during imaging showed 3‐Hz SWDs typical of human absence seizures. This synchronized EEG pattern started within 15 to 20 min of drug administration and persisted for >60 min. In addition, pretreatment with the antiepileptic drug, ethosuximide (ESM), blocked the behavioral and EEG changes caused by GBL. Changes in BOLD signal intensity in the thalamus and sensorimotor cortex correlated with the onset of 3‐Hz SWDs. The change in BOLD signal intensity was bilateral but heterogeneous, affecting some brain areas more than others. No significant negative BOLD changes were seen. Conclusions: The BOLD fMRI data obtained in this marmoset monkey model of absence status epilepticus shows activation within the thalamus and cortex.
Dynamic Cortical Activity during Spasms in Three Patients with West Syndrome: A Multichannel Near‐infrared Spectroscopic Topography Study
Authors: Munakata Mitsutoshi , Haginoya Kazuhiro , Ishitobi Mamiko , Sakamoto Osamu , Sato Ikuko , Kitamura Taro , Hirose Mieko , Yokoyama Hiroyuki , Iinuma Kazuie 
Published: September 2004

Summary:  Purpose: To investigate spatial and temporal cortical activity during clusters of naturally occurring epileptic spasms in patients with West syndrome (WS) by using multichannel near‐infrared spectroscopy (mNIRS). Methods: Conventional magnetic resonance imaging (MRI) and interictal and ictal single‐photon emission computed tomography (SPECT) were carried out in three patients with WS. Thereafter, cortical hemodynamics during naturally occurring epileptic spasms were measured by mNIRS with simultaneous video/electroencephalographic (EEG) monitoring. Results: Ictal SPECT revealed multiple hyperperfused areas within the cortex. With the use of mNIRS, an increase in regional cerebral blood volume (CBV) was observed in these areas, which is representative of cortical activation. The increase in CBV was accompanied by an increase in the concentrations of both oxy‐ and deoxyhemoglobin. The following heterogeneous regional changes in CBV during ictus were observed: (a) transient increases that were synchronized with spasms; (b) a gradual increase during an ictal event that fluctuated in synchrony with spasms; and (c) a combination of transient and gradual increases. An increase in regional CBV occurred in multiple areas that were activated either simultaneously or sequentially during an ictal event. Topographic changes in CBV were closely correlated with the phenotype of the spasm. Conclusions: During ictal events, multiple cortical areas were activated simultaneously or sequentially. The pattern of cortical activation closely affected the phenotype of the spasm, which suggested that the cortex was involved in the generation of spasms.
Shortness of Breath and Abdominal Pain Within Minutes of Starting Hemodialysis
Authors: Rodby Roger A. , Bellucci Allessandro 
Published: September 2004

ABSTRACTA 45‐year‐old woman on hemodialysis without significant problems for 6 years developed acute onset of anxiety, shortness of breath, and abdominal pain within minutes of initiating her hemodialysis treatment. Her blood pressure was stable throughout the episode. The treatment was discontinued and she was admitted to the hospital. Routine blood chemistries were unremarkable except for mild eosinophilia (5%). An ethylene oxide reaction was suspected. She was dialyzed the following day after rinsing the dialyzer with 2 L of saline. A similar reaction occurred. The following day she was dialyzed on an ethylene oxide‐free dialyzer and the hemodialysis treatment was uneventful.
Hemodialysis‐Induced Hypotension: Impact of Technologic Advances
Authors: Donauer Johannes 
Published: September 2004

ABSTRACTHemodialysis‐induced hypotension is one of the most serious complications in renal replacement therapy. The main cause of intradialytic hypotension is hypovolemia due to an imbalance between the amount of fluid removed and the refilling capacity of the intravascular compartment. Hypotension occurs when compensatory mechanisms for hypovolemia are overwhelmed by excessive fluid removal. As long as renal replacement therapy is limited to only a few hours per week, intradialytic hypotension will continue to be a relevant problem. Research has mainly focused on enlarging the compensatory capacity for ultrafiltration‐induced hypovolemia. This article critically discusses the technical approaches that have been introduced into therapy in recent years with the promise of reducing dialysis‐induced hypotensive episodes.
Inadequate Treatment of Cardiovascular Disease and Cardiovascular Disease Risk Factors in Dialysis Patients: A Commentary
Authors: Culleton Bruce F. , Hemmelgarn Brenda 
Published: September 2004

ABSTRACTCardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with end‐stage renal disease (ESRD). Despite its significant impact on health outcomes, which would imply a need for aggressive intervention, both CVD and CVD risk factors are inadequately treated in this patient population. The reasons for this inadequate treatment are unclear. This article reviews the contribution of traditional risk factors to the burden of CVD in ESRD patients, outlines the evidence regarding undertreatment of CVD and traditional CVD risk factors, and identifies potential factors that may be responsible for inadequate cardiovascular care in ESRD patients.
Phylogeny ofMaculineablues (Lepidoptera: Lycaenidae) based on morphological and ecological characters: evolution of parasitic myrmecophily
Authors: Pech Pavel , Fric Zdeněk , Konvička Martin , Zrzavý Jan 
Published: September 2004

AbstractA phylogeny of blue butterflies of the genusMaculineaand related genera (Lycaenidae) is proposed, based on 91 morphological and ecological characters. The resulting tree shows that: (1)Phengarisis a derived group nested withinMaculinea; (2) theMaculinea‐Phengarisclade is probably nested withinGlaucopsyche; (3) there are three well supported groups within theMaculinea‐Phengarisclade: (alcongroup ((teleiusgroup) (arion‐Phengarisgroup))). Some species (M. alcon,M. arionides) appear to be non‐monophyletic and require reclassification. The two alternative strategies of parasitic myrmecophily in theMaculinea‐Phengarisclade, viz., “predatory” and “cuckoo”, seem to be derived characters of thealcongroup, and of theteleiusandarion‐Phengarisgroups, respectively. The common ancestor ofMaculineaused dorsal nectary organ secretions for ant attraction, while this trait was reduced in the ancestor of thealcongroup and inM. nausithous(of theteleiusgroup). The three recentMaculinealineages utilize taxonomically diverse host plants, the asterid families Gentianaceae (alconandarion‐Phengarisgroups), Lamiaceae (arion‐Phengarisgroup), Campanulaceae (arion‐Phengarisgroup), and the rosid family Rosaceae (teleiusgroup).
Participation of Na/Ca‐exchanger and sarcoplasmic reticulum in the high [K]o‐protection against ischaemia‐reperfusion dysfunction in rat hearts
Authors: Consolini A. E. , Quiroga P. , Yuln G. , Volonté M. G. 
Published: September 2004

AbstractAim:  Na/Ca‐exchanger (NCX) and sarcoplasmic reticulum (SR) roles during the protection by a cardioplegic solution (25 mm K and 0.5 mm Ca, CPG) against ischaemia‐reperfusion was studied.Methods:  Contractile performance (CP) and high energy phosphates contents (HEP) were evaluated in isolated ventricles from rats. They were pre‐treated with Krebs (C) or CPG and submitted to no‐flow ischaemia and reperfusion (I–R). KB‐R7943 5 μm (inhibitor of NCX in reverse mode), 8 mm caffeine and ionic changes were used pre‐ischaemically to evaluate each pathway role.Results:  During R, CP recovered to 77 ± 8% of basal in CPG‐hearts vs. 55 ± 8% (P < 0.05) in C‐ones. CPG avoided the increases in end diastolic pressure (LVEDP) and in PCr/ATP ratio during I–R. Low [Na]o (78 mm) under both, CPG‐2 mm Ca and C, increased further the LVEDP during I–R. LVEDP was also transiently increased by caffeine‐CPG, but not modified by KB‐R7943. The recovery of CP during reperfusion of CPG‐hearts was decreased either, by caffeine (to ∼75%), low [Na]o‐2 mm Ca‐CPG (to ∼40%) and KB‐R7943 (to ∼16%).Conclusions:  CPG protected hearts from ischaemic contracture by attenuating the fall in ATP and removing diastolic Ca by means of NCX in forward mode. Moreover, CPG induces higher CP recovery during reperfusion by participation of SR and NCX in reverse mode. This work remarks the use of CPG based on the functional role of these Ca handling‐mechanisms in a pathophysiological condition as ischaemia‐reperfusion.
Review article: oesophago‐gastric adenocarcinoma — an epidemiological perspective
Authors: Forman D. 
Published: September 2004

SummaryThis article reviews the epidemiology of cancers arising in the distal oesophagus and proximal stomach, sometimes collectively termed oesophago‐gastric junctional adenocarcinomas. The several complexities involved in defining this group of cancers are considered and the reported increasing trends in incidence are reviewed, together with the descriptive epidemiology. The rates of these cancers are increasing, but not as dramatically as sometimes reported. They are also more common in white males than in other ethnic groups or in females. Although several aetiological risk factors have been reported, the two most consistent are an elevated body mass index (obesity) and a history of gastro‐oesophageal reflux disease. Reflux is also associated with Barrett's oesophagus, an important and increasingly diagnosed premalignant lesion. The rate of progression from Barrett's oesophagus to cancer is controversial, as is the cost–benefit balance of routine endoscopic surveillance of such patients. The development of molecular biomarkers to identify Barrett's oesophagus patients with high rates of malignant transformation would represent a significant advance.
Review article: gastro‐oesophageal reflux disease — how wide is its span?
Authors: Talley N. J. 
Published: September 2004

SummarySymptoms of gastro‐oesophageal reflux disease are highly prevalent in Western countries; however, it is less certain how many individuals with heartburn have clinically relevant disease. Although the prevalence of gastro‐oesophageal reflux disease in Asia is substantially lower, the incidence may be increasing. How much of this increase is explained by the increasing recognition of heartburn in clinical practice, dietary changes and increasing obesity, or the eradication of Helicobacter pylori, remains unclear.There has been speculation that endoscopy‐negative reflux disease represents a separate entity from reflux oesophagitis (as defined by the Los Angeles classification), but the evidence that might support this proposal is unconvincing.Patients with chronic reflux symptoms have a higher risk of Barrett's oesophagus, and the increased risk of developing oesophageal adenocarcinoma in individuals with a long history of heartburn is also well documented, but whether this always occurs via Barrett's oesophagus is debatable. Moreover, treatment with standard‐dose antisecretory therapies and anti‐reflux surgery seems unlikely, based on current evidence, to reduce the cancer risk in patients with Barrett's oesophagus. Gastro‐oesophageal reflux disease has also been implicated in an increasing array of other conditions, but arguably in these settings it is often over‐diagnosed.
Review article: is stringent control of gastric pH useful and practical in GERD?
Authors: Kahrilas P. J. 
Published: September 2004

SummaryAs the relative efficacy of therapeutic agents in the treatment of gastro‐oesophageal reflux disease is related to how consistently and completely gastric acid secretion is suppressed, intragastric pH monitoring is a useful tool in stratifying therapies. If there is no acid in the stomach, there can be none to reflux into the oesophagus. Comparative crossover studies have shown consistently that once‐daily esomeprazole (40 mg) provides more effective and longer lasting intragastric acid control than any other proton pump inhibitor currently available in healthy subjects and patients with gastro‐oesophageal reflux disease. However, esomeprazole maintained intragastric pH > 4 for ≥ 16 h in only about 55% of individuals tested. Thus, if more complete acid suppression is desirable, twice‐daily proton pump inhibitor therapy may be advantageous.One such scenario is in patients with Barrett's metaplasia. Data from the ProGERD study suggest that, for each Los Angeles grade of oesophagitis, the healing rate for patients with Barrett's metaplasia is 10–30% less than that for non‐Barrett's patients, being as low as 53% in patients with Los Angeles grade D oesophagitis. Also relevant to the Barrett's metaplasia population are studies on the oesophageal mucosa, which show that effective acid suppression favours differentiation and decreases epithelial cell proliferation. Both considerations argue for more intensive gastric acid inhibition than can be achieved with once‐daily therapy, leading to experimentation with twice‐daily proton pump inhibitor regimens.A randomized, double‐blind, three‐way crossover study compared esomeprazole 40 mg once daily with esomeprazole 20 mg and 40 mg twice daily and found that both twice‐daily regimens were superior, maintaining intragastric pH > 4 for 73%[95% confidence interval (CI), 67–79%] and 80% (95% CI, 75–86%) of the day, respectively, compared with 59% (95% CI, 54–65%) of the day with esomeprazole 40 mg once daily, arguing that a twice‐daily regimen may be the preferred strategy for patients with Barrett's metaplasia.
Clinical strategies — interactive case discussions
Authors: Dent J. , Talley N. J. 
Published: September 2004

SummaryInteractive case discussions held during the symposium illustrate the practical challenges and dilemmas faced in the management of Barrett's oesophagus. Opinions of the faculty and audience varied widely on how proton pump inhibitor therapy should be used, especially in patients with short‐segment Barrett's oesophagus. The therapeutic goal that received most support was to achieve sufficient acid control to keep the patient symptom free and heal any oesophagitis. At the same time, the patient should be reassured of the low risk associated with the endoscopic findings.When long‐segment Barrett's oesophagus is detected, it should be assessed in detail, with targeted biopsy of any irregular‐surfaced metaplastic mucosa and four quadrant biopsies every 2 cm, to diagnose intestinal metaplasia and to screen for dysplasia or cancer. Repeat endoscopy and biopsy may be appropriate to achieve a sensitive initial assessment because of potential sampling error. Proton pump inhibitor therapy, often twice daily, was considered a requirement for most cases of long‐segment Barrett's oesophagus. There was disagreement over the role of surveillance, although proponents viewed it as worthwhile even in patients at low risk for the development of adenocarcinoma, mainly for medico‐legal reasons. Endoscopic mucosal resection was seen to be appropriate in carefully selected patients with high‐grade dysplasia, depending on factors such as age and comorbidity, the extent of high‐grade dysplasia, findings on endoscopic ultrasound and the length of Barrett's oesophagus.
Review article: management of oesophageal adenocarcinoma — control of acid, bile and inflammation in intervention strategies for Barrett's oesophagus
Authors: Jankowski J. A. , Anderson M. 
Published: September 2004

SummaryOesophagitis is associated with Barrett's metaplasia in about 10% of individuals. The UK has one of the highest world‐wide prevalences of Barrett's metaplasia, with 1% of adults having the condition, resulting in an incidence of oesophageal adenocarcinoma two to three times that seen in either Europe or North America. In addition, the conversion rate to cancer in individuals with Barrett's metaplasia in UK surveillance programmes is twice that observed in the USA (0.96% per year vs. 0.4% per year), lending further support to the notion that the UK is a high‐risk region. The evidence base on what can be achieved with medical therapy to reduce the risk of dysplasia or the development of adenocarcinoma needs to be strengthened with data from randomized controlled trials, as existing data have many limitations. Patients with Barrett's metaplasia respond variably to proton pump inhibitor therapy (even high‐dose therapy ‘normalizes’ acid reflux in only 85% of cases), and symptom control is a poor determinant of the adequacy of suppression of acid reflux. Gastro‐oesophageal reflux is implicated in the pathogenesis of Barrett's metaplasia, and ex vivo and in vitro evidence suggests that its attenuation reverses proliferation and biological variables over days, and perhaps the metaplastic histology to a degree over years. The effect of proton pump inhibitor therapy on cancer risk in the long term is essentially unknown. Acid suppressant therapy or anti‐reflux surgery on its own does not result in the complete regression of the metaplastic epithelium. Bile acids, present especially frequently in the refluxate of Barrett's oesophagus patients, are also likely to influence the development and persistence of metaplasia. Barrett's metaplasia is replaced by a squamous epithelium when acid reflux is well controlled and the epithelium is physically destroyed by ablation with argon plasma coagulation or photodynamic therapy. These modalities are invasive and are not likely to be useful in the routine management of patients with Barrett's oesophagus without dysplasia or cancer. Why metaplasia does not fully regress once external initiating stimuli are removed is a mystery. There is some evidence to implicate a variety of molecules, including cyclo‐oxygenase‐2, tumour necrosis factor‐α, β‐catenin nuclear translocation and mitogen‐activated protein kinase signalling, because they are expressed preferentially in metaplastic rather than normal or inflamed squamous oesophageal mucosa. The use of non‐steroidal anti‐inflammatory drugs, including aspirin, is associated with a decreased incidence of oesophageal adenocarcinoma. There is therefore a great need for randomized controlled trials to assess the outcomes of such chemopreventive therapy in patients with Barrett's metaplasia.