bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors influencing rate of Barthel Index change in hospital following stroke
Authors: McNaughton Harry , Weatherall Mark , Taylor William , Mcpherson Kathryn 
Published: May 2003

Background and purpose:Randomized controlled trials of specific interventions in stroke rehabilitation are few. In using this study design to compare different rehabilitation interventions or different intensity of those interventions, measuring disability status at a fixed time point is one outcome option. In order for this approach to be valid, factors that might independently affect the speed of disability change have to be matched at baseline. We sought to investigate the impact of different factors on rate of disability change following stroke. Methods: A prospective hospital-based study of consecutive patients admitted to each of three general hospitals in Wellington, New Zealand with acute stroke. Patients were assessed using the Barthel Index (BI, scored 0–20) within a few days of stroke and fortnightly until hospital discharge. Strokes were classified using the Oxfordshire Community Stroke Project classification. Main outcome measure: Barthel Index rate of change (BRC) computed from the difference between the first and last hospital BI scores divided by the time in weeks between these assessments. Results: Of 104 subjects with two or more disability assessments in hospital, BRC was a mean 1.26 units per week (95% confidence interval (CI) 0.97, 1.56). The only factors significantly associated with BRC on univariate analysis were stroke type, pre-stroke Modified Rankin Scale (MRS) and pre-stroke London Handicap Score. In a general linear model analysis of covariance, stroke type (p = 0.015) and pre-stroke MRS (p < 0.001) remained significant. The mean BRC for lacunar infarcts (1.76 units per week, 95% CI 1.22, 2.30) was over three times that of total anterior circulation infarcts (0.48 units per week, 95% CI 0.20, 0.76). Conclusions: Future randomized controlled trials of rehabilitation interventions for stroke in hospitalized patients need to allow for pre-stroke level of dependence and stroke type in the study design, either excluding particular patients or ensuring even randomization of these key variables if speed of disability change is to be a valid outcome variable.
Association between amputation, arthritis and osteopenia in British male war veterans with major lower limb amputations
Authors: Kulkarni Jai , Adams Judith , Thomas Elaine , Silman Alan 
Published: May 2003

Objectives: To investigate the association between amputation, osteoarthritis and osteopenia in male war veterans with major lower limb amputations. Specific questions were to determine whether lower limb amputees following trauma are at subsequent risk of developing osteoarthritis (OA) and osteoporosis of the hip on both the amputated and nonamputated sides. Design: Retrospective cohort study in British Male Second World War veterans with major unilateral lower limb amputations. Subjects: Seventy-five male Second World War veterans with major lower limb amputations known to be alive were invited to participate from a subregional rehabilitation centre. After exclusions, 44 agreed to attend for examination and radiological screening. Methods: The presence of hip OA was determined from a single anterior posterior pelvic X-ray using two approaches: minimum joint space and the Kellgren and Lawrence (K&L) scoring system. Bone mineral density (BMD) was measured by a dual energy X-ray absorptiometry (DXA) scan and prosthetic rehabilitation outcome measures were recorded. Results: Twenty-seven (61%) hips on the amputated side and 10 (23%) on the nonamputated side were positive for OA (based on Kellgren and Lawrence grade of >2). Using a minimum joint space threshold of below 2.5 mm, 24 (55%) hips on the amputation side and 8 (18%) on the nonamputated side were also positive for OA. There was a threefold increased risk of OA for those with above-knee compared to a below-knee amputation. By contrast, from published general population surveys only 4 (11%) cases of hip OA would have been expected on both the amputated and nonamputated hips. There was a significant decrease in femoral neck BMD in the amputated side ( p <0.0001) and significantly lower BMD in above-knee amputees than in below-knee amputees ( p = 0.0027) as compared to normal age-and sexmatched population. Conclusion: Male war veterans with unilateral major lower limb amputations develop significantly more osteoarthritis of the hip than expected on both ipsi-and contralateral sides. Amputation was also associated with loss of bone density. Above-knee amputees develop significantly more hip osteoarthritis and osteopenia of greater severity in the amputated side than below-knee amputees.
A longitudinal physical profile assessment of skeletal muscle manifestations in myotonic dystrophy
Authors: Nitz J C , Burns Y R , Jackson R V 
Published: May 2003

Objectives: To develop an assessment that describes the skeletal muscle manifestations in myotonic dystrophy subjects and then use it to quantify the presentation of skeletal muscle disability and to show change over time. Design: A quantified skeletal muscle assessment was developed and applied three times over a two-year period at intervals around 12 months. Thirty-six subjects with myotonic dystrophy and 20 subjects without neuromuscular disability were evaluated. The assessment comprised manual muscle testing of five pairs of muscles, measuring neck flexor strength with a strain gauge, respiratory function tests, power and lateral pinch grip strength, all tests of impairment. Assessment of the ability to move from sitting to standing and fasten buttons tested disability. Results: Results from subjects with myotonic dystrophy were compared to the normal data. The subjects with myotonic dystrophy were significantly weaker in proximal upper limb muscles, quadriceps, tibialis anterior muscles and neck flexor muscles as well as power and lateral pinch grips. There was also significant reduction in forced expiratory volume at one second (FEV1) and forced vital capacity (FVC). Significant disability was seen in the myotonics in moving from sitting to standing and in fastening buttons. Over the two-year study period proximal upper limb and lower limb muscle strength, FVC and sit-to-stand ability declined significantly. Power grip declined but lateral pinch grip and FEV1 improved significantly. Button fastening ability improved significantly. Conclusion: The test developed was shown to be reliable and sensitive to the change in skeletal muscle manifestations in subjects with myotonic dystrophy who were shown to be significantly weaker than normal subjects.
Study of the relationship between premorbid urinary incontinence and stroke functional outcome
Authors: Jawad S H , Ward A B , Jones P 
Published: May 2003

Objective: To examine functional outcome in stroke patients with premorbid incontinence of urine. Method: Comparative study in stroke patients between premorbidly incontinent and continent groups. Both groups were subjected to structured interview, clinical examination and functional assessment at one week post stroke. Functional assessment was repeated six months later. Subjects: Eighty-six patients with first-time stroke younger than 80 years of age admitted to hospital, were divided into two groups according to their continence status. Outcome measure: The 20-point Barthel Index. Setting: Medical wards at North Staffordshire Teaching Hospitals. Results: Of 86 stroke patients (46 continent and 40 premorbidly incontinent), 19 died before six-month assessment, of whom 15 (79%) were premorbidly incontinent. Premorbid incontinence was the most significant variable predicting poor functional outcome (Barthel Index score <15) at six months, with a sensitivity of 82.6% and specificity of 86.4% and with age-corrected p-value of <0.001. Conclusions: This study shows a significant relationship between premorbid incontinence and functional outcome at six months. However, other causes that could have contributed to the premorbid incontinence were not excluded. This point needs to be considered in future studies, which should also examine whether premorbid incontinence per se reflects an underlying predisposition for stroke.
Should Adolescents With Acute Lymphoblastic Leukemia Be Treated as Old Children or Young Adults? Comparison of the French FRALLE-93 and LALA-94 Trials
Authors: Boissel Nicolas , Auclerc Marie-Françoise , Lhéritier Véronique , Perel Yves , Thomas Xavier , Leblanc Thierry , Rousselot Philippe , Cayuela Jean-Michel , Gabert Jean , Fegueux Nathalie , Piguet Christophe , Huguet-Rigal Françoise , Berthou Christian , Boiron Jean-Michel , Pautas Cécile , Michel Gérard , Fière Denis , Leverger Guy , Dombret Hervé , Baruchel André 
Published: May 2003

Purpose: To compare pediatric and adult therapeutic practices in the treatment of acute lymphoblastic leukemia (ALL) in adolescents. Patients and Methods: From June 1993 to September 1994, 77 and 100 adolescents (15 to 20 years of age) were enrolled in the pediatric FRALLE-93 and adult LALA-94 protocols, respectively. Among the different prognostic factors, we retrospectively analyzed the effect of the trial on achieving complete remission (CR) and event-free survival (EFS). Results: Patients were younger in the FRALLE-93 than in the LALA-94 protocol (median age, 15.9 v 17.9 years, respectively), but other characteristics were similar, including median WBC count (18 × 109 cells/L v 16 × 109 cells/L), B/T-lineage (54 of 23 v 72 of 28 patients), CD10-negative ALL (13% v 15%), and poor-risk cytogenetics (t(9;22), t(4;11), or hypodiploidy less than 45 chromosomes: 6% v 5%). The CR rate depended on WBC count (P = .005) and trial (94% v 83% in FRALLE-93 and LALA-94, respectively; P = .04). Univariate analysis showed that unfavorable prognostic factors for EFS were as follows: the trial (estimated 5-year EFS, 67% v 41% for FRALLE-93 and LALA-94, respectively; P < .0001), an increasing WBC count (P < .0001), poor-risk cytogenetics (P = .005), and T-lineage (P = .01). The trial and WBC count remained significant parameters for EFS in multivariate analysis (P < .0001 and P = .0004). Lineage subgroup analysis showed an advantage for the FRALLE-93 trial for CR achievement (98% v 81%; P = .002) and EFS (P = .0002) in B-lineage ALL and for EFS (P = .05) in T-lineage ALL. Age was not a significant prognostic factor in this population of adolescents. Conclusion: This study’s findings indicate that adolescents should be included in intensive pediatric protocols and that new trials should be designed, inspired by pediatric protocols, for the treatment of young adults with ALL.
The Cell Surface Form of Colony-Stimulating Factor-1 Is Biologically Active in Bone in Vivo
Authors: Yao Gang-Qing , Wu Jain-Jun , Sun Ben-Hua , Troiano Nancy , Mitnick Mary Ann , Insogna Karl 
Published: May 2003

Abstract
The specific biological function of the cell surface or membrane-bound isoform of colony-stimulating factor-1 (mCSF-1) is not well understood. To help define the role of this isoform in bone, we developed a transgenic mouse in which targeted expression of human mCSF-1 in osteoblasts was achieved under the control of the 2.4-kb rat collagen type I α promoter. Bone density, determined by peripheral quantitative computed tomography, was reduced 7% in mCSF-1 transgenic compared with that in wild-type mice. Histomorphometric analyses indicated that the number of osteoclasts in bone (NOc/BPm, NOc/TAR, OcS/BS) was significantly increased in transgenic mice (1.7- to 1.8-fold; P &lt; 0.05 to P &lt; 0.01) compared with that in wild-type animals. Interestingly, the osteoblast-restricted isoform transgene corrected the osteopetrosis seen in CSF-1-deficient op/op mice. Skeletal growth and bone density in op/op mice expressing mCSF-1 in osteoblasts were similar to those in wild-type mice and were dramatically different from those in the unmanipulated op/op animals. The op/op mice expressing mCSF-1 in bone had normal incisor and molar tooth eruption, whereas the op/op mice evidenced the expected failure of tooth eruption. These findings directly support the conclusion that mCSF-1 is functionally active in bone in vivo and is probably an important local source of CSF-1.
DEC1 (STRA13) protein expression relates to hypoxia‐ inducible factor 1‐alpha and carbonic anhydrase‐9 overexpression in non‐small cell lung cancer
Authors: Giatromanolaki Alexandra , Koukourakis Michael I , Sivridis Efthimios , Turley Helen , Wykoff Charles C , Gatter Kevin C , Harris Adrian L 
Published: May 2003

AbstractDifferentiated embryo‐chondrocyte expressed gene 1 (DEC1) is involved in cell differentiation, proliferation, and apoptosis, and was recently shown to be regulated by hypoxia. The present immunohistochemical study demonstrates extensive nuclear expression of the protein in 38% of a series of 115 non‐small cell lung carcinomas using a polyclonal antibody (Ab) recognizing DEC1 protein. Such expression was directly related to the expression of two hypoxia‐regulated proteins, namely the hypoxia‐inducible factor (HIF) 1α and carbonic anhydrase‐9. Although DEC1 was not related to angiogenesis or to the expression of VEGF and thymidine phosphorylase, a direct association with up‐regulated bFGF receptors was noted. DEC1 was persistently expressed in the nuclei of normal bronchial and alveolar tissue. It is suggested that loss of DEC1 expression is an early event in the development of lung cancer, while DEC1 gene expression occurs in a subset of tumours and parallels the overexpression of other hypoxia‐regulated proteins. Copyright © 2003 John Wiley & Sons, Ltd.
BCL‐2 family proteins in peripheral T‐cell lymphomas: correlation with tumour apoptosis and proliferation
Authors: Rassidakis George Z , Jones Dan , Lai Raymond , Ramalingam Preetha , Sarris Andreas H , McDonnell Timothy J , Jeffrey Medeiros L 
Published: May 2003

AbstractThe present study investigated expression levels of the anti‐apoptotic proteins BCL‐2, BCL‐XL and MCL‐1 and the pro‐apoptotic proteins BAX and BCL‐XS in a series of 112 peripheral T‐cell lymphomas (PTCLs) classified according to the WHO classification. Using immunohistochemical methods and a 10% cut‐off, each protein was detected in a subset of PTCLs: BCL‐2 in 46%, BCL‐XS in 49%, BAX in 57%, BCL‐XL in 57%, and MCL‐1 in 65%. The mean percentage of positive cells for these proteins varied significantly among the PTCL types. Only two types of PTCL, ALK‐positive anaplastic large cell lymphoma (ALCL) and enteropathy‐type T‐cell lymphoma, had a distinctive pattern of expression; all were BCL‐2‐negative and MCL‐1‐positive. The mean percentage of BAX‐positive and BCL‐XS‐positive tumour cells was higher in ALK‐positive ALCL than in ALK‐negative ALCL or other types of PTCL (p = 0.06 and p = 0.01, respectively, Kruskal–Wallis test). MCL‐1 was detected significantly more frequently (p = 0.01, chi‐square test) and at higher levels (p = 0.0001, Kruskal–Wallis test) in ALK‐positive ALCL and ALK‐negative ALCL than in other PTCL types. The apoptotic rate, evaluated by the TUNEL assay, correlated inversely with BCL‐2 expression (p = 0.035). The proliferation index, assessed by the MIB‐1 antibody, correlated with expression levels of MCL‐1 (R = 0.42, p = 0.003), BCL‐2 (R = 0.32, p = 0.027), BAX (R = 0.33, p = 0.014), and BCL‐XL (R = 0.34, p = 0.015) (Spearman rank). In conclusion, BCL‐2 family proteins are expressed by a subset of PTCLs and their levels correlate with some histological types, apoptotic rate, and proliferation index. Expression of these proteins may explain the poor response of many types of PTCL to standard chemotherapy. These proteins may also provide novel targets for experimental therapy. Copyright © 2003 John Wiley & Sons, Ltd.
Laminin α1 chain in human renal cell carcinomas and integrin‐mediated adhesion of renal cell carcinoma cells to human laminin isoforms
Authors: Rissanen Jan , Korhonen Matti , Lehto Veli‐Pekka , Virtanen Ismo 
Published: May 2003

AbstractIn human tissues, the laminin (Ln) α1 chain shows a restricted and developmentally regulated distribution in basement membranes (BMs) of a subset of epithelial tissues, including those of renal proximal convoluted tubules. The present study investigated the distribution of the Ln α1 chain in renal cell carcinomas (RCCs) and oncocytomas as well as in xenografted tumours induced in nude mice with four characterized RCC cell lines. These cell lines were also used in cell adhesion studies with purified laminins. By immunohistochemistry it was found that the Ln α1 chain is widely present in the BMs of RCCs, all of the specimens presenting immunoreactivity. High‐grade RCCs tended to contain more BM‐confined and stromal immunoreactivity than low‐grade tumours, none of the grade 3 (G3) carcinomas being negative and all of the metastatic specimens showing partial or overall BM immunoreactivity. Double immunolabelling experiments showed that in RCC BMs but not in vessel walls, the Ln α1 chain was co‐distributed with Ln α5, β1, and β2 chains, implying the presence of Ln‐1/Ln‐3 and Ln‐10/Ln‐11. In papillary RCCs, the Ln α1 chain co‐localized with Ln‐5. The oncocytomas lacked immunoreactivity for the Ln α1 chain. Xenografted tumours induced in nude mice showed BM‐like deposition of the Ln α1 chain. In cell adhesion studies, mouse and human Ln‐1 were equally effective in promoting cell adhesion of all RCC cell lines. For each cell line, Ln‐10 and Ln‐10/11 were equally effective adhesive substrates, all cell lines adhering more avidly to these laminins than to mouse or human Ln‐1. As judged by inhibition assays employing specific integrin antibodies, adhesion of normal human renal proximal tubular epithelial (RPTE) cells and RCC cells from a G1 tumour to human Ln‐1 was mediated mainly by α6β1 integrin, while only the G1 RCC cells adhered to mouse Ln‐1 by using α6β1 integrin. For adhesion to Ln‐10, RPTE cells and RCC cells from a G1 tumour used an unidentified β1 integrin. Cells from G3 tumours mainly used an α3β1 integrin complex for adhesion to mouse Ln‐1 and to human Ln‐1 and Ln‐10. For all cells, adhesion to the Ln‐10/11 mixture was mediated by an unidentified integrin complex or by other adhesion molecules. These results show that laminin trimers containing the α1 chain are, in contrast to oncocytomas, abundant in the BMs of RCCs. This is in keeping with their suggested origin from renal proximal tubular epithelium known for its capacity to produce the Ln α1 chain. The results also show that RCC cells utilize complex, mainly integrin α3β1‐ and integrin α6β1‐mediated, mechanisms for adhesion to laminins. The adhesion to Ln‐1 changes from integrin α6β1 to integrin α3β1 upon increasing malignancy and, especially for Ln‐10 and Ln‐10/11, other adhesion molecules of non‐integrin type may contribute to the adhesion. Copyright © 2003 John Wiley & Sons, Ltd.
Coronary Artery Bypass Grafting via Sternotomy in Conscious Patients
Authors: Meininger Dirk , Neidhart Gerd , Bremerich Dorothee H. , Aybek Tayfun , Lischke Volker , Byhahn Christian , Kessler Paul 
Published: May 2003

AbstractThe application of high thoracic epidural anesthesia (TEA) as an adjunct to general anesthesia is increasingly being used for coronary artery bypass grafting (CABG) with extracorporeal circulation. Recent developments in beating heart techniques rendered the sole use of TEA in conscious patients possible, and have been reported for single‐vessel beating heart CABG via lateral thoracotomy. For multi‐vessel revascularization, the heart is usually approached via sternotomy; therefore, the sole use of TEA was applied in awake patients who underwent CABG via sternotomy. A total of 7 patients scheduled for awake coronary artery bypass grafting (ACAB) received TEA via an epidural catheter placed at the levels of T1–2 or T2–3, respectively. Total arterial myocardial revascularization was performed after partial lower sternotomy. Besides standard monitoring, anesthetic levels were determined using an epidural scoring scale for arm movements (ESSAM). While 6 patients were awake and spontaneously breathing during the entire procedure, one patient had to be intubated intraoperatively because of respiratory distress caused by phrenic nerve palsy. Hemodynamics were stable throughout the operation. No significant arterial hypercarbia occurred. All patients rated TEA as “good” or “excellent.” We could demonstrate that the single use of TEA for CABG via sternotomy was feasible and that the patients felt well, were painfree, and remained hemodynamically stable. High patient satisfaction in our small and highly selected cohort can be reported. Because beating heart surgery in a conscious patient still carries a significant risk, further randomized controlled trials are mandatory to definitively evaluate the role of sole TEA in cardiac surgery.
Quantitative Determinations of Duodenogastric Reflux, Prevalence of Helicobacter pylori Infection, and Concentrations of Interleukin‐8
Authors: Fukuhara Kenichiro , Osugi Harushi , Takada Nobuyasu , Takemura Masashi , Ohmoto Yasukazu , Kinoshita Hiroaki 
Published: May 2003

AbstractBillroth I or II reconstruction after distal gastrectomy often is associated with inflammation in the gastric remnant. We sought to determine which reconstructive procedure was most effective in preventing such remnant gastritis. Patients undergoing curative distal gastrectomy for cancer (n = 82) were classified as group A (Roux‐en‐Y, n = 22); group B (Billroth I, n = 40); or group C (Billroth II, n = 20). Interleukin (IL)‐8 concentrations in gastric mucosa were measured 3 months after surgery. In the absence of Helicobacter pylori infection, IL‐8 concentrations were 13, 56, and 87 pg/mg protein in groups A, B, and C, respectively (p < 0.05). In the presence of H. pylori infection, IL‐8 concentrations were 61, 161, and 234 pg/mg protein in groups A, B, and C (p < 0.01). Roux‐en‐Y reconstruction is better able to prevent remnant gastritis than either the Billroth I or II procedure as judged from IL‐8 concentrations in gastric remnant mucosa.
Lymph Node Micrometastases in Early Gastric Cancer and Their Impact on Prognosis
Authors: Morgagni Paolo , Saragoni Luca , Scarpi Emanuela , Zattini Pier Sante , Zaccaroni Alberto , Morgagni Diana , Bazzocchi Francesca 
Published: May 2003

AbstractWhile the presence of lymph node metastases in early gastric cancer (EGC) is the most significant prognostic factor, the relevance of lymph node micrometastases remains uncertain. The authors studied 5400 lymph nodes dissected from 300 patients treated surgically for EGC between 1976 and 1999, all of whom were histologically pN0. Micrometastases were defined as single or small clusters of neoplastic cells identifiable only by immunohistochemical methods. Lymph node micrometastases were observed in 30 of the 300 patients (10%). No significant correlation was observed between micrometastases and other clinicopathological characteristics. Analysis of overall survival showed no significant difference between positive or negative micrometastasis groups. The results of our study show that the presence of lymph node micrometastases in EGC does not influence patient prognosis.
Technology choice with stochastic demands and dynamic capacity allocation: A two‐product analysis
Authors: Li Shanling , Tirupati Devanath 
Published: May 2003

AbstractIn this paper we examine issues related to technology choice and capacity expansion in an environment characterized by two product families with stochastic demands. The motivation for our work comes from developments in modern technologies such as FMS and CIM that provide considerable operational flexibility. In this paper we focus on the tradeoffs between product mix flexibility of integrated technologies and dedicated facilities designed to produce efficiently a limited range of products. We present an investment model to determine optimal mix of technology and capacity choices in order to satisfy specified service levels. Based on the detailed analysis of a special case with uniform distributions, we develop a solution procedure that is amenable for extension to other demand distributions. The scope of this approach for deriving managerial insights is illustrated with computational results.