bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of damage in juvenile‐onset systemic lupus erythematosus: A multicenter cohort study
Authors: Ravelli Angelo , Duarte‐Salazar Carolina , Buratti Silvia , Reiff Andreas , Bernstein Bram , Maldonado‐Velazquez Maria Rocio , Beristain‐Manterola Rosalia , Maeno Nobuaki , Takei Syuji , Gerloni Valeria , Spencer Charles H. , Pratsidou‐Gertsi Polyxeni , Ruperto Nicolino , Pistorio Angela , Martini Alberto 
Published: August 2003

AbstractObjectiveTo investigate the prevalence of cumulative organ damage in patients with juvenile‐onset systemic lupus erythematosus (SLE) and its association with demographic and clinical variables, medication use, and quality of life.MethodsThe occurrence of organ system damage, as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), was determined for 387 patients consecutively enrolled in pediatric rheumatology centers from Europe, the US, Mexico, and Japan. Risk factors for damage included demographic variables; clinical manifestations at diagnosis; previous corticosteroid, immunosuppressive, and antimalarial therapies; disease activity; and quality of life.ResultsOverall, 195 (50.5%) patients had damage within a mean of 5.7 years after disease onset. Renal (21.8%) and neuropsychiatric (15.8%) system involvement were observed most frequently, followed by musculoskeletal (11.7%), ocular (10.9%) and skin (9.6%) system involvement, with a mean SDI score of 1.1. In multivariate models, the occurrence of neuropsychiatric manifestations at diagnosis, a longer disease duration, and a greater number of intravenous cyclophosphamide pulses showed the strongest association with the presence of damage.ConclusionWe found evidence of cumulative organ damage, as measured by the SDI, in half of the patients with juvenile‐onset SLE. Damage was significantly more likely in patients who had experienced neuropsychiatric manifestations at diagnosis, had a longer disease duration, and had received more intravenous pulses of cyclophosphamide.
The use of rheumatoid arthritis health‐related quality of life patient questionnaires in clinical practice: Lessons learned
Authors: Russak Simcha M. , Croft Joseph D. , Furst Daniell E. , Hohlbauch Andriana , Liang Matthew H. , Moreland Larry , Ofman Joshua J. , Paulus Harold , Simon Lee S. , Weisman Michael , Tugwell Peter 
Published: August 2003

AbstractObjectiveThe utilization of health‐related quality of life (HRQOL) patient questionnaires by clinical rheumatologists is limited. Yet, considerable literature exists defining the value of such data. In an effort to understand this apparent paradox, we performed a literature review and conducted a survey to describe what has been learned over the past 2 decades concerning the use of these measures in clinical care and explore the reasons for their underutilization.MethodsA panel of rheumatologists with extensive clinical experience was convened to review the relevant literature pertaining to the use of HRQOL patient instruments in clinical practice. Additionally, a survey of all American College of Rheumatology practicing clinicians was conducted to assess the use of and beliefs about these measures.ResultsThe literature provided evidence to support the use of HRQOL patient measures in clinical practice. Forty‐seven percent of the responding rheumatologists stated that none of their patients complete HRQOL patient questionnaires. The majority of respondents (63%) reported that such information is “somewhat valuable.” The most frequently reported reason for the underutilization was that such instruments “require too much staff time.”ConclusionsThe literature supports the potential value of HRQOL patient questionnaires in clinical practice. Few rheumatologists routinely gather such information as part of patient care. Reasons for this discrepancy between utility and use are given along with recommendations intended to help increase their utilization in clinical care.
The combination of insulin‐like growth factor 1 and osteogenic protein 1 promotes increased survival of and matrix synthesis by normal and osteoarthritic human articular chondrocytes
Authors: Loeser Richard F. , Pacione Carol A. , Chubinskaya Susan 
Published: August 2003

AbstractObjectiveAlthough growth factor therapy could be an attractive method for stimulating the repair of damaged cartilage matrix, there is evidence that with aging and/or with the development of osteoarthritis (OA), articular chondrocytes may become unresponsive to growth factor stimulation. The aim of the current study was to compare the ability of insulin‐like growth factor+(IGF‐1) and osteogenic protein+(OP‐1), alone and in combination, to stimulate human normal and OA chondrocytes in culture.MethodsChondrocytes isolated by enzymatic digestion of cartilage obtained from subjects undergoing knee replacement for OA (n = 6) or from normal ankle joints of tissue donors (n = 7) were cultured in alginate beads in serum‐free medium and treated for 21 days with 100 ng/ml IGF‐1, 100 ng/ml OP‐1, or both. Controls were treated with vehicle alone. The cultures were evaluated for cell survival, cell number by DNA analysis, matrix production by particle exclusion assay, and level of accumulated proteoglycan by dimethylmethylene blue assay.ResultsAfter 21 days in serum‐free alginate culture, survival of cells from OA cartilage was 65 ± 2% (mean ± SEM), while survival of cells from normal cartilage was significantly greater (82 ± 3%). Treatment with either IGF‐1 or OP‐1 alone minimally improved survival, while the combination IGF +OP significantly improved survival, to 87 ± 2% for OA cells and 95±1% for normal cells. Cell proliferation was noted only in the IGF+OP group; this was significant for both normal and OA cells (∼2‐fold increase in DNA levels). Matrix production, assessed by particle exclusion and by proteoglycan accumulation, was greatest in the cells treated with IGF + OP in both normal and OA cultures. When proteoglycan levels were corrected for cell numbers (mg proteoglycan/ng DNA), a significant increase over control was noted with OP‐1 alone and IGF IGF‐1 alone, in both normal and OA cultures, with the greatest levels in the combination group (3‐fold increase over control).ConclusionOP‐1 was more potent than IGF‐1 in stimulating proteoglycan production in both normal and OA cells. However, the best results were obtained with the combination, suggesting that combined therapy with IGF‐1 and OP‐1 may be an effective strategy for treating OA cartilage damage.
Arthritis self‐management education programs: A meta‐analysis of the effect on pain and disability
Authors: Warsi Asra , LaValley Michael P. , Wang Philip S. , Avorn Jerry , Solomon Daniel H. 
Published: August 2003

AbstractObjectiveSome reports suggest that education programs help arthritis patients better manage their symptoms and improve function. This review of the published literature was undertaken to assess the effect of such programs on pain and disability.MethodsMedline and HealthSTAR were searched for the period 1964–1998. The references of each article were then hand‐searched for further publications. Studies were included in the meta‐analysis if the intervention contained a self‐management education component, a concurrent control group was included, and pain and/or disability were assessed as end points. Two authors reviewed each study. The methodologic attributes and efficacy of the interventions were assessed using a standardized abstraction tool, and the magnitude of the results was converted to a common measure, the effect size. Summary effect sizes were calculated separately for pain and disability.ResultsThe search strategy yielded 35 studies, of which 17 met inclusion criteria. The mean age of study participants was 61 years, and 69% were female. On average, 19% of patients did not complete followup (range 0–53%). The summary effect size was 0.12 for pain (95% confidence interval [95% CI] 0.00, 0.24) and 0.07 for disability (95% CI 0.00, 0.15). Funnel plots indicated no significant evidence of bias toward the publication of studies with findings that showed reductions in pain or disability.ConclusionThe summary effect sizes suggest that arthritis self‐management education programs result in small reductions in pain and disability.
Bone mineral density in juvenile dermatomyositis: Assessment using dual x‐ray absorptiometry
Authors: Stewart W. A. , Acott P. D. , Salisbury S. R. , Lang B. A. 
Published: August 2003

AbstractObjectiveTo determine the bone mineral density (BMD) status of our juvenile dermatomyositis (DM) population and to compare the frequency of osteopenia in patients with active disease requiring corticosteroids with that in patients with inactive disease who are not receiving corticosteroids.MethodsMedical charts of all children diagnosed as having juvenile DM at our institution between 1989 and 1999 were reviewed for demographic and clinical data, including disease activity and duration of corticosteroid therapy. BMD measurements of the lumbar spine (L1–L4) were performed using dual x‐ray absorptiometry (DXA). Z scores were calculated from the BMD data for comparison with published normative data.ResultsA total of 15 patients were assessed: 10 with active disease, and 5 with inactive disease who had not taken corticosteroids for an average of 6.0 years (range 3.4–8.1 years). Baseline BMD measurements demonstrated osteopenia or frank osteoporosis in the majority of patients, including 6 of the 10 patients with active disease and 4 of the 5 patients whose disease was in remission. Fourteen patients had serial BMD measurements. Persistent or worsening osteopenia was documented in all patients who had ongoing active disease, except for 3 patients who had been treated with bisphosphonates because of vertebral compression fractures.ConclusionOsteopenia is common in patients with juvenile DM, and it usually worsens with ongoing disease. It can persist for many years after the disease enters remission. Bisphosphonates appeared to beneficially affect bone mineralization in our patients. Treatment to prevent the long‐term complications of osteoporosis in patients with juvenile DM should be considered and requires further study.
Interstitial laser coagulation with temporary hepatic artery occlusion for patients with cirrhosis and irresectable hepatoma
Authors: Verhoef C , Kuiper J W , Heisterkamp J , de Man R A , Pattynama P M T , IJzermans J N M 
Published: August 2003

Abstract

Background
The aim was to determine the degree of local control of hepatocellular carcinoma (HCC) in patients with cirrhotic liver disease when treated with ultrasonographically guided interstitial laser coagulation (ILC) with temporary hepatic artery occlusion.

Methods
Sixteen patients with 24 HCC tumours were treated. Follow-up was by computed tomography or magnetic resonance imaging every 3 months.

Results
Nineteen of 24 tumours showed complete necrosis immediately after treatment, and there was no tumour recurrence during follow-up (mean 14 months, median 12 months). No effect on liver function was observed after 1 week and there was no death. In 13 of the 16 patients, new HCC foci developed at other sites.

Conclusion
Percutaneous ILC combined with temporary hepatic artery occlusion during a single session is an effective local treatment for HCC nodules smaller than 5 cm. However, new HCC lesions develop in the majority of patients, which underscores the need for adjuvant therapy or repeated treatment in these patients.
Laparoscopic surgery for recurrent Crohn's disease
Authors: Hasegawa H , Watanabe M , Nishibori H , Okabayashi K , Hibi T , Kitajima M 
Published: August 2003

Abstract

Background
The aim of this study was to assess the feasibility of laparoscopic surgery for recurrent Crohn's disease, and the role of repeated laparoscopy in reoperation.

Methods
Between January 1994 and May 2002, 61 laparoscopic operations were attempted in 52 patients with ileal or ileocolonic Crohn's disease. Of these, 16 procedures were performed for recurrence at the anastomotic site (recurrent group). The remaining 45 operations were performed as primary procedures (control group). The median follow-up was 48 (range 3–90) months.

Results
The median time to reoperation was 46 months. The incidence of enteric fistula and the conversion rate did not differ significantly between the two groups. Although the operating time was significantly longer in the recurrent group, there were no differences in the rate of postoperative complications (three in the recurrent group and six in the control group) and hospital stay (both median 8 days).

Conclusion
Laparoscopic surgery for recurrent Crohn's disease is feasible in selected patients without an increase in conversion rate or postoperative complications.
Protection against experimental small intestinal ischaemia–reperfusion injury with oxygenated perfluorochemical
Authors: Fujino Y , Suzuki Y , Kakinoki K , Tanioka Y , Ku Y , Kuroda Y 
Published: August 2003

Abstract

Background
Intestinal ischaemia–reperfusion (IR) injury frequently occurs in abdominal surgery. Perfluorochemical (PFC) can be used to oxygenate intestinal organs directly and allows adenosine 5′-triphosphate (ATP) production within the submerged organs during ischaemia. This study was designed to evaluate the protective effect of PFC in IR injury, focusing on cytokine production in rat small intestine.

Methods
The superior mesenteric artery was occluded in rats for 60 min and the small bowel placed in an intestinal bag containing either normal saline (group 1), oxygenated saline (group 2) or oxygenated PFC (group 3). The arterial clip was subsequently removed, allowing reperfusion. The number of rats that survived for 7 days, tissue ATP levels, biochemical variables, tissue lipid peroxidation (LPO), bacterial cultures and histological changes were examined after reperfusion.

Results
The use of oxygenated PFC in group 3 improved survival compared with the other groups. Serum creatine phosphokinase and lactate dehydrogenase levels in groups 1 and 2 reflected small intestinal damage, and plasma levels of tumour necrosis factor α and interleukin 6 were raised. In contrast, oxygenated PFC decreased these levels, and reduced LPO, bacterial translocation and augmented apoptosis of the small intestine after reperfusion.

Conclusion
An intestinal bag containing oxygenated PFC showed protective effects during bowel ischaemia.
Colonic anastomotic strength and matrix metalloproteinase activity in an experimental model of bacterial peritonitis
Authors: de Hingh I H J T , de Man B M , Lomme R M L M , van Goor H , Hendriks T 
Published: August 2003

AbstractBackgroundClinical studies report conflicting results on the safety of primary intestinal anastomoses in the presence of peritonitis, and comprehensive experimental data are lacking. The present study investigated whether the strength of experimental colonic anastomoses is affected if surgery is performed in the presence of pre-existing bacterial peritonitis.MethodsColonic anastomoses were constructed in Wistar rats 24 h after caecal ligation and puncture or a sham procedure. Anastomotic strength was assessed by measuring breaking strength and bursting pressure during the first 5 days after operation. Anastomotic hydroxyproline levels were measured and matrix metalloproteinase (MMP) activity was analysed by quantitative gelatin zymography.ResultsAnastomotic strength was lowered in the presence of bacterial peritonitis but in a minor and transient way. The breaking strength was lower only immediately after construction of the anastomosis (− 15 per cent, P = 0·011) and the bursting pressure only on the third postoperative day (− 33 per cent, P = 0·038); no anastomotic dehiscence was observed. At 3 days after operation increased levels of MMP activity were observed but anastomotic hydroxyproline content was not affected by bacterial peritonitis.ConclusionThe influence of bacterial peritonitis on the development of anastomotic strength is limited. This experimental finding lends support to recent clinical studies that have demonstrated the feasibility of constructing a primary anastomosis under these conditions.
Detection of disseminated tumour cells in blood and bone marrow samples of patients undergoing hepatic resection for metastasis of colorectal cancer
Authors: Vlems F A , Diepstra J H S , Punt C J A , Ligtenberg M J L , Cornelissen I M H A , van Krieken J H J M , Wobbes T , van Muijen G N P , Ruers T J M 
Published: August 2003

Abstract

Background
In 50–60 per cent of patients who undergo hepatic resection for metastasis of colorectal cancer the first site of tumour recurrence is extrahepatic, indicating the presence of more extensive disease at the time of resection. The aim of this study was to evaluate whether the presence of disseminated tumour cells in blood and bone marrow could predict extrahepatic tumour recurrence.

Methods
Cytokeratin 20 (CK20) reverse transcriptase–polymerase chain reaction was used to study the presence of tumour cells in preoperative peripheral blood and bone marrow samples from 41 patients with liver metastasis scheduled for surgical resection.

Results
CK20 expression was detected in six of 41 peripheral blood samples and in eight of 32 bone marrow samples. There was no correlation between CK20-positive samples and subsequent extrahepatic recurrence. Positive blood samples did, however, correlate with high serum carcinoembryonic antigen level and large tumour volume. None of the 14 patients previously treated with chemotherapy had CK20-positive samples, whereas six of 27 blood and eight of 20 bone marrow samples were positive in the chemotherapy-naive group.

Conclusion
Although the number of patients in this study is limited, the presence of disseminated tumour cells did not predict subsequent extrahepatic recurrence. The results strongly suggest that the presence of circulating tumour cells in peripheral blood may reflect transient shedding of tumour cells related to large tumour volume.
Randomized clinical trial of three-layer paste and four-layer bandages for venous leg ulcers
Authors: Meyer F J , McGuinness C L , Lagattolla N R F , Eastham D , Burnand K G 
Published: August 2003

AbstractBackgroundBoth four-layer and three-layer paste bandages are widely used in the treatment of venous leg ulcers. The aim of this study was to compare the efficacy of these two bandaging regimens.MethodsThe study was a prospective, randomized, open comparison of a consecutive cohort of 133 patients with venous ulcers. Participants were stratified by ulcer size into one of three groups and were randomized within each group to receive either three-layer paste or four-layer bandages. All patients were followed for 1 year. The time taken to complete ulcer healing was the primary endpoint. The time taken to apply the bandages, comfort, tolerability and cost were also assessed. Analysis was performed on the basis of intention to treat.ResultsUlcers healed completely in 51 (80 per cent) of 64 patients treated with three-layer paste bandages compared with 45 (65 per cent) of 69 patients treated with the four-layer regimen (P = 0·031). This difference developed only after 20 weeks of treatment. The median times to complete healing were 12 weeks for three-layer and 16 weeks for four-layer treatment (P = 0·040). Results of venous function tests, including half-refilling times, were similar in the two groups.ConclusionThree-layer paste bandages were significantly more effective at healing venous ulcers than the four-layer regimen in this study.
Randomized clinical trial comparing consultant-led or open access investigation for large bowel symptoms
Authors: MacKenzie S , Norrie J , Vella M , Drummond I , Walker A , Molloy R , Galloway D J , O'Dwyer P J 
Published: August 2003

Abstract

Background
Referral of patients with large bowel symptoms is common and increasing. Currently most of these referrals are assessed at an outpatient clinic to determine the need and priority for investigation.

Methods
Over 21 months, 1131 patients referred by the general practitioner with large bowel symptoms were randomized. Patients in the consultant-led group were assessed by surgeons with a colorectal interest while those in the open access group underwent colonoscopy if they were 55 years or older and flexible sigmoidoscopy if younger.

Results
The most common symptom among referred patients was rectal bleeding (69·1 per cent) followed by change in bowel habit (48·8 per cent) and abdominal pain (32·3 per cent). There was a significant trend (P &lt; 0·001) for patients in the consultant-led to have more investigations, and more patients in this group had no investigations (P &lt; 0·001). Despite this, the percentage of patients with colonic or other pathology diagnosed was the same in both groups, 63·6 per cent in the consultant-led group compared with 61·8 per cent in the open access group (P = 0·558). Likewise the percentage of patients with cancer or other significant pathology was similar in both groups (13·9 versus 15·4 per cent; P = 0·532). The mean(s.d.) time to diagnose cancer or other significant pathology was 55·1(39·2) days in the consultant-led group compared with 57·4(33·6) days in the open access group (P = 0·514). The cost per patient was almost £105 more for patients in the consultant-led group.

Conclusion
Patients referred by the general practitioner with large bowel symptoms should go directly to a properly managed and staffed open access large bowel investigation unit. This would enable most patients to have their investigations completed at one hospital attendance.
Origin of symptoms in diverticular disease
Authors: Simpson J , Scholefield J H , Spiller R C 
Published: August 2003

Abstract

Background
A significant number of patients with colonic diverticula experience unexplained, recurrent, short-lived but often debilitating abdominal pain and alteration in bowel habit. Such patients account for many medical consultations every year but, as our understanding of the cause of their symptoms remains imperfect, treatment options are limited. This article reviews the possible mechanisms that may be responsible for the symptoms of diverticular disease.

Methods
Medline and Science Citation Index searches were performed to locate English language articles relating to colonic diverticula and symptoms published between January 1966 and July 2002. Manual cross-referencing was also performed and some historical articles were included.

Results and conclusion
Several theories now exist about the mechanisms underlying the symptoms of diverticular disease. Initial studies suggested that they may be due to alterations in the intracolonic pressure, extrapolating earlier thoughts on the likely pathogenesis of diverticula. It seems more likely, however, that several inter-related processes, such as muscular dysfunction, visceral hypersensitivity and inflammation, are involved in symptom generation.