bluuebunny/crossref_metadata_2025_split huggingface dataset:
ROMEO: rethink organization to improve education and outcomes
Authors: Porta M. , Trento M. ,   on behalf of the ROMEO Writing Committee
Published: May 2004

AbstractAims  Scarcity of resources, expertise and evidence‐based models have so far limited delivery of patient‐centred diabetes education. We have developed and validated a group care approach that is applicable to everyday clinical practice and cost‐effective in improving metabolic control, knowledge of diabetes, health behaviours, and quality of life in Type 2 diabetes. A clinical trial (ROMEO) was planned to evaluate applicability and reproducibility of group care in other outpatients facilities and assess its impact on a larger patient population.Methods  Multicentre, randomized, controlled clinical trial of group vs. individual care in the routine management of Type 2 diabetes. Nine hundred patient aged < 80, with diabetes of ≥1 year known duration, treated by either diet alone or diet and oral agents, will be recruited in 15 centres and followed for 4 years. Training of physicians, nurses and dieticians included preparation of operating manual and videos, interactive sessions, and evaluation of local facilities and resources.Results  Primary measurements: 3‐monthly HbA1c, fasting blood glucose, body weight, waist–hip ratio, yearly blood lipids, and bi‐yearly assessment of knowledge of diabetes, health behaviours and quality of life. Secondary outcomes: systolic and diastolic blood pressure, evaluation of ECG for ischaemia and QT interval, hypoglycaemic and anti‐hypertensive medication and cardiovascular events. Analysis will be by intention‐to‐treat.Discussion If ROMEO confirms that group care can be successfully implemented in different clinics, a novel clinico‐pedagogic tool will have been acquired to support patient‐centred education, improve lifestyle and outcomes, support team work, enhance providers’ attitudes and competencies and ameliorate diabetes care organization.
Acute brain injury in hypoglycaemia‐induced hemiplegia
Authors: Shirayama H. , Ohshiro Y. , Kinjo Y. , Taira S. , Teruya I. , Nakachi K. , Tawata M. , Takasu N. 
Published: May 2004

AbstractBackground  The development of hemiplegia as a result of hypoglycaemia was first described in 1928. However, the mechanism remains unclear.Case report  We report a case of a 58‐year‐old male with diabetes, who developed left hemiplegia during a severe hypoglycaemic event.Results  Diffusion‐weighted magnetic resonance imaging detected an increased signal intensity in the pons, indicating that the patient's hemiplegia resulted from acute brain injury.Conclusions  This report provides evidence that acute brain injury may be a cause of the neurological deficit.
Plasma and urinary vascular endothelial growth factor and diabetic nephropathy in Type 2 diabetes mellitus
Authors: Kim N. H. , Kim K. B. , Kim D. L. , Kim S. G. , Choi K. M. , Baik S. H. , Choi D. S. , Kang Y. S. , Han S. Y. , Han K. H. , Ji Y. H. , Cha D. R. 
Published: May 2004

AbstractAims  Vascular endothelial growth factor (VEGF) has been implicated in the pathogenesis of diabetes mellitus. We determined whether alterations of plasma and urinary VEGF levels are related to diabetic nephropathy in Type 2 diabetic patients.Methods  One hundred and seven patients and 47 healthy controls were studied. Study subjects were divided into four groups using urinary albumin‐to‐creatinine ratio (ACR): a non‐diabetic healthy control group (n = 47), a normoalbuminuric diabetic group (n = 37), a microalbuminuric diabetic group (n = 37) and an overt proteinuric diabetic group (n = 33). VEGF levels were measured by enzyme‐linked immunosorbent assay.Results  (i) Urinary VEGF concentrations were significantly higher in the diabetic groups, even at the normoalbuminuric stage (log VEGF/Cr, normoalbuminuria; 4.33 ± 1.06 vs. control; 3.53 ± 0.79, P = 0.009). Urinary VEGF excretions increased as diabetic nephropathy advanced. (ii) Plasma and urinary VEGF levels were higher in hypertensive diabetic patients than in the normotensive individuals with diabetes. (iii) In those with diabetes, plasma VEGF levels were found to be positively correlated with plasma urea (r = 0.398, P = 0.039) and urinary ACR (r = 0.251, P = 0.044), and urinary VEGF to be positively correlated with urinary ACR (r = 0.645, P < 0.001), and creatinine (r = 0.336, P = 0.009), and to be negatively correlated with serum albumin (r = −0.557, P < 0.001). Urinary VEGF and serum creatinine were independently correlated with urinary ACR.Conclusions  Urinary excretion of VEGF increased during the earlier stage of diabetic nephropathy and was significantly correlated with urinary albumin excretion. This suggests that urinary VEGF might be used as a sensitive marker of diabetic nephropathy and for predicting disease progression.
Development and progression of diabetic retinopathy in patients with Type 1 diabetes who are positive for GAD autoantibody
Authors: Mimura T. , Funatsu H. , Uchigata Y. , Kitano S. , Shimizu E. , Noma H. , Amano S. , Araie M. , Iwamoto Y. , Hori S. 
Published: May 2004

AbstractAims  To investigate the relationship between autoantibodies to glutamic acid decarboxylase (GAD) and proliferative diabetic retinopathy (PDR) to assess the role of autoimmunity in retinopathy.Methods  Patients with Type 1 diabetes for more than 10 years who had been diagnosed under age 30 (13–28 years) were studied. They were classified into three groups. The PDR group consisted of 22 patients, the pre‐PDR group was 26 patients, while the non‐DR group was 32 patients who had Type 1 diabetes without retinopathy. Blood was collected to measure autoantibodies to GAD, and the relationship between PDR and GAD positivity was investigated in a cross‐sectional study.Results  The highest positivity rate of GAD autoantibodies was 50.0% in the non‐DR group, followed by the pre‐PDR group (30.8%) and the PDR group (18.2%).Conclusions  Production or existence of GAD autoantibodies may contribute to the prevention of retinopathy.
Omp35, a New
Enterobacter aerogenes
Porin Involved in Selective Susceptibility to Cephalosporins
Authors: Bornet Charléric , Saint Nathalie , Fetnaci Lilia , Dupont Myrielle , Davin-Régli Anne , Bollet Claude , Pagès Jean-Marie 
Published: May 2004

ABSTRACT

In
Enterobacter aerogenes
, β-lactam resistance often involves a decrease in outer membrane permeability induced by modifications of porin synthesis. In ATCC 15038 strain, we observed a different pattern of porin production associated with a variable antibiotic susceptibility. We purified Omp35, which is expressed under conditions of low osmolality and analyzed its pore-forming properties in artificial membranes. This porin was found to be an OmpF-like protein with high conductance values. It showed a noticeably higher conductance compared to Omp36 and a specific location of WNYT residues in the L3 loop. The importance of the constriction region in the porin function suggests that this organization is involved in the level of susceptibility to negative large cephalosporins such as ceftriaxone by bacteria producing the Omp35 porin subfamily.
Salivary testosterone and cortisol in rugby players: correlation with psychological overtraining items
Authors: Maso F , Lac G , Filaire E , Michaux O , Robert A 
Published: May 2004

Background:A psychocomportemental questionnaire has been devised by the consensus group of the Société Française de Médecine du Sport to characterise and quantify, using a list of functional and psychocomportemental signs, a state of “staleness”, for which no biological indicator is unanimously recognised.Objectives:To determine the relation between this diagnostic method and two hormones (cortisol and testosterone) often used as indicators of a state of fitness or staleness.Methods:The subjects were young rugby players. They were asked to complete the overtraining questionnaire and gave three saliva samples (at 8 am, 11 am, and 5 pm) during a rest day. Concentrations of cortisol and testosterone in the saliva were determined by radioimmunoassay.Results:A preferential relation was found between the questionnaire score and testosterone concentration but not between the questionnaire score and cortisol concentration.Conclusions:The questionnaire may be a useful tool for screening subjects at risk of overtraining. Testosterone concentration is influenced by tiredness, and is therefore a valid marker of tiredness.
Dose Escalation Study of Paclitaxel in Combination with Fixed-Dose Irinotecan in Patients with Advanced Non-Small Cell Lung Cancer (JCOG 9807)
Authors: Yamada Kouzo , Ikehara Mizuki , Tanaka Gaku , Nomura Ikuo , Oshita Fumihiro , Noda Kazumasa 
Published: May 2004

<i>Background:</i> Both irinotecan (CPT) and paclitaxel (Pac) are effective against non-small cell lung cancer (NSCLC), and besides, preclinical studies have demonstrated an additive or synergistic interaction between camptothecin and taxane. <i>Methods:</i> We conducted a phase I/II study of combination chemotherapy consisting of Pac and CPT to determine qualitative and quantitative toxicities and efficacy of the combination against advanced NSCLC. We fixed the dose of CPT at 60 mg/m<sup>2</sup> and escalated the Pac dose in 10 or 20 mg/m<sup>2</sup> increments from a starting dose of 80 mg/m<sup>2</sup>, and repeated the cycle every 2 weeks. Prophylactic G-CSF was also administered. <i>Results:</i> Between February 1999 and April 2001, 24 patients were registered in the study. None of the patients had a history of prior chemotherapy, but surgical resection had been performed in 3 of them. None of the patients experienced dose-limiting toxicity (DLT) up to and including level 6. At dose level 7 of Pac, 180 mg/m<sup>2</sup>, 2 patients experienced DLT, that is grades 2 and 3 dyspnea due to pneumonitis. Another patient experienced grade 1 dyspnea due to pneumonitis. Neutropenia, diarrhea, and other toxicities were mild; however, we concluded that dose level 7 of Pac was the maximum-tolerated dose. An objective response was observed in 58.3%. The median survival time was 370 days, and the 1-year survival rate was 54.2%. <i>Conclusion:</i> Pneumonitis was the DLT in this study, and Pac 160 mg/m<sup>2</sup> and CPT 60 mg/m<sup>2</sup> every 2 weeks are recommended for the phase II study. This combination shows appreciable activity against NSCLC.
Mineralo- and Glucocorticoid Receptor mRNAs Are Differently Regulated by Corticosterone in the Rat Hippocampus and Anterior Pituitary
Authors: Hügin-Flores Mirza E. , Steimer Thierry , Aubert Michel L. , Schulz Pierre 
Published: May 2004

In most cell lines and animal tissues, glucocorticoid receptors undergo downregulation after exposure to corticosterone. However, corticosterone treatment has not shown a consistent effect on mineralocorticoid (MR) and glucocorticoid receptors (GR) in the hippocampus, and it has been rarely assessed in the anterior pituitary. In this study we investigated dose-dependent effects of corticosterone on MR and GR mRNAs in the hippocampus and anterior pituitary. Adrenalectomized rats substituted with corticosterone in drinking fluid were injected subcutaneously with vehicle or 1, 10, 50, 100, or 200 mg of corticosterone, and sacrificed 4 h later. In the hippocampus we found a progressive decrease in MR and GR mRNAs with increasing doses of corticosterone. This was significant with 50 and 100 mg corticosterone for MR mRNA and with 10–200 mg corticosterone for GR mRNA at plasma corticosterone levels above 30 µg/dl. The anterior pituitary did not show significant changes at any dose. A time-course with 2 mg of corticosterone (non-response dose range at 4 h) revealed a significant decrease in MR and GR mRNAs in the hippocampus 8 h after the subcutaneous injection. In the anterior pituitary both mRNAs showed an increase that was significant 24 h after injection for MR and from 8 to 24 h for GR. In the hippocampus, adrenalectomy (absence of corticosterone) induced a significant increase in MR and GR mRNAs on day 3, but not on days 1, 8 and 21 after adrenalectomy. In the anterior pituitary there were no significant changes at any time after adrenalectomy. In summary, we have found an in vivo corticosterone dose- and time-dependent downregulation of MR and GR mRNAs in the hippocampus, whereas anterior pituitary MRs and GRs seem relatively insensitive to the excess or the absence of corticosterone, suggesting the lack of an autoregulatory effect in this tissue. Significant mRNA changes appearing later in time could suggest a secondary response via a glucocorticoid-induced gene product. Corticosteroid receptor downregulation in the hippocampus could prevent overstimulation or tissue damage when plasma corticosterone is high, while increased corticosteroid receptors in the anterior pituitary could buffer the excessive brain drive on the pituitary during chronic stress or pathological conditions associated with increased plasma glucocorticoids, such as depression.
Le grand jasaq de Gengis-khan, l'empire, la culture mongole et la shari'a
Authors: Aigle Denise 
Published: May 2004

AbstractMongol law, the jasaq, has provided the basis for a long tradition of studies which were inaugurated by Petis de la Croix in 1710. He was the first to define a list of precepts of the jasaq, but without taking into consideration either the chronology or their origins. Most subsequent scholars dealing with the question revived this same vision of the jasaq. Debate was especially focused on whether or not the Mongols possessed a written code of laws. But, until now, little discussion has taken place concerning what the jasaq represented for the Mongols themselves and how this Mongol law was perceived by Mediaeval authors who, on the whole, confused the imperial edicts (jasaq) with customs (yosun). The present article is an attempt to clarify these issues. The author examines the jasaq in its politico-cultural context and, in particular, the analysis of the precepts takes into consideration shamanism, the Mongol system of representations. Reasons for the lack of understanding by Muslims of certain customs in disharmony with Islam are thereby highlighted, reasons which led them to see, in the jasaq, an equivalent of the sharī'a: a Mongol order imposed on populations which had fallen under their domination. La loi mongole, le jasaq, a donné lieu à une longue tradition d'études qui fut inaugurée par Petis de la Croix au XVIIe siècle. Il fut le premier à dresser une liste des préceptes du jasaq, sans tenir compte de la chronologie des sources et de leur provenance. Les chercheurs qui se sont penchés par la suite sur cette question ont repris, pour la plupart d'entre eux, cette vision du jasaq. Le débat s'est surtout focalisé sur l'existence ou non d'un code de loi écrit chez les Mongols. Mais, jusqu'à présent, il a été peu discuté de ce que le jasaq représentait pour les Mongols eux-mêmes et comment cette loi mongole a été perçue par les auteurs médiévaux qui confondaient, la plupart du temps, les édités impériaux (jasaq) et les coutumes (yosun). Cet article fait le point sur ces questions. L'auteur examine le jasaq dans son contexte politico-culturel et, en particulier, il prend en compte, dans l'analyse des préceptes, le système de représentations des Mongols, le chamanisme. Il met ainsi en lumière les raisons de l'incompréhension, de la part des musulmans, de certaines coutumes en désaccord avec l'islam, ce qui les a conduits à voir dans le jasaq l'équivalent de la sharī'a: un ordre mongol imposé aux populations tombées sous leur domination.
Psychometric properties of the sensory scale of the Fugl-Meyer Assessment in stroke patients
Authors: Lin Jau-Hong , Hsueh I-Ping , Sheu Ching-Fan , Hsieh Ching-Lin 
Published: May 2004

Objective: To examine the psychometric properties of the sensory scale of the Fugl-Meyer Assessment (FMA-S) in stroke patients with a broad range of neurological and functional impairment at times from 14 to 180 days after stroke. Subjects: A total of 176 first stroke patients consecutively admitted to a university based medical centre. Design: This prospective, longitudinal investigation was based on data collected at 14, 30, 90 and 180 days after stroke. Main outcome measures: Reliability (inter-rater reliability and internal consistency), validity (convergent and predictive validity) and responsiveness of the FMA-S were examined. Results: The inter-rater agreement of the total score of the FMA-S was excellent, with an intraclass correlation coefficient of 0.93. The Cronbach's alphas of the FMA-S at four time points after stroke ranged from 0.94 to 0.98, indicating excellent internal consistency. However, the FMA-S showed a significant ceiling effect (more than 44.4% of the subjects achieving the highest score), poor to moderate inter-rater reliability for light touch items (weighted kappa ranging from 0.30 to 0.55), low to moderate validity (Spearman's rho ranging from 0.29 to 0.53), and low to moderate responsiveness (standardized response mean ranging from 0.27 to 0.67) at different post-stroke stages of recovery. Conclusions: The psychometric properties of the FMA-S in measuring sensory function do not support its clinical use in stroke patients. Further studies on methods to improve the psychometric properties of the FMA-S are needed.
Rehabilitation outcomes after brain injury: disability measures or goal achievement?
Authors: Liu Clarence , McNeil Jane E , Greenwood Richard 
Published: May 2004

Background: The outcome of rehabilitation interventions following brain injury is commonly rated by disability scales. Goal-setting and achievement are important in inpatient rehabilitation, but seldom assessed as outcomes. Objective: To compare the information acquired from using disability ratings and goal attainment/variances as outcome measures in brain injury rehabilitation. Setting: An inpatient regional neurological rehabilitation unit. Subjects: One hundred and seventy-seven patients admitted after single incident brain injury over a three-year period. Main measures: (1) Disability outcomes by the Barthel Index and the Functional Independence Measure, (2) goal achievement and variance distribution, and (3) the influence of diagnosis and demographics on these measures. Results: Patients improved significantly on all disability scales employed (p < 0.0001), with the baseline admission scores being inversely correlated with changes in dependency by discharge (rho∼0.4). The median attainment rate of long-term goals was 75% per patient. Nonachievement was most frequently due to cognitive problems (38%), followed by behavioural difficulties and physical limitations (18% each). Goal achievement correlated poorly with disability outcome at discharge (rho∼0.3). Patients who accomplished all their goals tended to be less disabled at admission. Diagnostic groups and demographic factors had little influence on either disability or goal achievement outcomes. Conclusions: The use of a simple goal achievement and variance coding scheme has been relatively straight forward to incorporate into the daily practice of the unit. It provides useful information on rehabilitation process and outcome after brain injury that is complementary to the utilization of disability measures.
A Clinical Comparison of Calculated versus Direct Measurement of Low‐Density Lipoprotein Cholesterol Level
Authors: Lindsey Cameron C. , Graham Maqual R. , Johnston Thomas P. , Kiroff Chelsea G. , Freshley Anna 
Published: May 2004

Study Objectives. To determine if, and to what extent, the low‐density lipoprotein cholesterol (LDL) level is underestimated when it is calculated by the Friedewald formula compared with the LDL level measured by a direct method. A secondary objective was to determine and compare the percentages of patients meeting LDL goal using each of these two methods.Design. Retrospective chart review.Setting. Kansas City Veterans Affairs Medical Center.Subjects. Patients aged 18 years or older and whose laboratory results reflected a complete lipid profile for 1 year.Measurement and Main Results. Calculated LDL level (C‐LDL) was derived using the Friedewald formula and was compared with Wako method–derived direct LDL level (D‐LDL) to ascertain whether a positive correlation existed. The absolute difference between the methods for each sample was determined and compared overall and for various subgroups. The number of patient samples achieving National Cholesterol Education Program–defined LDL goal was determined and compared for both methods. A total of 20,224 lipid profiles were generated and 19,343 were included in the analysis. A strong correlation was found between D‐LDL and C‐LDL (r = 0.94). The absolute difference between the two methods demonstrated an underestimation of C‐LDL of 19.5 ± 11.8 mg/dl. The degree of underestimation increased as the triglyceride level increased (p<0.05). Age within the fifth and sixth decades resulted in significantly higher differences compared with age in the eighth decade or greater (p<0.05). Female sex and elevated body mass index also resulted in increased discrepancies between the two methods (p<0.05 for both). Seventy‐six percent of the lipid profiles were derived from patients with coronary heart disease (CHD) or a CHD risk equivalent. Approximately one half of these patients met their LDL goal when LDL level was measured versus calculated (p<0.0001).Conclusion. When compared with D‐LDL, an underestimation of approximately 20 mg/dl was found with C‐LDL, resulting in a loss of LDL goal attainment for half of the patients with CHD or a CHD risk equivalent.
Evaluation of Fatigability of the Levator Veli Palatini Muscle during Continuous Blowing Using Power Spectra Analysis
Authors: Tachimura Takashi , Nohara Kanji , Satoh Koichi , Wada Takeshi 
Published: May 2004

Objective The purpose of this study was to compare the fatigability of the levator veli palatini (LVP) muscle during blowing in speakers who exhibit velopharyngeal incompetence with that from normal speakers by means of power spectra analysis. Design All subjects were instructed to blow into a tube for more than 10 seconds at maximum possible effort. The LVP muscle activity (electromyography) was sampled at 2 kHz for 10 seconds from the time when the oral air pressure during blowing was stabilized. These samples were subjected to Fast Fourier Transfer analysis with analytic windows of 0.5-second width. The electromyography mean power frequency slope with respect to time for each subject was estimated. Participants Three speakers with repaired cleft palate and three normal speakers were selected as subjects. Results The slopes of the regression lines for all three subjects with repaired cleft palate were negatively signed with statistical significance (t test, p < .01). The slopes for all of the normal speakers were negatively signed, but these were not statistically significant. Conclusion These results suggest that the LVP muscle of speakers with repaired cleft palate who exhibit varying degrees of velopharyngeal dysfunction may deteriorate more easily in comparison with the LVP muscle of normal speakers.