bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perfusion technique for nonhaemic cardiopulmonary bypass prime in neonates and infants under 6 kg body weight
Authors: Merkle Frank , Boettcher Wolfgang , Schulz Fritz , Koster Andreas , Huebler Michael , Hetzer Roland 
Published: July 2004

Background: Cardiopulmonary bypass (CPB) in neonates and infants is associated with significant haemodilution when priming of the CPB circuit is accomplished without transfusion of homologous blood components. The degree of haemodilution and, thus, the requirements for blood transfusion may be reduced when the CPB circuit is miniaturized without compromising patient safety. Method: Between January 2002 and October 2003, selected neonates and small infants were operated on using a nonhaemic prime extracorporeal circuit. CPB priming volume could be reduced from 300 mL to 190 mL by using a dedicated neonatal CPB console with mast-mounted roller pump heads. Reduction of priming volume resulted from shortening of all CPB lines to the minimum, downsizing of all CPB lines, exclusion of unused CPB components, use of vacuum-assisted venous drainage and from close co-operation between the perfusionist, cardiac surgeon and anaesthesiologist. The reduction in priming volume was achieved without eliminating the arterial line filter as safety device. Results: A total of nine patients weighing between 3.2 and 5.9 kg (mean 4.7 kg) and with a body surface area of 0.22 - 0.35m2 (mean 0.29m2) were operated on with the use of the modified neonatal CPB circuit and a nonhaemic prime. Bypass time varied from 38 to 167 min (mean 96 min). The mean haematocrit on CPB was 22.5% with a range of 17 - 29%. The postoperative course of all patients was uneventful. Conclusion: A significant reduction in CPB priming volume makes nonhaemic prime CPB in neonates and small infants undergoing complex repair of congenital heart defects possible.
Mini extracorporeal circuit for coronary artery bypass grafting: initial clinical and biochemical results
Authors: van Boven W J , Gerritsen W B , Waanders F G , Haas F J , Aarts L P 
Published: July 2004

Background: The new concept of mini-extracorporeal circulation (MECC) for coronary artery bypass grafts (MCABG) consists of minimal priming volume, a heparin-coated closed circuit, a centrifugal pump, active drainage, blood cardioplegia and a cell-saving device. The potential organ protective effect of this technique during CABG is unknown. Initial clinical outcomes, oxidative stress, alveolar shunting and need for blood transfusion were investigated for MCABG patients. Subsets of these data were compared to outcomes of matched groups of patients operated conventionally (CCABG) and off-pump (OPCAB). Methods: Data of 184 patients were gathered and analysed from a prospective observational database system. This database consists of the initial experience with the first 114 MCABG operations. Of these, the clinical outcome was investigated. In a subset of 60 MCABGs, need for transfusion was monitored and compared to 60 CCABGs. Serum concentrations of malondialdehyde (MDA), allantoin/urate ratios, shunt fractions and lung epithelium-specific proteins (CC16) were measured as biomarkers of damage during MCABG, CCABG and OPCAB (n-30). Results: Patient groups were similar concerning age, risk and number of distal anastomoses. Clinical outcomes are shown for MCABGs only. During MCABG, need for trans-fusion was significantly reduced compared to CCABG (pB/0.001). Serum concentrations of MDA and allantoin/urate ratios showed significantly reduced oxidative stress during MCABG compared to CCABG. During MCABG, F-shunts were reduced shortly after surgery. Increased concentrations of pneumoprotein CC16 were measured during CCABG compared to MCABG (data submitted). Conclusion: Short-term clinical outcomes of MCABG patients are satisfactory. Compared to CCABG the need for transfusion is significantly reduced when a MECC is used. Oxidative stress parameters show a tendency towards improved global organ protection compared to CCABG. F-shunt fractions and CC16 concentrations suggest reduced alveolar damage during MCABG. In a prospective study, the protective effect of mini-CABG has to be confirmed.
Compact intra-and extracorporeal oxygenator developments
Authors: Cattaneo Giorgio , Strauß Andreas , Reul Helmut 
Published: July 2004

For patients with acute lung failure, mechanical ventilation entails the risk of lung tissue damage due to high oxygen pressure and concentration. Membrane oxygenation for one to two weeks can rest the lungs due to decreased ventilation parameters, representing a potential bridge to recovery, but implies the substantial risks of blood damage, plasma leakage and infection, which often have fatal results for patients. At the Helmholtz Institute in Aachen, two types of membrane oxygenators, which aim to overcome previous limits, are under development. Both present compact designs, reduced surface and priming volumes and easier handling. HEXMO is a miniaturized extracorporeal membrane oxygenator. The integration of a small rotary blood pump into the centre of the oxygenator reduces the amount of tubing and connectors in the system. Blood is convectively warmed by the pump motor housing, thus, the use of a heat-exchanger can be avoided. This compact design reduces surface and priming volume and allows better handling, especially in critical situations. A second development is the intravascular oxygenator HIMOX, which is inserted directly into the vena cava. Priming volume and blood contact surface are reduced, as well as infection risk and control needs for the patient. A new cross-flow fibre configuration is used for improving gas transfer within the limited space inside the vena cava. A microaxial blood pump is integrated into the device for compensating the pressure drop across the fibres and allowing venous return and physiological pressure in the organs proximal to the oxygenator.
Vascular disease/risk and late-life depression in a Korean community population
Authors: Kim Jae-Min , Stewart Robert , Shin Il-Seon , Yoon Jin-Sang 
Published: July 2004

BackgroundAssociations between vascular risk factors and late-life depression are controversial.AimsTo investigate the association between measures of vascular disease/ risk and depression and confounding and effect modification by APOE genotype and cognitive function.MethodIn a Korean community population aged 65+ (n=732), diagnosis of depression (Geriatric Mental State Schedule) and information on vascular status, disability, APOE genotype and cognitive function were obtained.ResultsPrevious stroke and lower high-density lipoprotein cholesterol level (but neither hypertension nor diabetes) were significantly associated with depression (independently of disability and cognitive function). These associations were stronger in participants with borderline cognitive impairment, although not to a significant extent.ConclusionsExcept for previous stroke and an atherogenic lipid profile, associations between depression and other common risk factors for cerebrovascular disease were not evident.
Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital
Authors: Chong Mian-Yoon , Wang Wen-Chih , Hsieh Wen-Chien , Lee Chun-Yi , Chiu Nien-Mu , Yeh Wei-Chiang , Huang Tiao-Lai , Wen Jung-Kwang , Chen Chao-Long 
Published: July 2004

BackgroundThe sudden emergence of severe acute respiratory syndrome (SARS) caused international anxiety owing to its highly contagious and pandemic transmission. Health workers are vulnerable and are at high risk of infection.AimsTo assess SARS-related stress and its immediate psychological impact and responses among health workers.MethodHealth workers in a tertiary hospital affected by SARS were invited to complete a questionnaire designed to evaluate exposure experience, psychological impact and psychiatric morbidity. The risk and rates of psychiatric morbidity were estimated for exposure experience.ResultsAltogether, 1257 health workers successfully completed the survey. In the initial phase of the outbreak, when the infection was spreading rapidly, feelings of extreme vulnerability, uncertainty and threat to life were perceived, dominated by somatic and cognitive symptoms of anxiety. During the ‘repair’ phase, when the infection was being brought under control, depression and avoidance were evident. The estimated prevalence of psychiatric morbidity measured by the Chinese Health Questionnaire was about 75%.ConclusionsThe outbreak of SARS could be regarded as an acute episode of a bio-disaster, leading to a significantly high rate of psychiatric morbidity.
Childhood experience and health care use in adulthood
Authors: Kapur Navneet , Hunt Isabelle , Macfarlane Gary , McBeth John , Creed Francis 
Published: July 2004

BackgroundFew studies have considered the role of childhood experiences in adult health care use.AimsTo examine the hypotheses that individuals frequently attending primary care report childhood adversities and illness exposures more commonly than the remainder of patients and that any association is independent of adult psychiatric disorder.MethodA nested case–control study was carried out in a single general practice in Manchester, UK. Fifty frequent attenders (randomly selected from adult patients in the top decile of consultation frequency) and fifty normal attenders (randomly selected from the remainder of adult patients) underwent a structured psychiatric interview and a detailed, semi-structured interview of childhood experience.ResultsThere was a strong association between frequent attendance and childhood experiences. Multivariate analysis suggested that reported childhood illness exposures and reports of childhood adversity were each associated independently with adult consultation behaviour, even after adjustment for adult psychiatric disorder.ConclusionsInterventions for high users of health care may need to address childhood experiences of illness and childhood adversities, as well as adult psychiatric disorder.
Prolactin levels in antipsychotic treatment of patients with schizophrenia carrying the DRD2*A1 allele
Authors: Young Ross Mcd. , Lawford Bruce R. , Barnes Mark , Burton Simon C. , Ritchie Terry , Ward Warren K. , Noble Ernest P. 
Published: July 2004

BackgroundHyperprolactinaemia induced by D2 dopamine receptor antagonist antipsychotic medication can result in significant health problems.AimsTo examine the role of DRD2 polymorphism on prolactin levels in patients treated with antipsychotic medication.MethodAntipsychotic drugs with different degrees of D2 receptor binding were given to 144 patients with schizophrenia. Serum prolactin levels were obtained and Taq1A DRD2 alleles were determined.ResultsProlactin levels increased across medication groups reflecting increasingly tight D2 receptor binding (clozapine, olanzapine, typical antipsychotics and risperidone). In the combined medication group, patients with the DRD2∗A1 allele had 40% higher prolactin levels than patients without this allele. In patients treated with clozapine (the loosest D2 receptor binding agent), patients with the DRD2∗A1 allele had prolactin levels twice those of patients without this allele.ConclusionsPatients with the DRD2A1 allele receiving antipsychotic medications had higher prolactin levels and were overrepresented among those with hyperprolactinaemia, suggesting greater functional D2 receptor binding in this group.
Testing for diabetes in hospitalised patients prescribed antipsychotic drugs
Authors: Taylor David , Young Corina , Esop Raadiyya , Paton Carol , Walwyn Rebecca 
Published: July 2004

BackgroundStudies using computer databases suggest that atypical antipsychotic agents are more likely to be associated with diabetes than are conventional drugs.AimsTo discover the extent of testing for diabetes mellitus in hospital in-patients prescribed antipsychotics.MethodPrescription charts were screened to identify patients prescribed antipsychotics. Case notes were then searched for evidence of testing for diabetes.ResultsIn all, 606 patients were prescribed antipsychotics, of whom 250 (41.3%) had evidence of prior testing for diabetes. Patients prescribed atypicals were 40% more likely to have been tested than those prescribed conventional drugs (RR = 1.4, 95% C11.1–1.9). Adjusted odds ratiosv.conventional antipsychotics for testing were significantly higher for clozapine (OR = 4.64, 95% C12.42–8.90), olanzapine (OR= 1.85, 95% C11.04–3.30) and antipsychotic polypharmacy (OR= 2.96, 95% C11.59–5.52).ConclusionsTesting for diabetes was undertaken in less than half of the patients studied. Testing was more common in those receiving atypical antipsychotics. Apparent differences in claimed causal association of the use of some antipsychotics with diabetes may in part reflect different rates of testing.
Subjective experience of electroconvulsive therapy
Authors: Benbow Susan M. , Crentsil Joe 
Published: July 2004

Aims and MethodPeople receiving electroconvulsive therapy (ECT) in one clinic completed side-effect rating questionnaires during treatment, and a questionnaire rating their experience of different aspects of treatment on completion of the treatment course.ResultsSide-effects were commonly reported, but predominantly rated as mild or moderate. Most people reported that ECT had made them a little or a lot better, and that the treatment had been fairly or very well explained. Fewer than a fifth of respondents rated ECT as slightly or much worse than going to the dentist.Clinical ImplicationsWe recommend routine monitoring of the subjective experience of ECT, during treatment and on completion of the course. Ratings should inform the treatment plan, the policies and procedures of the ECT clinic.
A Randomized Trial Comparing Defined-Duration With Continuous Irinotecan Until Disease Progression in Fluoropyrimidine and Thymidylate Synthase Inhibitor—Resistant Advanced Colorectal Cancer
Authors: Lal Rohit , Dickson James , Cunningham David , Chau Ian , Norman Andrew R. , Ross Paul J. , Topham Clare , Middleton Gary , Hill Mark , Oates Jacqui 
Published: July 2004

Purpose Irinotecan given until disease progression is an accepted standard treatment for advanced colorectal cancer (CRC) resistant to fluoropyrimidines. It is not known whether a predefined period of irinotecan treatment would result in similar duration of disease control. We performed a multicenter phase III trial to compare the two policies of defined-duration versus continuous irinotecan treatment. Patients and Methods Three hundred thirty-three eligible patients with advanced CRC progressing on or within 24 weeks of completing fluoropyrimidine-based chemotherapy were prospectively registered. After receiving eight cycles of irinotecan given at 350 mg/m2 once every 3 weeks, 55 patients with responding or stable disease were randomly assigned to stop irinotecan (n = 30) or continue until disease progression (n = 25). Registered patients were not randomly assigned predominantly due to disease progression (n = 236) and intolerable toxicity (n = 38). Results From the time of random assignment, there were no differences in failure-free survival (P = .999) or overall survival (P = .11) between the two arms. No difference was seen in mean global health status quality-of-life score between the two arms at 12 weeks after random assignment. No grade 3 diarrhea and febrile neutropenia was seen in the continue-irinotecan arm after random assignment. Conclusion For most patients, the decision to continue on irinotecan beyond 24 weeks is influenced by disease progression or treatment-related toxicity. However, for 17% of patients in whom this decision is clinically relevant, there seems to be little benefit from continuing irinotecan, though the drug was well tolerated without any deterioration in quality of life.
Long-Term Silicone Central Venous Catheters Impregnated With Minocycline and Rifampin Decrease Rates of Catheter-Related Bloodstream Infection in Cancer Patients: A Prospective Randomized Clinical Trial
Authors: Hanna Hend , Benjamin Robert , Chatzinikolaou Ioannis , Alakech Badie , Richardson Deborah , Mansfield Paul , Dvorak Tanya , Munsell Mark F. , Darouiche Rabih , Kantarjian Hagop , Raad Issam 
Published: July 2004

Purpose To evaluate the efficacy of long-term nontunneled silicone catheters impregnated with minocycline and rifampin (M-R) in reducing catheter-related bloodstream infections. Patients and Methods This prospective, randomized, double-blind clinical trial was conducted at M.D. Anderson Cancer Center, a tertiary care hospital in Houston, TX. All patients in the trial had a malignancy. Results Between September 1999 and May 2002, 356 assessable catheters were used: 182 M-R and 174 nonimpregnated. The patients' characteristics were comparable between the two study groups. The mean (± standard deviation) duration of catheterization with M-R catheters was comparable to that of nonimpregnated catheters (66.21 ± 30.88 v 63.01 ± 30.80 days). A total of 17 catheter-related bloodstream infections occurred during the course of the study. Three were associated with the use of M-R catheters and 14 were associated with the nonimpregnated catheters, with a rate of catheter-related bloodstream infection of 0.25 and 1.28/1,000 catheter-days, respectively (P = .003). Gram-positive cocci accounted for the majority of the organisms causing the infections. There were no allergic reactions associated with M-R catheters. Conclusion Long-term nontunneled central venous catheters impregnated with minocycline and rifampin are efficacious and safe in reducing catheter-related bloodstream infections in cancer patients.
Phase III Study of Cisplatin With or Without Paclitaxel in Stage IVB, Recurrent, or Persistent Squamous Cell Carcinoma of the Cervix: A Gynecologic Oncology Group Study
Authors: Moore David H. , Blessing John A. , McQuellon Richard P. , Thaler Howard T. , Cella David , Benda Jo , Miller David S. , Olt George , King Stephanie , Boggess John F. , Rocereto Thomas F. 
Published: July 2004

Purpose To determine whether cisplatin plus paclitaxel (C+P) improved response rate, progression-free survival (PFS), or survival compared with cisplatin alone in patients with stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix. Patients and Methods Eligible patients with measurable disease, performance status (PS) 0 to 2, and adequate hematologic, hepatic, and renal function received either cisplatin 50 mg/m2 or C+P (cisplatin 50 mg/m2 plus paclitaxel 135 mg/m2) every 3 weeks for six cycles. Tumor measurements and quality-of-life (QOL) assessments were obtained before each treatment cycle. Results Of 280 patients entered, 6% were ineligible. Among 264 eligible patients, 134 received cisplatin and 130 received C+P. Groups were well matched with respect to age, ethnicity, PS, tumor grade, disease site, and number of cycles received. The majority of all patients had prior radiation therapy (cisplatin, 92%; C+P, 91%). Objective responses occurred in 19% (6% complete plus 13% partial) of patients receiving cisplatin versus 36% (15% complete plus 21% partial) receiving C+P (P = .002). The median PFS was 2.8 and 4.8 months, respectively, for cisplatin versus C+P (P < .001). There was no difference in median survival (8.8 months v 9.7 months). Grade 3 to 4 anemia and neutropenia were more common in the combination arm. There was no significant difference in QOL scores, although a disproportionate number of patients (cisplatin, n= 50; C+P, n = 33) dropped out of the QOL component, presumably because of increasing disease, deteriorating health status, or early death. Conclusion C+P is superior to cisplatin alone with respect to response rate and PFS with sustained QOL.
Evaluation of Biologic End Points and Pharmacokinetics in Patients With Metastatic Breast Cancer After Treatment With Erlotinib, an Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor
Authors: Tan Antoinette R. , Yang Xiaowei , Hewitt Stephen M. , Berman Arlene , Lepper Erin R. , Sparreboom Alex , Parr Allyson L. , Figg William D. , Chow Catherine , Steinberg Seth M. , Bacharach Stephen L. , Whatley Millie , Carrasquillo Jorge A. , Brahim Jaime S. , Ettenberg Seth A. , Lipkowitz Stan , Swain Sandra M. 
Published: July 2004

Purpose To evaluate changes in epidermal growth factor receptor (EGFR) phosphorylation and its downstream signaling in tumor and surrogate tissue biopsies in patients with metastatic breast cancer treated with erlotinib, an EGFR tyrosine kinase inhibitor, and to assess relationships between biomarkers in tumor and normal tissues and between biomarkers and pharmacokinetics. Patients and Methods Eighteen patients were treated orally with 150 mg/d of erlotinib. Ki67, EGFR, phosphorylated EGFR (pEGFR), phosphorylated mitogen-activated protein kinase (pMAPK), and phosphorylated AKT (pAKT) in 15 paired tumor, skin, and buccal mucosa biopsies (at baseline and after 1 month of therapy) were examined by immunohistochemistry and analyzed quantitatively. Pharmacokinetic sampling was also obtained. Results The stratum corneum layer and Ki67 in keratinocytes of the epidermis in 15 paired skin biopsies significantly decreased after treatment (P = .0005 and P = .0003, respectively). No significant change in Ki67 was detected in 15 tumors, and no responses were observed. One was EGFR-positive and displayed heterogeneous expression of the receptor, and 14 were EGFR-negative. In the EGFR-positive tumor, pEGFR, pMAPK, and pAKT were reduced after treatment. Paradoxically, pEGFR was increased in EGFR-negative tumors post-treatment (P = .001). Although markers were reduced in surrogate and tumor tissues in the patient with EGFR-positive tumor, no apparent associations were observed in patients with EGFR-negative tumor. Conclusion Erlotinib has inhibitory biologic effects on normal surrogate tissues and on an EGFR-positive tumor. The lack of reduced tumor proliferation may be attributed to the heterogeneous expression of receptor in the EGFR-positive patient and absence of target in this cohort of heavily pretreated patients.
Cardiovascular Status in Long-Term Survivors of Hodgkin's Disease Treated With Chest Radiotherapy
Authors: Adams M. Jacob , Lipsitz Stuart R. , Colan Steven D. , Tarbell Nancy J. , Treves S. Ted , Diller Lisa , Greenbaum Nina , Mauch Peter , Lipshultz Steven E. 
Published: July 2004

Purpose Cardiovascular status was assessed in 48 Hodgkin's disease (HD) survivors at a median of 14.3 years (range, 5.9 to 27.5 years) after diagnosis because they may be at increased risk for cardiovascular abnormalities. Patients and Methods Patients completed the Short-Form 36 quality-of-life instrument and were screened by echocardiography, exercise stress testing, and resting and 24-hour ECG. Results All patients received mediastinal irradiation (median, 40.0 Gy; range, 27.0 to 51.7 Gy) at a median age of 16.5 years (range, 6.4 to 25.0 years). Four patients received an anthracycline. Although every patient described their health as good or better, and none had symptomatic heart disease at screening, all but one had cardiac abnormalities on screening. Restrictive cardiomyopathy was suggested by reduced average left ventricular (LV) dimension (P < .001) and mass (P < .001), without increased LV wall thickness. Significant valvular defects were present in 42%; 75% had conduction defects. One survivor developed complete heart block shortly after the study visit. Autonomic dysfunction was suggested by a monotonous heart rate in 57%, persistent tachycardia in 31%, and blunted hemodynamic responses to exercise in 27%. Peak oxygen uptake (VO2max) during exercise, a predictor of mortality in heart failure, was significantly reduced (< 20 mL/kg/m2) in 30% of survivors. VO2max was correlated with increasing fatigue, increasing shortness of breath (both, r = −0.35; P = .02), and decreasing physical component score on the SF-36 (r = 0.554; P = .00017). Conclusion A variety of unsuspected, clinically significant cardiovascular abnormalities are common in long-term survivors of HD who are treated at a young age with mediastinal irradiation. We recommend serial, comprehensive cardiac screening of HD survivors who fit this profile.