bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Divalproex on Metabolic Parameters Is Dose Related in Migraine Prophylaxis
Authors: Green Mark W. , Giordano Suzanne , Jiang Ping , Jafari Mahtab , Smith Thomas B. 
Published: August 2005

Objective.—To examine the metabolic effects of three divalproex dosing regimens in patients with migraine.Background.—Epidemiological and clinical studies have demonstrated a strong association between serum lipid levels and the development of coronary artery disease. Thus, it is important to understand the impact of chronically administered medications on serum lipids. Metabolic properties of divalproex, an approved and commonly used treatment for migraine prophylaxis, have not been systematically studied in patients with migraine.Methods.—Adult patients with migraine were randomized to receive one of three daily doses of divalproex (500 mg [n = 45], 1000 mg [n = 43], or 1500 mg [n = 44]) or placebo (n = 44) for 12 weeks. Post hoc analyses were performed to determine the effects of divalproex on total cholesterol, glucose, weight, and body mass index (BMI).Results.—The treatment groups were similar at baseline based on demographic and clinical characteristics and the use of concomitant medications. Divalproex resulted in a dose‐related mean decrease from baseline in total cholesterol: −5.7 mg/dL or 3% reduction with 500 mg/day; −8.4 mg/dL or 4% reduction with 1000 mg/day; and −12.8 mg/dL or 7% reduction with 1500 mg/day (P < .05 for 1500 mg/day vs. placebo). There were no differences between any divalproex dose group and placebo for mean change from baseline in glucose, weight, or BMI.Conclusions.—Divalproex results in a dose‐dependent reduction in serum cholesterol within the first 3 months of therapy, with no significant change in serum glucose or BMI.
Migraine Pain Location: A Tertiary Care Study of 1283 Migraineurs
Authors: Kelman Leslie 
Published: August 2005

Objectives.—This study of headache location in migraine was performed (1) to document the location of pain in a large group of migraine patients and (2) to assess the impact of different types of migraine, gender, aura, and headache features on the location of the headache.Background.—The literature documenting the location of the pain of acute attack of migraine is sparse.Methods.—A total of 1283 migraine patients (ICHD, 2004, 1.1, 1.2, 1.5.1, and 1.6) were evaluated at the 1st visit. Headache location and character were graded on a scale of 0 to 3 with 0 being none and 3 the most. Triggers were graded on a frequency scale of 0 to 3; 0 = none; 1 = less than 1/3 of time; 2 = between 1/3 and 2/3 of time; 3 = greater than 2/3 of time. Other headache features and medication responsiveness, were also recorded. Patients were stratified by migraine type and headache frequency. Combined and isolated locations, and the impact of age, gender, headache frequency, migraine types, and aura were addressed. Unremitting headache was excluded.Results.—Migraine patients reported that the highest location frequencies were in the eyes (67.1%), temporal (58.0%), and frontal (55.9%). The lowest were diffusely (17.5%) and vertex (24.1%). The intermediate were in the occipital (39.8%) and neck areas (39.7%). Other migraine types were remarkably similar. Hemicranial location was present in 66.6% of patients, 71.2% in episodic migraine and 61.4% in chronic migraine, 67.2% in females and 63.2% in males, 59.7% inmigraine without aura and 68.9% inmigraine with aura 100% of the time. Headaches were reported on the right side in 27.3%, left side 24.3%, both sides 23.7%, either side 15.0%, and in the middle of the head in 4.6% of cases. Significant differences in headache location were seen only within migraine and not other migraine types. Headache location was not correlated with lifetime duration of migraine, prodrome, response to triptan, intensity, time to peak of headache, recurrence frequency, and time to recurrence.Conclusions.—This study provides a detailed documentation of headache location in a large cohort of patients. The commonest locations are the orbital, frontal, and temporal areas and least common sites being diffuse and the vertex. A single location is infrequent. Hemicranial location is present in two thirds of subjects and a quarter each are on the left side, right side, and both sides. The locations of the headache are very similar in different migraine types, but there are some differences. Under age 21 and older patients tended to show some differences in location and side. Location differences are seen with gender, headache frequency, and aura. Location shows many correlations with triggers and headache features.
Serotonin Transporter Gene Polymorphism and Migraine in the Korean Population
Authors: Kim Woo‐Kyung , Kim Hyun‐Sook , Kim Won‐Joo , Lee Kyung‐Yul , Park Hyojin , Kim Chan‐Hyung , Kim Se Joo , Choi Young‐Chul 
Published: August 2005

Objective.—To evaluate the association between a serotonin (5‐HT) transporter gene polymorphism and migraines in Koreans.Background.—The 5‐HT metabolism is believed to play an important part in the pathophysiology of migraines, and a polymorphism of the serotonin transporter (5‐HTT) promoter region might influence 5‐HTT expression and serotonin uptake.Methods.—This study compared 52 patients with migraine and 170 healthy control subjects in order to determine the association between a polymorphism of the 5‐HTT gene‐linked polymorphic region (5‐HTTLPR) and migraine. Using PCR techniques, the products of the 484‐base pair (bp) fragments were denoted as being short alleles (s) and those of 528 bp as being long (l).Results.—The genotype distribution of the healthy controls was s/s (56.5%), s/l (38.2%), and l/l (5.3%) and that of the patients with migraine was 65.4%, 30.8%, and 3.8%, respectively. No significant differences were noted in the genotype and allele frequencies of 5‐HTTLPR between the patients with migraine and the control subjects.Conclusions.—A 5‐HTTLPR polymorphism does not appear to be involved in the genetic predisposition to migraines.
Impact of Reversibility of No Reflow Phenomenon on 30‐Day Mortality Following Percutaneous Revascularization for Acute Myocardial Infarction—Insights from a 1,328 Patient Registry
Authors: LEE CHI HANG , WONG HWEE BEE , TAN HUAY CHEEM , ZHANG JUN JIE , TEO SWEE GUAN , ONG HEAN YEE , LOW ADRIAN , SUTANDAR ANTONO , LIM YEAN TENG 
Published: August 2005

Background: Occurrence of no reflow phenomenon during percutaneous coronary intervention (PCI) is associated with increased mortality. Although intracoronary medications can improve coronary flow, the effect on mortality is not known.
Methods: Patients who had PCI for myocardial infarction (MI) at the Singapore National University Hospital from January 2000 to March 2004 were studied. Our analysis stratified patients into three groups according to the occurrence and persistence of no reflow during PCI. (1) Adequate reflow: without no reflow occurrence; (2) Reversible no reflow: no reflow occurred, but final thrombolysis in myocardial infarction (TIMI) 3 flow restored after intracoronary medications; and (3) Refractory no reflow: no reflow occurred and persisted, final TIMI flow < 3 despite medications. Thirty‐day mortality was determined for each group.
Results: A total of 1,328 patients (82% male), 703 (53%) underwent primary PCI and 625 (47%) rescue PCI were analyzed. Among the study patients, no reflow (including reversible and refractory) occurred in 135 patients (10.2%). Intracoronary verapamil, adenosine, nitroprusside, or a combination of drugs were used to treat the no reflow in 70.0%, 17.7%, 3.5%, and 8.8% of cases, respectively. Intracoronary medications successfully restored final TIMI 3 in 108 patients (80%, reversible no reflow). The remaining 27 patients (20%) have final TIMI < 3 (refractory no reflow). In comparison with the adequate reflow and reversible no reflow groups, those with refractory no reflow had an increased 30‐day mortality (3.7% vs 2.8% vs 32.0%, P < 0.001). Logistic regression analyses showed that patients with refractory no reflow had a significantly higher 30‐day mortality compared to patients with adequate reflow (P < 0.001) and reversible no reflow (P = 0.001), but no significant differences in the 30‐day mortality between patients with adequate reflow and reversible no reflow (P = 0.157) were detected after adjusting for relevant covariates.
Conclusion: Among patients undergoing PCI for MI, reversible no reflow was associated with a significantly lower 30‐day mortality compared with the refractory counterpart.
Transcatheter Device Closure of Interatrial Septal Defects in Patients with Hypoxia
Authors: ILKHANOFF LEONARD , NAIDU SRIHARI S. , ROHATGI SAMEER , ROSS MITCHELL J. , SILVESTRY FRANK E. , HERRMANN HOWARD C. 
Published: August 2005

Background: There has been growing interest in transcatheter closure of interatrial septal defects (IASDs) for a variety of indications, but reports are limited in patients with hypoxia from right‐to‐left shunting.
Methods: Between August 2000 and October 2004, 181 patients were referred to our institution for elective closure of a patent foramen ovale (PFO) or atrial septal defect (ASD). Among these patients, 10 (5.5%) underwent closure for hypoxia due to persistent or intermittent right‐to‐left shunting. Clinical evaluation, including echocardiography with color Doppler and agitated saline, was performed in all patients to determine the degree of right‐to‐left shunting. Defects were closed with Amplatzer (n = 4) or Cardioseal (n = 6) devices, under transesophageal (TEE) or intracardiac echocardiography (ICE) guidance.
Results: Mean age was 62.7 years (range: 31–88 years) with 70% female. Characteristics for closure included four patients with persistent hypoxia and six with intermittent hypoxia, including two with platypnea‐orthodeoxia syndrome. All patients had echocardiography showing moderate (n = 6) or severe (n = 4) shunting. Patients had significant comorbidities, including chronic lung disease requiring supplemental oxygen (n = 5) and congestive heart failure (n = 2). TEE guidance was used in three patients, and ICE was performed in the remainder. Mean closure device diameter was 27 mm. Mean preprocedural arterial oxygen saturation of 86.7% improved to 95.9% immediately after closure, with color Doppler and agitated saline revealing the absence of (n = 5) or mild (n = 5) shunting. In‐hospital major complications were limited to one patient with a transient ischemic attack after an initially unsuccessful closure attempt.
Conclusions: Percutaneous closure of IASDs in a heterogeneous group of patients with hypoxia can be safely and effectively performed. The procedure results in immediate arterial saturation improvement and reduced right‐to‐left shunting.
Comparison of the X‐SIZER Thrombectomy Device with Adjunct Abciximab During Primary Angioplasty and Stenting for ST‐Segment Elevation Myocardial Infarction
Authors: LOW ADRIAN F. , LIM YEAN‐TENG , TEO SWEE‐GUAN , BUDIONO BAMBANG , SUTANDAR ANTONO , TAN HUAY‐CHEEM 
Published: August 2005

Objective: To evaluate the safety and efficacy of the X‐SIZER thrombectomy device versus the use of abciximab during primary angioplasty for acute ST‐elevation myocardial infarction (STEMI).
Design: Retrospective analysis of patients undergoing primary angioplasty for STEMI from October 2000 to December 2002 using the X‐SIZER thrombectomy device versus abciximab.
Setting: National University Hospital, Singapore.
Patients: Out of 79 patients, 44 underwent X‐SIZER use, while 35 received adjunct abciximab. Both groups were similarly represented with regards to age, gender, risk factors, target vessel site/diameter, cardiogenic shock, and onset of chest pain to procedure time. The infarct‐related artery was occluded in 88.6% in both groups.
Interventions: A 2‐mm X‐SIZER was used in 34/44 (77.3%), while a 1.5‐mm device was used in the remainder. Final TIMI 3 flow was obtained in 38/44 (86.4%) in the X‐SIZER group compared to 26/35 (74.3%) in the abciximab group (P = 0.175).
Main Outcome Measures: Coronary TIMI flow rate, electrocardiogram (ECG) resolution, slow flow/no reflow phenomenon, and patient outcome (death, cardiac failure, or repeat revascularization) at 1 month.
Results: ECG resolution and slow flow/no reflow were better in the X‐SIZER group (77.3% vs 54.3%, P = 0.031; 9.1% vs 25.7%, P = 0.047, respectively). Patient outcome at 1 month was, however, not significantly different (18.2% vs 17.1%, P = 0.904, respectively, for X‐SIZER and abciximab).
Conclusion: X‐SIZER thrombectomy during primary percutaneous coronary intervention for thrombus‐laden STEMI is a safe and effective strategy. When compared to patients receiving abciximab, it was associated with improved ECG resolution, less slow flow/no reflow and a trend to better TIMI 3 flow.
The Impact of Age in the Immediate and Long‐Term Outcomes of Percutaneous Mitral Balloon Valvuloplasty
Authors: SANCHEZ PEDRO L. , RODRIGUEZ‐ALEMPARTE MAXIMO , INGLESSIS IGNACIO , PALACIOS IGOR F. 
Published: August 2005

Background: Differences in age, clinical characteristics, and valve morphology may account for controversial results of percutaneous mitral balloon valvuloplasty (PMV).
Methods: We have previously reported the immediate and long‐term clinical follow‐up (50 ± 45 months) of 879 patients who underwent PMV at the Massachusetts General Hospital. In the present study, we used this database to determine the impact of age in the immediate and long‐term outcome of PMV. For purpose of analysis, these patients were divided into four age groups: group 1 (≤35 years), group 2 (36–55 years), group 3 (56–75 years), and group 4 (>75 years).
Results: The incidence of atrial fibrillation, calcified valves under fluoroscopy, higher echocardiographic score, New York Heart Association (NYHA) class IV and pre‐PMV mitral regurgitation (MR) increased with patient's age. As patients became older, a lower post‐PMV mitral valve area (2.1 ± 0.7, 2.0 ± 0.6, 1.8 ± 0.6, and 1.6 ± 0.6; P < 0.0001) and progressive decrease in procedural success (81.4%, 80.5%, 65.3%, and 53%; P < 0.0001) were observed. Younger age was identified as an independent predictor of PMV success by multiple stepwise logistic regression (odds ratio [OR]: 3.33; confidence interval [CI]: 1.41–7.69, P = 0.006). Furthermore, age was identified as an independent predictor of long‐term events by Cox regression analysis (risk ratio [RR]: 1.02; CI: 1.01–1.03, P < 0.00001). However, the effect of age seemed to be blunted by the morphology of the valve at follow‐up, as patients with echocardiogram score >8 in groups 2, 3, and 4 presented similar combined event‐free survival (death, mitral valve replacement, or redo PMV).
Conclusion: Age is an important predictor of immediate and long‐term outcomes after PMV, particularly in patients with optimal mitral valve morphology.
Left Ventricular Remodeling and Systolic Deterioration in Acute Myocardial Infarction: Findings from the Stent‐PAMI Study
Authors: MATTICHAK STEPHEN J. , HARJAI KISHORE J. , DUTCHER JACOB R. , BOURA JUDITH A. , STONE GREGG , COX DAVID , BRODIE BRUCE R. , O'NEILL WILLIAM W. , GRINES CINDY L. 
Published: August 2005

Background: Left ventricular systolic deterioration (LVSD) develops in some patients despite successful percutaneous intervention and medical therapy for myocardial infarction (MI). We sought to determine predictors of LVSD by comparing demographic, procedural, angiographic variables, and 6‐month major adverse cardiac events (MACE) in patients with and without LVSD after MI.
Methods: We performed a posthoc analysis of patients prospectively enrolled in the Stent‐PAMI trial if they had successful percutaneous intervention for MI (<50% residual stenosis and TIMI‐3 grade flow), normal left ventricular systolic function on index ventriculogram, and protocol driven coronary angiography with ventriculography at 6 months. We defined LVSD as an absolute decrease in ejection fraction ≥15% compared to baseline value.
Results: Of the 900 patients enrolled in Stent‐PAMI, 187 patients met the inclusion criteria. LVSD developed in 30 patients (16%) and occurred independent of demographic, procedural, angiographic variables, and 6‐month MACE. Multivariate predictors of LVSD were higher baseline ejection fraction (P = 0.0065, OR 1.09; 95% CI = 1.02–1.16) and peak creatine phosphokinase (CPK) level (P = 0.0022, OR 1.04; 95% CI = 1.02–1.07).
Conclusions: LVSD occurs in a minority of patients despite successful mechanical reperfusion and occurred independent of procedural, angiographic variables, target vessel revascularization, reinfarction, and combined MACE. Infarct size (determined by peak CPK) and high baseline ejection fraction predicted development of LVSD at 6 months. LVSD in this population likely occurred by negative left ventricular remodeling.
Clomiphene Citrate Effects on Testosterone/Estrogen Ratio in Male Hypogonadism
Authors: Shabsigh Ahmad , Kang Young , Shabsign Ridwan , Gonzalez Mark , Liberson Gary , Fisch Harry , Goluboff Erik 
Published: August 2005

ABSTRACT

Aim
Symptomatic late–onset hypogonadism is associated not only with a decline in serum testosterone, but also with a rise in serum estradiol. These endocrine changes negatively affect libido, sexual function, mood, behavior, lean body mass, and bone density. Currently, the most common treatment is exogenous testostosterone therapy. This treatment can be associated with skin irritation, gynecomastia, nipple tenderness, testicular atrophy, and decline in sperm counts. In this study we investigated the efficacy of clomiphene citrate in the treatment of hypogonadism with the objectives of raising endogenous serum testosterone (T) and improving the testosterone/estrogen (T/E) ratio.

Methods
Our cohort consisted of 36 Caucasian men with hypogonadism defined as serum testosterone level less than 300 ng/dL. Each patient was treated with a daily dose of 25 mg clomiphene citrate and followed prospectively. Analysis of baseline and follow–up serum levels of testosterone and estradiol levels were performed.

Results
The mean age was 39 years, and the mean pretreatment testosterone and estrogen levels were 247.6 ± 39.8 ng/dL and 32.3 ± 10.9, respectively. By the first follow–up visit (4–6 weeks), the mean testosterone level rose to 610.0 ± 178.6 ng/dL (P &lt; 0.00001). Moreover, the T/E ratio improved from 8.7 to 14.2 (P &lt; 0.001). There were no side effects reported by the patients.

Conclusions
Low dose clomiphene citrate is effective in elevating serum testosterone levels and improving the testosterone/estadiol ratio in men with hypogonadism. This therapy represents an alternative to testosterone therapy by stimulating the endogenous androgen production pathway.
Development of a New Geometric Bicycle Saddle for the Maintenance of Genital–Perineal Vascular Perfusion
Authors: Breda G. , Piazza N. , Bernardi V. , Lunardon E. , Caruso Adara 
Published: August 2005

ABSTRACT

Objective
To identify a bicycle saddle model for cyclists who cover long distances, to minimally reduce the compression on the structures of the pelvic floor, thereby protecting blood perfusion of the penis and avoiding possible consequences on penile erection.

Materials and Methods
A comparison between a new geometric development of a bicycle saddle model (SMP) and one of the more frequently used models by professional cyclists was made. The measurement of the partial pressure of penile transcutaneous oxygen (PtcO2) in 29 healthy voluntary cyclists was recorded to investigate the differences of compression from two different saddles on the vascular structures of the perineum. The PtcO2 was recorded at 3 and 10 minutes in conditions of static sitting. Then, the values of PtcO2 were recorded for 15 minutes while the cyclists were in a 60–degree position and in stable hemodynamic conditions.

Results
A t–test was performed to measure the level of confidence. The clear superiority of the SMP saddle in preventing vascular compression of the perineal structures was demonstrated to be statistically significant.

Conclusion
The experiment validated the effectiveness of the SMP saddle in limiting the compression on the pelvic floor. In addition, the SMP saddle introduces compatible seat dimensions that cyclists prefer to cover long distances.
Only the Nose Knows: Penile Hemodynamic Study of the Perineum–Saddle Interface in Men with Erectile Dysfunction Utilizing Bicycle Saddles and Seats with and Without Nose Extensions
Authors: Munarriz Ricardo , Huang Vincent , Uberoi Jayant , Maitland Scott , Payton Terry , Goldstein Irwin 
Published: August 2005

ABSTRACT

Purpose
To investigate the differential impact of straddles (Ans and Bns) and noseless two–cheek seats (Antcs and Bntcs) on penile hemodynamics and perineal compressive forces in subjects who cycle in a stationary bicycle.

Materials and Methods
Subjects underwent cavernosal artery peak systolic velocity (CAPSV) measurements after intracavernosal injection of vasoactive agents while supine, sitting upright on an examination table, straddling a saddle, sitting on a seat, and again supine. Mean perineal compression pressures recorded while straddling the saddles were compared with those while sitting upright.

Results
No differences were found in right and left CAPSV values while supine, sitting upright on an examination table, sitting on a seat, and supine again. Right/left CAPSV (cm/second) values straddling Ans and saddle Bns (0.7 ± 2.9/1.5 ± 6.2 and 0/0, respectively) were significantly lower than values obtained while sitting on Antcs and Bntcs (25.6 ± 13.4/23.8 ± 12.0 and 17.3 ± 6.4/18.3 ± 6.5, respectively) (P &lt; 0.001). Mean perineal compression pressures (mm Hg) on Ans and saddle Bns (315.2 ± 39 and 387.9 ± 64.3, respectively) were significantly higher than values obtained while sitting upright on an examination table (47.6 ± 5.2 and 46.0 ± 8.1, respectively) (P &lt; 0.001).

Conclusions
We have identified an objective test to assess if an individual bicycle rider, sitting on a certain shape of bicycle saddle or seat generates sufficient compressive forces at the perineal–saddle interface to obstruct cavernosal arterial inflow. This study also demonstrated that straddling bicycle saddles with nose extensions is associated with perineum–saddle interface compressive pressures that exceed systolic perfusion pressures, significantly diminishing penile hemodynamics.