bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resource utilisation, length of hospital stay, and pattern of investigation during acute medical hospital admission
Authors: McMullan R , Silke B , Bennett K , Callachand S 
Published: February 2004

Abstract

Objectives
To describe the patient demographic characteristics and organisational factors that influence length of stay (LOS) among emergency medical admissions. Also, to describe differences in investigation practice among consultant physicians and to examine the impact of these on LOS.

Design
Prospective observational study.

Setting
General medicine department of a teaching hospital in Belfast, UK.

Participants
Data were recorded for patients who were admitted as emergencies and reviewed on the post-take ward rounds (PTWR) attended by the investigation coordinator.

Outcome measures
Non-laboratory investigations requested, LOS, and diagnosis on discharge.

Results
Of 830 episodes evaluated, the median LOS was 7 days (interquartile range 3–12 days); this was significantly longer for admissions on Fridays (p = 0.0011) and for patients managed on medical wards (p&lt;0.0001). There was a positive correlation between patient age and LOS (r = 0.32, p&lt;0.0001). Chest radiographs (p = 0.002) and echocardiography (p = 0.015) were associated with a prolonged LOS; no investigations were associated with a shortened LOS. Diagnoses of congestive heart failure, respiratory disease, and cancer were associated with a longer LOS; a diagnosis of angina was associated with a shorter LOS. Considerable variation in investigation ordering, but no difference in LOS, was observed between consultants. High use of a given medical test did not correlate with high use of other tests.

Conclusion
A systematic means of dealing with the NHS resource crisis should include an improved organisational strategy as well as social care provision. A more unified approach to investigation practice should also have a sparing effect on resources.
Attitudes of preclinical medical students towards caring for chronically ill and dying patients: does palliative care teaching make a difference?
Authors: Lloyd-Williams M , Dogra N 
Published: February 2004

Abstract

Introduction
Students entering medical school today will encounter an ageing population and a higher incidence of diseases affecting the elderly—for example, chronic respiratory and cardiac disease and malignancy.

Purpose
This study was carried out to determine the attitudes of preclinical medical students towards the care of patients for whom a cure is not possible.

Methods
All students were invited to complete a 23 item questionnaire prior to initial teaching and again following the second teaching session in palliative care.

Results
Overall, 149 of the 186 students (80%) completed the pre-teaching questionnaire (59 males and 90 females; median age 20 years, range 19–27 years), and 66 students (35%) completed the post-teaching questionnaire. Attitudes towards chronically ill and dying patients were generally positive. It was found that increasing age was associated with a more positive view of caring for patients with chronic or terminal illness, a more positive view of listening to patients reminisce, and a more positive view of patients dying at home (p = 0.014). The only notable result was that after palliative care teaching students had a significantly more positive view of hospices.

Conclusion
Caring for patients at the end of life can be one of the most rewarding aspects of being a doctor. This study suggests that the majority of medical students have a positive attitude towards patients with chronic incurable illness, and the trend for encouraging older students to enter medicine may be an influencing factor.
Intravenous therapy
Authors: Waitt C , Waitt P , Pirmohamed M 
Published: February 2004

Abstract
Intravenous administration of fluids, drugs, and nutrition is very common in hospitals. Although insertion of peripheral and central cannulae and subsequent intravenous therapy are usually well tolerated, complications that prolong hospitalisation, and in some cases cause death, can arise on occasions. Additionally, many cannulae are inserted unnecessarily. This article seeks to review this area and to outline good medical practice.
The Worshipful Society of Apothecaries of London
Authors: Hunting P 
Published: February 2004

Abstract
The Society of Apothecaries is both a City livery company and an examining authority for the medical profession. Founded in 1617 by the royal apothecary Gideon de Laune leading a breakaway group from the Grocers’ Company, the Society was instrumental in raising the status of apothecaries as general practitioners. Under the Apothecaries’ Act (1815) the Society examined for the LSA and it now awards the LMSSA (Licence in Medicine and Surgery of the Society of Apothecaries) and postgraduate diplomas, while maintaining the civic, charitable, and ceremonial traditions of a livery company of the City of London.
Evidence for a Role of Macrophage Migration Inhibitory Factor in Vascular Disease
Authors: Chen Zhiping , Sakuma Masashi , Zago Alexandre C. , Zhang Xiaobin , Shi Can , Leng Lin , Mizue Yuka , Bucala Richard , Simon Daniel I. 
Published: February 2004

Objective—Inflammation plays an essential role in atherosclerosis and restenosis. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine that is widely expressed in vascular cells. However, there is no in vivo evidence that MIF participates directly in vascular injury and repair. Therefore, we investigated the effect of MIF blockade on the response to experimental angioplasty in atherosclerosis-susceptible mice.Methods and Results—Carotid artery dilation (2.5 atm) and complete endothelial denudation were performed in male C57BL/6J LDL receptor-deficient mice treated with a neutralizing anti-MIF or isotype control monoclonal antibody. After 7 days and 28 days, intimal and medial sizes were measured and intima/media area ratio (I/M) was calculated. Intimal thickening and I/M were reduced significantly by anti-MIF compared with control antibody. Vascular injury was accompanied by progressive vessel enlargement or “positive remodeling” that was comparable in both treatment groups. MIF blockade was associated with reduced inflammation and cellular proliferation and increased apoptosis after injury.Conclusion—Neutralizing MIF bioactivity after experimental angioplasty in atherosclerosis-susceptible mice reduces vascular inflammation, cellular proliferation, and neointimal thickening. Although the molecular mechanisms responsible for these effects are not yet established, these data prompt further research directed at understanding the role of MIF in vascular disease and suggest novel therapeutic interventions for preventing atherosclerosis and restenosis.
The small oligomerization domain of gephyrin converts MLL to an oncogene
Authors: Eguchi Mariko , Eguchi-Ishimae Minenori , Greaves Mel 
Published: February 2004

AbstractThe MLL (mixed lineage leukemia) gene forms chimeric fusions with a diverse set of partner genes as a consequence of chromosome translocations in leukemia. In several fusion partners, a transcriptional activation domain appears to be essential for conferring leukemogenic capacity on MLL protein. Other fusion partners, however, lack such domains. Here we show that gephyrin (GPHN), a neuronal receptor assembly protein and rare fusion partner of MLL in leukemia, has the capacity as an MLL-GPHN chimera to transform hematopoietic progenitors, despite lack of transcriptional activity. A small 15–amino acid tubulin-binding domain of GPHN is necessary and sufficient for this activity in vitro and in vivo. This domain also confers oligomerization capacity on MLL protein, suggesting that such activity may contribute critically to leukemogenesis. The transduction of MLL-GPHN into hematopoietic progenitor cells caused myeloid and lymphoid lineage leukemias in mice, suggesting that MLL-GPHN can target multipotent progenitor cells. Our results, and other recent data, provide a mechanism for oncogenic conversion of MLL by fusion partners encoding cytoplasmic proteins.
Acute Regulation of Translation Initiation by Gonadotropin-Releasing Hormone in the Gonadotrope Cell Line LβT2
Authors: Nguyen Kathryn A. , Santos Sharon J. , Kreidel Marit K. , Diaz Alejandro L. , Rey Rodolfo , Lawson Mark A. 
Published: February 2004

AbstractThe hypothalamic neuropeptide hormone GnRH is the central regulator of reproductive function. GnRH stimulates the synthesis and release of the gonadotropins LH and FSH by the gonadotropes of the anterior pituitary through activation of the G-protein-coupled GnRH receptor. In this study, we investigated the role of translational control of hormone synthesis by the GnRH receptor in the novel gonadotrope cell line LβT2. Using immunohistochemical and RIA studies with this model, we show that acute GnRH-induced synthesis and secretion of LH are dependent upon new protein synthesis but not new mRNA synthesis. We examined the response to GnRH and found that activation of cap-dependent translation occurs within 4 h. LHβ promoter activity was also examined, and we found no increases in LHβ promoter activity after 6 h of GnRH stimulation. Additionally, we show that increased phosphorylation of translation initiation proteins, 4E-binding protein 1, eukaryotic initiation factor 4E, and eukaryotic initiation factor 4G, occur in a dose- and time-dependent manner in response to GnRH stimulation. Quantitative luminescent image analysis of Western blots shows that 10 nm GnRH is sufficient to cause a maximal increase in factor phosphorylation, and maximal responses occur within 30 min of stimulation. Further, we demonstrate that the MAPK kinase inhibitor, PD 98059, abolishes the GnRH-mediated stimulation of a cap-dependent translation reporter. More specifically, we demonstrate that PD 98059 abolishes the GnRH-mediated stimulation of a downstream target of the ERK pathway, MAPK-interacting kinase. Based on these findings, we conclude that acute GnRH stimulation of LβT2 cells increases translation initiation through ERK signaling. This may contribute to the acute increases in LHβ subunit production.
Immuno-PCR for Detection of Antigen to Angiostrongylus cantonensis Circulating Fifth-Stage Worms
Authors: Chye Soi-Moi , Lin Shiu-Ru , Chen Ya-Lei , Chung Lee-Yi , Yen Chuan-Min 
Published: February 2004

Abstract
Background: Definitive diagnosis of infestation with Angiostrongylus cantonensis is difficult because the parasitic nematode is undetectable in the cerebrospinal fluid (CSF) of one-half of afflicted patients and the diagnostic sensitivity of ELISA for circulating worm antigens in patient sera is low. We studied immuno-PCR as a diagnostic tool.
Methods: We studied 30 controls and 60 afflicted patients (30 confirmed by parasitologic analysis of CSF). We used a monoclonal antibody to capture circulating A. cantonensis antigens in serum samples. A DNA label generated by PCR amplification with biotinylated primer was bound by use of streptavidin to a biotinylated third antibody. Circulating antigens sandwiched by monoclonal antibody were detected by PCR amplification of the DNA label.
Results: The detection limit of the ELISA was 100–1000 times higher than that of the immuno-PCR. The concentrations of circulating antigens in patients were markedly higher than those in controls (Wilcoxon rank-sum test, P &lt;0.001). At a cutoff of 0.1 ng/L, sensitivity and specificity for immunodiagnosis of patients with angiostrongyliasis by immuno-PCR were 98% (95% confidence interval, 91–99%) and 100% (93–100%), respectively. The test was positive in all parasitologically confirmed cases.
Conclusions: Immuno-PCR is a promising technique for diagnosis of A. cantonensis infestation.
[13C]Nandrolone Excretion in Trained Athletes: Interindividual Variability in Metabolism
Authors: Baume Norbert , Avois Lidia , Schweizer Carine , Cardis Christine , Dvorak Jiri , Cauderay Michel , Mangin Patrice , Saugy Martial 
Published: February 2004

AbstractBackground: Nandrolone is one of the most abused anabolic steroids, and its use in doping is increasing, as revealed by numerous positive cases during recent years in various sports. Different authors have reported the possible natural production of nandrolone metabolites in humans, and some of these authors argued that exhaustive exercise could increase nandrolone production in the body or induce dehydration and consequently lead to an increase of nandrolone metabolites in urine.Methods: Volunteers (n = 22) ingested two 25-mg doses of [13C]nandrolone at 24-h intervals and collected urine specimens for 5 days. The labeled nandrolone metabolites 19-norandrosterone and 19-noretiocholanolone were identified and quantified by gas chromatography–mass spectrometry.Results: Interindividual variability was observed in nandrolone excretion patterns and kinetics, as well as for the noretiocholanolone:norandrosterone ratio. The amounts of nandrolone metabolites measured at the excretion peak varied between 1180 and 38 661 μg/L for norandrosterone and 576 and 12 328 μg/L for noretiocholanolone. At the end of the excretion period, the noretiocholanolone:norandrosterone ratio was sometimes &gt;1. The analysis of numerous spot-urine samples allowed the determination of an acceptable correlation between urinary creatinine and specific gravity for placebo- and steroid-treated individuals: y = 0.0052ln(x) + 1.0178 (r2 = 0.8142) and y = 0.0068ln(x) + 1.0172 (r2 = 0.7730), respectively.Conclusions: The excretion kinetics and patterns of labeled nandrolone show interindividual variability. More investigations are currently underway to estimate the influence of exhaustive exercises on excretion of labeled nandrolone metabolites in urine.
Immunoassay of Estradiol: Unanticipated Suppression by Unconjugated Estriol
Authors: Cao Zhimin (Tim) , Swift Thomas A , West Clint A , Rosano Thomas G , Rej Robert 
Published: February 2004

Abstract
Background: Accurate measurement of estradiol is important in clinical settings. The quality of laboratory estimations of estradiol may be assessed through external quality-assurance surveys.
Methods: Estradiol was measured by microparticle enzyme immunoassay (MEIA) and other immunoassays. Proficiency testing of medical laboratories was conducted using samples prepared from normal male human serum supplemented with exogenous estradiol and other steroid and nonsteroid hormones, and participant laboratories measured estradiol by a variety of commonly used immunoassay techniques.
Results: The imprecision (CV) for measurement of estradiol [100–300 ng/L (367–1102 pmol/L)] was ≤22% for most analytical techniques. Greater imprecision, as high as 40% for the same concentration range, was observed for the (AxSYM) MEIA method in the proficiency testing event of September 2001. Results from this method were bimodal in distribution. We found that unconjugated estriol at concentrations &gt;1.5 μg/L (&gt;5.2 nmol/L) interfered with the MEIA method, leading to decreased recovery of added estradiol by up to 50%. This suppression in estradiol measurement was prevented by dilution of the specimen before measurement. Addition of unconjugated estriol gave a positive bias in some other immunoassay methods for estradiol. Poor comparability among the immunoassay methods for measurement of estradiol at clinically relevant concentrations [∼60 ng/L (220 pmol/L)] was revealed.
Conclusions: A negative interference of unconjugated estriol with the MEIA method is a source of error for estradiol measurement. Lack of specificity and lack of comparability among immunoassay methods for estradiol may have detrimental effects on medical practice.
Invasive Trophoblast Antigen (Hyperglycosylated Human Chorionic Gonadotropin) in Second-Trimester Maternal Urine as a Marker for Down Syndrome: Preliminary Results of an Observational Study on Fresh Samples
Authors: Palomaki Glenn E , Knight George J , Roberson Marie M , Cunningham George C , Lee Jo Ellen , Strom Charles M , Pandian Raj 
Published: February 2004

AbstractBackground: Down syndrome screening is commonly performed in the US using maternal age and three or four second-trimester maternal serum markers that can identify up to 75% of affected pregnancies by offering diagnostic studies to 5% of women. Invasive trophoblast antigen [ITA; hyperglycosylated human chorionic gonadotropin (hCG)] is a promising marker that can be measured in urine or serum in the first or second trimester. We report preliminary results for urinary ITA in an ongoing observational study.Methods: Women undergoing second-trimester amniocentesis for reasons not associated with biochemical testing provided consent and a urine (and possibly serum) sample that was tested within a few days. Demographic and pregnancy-related information was collected, along with karyotype. Screening performance was modeled for ITA alone and in combination with serum markersResults: Twelve recruitment centers collected urine from 2055 women with singleton pregnancies between 15 and 20 weeks of gestation (2023 unaffected, 28 Down syndrome, and 4 pregnancies with other chromosome abnormalities). After correction for gestational age, urine concentration, and maternal race and weight, the ITA measurements were higher in women with a Down syndrome pregnancy (median ITA, 4.33 multiples of the median). At a 75% detection rate, the false-positive rate could be reduced by substituting ITA for hCG measurements (from 5.6% to 2.6% for the triple test) or by adding ITA measurements to existing combinations (from 3.3% to 2.0% for the quadruple test).Conclusions: Our data provide preliminary confirmation of the potential usefulness of urinary ITA measurements in detecting Down syndrome in a setting that simulates routine usage.
Real-Time Quantitative Reverse Transcription-PCR for Cyclin D1 mRNA in Blood, Marrow, and Tissue Specimens for Diagnosis of Mantle Cell Lymphoma
Authors: Howe John Greg , Crouch Jill , Cooper Dennis , Smith Brian R 
Published: February 2004

Abstract
Background: Overexpression of cyclin D1 mRNA, found in mantle cell lymphoma (MCL), is a critical diagnostic marker. We investigated the use of real-time reverse transcription-PCR (RT-PCR) for cyclin D1.
Methods: We studied 97 fresh specimens (50 blood, 30 bone marrow, 15 lymph node, and 2 other samples) from patients diagnosed with a variety of lymphoproliferative diseases, including 25 cases of MCL. We used real-time quantitative RT-PCR to evaluate cyclin D1 mRNA expression. Because blood and marrow specimens may contain only a minority of potentially malignant cells (as opposed to most lymph nodes) and to increase sensitivity, we normalized the cyclin D1 mRNA concentrations to mRNA of a B-cell-specific marker, CD19, as well as to previously characterized β2-microglobulin mRNA.
Results: In 16 of 21 cases of MCL with overt disease, the ratio of cyclin D1 mRNA to β2-microglobulin mRNA was increased, but all 21 cases showed increased ratios of cyclin D1 mRNA to CD19 mRNA. Cyclin D1 mRNA was low or undetectable in various lymphoproliferative diseases, including cases of ambiguous immunophenotype. The mRNA ratios were stable over 3–7 days of sample storage.
Conclusion: Quantitative RT-PCR for cyclin D1 mRNA normalized to CD19 mRNA can be used in the diagnosis of MCL in blood, marrow, and tissue.
Light-Induced Byproducts of Vitamin C in Multivitamin Solutions
Authors: Lavoie Jean-Claude , Chessex Philippe , Rouleau Thérèse , Migneault Diane , Comte Blandine 
Published: February 2004

Abstract
Background: When solutions of multivitamin preparations (MVPs) are exposed to light, H2O2 as well as organic peroxides are generated and the concentration of vitamin C decreases. The aim of this study was to determine, using mass spectrometry, whether the generation of oxidative byproducts of vitamin C, such as dehydroascorbate (DHA) and 2,3-diketogulonic acid (DKG), accounted for the reported decrease in ascorbic acid in MVPs exposed to light.
Methods: Mass spectrometry was used to document the formation of byproducts of ascorbic acid in solutions containing a MVP, vitamin C + riboflavin, and vitamin C + H2O2 + Fe2+. The involvement of ascorbic acid and H2O2 in the formation of organic peroxides was tested by measuring peroxide concentrations in solutions containing H2O2 with or without ascorbic acid and with or without Fe2+ before and after addition of catalase.
Results: The loss of ascorbic acid in photo-exposed MVPs was associated with the concomitant generation of byproducts different from DHA and DKG. Among them, one mass fingerprint was particularly observed with solutions of vitamin C + riboflavin exposed to ambient light as well as with the solution of vitamin C + H2O2 + Fe2+, suggesting a Fenton-like reaction. This fingerprint was associated with the formation of catalase-resistant peroxides.
Conclusion: Exposure of MVPs to light leads to the rapid loss of ascorbic acid and generation of specific byproducts that differ from DHA and DKG. The conversion of vitamin C into byproducts could be of biological importance in accounting for the decrease in ascorbic acid concentrations and the generation of organic peroxides in light-exposed MVPs.
Evaluation of Imprecision for Cardiac Troponin Assays at Low-Range Concentrations
Authors: Panteghini Mauro , Pagani Franca , Yeo Kiang-Teck J , Apple Fred S , Christenson Robert H , Dati Francesco , Mair Johannes , Ravkilde Jan , Wu Alan H B ,   the Committee on Standardization of Markers of Cardiac Damage of the IFCC
Published: February 2004

AbstractBackground: The European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction (MI) has recommended that an increased cardiac troponin should be defined as a measurement above the 99th percentile value of the reference group. A total imprecision (CV) at the decision limit of ≤10% is recommended. However, peer-reviewed data on assay imprecision are lacking. The purpose of this study was to construct the clinically relevant imprecision profiles for each of the commercially available cardiac troponin assays. Pools of human sera containing cardiac troponin concentrations around the MI decision limit were assessed to identify the lowest concentration associated with a 10% CV.Methods: Eight serum pools targeting different concentrations of cardiac troponin (I and T) were prepared and stored at −70 °C until usage. The cardiac troponin measurement protocol consisted of two replicates per specimen per run, and one run per day for 20 days, using two reagent lots and three calibrations. Manufacturers of each cardiac troponin assay directly performed the measurements. Data analysis for each assay was centralized and performed according to the NCCLS EP5-A guideline.Results: The lowest concentrations (μg/L) providing a 10% CV were as follows: AxSYM, 1.22; ACS:180, 0.37; Centaur, 0.33; Immuno 1, 0.34; Access, 0.06; Vidas, 0.36; Liaison, 0.065; Dimension, 0.26; Opus, 0.90; Stratus CS, 0.10; Immulite, 0.32; Vitros ECi, 0.44; Elecsys, 0.04; AIA 21, 0.09.Conclusion: No cardiac troponin assay was able to achieve the 10% CV recommendation at the 99th percentile reference limit defined by the manufacturer.