bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognosis of patients with chronic coronary artery disease and severe left ventricular dysfunction. The importance of myocardial viability
Authors: Meluzín Jaroslav , Černý Jan , Špinarová Lenka , Toman Jiří , Groch Ladislav , Štětka František , Frélich Milan , Hude Petr , Krejčí Jan , Rambousková Lada , Panovský Roman 
Published: January 2003

AbstractBackground and aim:The choice of optimal treatment strategy in patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction is often difficult. The aim of this study was to compare long‐term results of patients with chronic CAD, severe heart failure and a defined scope of myocardial viability treated with coronary revascularization, heart transplantation, or kept on medical therapy.Methods:From 1993 to 2000, viability evaluation using low‐dose dobutamine echocardiography was performed in 124 patients with CAD and LV ejection fraction ≤30%. The dysfunctional myocardial segments were defined as viable if they exhibited improvement in their thickening at any dose of dobutamine or worsening without initial improvement. The patients were divided into five groups and followed up for a mean period of 27±23 months. Group A consisted of 39 patients with viability (at least two dysfunctional but viable segments) who were revascularized. Group B consisted of 29 patients with viability treated medically. Groups C (n=23) and D (n=22) comprised patients with non‐viable dysfunctional myocardial segments who were revascularized or kept on medical therapy, respectively. Eleven patients referred for heart transplantation after dobutamine echocardiography and 62 patients with ischemic cardiomyopathy transplanted in the same time interval were included in the group of transplanted patients (Group E).Results:The Kaplan–Meier survival analysis demonstrated a significantly better survival of group A patients as compared with group B patients (P<0.05). The prognostic benefit of revascularization in patients with viability was not manifested until 3 years after the procedure. At 5 years, survival in groups A, B, C, D and E was 89, 60, 67, 50 and 78%, respectively.Conclusion:In patients with CAD, severe LV dysfunction, and the evidence of viability in dysfunctional myocardium, coronary revascularization improves survival. At least 3‐years follow‐up is necessary to objectively assess the prognostic effect of coronary revascularization.
Pharmacotherapeutic approaches for decompensated heart failure: a role for the calcium sensitiser, levosimendan?
Authors: Greenberg Barry , Borghi Claudio , Perrone Sergio 
Published: January 2003

AbstractAlthough no universal definition exists, decompensated heart failure may be regarded as either a worsening of chronic heart failure or new‐onset heart failure precipitated by an acute incident. Haemodynamic management of patients hospitalised with decompensated heart failure may include the administration of diuretics, vasodilators and positive inotropic agents. Until recently, these latter agents constituted the only drug class to produce a direct increase in stroke volume via enhanced myocardial contractility. However, despite their short‐term benefits, the clinical utility of inotropic agents is compromised by their potentially deleterious effects on calcium handling and oxygen consumption, resulting in an increased risk of serious ventricular arrhythmias and death. In contrast, calcium sensitisers enhance cardiac performance without affecting calcium movement and, therefore, are potentially associated with a reduced risk of rhythmic disturbances. These agents constitute a heterogeneous group of compounds with different affinities for calcium sensitisation. Levosimendan is a potent calcium sensitiser with vasodilating properties that has been shown to provide symptomatic and haemodynamic improvement with no increase in oxygen consumption. Calcium sensitisation is therefore emerging as a promising treatment approach in this challenging therapeutic area.
Quantification of proinflammatory cytokines in the urine of congestive heart failure patients. Its relationship with plasma levels
Authors: Sirera Rafael , Salvador Antonio , Roldán Ildefonso , Talens Raquel , González‐Molina Andrés , Rivera Miguel 
Published: January 2003

AbstractAims:Proinflammatory cytokines are important mediators for the development of heart failure and increased plasma levels of these cytokines have been reported in patients with this condition. The purpose of the study was to investigate whether urine, a non‐invasively obtained biological sample, was an appropriate medium in which to measure the concentration of tumor necrosis factor‐alpha (TNF‐α) and interleukin‐6 (IL‐6) in patients in the advanced stages of the disease.Methods and results:Thirty consecutive patients who had severe congestive heart failure (NYHA classes III and IV) and 30 matched healthy control subjects were enrolled. Plasma and the first urine of the day were collected and TNF‐α and IL‐6 were quantitatively analyzed by enzyme‐linked immunosorbent assays. For every subject there were no differences in the amount of cytokine determined in plasma and urine. Both urine and plasma levels of IL‐6 and TNF‐α were greater in heart failure patients than in controls.Conclusion:Our results show that plasmatic and urinary levels of proinflammatory cytokines did not differ significantly. Thus, urine may be a good milieu in which to study these cytokines and may have diagnostic, prognostic and therapeutic implications.
The frequency of systolic versus diastolic heart failure in an Egyptian cohort
Authors: Ibrahim Bassem S. 
Published: January 2003

AbstractBackground:All factors predisposing for congestive heart failure (CHF), such as coronary artery disease (CAD), hypertension and diabetes are increasing in prevalence in Egypt. Despite this, no data about CHF in our country are available.Aims:To study the relative contribution of systolic vs. diastolic heart failure in Egyptians and the prevalence of risk factors in this population, as well as their prognosis.Methods:This was a retrospective study of patients with a diagnosis of CHF over a 3.5‐year period in a general cardiology clinic. Demographic, ECG and echocardiographic data for left ventricular systolic and diastolic function were collected. The differential effect of systolic versus diastolic CHF was analyzed regarding hospitalization and mortality.Results:After exclusion of valvular diseases, we found 155 patients diagnosed with heart failure, 102 patients (66%) had systolic heart failure, and 53 (34%) had diastolic heart failure. Mean age was 60±10 and 63±11 years, respectively (P=0.13). Systolic CHF patients had significantly more CAD, while those with diastolic failure were mostly hypertensives (P<0.01) for both. There was no significant difference in the incidence of diabetes mellitus, cerebrovascular accidents or atrial fibrillation between the two groups. Patients with systolic failure required more hospitalization, P<0.05, and had a mortality rate of 17.6% vs. 11.3% for patients with diastolic heart failure (P=0.3).Conclusion:Diastolic heart failure is present in one‐third of cases of CHF in Egyptians. Hypertension is very common in this group. These patients require less hospitalization but have a similar mortality rate.
Elevated serum levels of leptin and soluble leptin receptor in patients with advanced chronic heart failure
Authors: Schulze P. Christian , Kratzsch Juergen , Linke Axel , Schoene Nina , Adams Volker , Gielen Stephan , Erbs Sandra , Moebius‐Winkler Sven , Schuler Gerhard 
Published: January 2003

AbstractPatients with chronic heart failure (CHF) have metabolic abnormalities, leading to a catabolic syndrome, with progressive loss of skeletal muscle in advanced stages of the disease. Leptin, the product of an obesity gene, has been associated with energy expenditure and weight regulation. The aim of this study was to assess serum levels of leptin and its soluble receptor in relation to exercise intolerance and neurohumoral activation in patients with CHF. We investigated 53 patients with CHF left ventricular ejection fraction (LVEF) 25±1%, age 56.6±1.3 years, Maximal oxygen uptake (VO2 max) 16.3±0.6 ml/min·kg) sub‐classified according to peak oxygen consumption of > or ≤14 ml/min·kg and 11 age‐matched controls (LVEF 70±1, age 60.5±4.0 years, (VO2max) 26.9±1.6 ml/min·kg). Body mass index‐adjusted serum levels of leptin and soluble leptin receptor were increased in patients with CHF compared to the controls (0.28±0.03 vs. 0.22±0.04 ng·m2/ml·kg and 32.6±1.9 ng/ml vs. 22.9±2.3, P<0.05). This increase was even more pronounced in patients with CHF and severe exercise intolerance (0.43±0.08 vs. 0.21±0.02 and 0.22±0.04 ng·m2/ml·kg; P<0.01 vs. VO2max>14 ml/min·kg and controls). Elevated levels of leptin correlated with an increased serum concentration of TNFα (r=0.749, P<0.01) in this subgroup of patients with CHF. We conclude that patients with advanced CHF show elevated serum levels of leptin and its soluble receptor. This finding indicates that leptin may participate in the catabolic state leading to the development of cardiac cachexia in the course of CHF.
Intravenous levosimendan treatment is cost‐effective compared with dobutamine in severe low‐output heart failure: an analysis based on the international LIDO trial
Authors: Cleland J.G.F. , Takala A. , Apajasalo M. , Zethraeus N. , Kobelt G. 
Published: January 2003

AbstractBackground:Levosimendan, a novel calcium sensitiser, improves cardiac performance and symptoms without increasing oxygen consumption, and decreases the mortality of patients with low‐output heart failure.Aims:To estimate the cost‐effectiveness of intravenous treatment with levosimendan compared with dobutamine in patients with severe low‐output heart failure.Methods:This economic evaluation was based on a European clinical trial (LIDO), in which 203 patients with severe heart failure randomly received a 24 h infusion with either levosimendan or dobutamine. Survival and resource utilisation data were collected for 6 months; survival was extrapolated assuming a mean additional lifetime of 3 years based on data from the Cooperative North Scandinavian Enalapril Survival Study trial. Costs were based on study drug usage and hospitalisation in the 6‐month follow‐up. A sensitivity analysis on dosage of drug and duration of survival was performed.Results:The mean survival over 6 months was 157±52 days in the levosimendan group and 139±64 days in the dobutamine group (P<0.01). When extrapolated up to 3 years, the gain in life expectancy was estimated at 0.35 years (discounted at 3%). Levosimendan increased the mean cost per patient by €1108, which was entirely due to the cost of the study drug. The incremental cost per life‐year saved (LYS) was €3205 at the European level; in the individual countries the cost per LYS ranged between €3091 and €3331. The result was robust in the sensitivity analysis.Conclusions:Although the patients in the levosimendan group were alive for more days and thus at risk of hospitalisation for longer, there was no increase in hospitalisation or hospitalisation costs with levosimendan treatment. The cost per LYS using levosimendan compares favourably with other cost‐effectiveness analyses in cardiology.
Clinical trials update from the American Heart Association meeting: PROSPER, DIAL, home care monitoring trials, immune modulation therapy, COMPANION and anaemia in heart failure
Authors: Coletta A.P. , Nikitin N. , Clark A.L. , Cleland J.G.F. 
Published: January 2003

AbstractThis article continues a series of reports on research developments of particular interest to those involved in the management of patients with heart failure. Summaries of the following trials, reported at the 75th Scientific Sessions of the American Heart Association held in Chicago, Illinois between 17th and 20th November 2002 are included: PROSPER; DIAL; home care monitoring trials; immune modulation therapy; COMPANION; and anaemia in heart failure.
Higher education and civic engagement*
Authors: Egerton Muriel 
Published: January 2003

ABSTRACTThis paper focuses on the relationship between social engagement, particularly civic engagement, and education. It is well known that more highly educated people are more likely to engage in voluntary work in formalized settings. It has been difficult to disentangle the effect of higher education from that of family origin and occupational socialization. This paper examines the effects of tertiary education on the social and civic engagement of young people, using the British Household Panel Study. The social and civic activity of young people is observed in their late teens, before entering the labour market or tertiary education, and compared with that of the same young people in their early 20s, after completing tertiary education courses or gaining labour market experience. It was found that the social and civic engagement of young people who would enter higher education was higher in their late teens than that of their peers who did not enter. However, higher education had a small additional effect on civic engagement, for both young and mature students. The children of professionals were the social grouping most likely to be involved in civic activities. The relationship of higher education, professional occupations and family socialization is discussed.
Positivism in sociological research: USA and UK (1966–1990) 1
Authors: Gartrell C. David , Gartrell John W. 
Published: January 2003

ABSTRACTPositivism has been declared dead in sociological theory circles, yet questions remain as to its viability among researchers. The authors present diagnostic evidence about positivism in sociological practice through a content analysis of journal articles published in the late 1960s and the late 1980s in the sociological journals of the USA and Britain. Using an index based on seven elements of positivism that were characteristic of the ‘theory construction’ movement of the late 1960s, the authors find evidence of the effects of time and nation on the use of positivism. Disaggregation of the index reveals that most of the observed change is associated with the elements of ‘instrumental’ positivism, particularly statistics. The results raise questions about the relationship between theory and research and about sociologists’ philosophies of science.
Complexity and practical knowledge in the social sciences: a comment on Stehr and Grundmann
Authors: Meagher Gabrielle , Wilson Shaun 
Published: January 2003

ABSTRACTThis paper takes issue with Stehr and Grundmann's argument in this journal that sociology's poor record of contribution to practical knowledge results from sociologists’ misguided attachment to the idea that social phenomena are peculiarly complex, and so peculiarly resistant to efforts at practical knowledge formation. Stehr and Grundmann develop their thesis by contrasting sociology to economics, claiming the latter's superior methods and disciplinary cultures enable it to contribute more successfully to solving practical problems. We argue that Stehr and Grundmann's comparison of the relative success of economics and sociology as policy sciences underestimates the extent to which the complexity argument has been destructive of economics’ capacity to contribute practical knowledge, and overestimates the importance of disciplinary methods and cultures in explaining the use of economics in policy making. Further, we argue that the ‘complexity argument’ can contribute to better policy making, by virtue of its capacity to high‐light the dangers of simplistic or fundamentalist solutions to social problems with complex causes.
Suppression of Arylamine Toxicity in the Fischer-344 Rat Following Ingestion of a Complex Mixture
Authors: Boudreau Mary D. , Baker David G. , Taylor H. Wayne , Barker Steven A. , Means Jay C. 
Published: January 2003

The toxic effects of a mixture of 2-aminoanthracene (2-AA), benzanthracene (BA), and dinitropyrene isomers (DNP), and the toxic effects of these compounds individually, were investigated in the Fischer-344 rat following dietary exposure via a powdered basal diet. Animals were sacrifi ced at 14-, 30-, and 80-day s of dietary exposure. Exposure to dietary 2-AA alone induced anorexia, cachexia, variable mortality, and altered serum chemistry profi les in the F-344 rat. Reduced lymphocyte counts were also shown in rats exposed to 2-AA. A temporal pattern of effect of 2-AA dietary exposure was observed in the progression of hepatic lesions in exposed animals. Dietary exposure to either DNP isomers or BA at a 10-fold higher concentration in the diet, relative to 2-AA, did not induce detectable toxic responses. However, exposure of rats to a mixture of 2-AA, BA, and DNP isomers (100 mg/kg, 1.0 g/kg, and 1.0 g/kg of diet, respectively) resulted in the attenuation of toxic effects when compared to exposure of F-344 rats to 2-AA alone. These results indicate that the toxic effects of 2-AA are suppressed by co-administration of DNP and BA and suggest that compound interactions need to be considered when predicting the toxic potential of specifi c environmental pollutants.
Dynamics of nasopharyngeal colonization by potential respiratory pathogens
Authors: García-Rodríguez J. Á. , Fresnadillo Martínez M. J. 
Published: January 2003

Abstract
Studies have shown that colonization of the nasopharynx by potential respiratory pathogens Streptococcus pneumoniae , Haemophilus influenzae and Moraxella catarrhalis is established early in childhood, although rates vary greatly according to locality, sampling frequency, individual and social factors. Factors influencing colonization and elimination are not as yet fully understood, but adhesion to mucosal receptors and immune responses are implicated in addition to bacterial properties and colonization resistance dynamics. Colonization in children and adults has been intensively studied in various localities. Potential pathogens are more likely to colonize the nasopharynx of children prone to recurrent otitis media, where impaired local immunity and repeated exposure to respiratory pathogens are additional risk factors. Adults with chronic respiratory tract disease also have higher carriage rates. The factors contributing to increased risk of carriage of potential respiratory pathogens, as well as to clinical infection and antimicrobial resistance, are summarized in this review.
Randomized, Multicenter, Open-Label Study of Pegfilgrastim Compared With Daily Filgrastim After Chemotherapy for Lymphoma
Authors: Vose J.M. , Crump M. , Lazarus H. , Emmanouilides C. , Schenkein D. , Moore J. , Frankel S. , Flinn I. , Lovelace W. , Hackett J. , Liang B.C. 
Published: January 2003

Purpose: The primary objective was to assess the duration of grade 4 neutropenia (neutrophil count < 0.5 × 109/L) after one cycle of chemotherapy with etoposide, methylprednisolone, cisplatin, and cytarabine in patients randomly assigned to receive one dose of pegfilgrastim or daily filgrastim after chemotherapy. Febrile neutropenia, neutrophil profiles, time to neutrophil recovery, pharmacokinetics, and safety were also assessed. Patients and Methods: An open-label, randomized, phase II study was designed to compare the effects of a single subcutaneous injection of pegfilgrastim (sustained-duration filgrastim) 100 μg/kg per chemotherapy cycle (n = 33) with daily subcutaneous injections of filgrastim 5 μg/kg (n = 33) in patients receiving salvage chemotherapy for relapsed or refractory Hodgkin’s or non-Hodgkin’s lymphoma. Results: The incidence of grade 4 neutropenia in the pegfilgrastim and filgrastim groups was 69% and 68%, respectively. In addition, the mean duration of grade 4 neutropenia was similar in both groups (2.8 and 2.4 days, respectively). The results for the two groups were also not significantly different for febrile neutropenia, neutrophil profile, time to neutrophil recovery, or toxicity profile. A single subcutaneous injection of pegfilgrastim 100 μg/kg produced a sustained serum concentration relative to daily subcutaneous injections of filgrastim. Filgrastim-treated patients received a median of 11 injections per cycle. Conclusion: Pegfilgrastim was safe and well tolerated in this patient population. A single injection of pegfilgrastim per chemotherapy cycle provided neutrophil support with safety and efficacy similar to that provided by daily injections of filgrastim. Once-per-cycle administration of pegfilgrastim simplifies the management of neutropenia and may have important clinical benefits for patients and healthcare providers.
Matched and Mismatched Allogeneic Stem-Cell Transplantation From Unrelated Donors Using Combined Graft-Versus-Host Disease Prophylaxis Including Rabbit Anti–T Lymphocyte Globulin
Authors: Finke Jürgen , Schmoor Claudia , Lang Helmut , Potthoff Karin , Bertz Hartmut 
Published: January 2003

Purpose: With improved HLA-typing techniques, it is presently unclear what degree of identity is necessary for successful unrelated-donor stem-cell transplantation (UD SCT). Here, we describe the outcome after matched and mismatched UD SCT using a graft-versus-host disease (GVHD) prophylaxis including high-dose rabbit anti–T lymphocyte globulin (ATG). Patients and Methods: One hundred adult patients (median age, 37 years; range, 17 to 65 years) with hematologic malignancies underwent transplantation in early disease (first complete remission [CR1] or first chronic phase [CP1]; n = 34) or in advanced disease (second complete remission or second chronic phase, no remission, refractory; n = 66) with nondepleted bone marrow (n = 87) or peripheral-blood–derived (n = 13) stem cells from an HLA-A, HLA-B, HLA-DRB1*, or HLA-DQB1* identical (n = 75) or mismatched (one antigen, n = 21; two to three antigens, n = 4) unrelated donor. GVHD prophylaxis consisted of rabbit ATG before transplantation in addition to cyclosporine and short-course methotrexate. Results: The cumulative incidence of acute GVHD °II-°IV was 21% (95% confidence interval [CI], 14% to 33%) and 20% (95% CI, 9% to 44%) and acute GVHD °III–°IV was 5.3% (95% CI, 2% to 14%) and 4% (95% CI, 0.6% to 28%) in HLA-matched and HLA-mismatched transplantations, respectively. The risk for extensive chronic GVHD was 43% (95% CI, 32% to 59%) and 44% (95% CI, 26% to 75%) for HLA-matched and HLA-mismatched patients, respectively. The risk of relapse at 4 years was 17% (95% CI, 7% to 43%) and 43% (95% CI, 31% to 60%) for CR1/CP1 and advanced disease patients, respectively. With a median follow-up of 1,068 days (range, 12 to 1,958 days), 3-year disease-free and overall survival for patients who underwent transplantation in CR1/CP1 was 63% (95% CI, 46% to 81%) and 75% (95% CI, 59% to 90%), respectively; and for patients with advanced disease, it was 34% (95% CI, 22% to 46%) and 39% (95% CI, 25% to 53%), respectively. Conclusion: A certain degree of one antigen mismatching may not compromise the outcome after UD SCT when using this rabbit ATG in addition to standard GVHD prophylaxis regimen.