bluuebunny/crossref_metadata_2025_split huggingface dataset:
The economic impact of irritable bowel syndrome
Authors: Inadomi J. M. , Fennerty M. B. , Bjorkman D. 
Published: September 2003

SummaryBackground: Although little mortality is associated with irritable bowel syndrome, curative therapy does not exist and thus the economic impact of this disorder may be considerable.Methods: A systematic review of the literature was performed. Studies were included if their focus was irritable bowel syndrome, and direct and/or productivity (indirect) costs were reported. Two investigators abstracted the data independently.Results: One hundred and seventy‐four studies were retrieved by the search; 11 fulfilled all criteria for entry into the review. The mean direct costs of irritable bowel syndrome management were reported to be UK£90, Canadian$259 and US$619 per patient annually, with total annual direct costs related to irritable bowel syndrome of £45.6 million (UK) and $1.35 billion (USA). Direct resource consumption of all health care for irritable bowel syndrome patients ranged from US$742 to US$3166. Productivity costs ranged from US$335 to US$748, with total annual costs of $205 million estimated in the USA. Annual expenditure for all health care, in addition to expenditure limited to gastrointestinal disorders, was significantly higher in irritable bowel syndrome patients than in control populations.Conclusions: Despite the lack of significant mortality, irritable bowel syndrome is associated with high direct and productivity costs. Irritable bowel syndrome patients consume more gastrointestinal‐related and more total health care resources than non‐irritable bowel syndrome controls, and sustain significantly greater productivity losses.
Central venous catheter‐related thrombosis presenting as superior vena cava syndrome in a haemophilic patient with inhibitors
Authors: Carcao M. D. , Connolly B. L. , Chait P. , Stain A. M. , Acebes M. , Massicotte P. , Blanchette V. S. 
Published: September 2003

Summary.  We report the case of a 10.5‐year‐old boy with severe haemophilia A (SHA) and inhibitors who presented with superior vena cava (SVC) obstruction while on immune tolerance induction (ITI) with daily recombinant factor VIII (rFVIII) and factor eight bypassing activity (FEIBA) (75 U kg−1) twice a week. The boy had a right‐sided implanted central venous catheter. Imaging revealed a large occlusive thrombus in the SVC with all upper venous system drainage occurring through the azygos and collateral veins. Despite initial success with local thrombolytic therapy using recombinant tissue plasminogen activator, the thrombus persisted. Mechanical thrombolysis and angioplasty resulted in the successful removal of the thrombus and resolution of the SVC syndrome. Unfractionated heparin was used to prevent thrombus reformation/propagation. A work‐up did not reveal any underlying genetic prothrombotic risk factors.The occurrence of such a profoundly symptomatic thromboembolism (TE) in a boy with SHA with inhibitors is unusual. A combination of risk factors, including the ongoing infusion of high doses of FVIII in the context of a disappearance of inhibitors together with the infusion of clotting factors known to be potentially thrombogenic, may place haemophilic patients on ITI (immune tolerance induction) at risk for this rare, life‐threatening complication. The appropriate management of TEs in such a setting is unknown.
Surveillance of infectious complications associated with central venous access devices in children with haemophilia
Authors: Tarantino M. D. , Lail A. , Donfield S. M. , Lynn H. , Peddle L. , Hunsberger S. , Shapiro A. D. 
Published: September 2003

Summary.Purpose : To analyse the risk factors for infection associated with central venous access device (CVAD) use in children with haemophilia.Methods : Risk factors for CVAD infection among patients with congenital haemophilia who had had a CVAD implanted at a single institution were evaluated utilizing the following variables: age at CVAD placement, age at end of study, number of days with a CVAD, percentage of lifetime with a CVAD, and history of inhibitor.Results : Fifty‐nine patients had a total of 97 936 (median 1768 days per patient) CVAD days in the study period. The median age at CVAD placement was 2.7 years (range 0–14.0). Twenty‐six (44%) patients reported CVAD infections during the study period from January 1993 to October 2000. Twenty‐four patients had their CVAD replaced, 17 (71%) of whom reported having infections and seven (29%) of whom had a history of inhibitor. The strongest predictor for having any infections was inhibitor status (P = 0.16), although none of the risk factors had statistically significant effects.Among the 26 patients reporting infections, 42% had more than one CVAD‐related infection. Seven patients had multiple infections involving the same organism. The mean rate of infection was 0.45 per 1000 catheter days, with a 95% confidence interval of 0.33–0.60. Those with a history of inhibitor had an infection rate of 0.66 compared with 0.38 per 1000 catheter days (P = 0.09) for those without a history of inhibitor. Patients who were older (greater than the median age of 2.7) at CVAD placement had a lower rate of infection (0.29 vs. 0.65, P < 0.01) compared with those ≤2.7 years. Adjustment for inhibitor status had little impact on these results.For the group as a whole, the median time to first infection was 1977 days from CVAD placement. Patients who were older at CVAD placement or study exit had lower relative hazards of infection (P = 0.05 and P = 0.09 respectively), while those who had inhibitors had a higher but not statistically significant relative hazard of 1.88 (P = 0.13).Conclusions : These data reveal that while considerable numbers of patients develop CVAD‐related infection, the interval between catheter placement and infection can be quite long. In addition, the earlier in life a CVAD is placed, the higher the risk of infectious complications, as evidenced by the tendency towards a higher infection rate. Measures to prevent CVAD‐related infection might be focused on very young patients who appear to be at higher risk.
Type I coagulation factor V deficiency caused by compound heterozygous mutation of F5 gene
Authors: Fu Q. , Wu W. , Ding Q. , Hu Y. , Wang X. , Wang H. , Wang Z. 
Published: September 2003

Summary.A 16‐year‐old Chinese female with prolonged bleeding after surgery has been studied. Routine clotting tests revealed a prolonged activated partial thromboplastin time (APTT; 126.6 s) and prothrombin time (PT; 42.8 s). The coagulation factors activities were normal except for factor V, which was only 0.3% of normal. DNA analysis of the FV gene revealed five nucleotide substitutions in exons, including two silent mutations (G327A and A5112G), one polymorphism (G1628A), a G1348T missense mutation and 4887∼8delG. These abnormalities were associated with her FV deficiency, perhaps by causing a Gly392Cys substitution in FV amino acid sequence or by introducing a premature stop codon at amino acid position 1390. This is the third case in which FV deficiency is caused by compound heterozygous mutation of F5 gene, and is the first report from a Chinese family.
Transjugular liver biopsy is safe and diagnostic for patients with congenital bleeding disorders and hepatitis C infection
Authors: DiMichele D. M. , Mirani G. , Wilfredo Canchis P. , Trost D. W. , Talal A. H. 
Published: September 2003

Summary.  The prevalence of chronic hepatitis C virus (HCV) infection among patients with severe congenital bleeding disorders is as high as 98%. Advances in HCV treatment currently result in sustained virological response rates of ≥50%. Recent recommendations have reaffirmed that liver biopsy, which provides a direct histological assessment of liver inflammation and fibrosis, is still important for accurate diagnosis and therapeutic decision making. Percutaneous liver biopsy is a simple, standardized procedure that can be performed rapidly and relatively inexpensively, and has been safely performed in patients with congenital coagulopathies. However, the safety and efficacy of the transjugular approach (transjugular liver biopsy, TJLB), recommended for patients with acquired coagulopathies, has only been minimally studied in the congenital bleeding diathesis population.We now report our institutional experience with TJLB in 13 such adult patients (mean age 33 years) with severe/mild haemophilia A/B (10); von Willebrand disease (1); factor V deficiency (1) and factor XIII deficiency (1). Data were collected by retrospective chart review and the TJLB was performed according to institutional protocol as described. Haemostasis prophylaxis was given for 1–5 days. Patients were hospitalized for ≤48 h and all tolerated the procedure without bleeding. Three patients experienced self‐limited abdominal discomfort; one episode was accompanied by transient transaminaemia. Diagnostic specimens were obtained from all patients and were instrumental in the therapeutic decision‐making process. We suggest that with a co‐ordinated multidisciplinary approach to care, TJLB is a safe, effective and potentially cost‐effective alternative to the percutaneous approach in the congenital bleeding disorders population.
Impact of inhibitor epitope profile on the neutralizing effect against plasma‐derived and recombinant factor VIII concentrates in vitro
Authors: Astermark J. , Voorberg J. , Lenk H. , DiMichele D. , Shapiro A. , Tjönnfjord G. , Berntorp E. 
Published: September 2003

Summary.  The inhibitory capacity of plasma samples from 24 patients with severe haemophilia A and high‐responding inhibitors were evaluated in a concentrate‐based assay using two plasma‐derived (Haemate and Monoclate‐P) and three recombinant (Helixate, Recombinate and ReFacto) factor VIII concentrates and correlated with the corresponding epitope profile. In most, but not all, inhibitor plasmas with a relatively low reactivity against the von Willebrand‐containing product Haemate, the main epitopes were located in the FVIII light chain. The reactivities within the group of recombinant products varied in that the reactivity against the B‐domain deleted ReFacto was in general higher than that against Recombinate and Helixate. This difference did not correlate with any particular epitope profile and indicates that the B‐domain, type of formulation and/or purification procedures may have an impact on the inhibitor reactivity in vitro. The ratio between the inhibitor titres in the concentrate‐based assay and the Bethesda assay was dependent on the inhibitor plasma and concentrate used. Taken together, our results show that the reactivity of inhibitor plasmas varies considerably between different FVIII concentrates and that it does not fully correlate with the epitope profile. Potential clinical implications of the observed differences in inhibitor reactivity are discussed.
Comparison of papilla healing following sulcular full‐thickness flap and papilla base flap in endodontic surgery
Authors: Velvart P. , Ebner‐Zimmermann U. , Ebner J. P. 
Published: September 2003

AbstractAim  To compare the loss of papilla height when using the papilla base incision (PBI) or the standard papilla mobilization incision in marginal full‐thickness flap in cases with no evidence of marginal periodontitis.Methodology  Twelve healthy patients referred for surgical treatment of persisting apical periodontitis, who were free from periodontal disease and had intact interdental papillae, were included in the study. The preoperative papilla height was recorded by measuring the distance between a reproducible coronal point on the tooth and the most coronal point of the papilla. The flap design consisted of two releasing incisions connected by a horizontal incision. The marginal incision involved the complete mobilization of the entire papilla in one interproximal space, and the PBI in the other interproximal space. The PBI consisted of a shallow first incision at the base of the papilla and a second incision directed to the crestal bone creating a split thickness flap in the area of the papilla base. Further, apically, a full‐thickness flap was raised. In the other interproximal space, the buccal papilla was carefully incised and elevated completely. Following flap retraction, standard root‐end resection and root‐end filling were performed. Flap closure was achieved with microsurgical sutures. The PBI was sutured with two to three interrupted sutures (size 7/0) and the elevated papilla was reapproximated with vertical mattress sutures, which were removed 3–5 days after the surgery. The height of the interdental papilla was evaluated preoperatively and postoperatively after 1 month and at the 3‐month recall, using plaster replicas. The loss of papilla height was measured using a laser scanner. Twelve papilla‐paired sites were evaluated. The results were statistically analysed using the t‐test.Results  Complete closure of the wound was achieved in all treated sites followed by uneventful healing in all patients. The total mobilization of the papilla resulted in loss of papilla height of 1.10 ± 0.71 mm at 1 month and 1.25 ± 0.81 mm at the 3‐month recall. At the 3‐month recall, the retraction had increased in nine sites, whereas in three sites, the loss of height had slightly diminished compared to 1 month. In contrast, after the PBI, only minor changes could be detected: 0.07 ± 0.09 mm at 1 month and 0.10 ± 0.15 mm at 3 months. There was a significant difference between the two incision techniques studied (P < 0.007).Conclusions  In patients with healthy marginal periodontal conditions, the PBI allows rapid and predictable recession‐free healing, whereas complete mobilization of the papilla led to a marked loss of the papilla height. In aesthetically relevant areas, the use of the PBI is recommended, to avoid opening of the interproximal space, when periradicular surgical treatment is necessary.
Root canal treatment of three‐rooted maxillary first and second premolars – a case report
Authors: Soares J. A. , Leonardo R. T. 
Published: September 2003

AbstractAim  To report the diagnosis and successful clinical management of a patient with anatomical variation in maxillary first and second premolars.Summary  Maxillary premolars have a highly variable root canal morphology, but it is rare, especially in the second premolar, to find three canals. This article describes the diagnosis and clinical management of first and second premolars with three canals and three separate roots, drawing particular attention to radiographic interpretation and access refinements.Key learning points

Clinicians should be aware of anatomical variations in maxillary premolars and be able to apply this knowledge in radiographic and clinical interpretation.
Access cavity refinements may be required for stress‐free entry to complex anatomy.
Complex premolar anatomy may be predictably managed following its identification and negotiation.
Facilitation of iontophoretic drug delivery through intact and caries‐affected dentine
Authors: Puapichartdumrong P. , Ikeda H. , Suda H. 
Published: September 2003

AbstractAim  To investigate the facilitative role of iontophoresis in drug delivery through intact and caries‐affected dentine into the pulp.Methodology  Forty‐eight intact dentine or caries‐affected dentine discs were prepared from freshly extracted human third molars. The hydraulic conductance was measured before and after the experiments. Drug diffusion with and without iontophoresis (0.05 mA, 10 min) was evaluated using a split‐chamber device. The enamel side chamber was filled with metronidazole (MN), sodium salicylate (SS) or naproxen sodium (NA), while the pulpal side was circulated with phosphate buffered saline (PBS) and pressurized (15 cmH2O). Samples were collected after 1 h. Drug concentrations of the pulpal side solution were determined using a spectrophotometer. Then, electrical impedance of each dentine disc was measured. Finally, the dentine disc surfaces were observed by scanning electron microscopy.Results  Drug diffusion was significantly influenced by iontophoresis, caries‐induced changes in dentine and the drugs used (three‐way anova, P < 0.05). The diffusion of all the drugs through caries‐affected dentine was significantly less than that through intact dentine (independent t‐test, P < 0.05). Also, iontophoresis facilitated the diffusion of all the drugs through intact and caries‐affected dentine. The drug diffusion of SS was significantly higher than MN and NA (one‐way anova, P < 0.05), independent of iontophoresis.Conclusions  Presence of dental caries may inhibit drug diffusion through dentine into the pulp. However, iontophoresis could enhance the delivery of ionized drugs through both intact and caries‐affected dentine.
Diagnostic accuracy of endoscopy in periradicular surgery – a comparison with scanning electron microscopy
Authors: Von Arx T. , Montagne D. , Zwinggi C. , Lussi A. 
Published: September 2003

AbstractAim  To compare the accuracy of endoscopic diagnostics with the scanning electron microscope (SEM) in evaluating elements of periradicular surgery.Methodology  The material consisted of 22 extracted human molars, which were subjected to the following treatments: orthograde root‐canal obturation, root‐end resection and root‐end cavity preparation with diamond‐coated sonic microtips. After each step, the cut root face was inspected with an endoscope, and subsequently, the roots were duplicated for SEM evaluation. Endoscope findings were compared to those obtained with SEM serving as the ‘gold standard’ with a blinded observer. The presence of the following structures was assessed including specificity and sensitivity: isthmuses, accessory canals, obturation gaps, microfractures and chipping of cavity margins.Results  The specificity and sensitivity of the identification of isthmuses or accessory canals was 100% each for the endoscope compared to SEM. The sensitivity of identification of obturation gaps, crack formation or chipping ranged between 73 and 95% (except intradentine cracks with only 36% sensitivity). The specificity of the same parameters ranged between 77 and 100% for the endoscope compared to SEM.Conclusions  With the exception of intradentine cracks, the endoscope accurately identified microstructures following root‐end resection and root‐end preparation. The endoscope could be considered for use during intraoperative diagnostics in periradicular surgery.
Measurement of periapical pressure created by occlusal loading
Authors: Dobó‐Nagy C. , Fejérdy P. , Angyal J. , Harasztosi L. , Daróczi L. , Beke D. , Wesselink P. R. 
Published: September 2003

AbstractAim  To develop an in vitro model in which the pressure in the periapical tissues can be measured during loading.Methodology  Extracted human maxillary central incisors were embedded in resin blocks that had physical characteristics similar to those of bone and periodontal ligament. Each tooth was loaded with 20, 40, 50, 60, 75, 85, 100, 200, 300 and 450 N vertical forces from the incisal edge of the crown on three consecutive occasions. A minute resistor embedded in the periapical space was used to detect apical pressure changes during occlusal loading. The ratio of apical pressure changes (ΔP) to the loading force changes (ΔF) was calculated.Results  The periapical pressure detected was in direct proportion to the loading force. The mean value of ΔP/ΔF was 5.994 kPa N−1 (SD = 2.04).Conclusions  Direct proportionality was found between the coronal loading and the apical hydrostatic pressure. The ΔP/ΔF ratio determined in this study makes it easier to estimate the apical hydrostatic pressure values during occlusal loading of single‐rooted teeth. In this study, the apical pressure generated under occlusal loading was the same magnitude as that estimated with the finite element method.
A model of human hunting impacts in multi‐prey communities
Authors: Rowcliffe J. Marcus , Cowlishaw Guy , Long Janice 
Published: September 2003

Summary

The hunting of wild animals for consumption by people currently threatens many species with extinction. In the tropics, where the threat is most acute, hunting frequently targets many prey species simultaneously, yet our understanding of the dynamics of hunting in such multi‐prey systems is limited. This study addressed this issue by modelling the effects of human hunters on prey population dynamics in a multi‐species prey community. Both pursuit hunting (in which offtake depends partly on hunters’ prey preferences) and trap hunting (in which the offtake is determined solely by random processes) were considered as submodels.
The pursuit hunting submodel was validated against studies of subsistence hunting in tropical forests, while the trap hunting submodel was validated against data from five studies of offtake rates by snare hunters in subSaharan Africa. In all cases, observed prey removal rates were predicted well by the model.
Simulations demonstrated the emergence of distinctive prey profiles at different intensities of hunting, related to sequences of overexploitation dependent on species’ vulnerabilities to exploitation.
Synthesis and applications. A model is developed to explore the impacts of harvesting on multi‐species prey communities. Model predictions can be used to aid the interpretation of incomplete monitoring data, such as snapshots of the species taken by hunters. This will improve our ability to assess the sustainability of multi‐species hunting systems using the limited information typically available in these cases.
Predicting the impacts of harvesting using structured population models: the importance of density‐dependence and timing of harvest for a tropical palm tree
Authors: Freckleton R. P. , Matos D. M. Silva , Bovi M. L. A. , Watkinson A. R. 
Published: September 2003

Summary

Structured population models are used in a range of forms to predict the long‐term behaviour of populations of economic or conservation interest. Such models rarely include density‐dependence and do not account explicitly for the ordering of events within a generation.
We analysed a model for the harvesting of adults of the edible palm Euterpe edulis in which the role of density‐dependence had been clearly defined. We modified the timing of harvesting in relation to the point in the life cycle at which populations were censused.
It is shown that the timing, form and intensity of harvesting are all important in determining asymptotic population behaviour. If harvesting affects only those individuals that were recorded as being adults at the start of a year, then the model predicts that all adults may be harvested without population eradication. In contrast, if harvesting also affects individuals moving from the next smaller size class during the course of a year then populations can, under some forms of harvesting, tolerate much lower levels of harvesting.
If density‐dependence is not taken into consideration, predictions of population responses to harvesting may be erroneous. A review of transition matrices for woody plants indicates that many of these may have been derived from populations subject to strong population regulation.
Synthesis and applications. In the specific case of E. edulis our model shows that, although populations appear to be robust to very high levels of harvesting, when modelled as affecting only reproductive adults, this conclusion may be sensitive to varying the timing and form of harvest, and to the assumption that only reproductive individuals are removed. Structure population models used to determine levels of harvesting should account for the existence of density‐dependence as well as its timing.