bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving glycaemic control in patients with Type 2 diabetes mellitus without insulin therapy
Authors: Goudswaard A. N. , Stolk R. P. , De Valk H. W. , Rutten G. E. H. M. 
Published: December 2004

AbstractAims In general practice at least 30% of those with Type 2 diabetes do not achieve good glycaemic control. We studied the effect of improving oral glucose‐lowering medication in a primary care setting in patients treated with oral hypoglycaemic agents without satisfactory glycaemic control.Methods We provided flowcharts to general practitioners and outreach visits by trained facilitators, who checked adherence to the protocol. Fifty‐two Dutch general practices with 2140 Type 2 diabetes mellitus (DM) patients recruited 288 patients ≤ 75 years old inadequately controlled (HbA1c > 7%) by diet or oral medication. Outcome measures were decrease of HbA1c, number of patients with HbA1c ≤ 7%, and non‐compliance rate.Results After a mean of 3.3 consultations over 14 weeks, 209 patients were following the protocol fully with a reduction in HbA1c from 8.7% to 6.7% (P < 0.001). One hundred and fifty‐eight patients (55%) achieved HbA1c≤ 7%, and 51 (18%) persisted with HbA1c > 7% unless fasting blood glucose ≤ 7 mmol/l (n = 18) or a maximum of medication (n = 33). Seventy‐nine patients (27%) did not adhere to the protocol, mostly due to loss of motivation and non‐attendance.Conclusions A simple flowchart and relatively little support by trained facilitators results in improved glycaemic control.Diabet. Med. 20, 540–544 (2003)
Peripheral vascular disease in Type 2 diabetic Chinese patients: associations with metabolic indices, concomitant vascular disease and genetic factors
Authors: Thomas G. N. , Critchley J. A. J. H. , Tomlinson B. , Cockram C. S. , Chan J. C. N. 
Published: December 2004

AbstractAims  Conventional and genetic risk factors have been reported to play a role in the pathogenesis of vascular disease, but do not explain the lower burden of cardiac and peripheral vascular disease (PVD) in Chinese compared with Caucasians. The role of renin‐angiotensin system (RAS) gene polymorphisms and conventional vascular risk factors has not been determined.Methods  A total of 3097 Chinese diabetic subjects were screened for PVD, which was identified in 194 of the 2967 patients with Type 2 diabetes. Biochemical parameters and the genotype and allele frequencies of three RAS gene polymorphisms, the angiotensin‐converting enzyme (ACE) insertion/deletion, angiotensinogen (AGT) M235T and angiotensin II type 1 receptor (AT1R) A1166C polymorphisms were then compared between the PVD patients and 1046 age, gender and diabetes duration‐matched patients without PVD.Results  PVD identified in 6.5% was associated with significantly worse glycaemic control, lipid profile and renal function. Smoking was more common, as were the other macro‐ and microvascular diseases. The prevalence of hypertension was similar between the groups, yet diastolic blood pressure was slightly lower in the PVD group. The ACE D allele was significantly more frequent in patients with PVD compared with the matched diabetic controls (38.1 vs. 29.8%, P = 0.039). No differences in the AT1R or AGT polymorphisms were observed.Conclusions  PVD was associated with a worse metabolic profile and greater concomitant vascular disease than controls. The ACE I/D polymorphism was associated with PVD in these Type 2 diabetic patients.Diabet. Med. 20, ***–*** (2003)
Specialist general practitioners and diabetes clinics in primary care: a qualitative and descriptive evaluation
Authors: Nocon A. , Rhodes P. J. , Wright J. P. , Eastham J. , Williams D. R. R. , Harrison S. R. , Young R. J. 
Published: December 2004

AbstractAims  The aim of this study was to evaluate an innovative approach to the provision of primary care‐based diabetes services in Bradford, UK. The service model differs from others in comprising 19 clinics which offer a specialist service, intermediate between primary and secondary care, to all patients within the Bradford area.Methods  The study included: analysis of referral, attendance and register data; questionnaires to general practitioners (GPs) and specialist clinic providers; qualitative interviews with clinic and other professional staff and patients; and an economic analysis.Results  The 19 clinics adopt a range of organizational models. In the first 3½ years, 2415 patients were referred. There was a significant reduction in out‐patient attendances at hospital, but also a significant increase in overall patient attendances. Specialist clinic patients differed from hospital patients in being older and having had diabetes for longer since diagnosis. Ten of the 14 clinics run by practising GPs attracted more referrals from within their practices than from outside. GPs and patients across the city believed the clinics were valuable, the main benefits being geographical accessibility, availability of specialists in a community setting, short waiting times for first appointments at most clinics, and continuity of staff. Their reservations included a lack of strategic planning in the location of clinics, long waiting times at some clinics, and poor communication at some clinics with referring GPs. The cost of the primary care clinics is similar to hospital clinics.Conclusions  This model of specialist primary care services offers an opportunity to develop diabetes services that are convenient to patients, popular with practitioners, and increase capacity. However, the shortcomings as well as the advantages of the model need to be addressed if it is to be implemented elsewhere or for other patient groups.
Sudden hearing loss as a first complication of long‐standing Type 1 diabetes mellitus: a case report
Authors: Gawron W. , Pospiech L. , Noczynska A. , Koziorowska E. 
Published: December 2004

AbstractThe term ‘sudden hypoacusis’ describes a hearing loss of a rapid onset and unknown origin that can progress to severe deafness. Its pathophysiology is still unknown, the proposed aetiological mechanisms being vascular disease or autoimmune reaction. We present the case of a 19‐year‐old woman with Type 1 diabetes mellitus who experienced sudden hearing loss on her right side. She had no complications related to diabetes. After being referred to the hospital she was diagnosed with sudden sensorineural right‐sided hearing loss accompanied by high frequency tinnitus. After administration of vasoactive drugs, there was partial improvement after 7 days, followed by gradual improvement over the next 4 weeks to 5 months. The tinnitus did not disappear completely. We conclude that hearing organ disturbances can be present in Type 1 diabetes and represent an early complication.
Automated detection of diabetic retinopathy in digital retinal images: a tool for diabetic retinopathy screening
Authors: Usher D. , Dumskyj M. , Himaga M. , Williamson T. H. , Nussey S. , Boyce J. 
Published: December 2004

AbstractAims  To develop a system to detect automatically features of diabetic retinopathy in colour digital retinal images and to evaluate its potential in diabetic retinopathy screening.Methods  Macular centred 45° colour retinal images from 1273 patients in an inner city diabetic retinopathy screening programme. A system was used involving pre‐processing to standardize colour and enhance contrast, segmentation to reveal possible lesions and classification of lesions using an artificial neural network. The system was trained using a subset of images from 500 patients and evaluated by comparing its performance with a human grader on a test set of images from 773 patients.Results  Maximum sensitivity for detection of any retinopathy on a per patient basis was 95.1%, accompanied by specificity of 46.3%. Specificity could be increased as far as 78.9% but was accompanied by a fall in sensitivity to 70.8%. At a setting with 94.8% sensitivity and 52.8% specificity, no cases of sight‐threatening retinopathy were missed (retinopathy warranting immediate ophthalmology referral or re‐examination sooner than 1 year by National Institute for Clinical Excellence criteria). If the system was implemented at 94.8% sensitivity setting over half the images with no retinopathy would be correctly identified, reducing the need for a human grader to examine images in 1/3 of patients.Conclusion  This system could be used when screening for diabetic retinopathy. At 94.8% sensitivity setting the number of normal images requiring examination by a human grader could be halved.
The implementation of nutritional advice for people with diabetes
Authors:   Nutrition Subcommittee of the Diabetes Care Advisory Committee of Diabetes UK
Published: December 2004

AbstractThese consensus‐based recommendations emphasize the practical implementation of nutritional advice for people with diabetes, and describe the provision of services required to provide the information. Important changes from previous recommendations include greater flexibility in the proportions of energy derived from carbohydrate and monounsaturated fat, further liberalization in the consumption of sucrose, more active promotion of foods with a low glycaemic index, and greater emphasis on the provision of nutritional advice in the context of wider lifestyle changes, particularly physical activity. Monounsaturated fats are now promoted as the main source of dietary fat because of their lower susceptibility to lipid peroxidation and consequent lower atherogenic potential. Consumption of sucrose for patients who are not overweight can be increased up to 10% of daily energy derived from carbohydrate provided that this is eaten in the context of a healthy diet and distributed throughout the day. Evidence is presented for the effectiveness of advice provided by trained dieticians. The increasing evidence for the importance of good metabolic control and the growing requirement for measures to prevent Type 2 diabetes in an increasingly obese population will require major expansion of dietetic services if the standards in National Service Frameworks are to be successfully implemented.
Excitability of Visual V1-V2 and Motor Cortices To Single Transcranial Magnetic Stimuli in Migraine: A Reappraisal Using A Figure-Of-Eight Coil
Authors: Bohotin V , Fumai A , Vandenheede M , Bohotin C , Schoenen J 
Published: December 2004

We used transcranial magnetic stimulation (TMS) with a figure-of-eight coil to excite motor and visual V1-V2 cortices in patients suffering from migraine without (MO) ( n = 24) or with aura (MA) ( n = 13) and in healthy volunteers (HV) ( n = 33). Patients who had a migraine attack within 3 days before or after the recordings were excluded. All females were recorded at mid-cycle. Single TMS pulses over the occipital cortex elicited phosphenes in 64% of HV, 63% of MO and 69% of MA patients. Compared with HV, the phosphene threshold was significantly increased in MO ( P = 0.001) and in MA ( P = 0.007), but there was no difference between the two groups of migraineurs. The motor threshold tended to be higher in both migraine groups than in HV, but the differences were not significant. In conclusion, this study shows that two-thirds (64.86%) of patients affected by either migraine type present an increased phosphene threshold in the interictal period, which suggests that their visual cortex is hypoexcitable.
Trigeminofacial Reflexes in Primary Headaches
Authors: Cecchini A Proietti , Sandrini G , Fokin I.V. , Moglia A , Nappi G 
Published: December 2004

Nociceptive processing in trigeminal system is likely to undergo to significant changes in chronic pain disorders such as in primary headache. The electrophysiological testing of brainstem reflexes seems to offer a valuable adjunct to the clinical evaluation, providing direct evidence for central dysmodulation of sensory and pain neurotransmission, i.e. dishabituation pattern and reduced pain threshold. We review the contribution of trigeminofacial reflex studies in the light of those recent data supporting the view of a dysfunctional sensory processing in primary headache.
Peripheral and Central Activation of Trigeminal Pain Pathways in Migraine: Data From Experimental Animal Models
Authors: Buzzi MG , Tassorelli C , Nappi G 
Published: December 2004

EEG-studies in migraine in the last decade has contributed modestly to the understanding of headache pathogenesis. Headache patient groups seem to have increased EEG responses to photic stimulation, but a useful biological marker for migraine in single patients has not been found. In future EEG and QEEG studies we recommend to use follow-up designs and record several EEGs across the migraine cycle. It is also important to use a blinded study design in order to avoid selection bias. A clinical EEG should be performed in patients with acute headache attacks when either epilepsy, basilar migraine, migraine with prolonged aura or alternating hemiplegia is suspected. Unequivocal epileptiform abnormalities usually suggest a diagnosis of epilepsy. In children with occipital spike-wave activity the probable diagnosis is childhood epilepsy with occipital paroxysms (CEOP). The final diagnosis of either an epilepsy syndrome or migraine must be mainly based on a clinical judgement.
Relating species abundance distributions to species‐area curves in two Mediterranean‐type shrublands
Authors: Keeley Jon E. 
Published: December 2004

Abstract. Based on both theoretical and empirical studies there is evidence that different species abundance distributions underlie different species‐area relationships. Here I show that Australian and Californian shrubland communities (at the scale from 1 to 1000 m2) exhibit different species‐area relationships and different species abundance patterns. The species‐area relationship in Australian heathlands best fits an exponential model and species abundance (based on both density and cover) follows a narrow log normal distribution. In contrast, the species‐area relationship in Californian shrublands is best fit with the power model and, although species abundance appears to fit a log normal distribution, the distribution is much broader than in Australian heathlands. I hypothesize that the primary driver of these differences is the abundance of small‐stature annual species in California and the lack of annuals in Australian heathlands. Species‐area is best fit by an exponential model in Australian heathlands because the bulk of the species are common and thus the species‐area curves initially rise rapidly between 1 and 100 m2. Annuals in Californian shrublands generate very broad species abundance distributions with many uncommon or rare species. The power function is a better model in these communities because richness increases slowly from 1 to 100 m2 but more rapidly between 100 and 1000 m2 due to the abundance of rare or uncommon species that are more likely to be encountered at coarser spatial scales. The implications of this study are that both the exponential and power function models are legitimate representations of species‐area relationships in different plant communities. Also, structural differences in community organization, arising from different species abundance distributions, may lead to different species‐area curves, and this may be tied to patterns of life form distribution.
Performance of nonparametric species richness estimators in a high diversity plant community
Authors: Chiarucci A. , Enright N. J. , Perry G. L. W. , Miller B. P. , Lamont B. B. 
Published: December 2004

Abstract. The efficiency of four nonparametric species richness estimators — first‐order Jackknife, second‐order Jackknife, Chao2 and Bootstrap — was tested using simulated quadrat sampling of two field data sets (a sandy ‘Dune’ and adjacent ‘Swale’) in high diversity shrublands (kwongan) in south‐western Australia. The data sets each comprised > 100 perennial plant species and > 10 000 individuals, and the explicit (x‐y co‐ordinate) location of every individual. We applied two simulated sampling strategies to these data sets based on sampling quadrats of unit sizes 1/400th and 1/100th of total plot area. For each site and sampling strategy we obtained 250 independent sample curves, of 250 quadrats each, and compared the estimators’ performances by using three indices of bias and precision: MRE (mean relative error), MSRE (mean squared relative error) and OVER (percentage overestimation). The analysis presented here is unique in providing sample estimates derived from a complete, field‐based population census for a high diversity plant community. In general the true reference value was approached faster for a comparable area sampled for the smaller quadrat size and for the swale field data set, which was characterized by smaller plant size and higher plant density. Nevertheless, at least 15–30% of the total area needed to be sampled before reasonable estimates of St (total species richness) were obtained. In most field surveys, typically less than 1% of the total study domain is likely to be sampled, and at this sampling intensity underestimation is a problem. Results showed that the second‐order Jackknife approached the actual value of St more quickly than the other estimators. All four estimators were better than Sobs (observed number of species). However, the behaviour of the tested estimators was not as good as expected, and even with large sample size (number of quadrats sampled) all of them failed to provide reliable estimates. First‐ and second‐order Jackknives were positively biased whereas Chao2 and Bootstrap were negatively biased. The observed limitations in the estimators’ performance suggests that there is still scope for new tools to be developed by statisticians to assist in the estimation of species richness from sample data, especially in communities with high species richness.
Poincaré plot indexes of heart rate variability capture dynamic adaptations after haemodialysis in chronic renal failure patients
Authors: Claudia Lerma , Oscar Infante , Héctor Pérez‐Grovas , Marco V. José 
Published: December 2004

SummaryThe hypothesis that the Poincaré plot indexes of heart rate variability (HRV) detect dynamic changes after haemodialysis (HD) over the HRV in haemodynamically stable chronic renal failure (CRF) patients was examined. Minor axis (SD1), major axis (SD2) and the SD1/SD2 ratio were compared against standard HRV indexes in time and frequency domain, in a group of healthy subjects and in a group of CRF patients before and after HD. These indexes were estimated from Poincaré plots reconstructed with lags of one, two and four heartbeats. The surrogate data analysis technique was applied in order to discern if only random components or linear features of HRV contribute to its dynamics. None of the standard linear HRV indexes changed after HD. The Poincaré plot indexes measured from CRF patients were smaller than the ones measured from healthy subjects. In CRF patients the SD1/SD2 ratio decreased after HD, when a lag of four heartbeats was used (0·68 ± 0·19 before HD versus 0·55 ± 0·12 after HD, P<0·05). The presence of deterministic components in HRV were confirmed for all measures of the SD1/SD2 ratio. Moreover, a loss of non‐linear components after HD was detected by the surrogate analysis over the SD1/SD2 ratio with a lag of four heartbeats. In conclusion, the SD1/SD2 ratio measured at lag of 4 heartbeats capture dynamic changes after HD upon the HRV of CRF patients that are not solely related to linear autocorrelations of HRV. This suggests that the SD1/SD2 ratio reflects non‐linear information of HRV.
Beat‐to‐beat measurement of the finger arterial pressure pulse shape index at rest and during exercise
Authors: Raamat Rein , Jagomägi Kersti , Talts Jaak , Toska Karin , Walløe Lars 
Published: December 2004

SummaryArterial pressure waveform can be characterized by the pulse shape index kpulse determined as kpulse = (Pmean − Pdiast) / (Psyst − Pdiast). For brachial artery, the shape index value of 0·33 is usually applied to approximate Pmean from the measured Psyst and Pdiast. Our purpose was to test whether this value can validly be applied to finger vascular beds under different experimental conditions. By using Finapres®, we non‐invasively estimated the beat‐to‐beat values of kpulse in the fingers of young healthy persons in supine position at rest and during a 4‐min moderate exercise (rhythmical exercise with the quadricep muscles in combination with handgrip compression). To detect intensive peripheral vasoconstrictions, a laser‐Doppler probe was attached to the thumb pulp of the same hand. Periods of 30 s without intensive vasoconstriction for rest, different stages of exercise and recovery were involved in the analysis in every subject. The results demonstrated that the group‐averaged value of kpulse (median with a 95% confidence interval) in the fingers of 11 healthy volunteers aged from 20 to 24, equalled 0·33 (0·31– 0·34), 0·31 (0·28–0·34), 0·35 (0·33–0·39) and 0·38 (0·34–0·43) for rest, first and second stages of exercise and recovery, respectively. We conclude that in the fingers of young healthy persons in supine position formula Pmean = Pdiast + 1/3 (Psyst − Pdiast) gives an adequate approximation for rest and low intensity exercise (first stage), and slightly underestimates the actual finger mean blood pressure during moderate exercise (second stage) and recovery.
Cerebral oxygenation responses to standing in elderly patients with predominantly diastolic dysfunction
Authors: Mehagnoul‐Schipper D. Jannet , Vloet Lilian C.M. , Colier Willy N.J.M. , Hoefnagels Willibrord H.L. , Verheugt Freek W.A. , Jansen René W.M.M. 
Published: December 2004

SummaryPatients with left ventricular dysfunction may have different orthostatic responses of blood pressure (BP) and cerebral oxygenation than healthy elderly subjects. We investigated orthostatic changes in systemic haemodynamic variables and cerebral oxygenation in 21 elderly patients with heart failure New York Heart Association class I–III in stable condition (age 70–83 years) after withdrawal of furosemide and captopril for 2 weeks, and in 18 healthy elderly subjects (age 70–84 years). Frontal cortical concentration changes of oxyhaemoglobin ([O2Hb]) and deoxyhaemoglobin ([HHb]) were continuously measured by near‐infrared spectrophotometry and BP changes by Finapres before and during 10 min of standing. Upon standing [O2Hb] reflecting blood flow, changed by −1·2 ± 0·9 μmol L−1 (mean ± SEM) in the patients, whereas it decreased by −4·5 ± 0·6 μmol L−1 (P<0·01) in the healthy subjects after standing (P<0·05 between groups). [HHb] reflecting the sum of cerebral blood flow, arterial oxygen saturation and cerebral oxygen uptake, increased by 1·5 ± 0·5 μmol L−1 (P<0·05) and 1·7 ± 0·6 μmol L−1 (P<0·05), respectively. Compared with healthy elderly subjects, elderly patients with left ventricular dysfunction showed smaller orthostatic [O2Hb] decreases (P<0·01), in relation to higher orthostatic BP rises (P<0·05). These findings indicate that BP changes and an altered cardiovascular balance may influence orthostatic cortical haemodynamic responses in elderly subjects.
31P MRS evaluation of fatigue in anterior tibial muscle in postpoliomyelitis patients and healthy volunteers
Authors: Ljungberg M. , Stibrant Sunnerhagen K. , Vikhoff‐Baaz B. , Starck G. , Forssell‐Aronsson E. , Hedberg M. , Ekholm S. , Grimby G. 
Published: December 2004

SummaryChanges in concentration of high energy phosphates and pH were studied during rest, exercise and subsequent recovery in the anterior tibial muscle of 10 patients with late effects of poliomyelitis and 10 age‐ and sex‐matched healthy volunteers using31P MRS. The exercise was dynamic and isometric, and the force levels were individually adapted to each subject and stepwise increased. In general, there were no differences in metabolite changes between the groups, except for lower Piand Pi/PCr for the volunteers during the recovery phase, also reflected by shorter recovery half‐time for Pi. The interindividual variation was much higher for the patient group. Some of the patients showed deviating results probably because of differences in muscle fibre type.