bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electronic Pancreatoscopy for The Diagnosis of Pancreatic Diseases
Authors: Kodama Tadashi , Koshitani Tatsuya , Sato Hideki , Imamura Yoichi , Kato Keimei , Abe Mitsumasa , Wakabayashi Naoki , Tatsumi Yoshihide , Horii Yoshiyuki , Yamane Yukio , Yamagishi Hisakazu 
Published: March 2004

ABSTRACT

OBJECTIVES:
Diagnostic pancreatoscopy was performed in 56 patients using the newly developed peroral electronic pancreatoscope (PEPS). The diagnostic value of the PEPS for pancreatic diseases was evaluated.

METHODS:
The PEPS (external diameter = 2.1 mm, bidirectional tip deflection) was developed with a minute 50,000-pixel interline charge-coupled device. Pancreatoscopy was performed by means of an endoscopic retrograde approach without sphincterotomy. The cases examined were normal (three), chronic pancreatitis (32), pancreatic cancer (eight), and intraductal papillary mucinous tumors (13).

RESULTS:
Of the 56 cases, 42 (75%) were adequately seen. In normal cases, fine capillary vessels were clearly visualized on the smooth whitish-pink mucosa. Findings in chronic pancreatitis included protein plugs, calcified stones, rough whitish mucosa, scar formation, edema, erythema, and indistinct capillary appearance. All the stenoses of chronic pancreatitis could be differentiated from those of pancreatic cancer with the PEPS. In the pancreatic cancer cases, all patients had stenoses or duct cutoffs; most cases had friable mucosa with erythema and erosive changes, and a single patient had a compressed pancreatic duct wall covered with normal epithelium. In the cases of intraductal papillary mucinous tumors, papillary tumors were visualized with extreme clarity. In the case of adenocarcinoma, the PEPS revealed oval-shaped tumors with spotty redness or villous tumors with dilation of capillary vessels. Moderate acute pancreatitis was recognized after pancreatoscopy in one of the 56 cases (1.8%).

CONCLUSIONS:
Electronic pancreatoscopy with the PEPS is feasible in most patients and technically safe, and improves diagnostic yield over conventional pancreatoscopy.
Combined Ligation and Sclerotherapy Versus Ligation Alone for Secondary Prophylaxis of Esophageal Variceal Bleeding: A Meta-Analysis
Authors: Singh Pankaj , Pooran Nakechand , Indaram Anant , Bank Simmy 
Published: March 2004

ABSTRACT

OBJECTIVES:
Variceal ligation has been shown to be superior to sclerotherapy in prevention of rebleeding and improving survival in patients with cirrhosis. However, 25% of patients will rebleed before completion of treatment. A number of trials have compared the combination of ligation and sclerotherapy to ligation alone in achieving rapid and complete eradication of esophageal varices, with conflicting results.

METHODS:
Two reviewers independently identified seven randomized, controlled trials that compared endoscopic variceal ligation with the combination of sclerotherapy and ligation for the treatment of esophageal varices. Studies were identified by searching MEDLINE, reviewing references from retrieved articles, and scanning abstracts from conference proceedings. For each outcome, odds ratios (ORs) were calculated using fixed-effects and random-effects models. The Mantel-Haenszel test for statistical heterogeneity was used to assess the validity of combining results from individual studies.

RESULTS:
No significant difference was seen in cessation of actively bleeding varices (OR = 1.01, 95% CI = 0.43–2.36), variceal rebleeding (OR = 1.12, CI = 0.69–1.81), and mortality (OR = 1.1, CI = 0.70–1.74) in patients with variceal ligation versus patients receiving the combination treatment of ligation and sclerotherapy. Treatment sessions required to achieve complete variceal eradication were similar in the two treatment arms. A significantly higher incidence of esophageal stricture was seen in combination therapy (p < 0.001).

CONCLUSIONS:
The combination of ligation and sclerotherapy offers no advantage over ligation alone in prevention of rebleeding and in reduction of mortality. It is also associated with a higher complication rate of esophageal stricture.
Prospective Validation of The Rockall Risk Scoring System for Upper Gi Hemorrhage in Subgroups of Patients With Varices and Peptic Ulcers
Authors: Sanders D S , Carter M J , Goodchap R J , Cross S S , Gleeson D C , Lobo A J 
Published: March 2004

ABSTRACT

OBJECTIVES:
The Rockall risk assessment score was devised to allow prediction of the risk of rebleeding and death in patients with upper GI hemorrhage. The score was derived by multivariate analysis in a cohort of patients with upper GI hemorrhage and subsequently validated in a second cohort. Only 4.4% of patients included in the initial study had esophageal varices, and analysis was not performed according to the etiology of the bleeding. Our aim was to assess the validity of the Rockall risk scoring system in predicting rebleeding and mortality in patients with esophageal varices or peptic ulcers.

METHODS:
Admissions (n = 358) over 32 months to a single specialist GI bleeding unit were scored prospectively. The distribution of episodes of rebleeding and mortality by Rockall score were statistically analyzed using Fisher's exact test with 99% CIs calculated using a Monte Carlo method. The Child-Pugh score was determined in patients with esophageal varices.

RESULTS:
The Rockall score was predictive of both rebleeding and mortality in patients with variceal hemorrhage (both ps < 0.0005), as was the Child-Pugh score (p = 0.001 and p < 0.0005, respectively). The initial Rockall score was predictive of mortality in patients with peptic ulcers (p = 0.01), although the complete score was not (p > 0.05). The complete score did, however, predict rebleeding in these patients (p = 0.001).

CONCLUSION:
This is the first study to validate the Rockall score in specific subgroups of patients with esophageal varices or peptic ulcers and suggests that it is particularly applicable to variceal hemorrhage.
Generational Differences in The Age at Diagnosis With Ibd: Genetic Anticipation, Bias, Or Temporal Effects
Authors: Faybush E M , Blanchard J F , Rawsthorne P , Bernstein C N 
Published: March 2004

ABSTRACT

OBJECTIVE:
Previous cross-sectional research has demonstrated generational differences in age at diagnosis (AAD) in inflammatory bowel disease (IBD). This observation has at times been ascribed to genetic anticipation, but could also be due to biases related to case ascertainment or follow-up or to temporal changes in IBD epidemiology. We aimed to explore this issue using a population-based database.

METHODS:
In 1995 we used the comprehensive administrative databases in the province of Manitoba, Canada to establish a population-based IBD Research Registry that includes clinical and demographic information for persons. We contacted those subjects within our Research Registry who reported having any family members with IBD and their family members for verification of diagnosis and AAD. Differences in AAD between familial pairs were calculated. In addition, to assess whether duration of follow-up accounted for generational differences in AAD, we computed the mean AAD for subjects with and without family histories of IBD based on age at the time of interview (i.e., <45 and ≥45 yr of age).

RESULTS:
Of the 2445 persons with IBD in the Research Registry, 548 reported positive family histories, and 315 of these (58%) were reached by telephone. There were 169 Crohn's disease and 146 ulcerative colitis subjects with positive family histories. The mean AADs for the parents, aunts/uncles, and grandparents were significantly greater than the mean AADs for the children, nieces/nephews, and grandchildren, respectively. There was a doubling of the mean AAD when comparing the grandparent/grandchild cases with the parent/child or aunt/uncle–niece/nephew cases. No statistically significant difference in anticipation was observed, whether or not the older generation was male or female or had Crohn's disease or ulcerative colitis. The AAD was substantially greater for those interviewed at ≥45 yr of age for subjects with and without family histories. However, there was no substantial difference in mean AAD between familial and nonfamilial subjects.

CONCLUSION:
The present study has demonstrated that there is a tendency for children to be younger than their parents at the time of diagnosis of familial IBD, and that this difference in mean AAD is almost doubled for grandparent/grandchild pairs. However, we conclude that these differences are most likely due to a bias based on length of follow-up or recent multigenerational temporal changes in the risk of IBD, or both.
Outcomes of Infants Born To Mothers With Inflammatory Bowel Disease: A Population-Based Cohort Study
Authors: Dominitz Jason A , Young Josephine C C , Boyko Edward J 
Published: March 2004

ABSTRACT

OBJECTIVE:
Limited population-based data on inflammatory bowel disease (IBD) and pregnancy outcomes exist. The purpose of this study is to determine the association between maternal IBD status and adverse pregnancy outcomes.

METHODS:
Using computerized birth records of infants born to mothers with Crohn's disease (CD) or ulcerative colitis (UC) and mothers without diagnoses of IBD (no-IBD) in Washington State, we performed a cross-sectional retrospective study to determine gestational age, birth weight, and congenital malformations.

RESULTS:
Preterm delivery was seen in 15.2% of CD births, 10.4% of UC births, and 7.2% of no-IBD births. Low birth weight was found in 16.8% of CD births, 7.6% of UC births, and 5.3% of no-IBD births. Smallness for gestational age was present in 15.2% of CD births, 10.5% of UC births, and 6.9% of no-IBD births. Only CD births were at significantly increased risk of preterm delivery (p < 0.0025), low birth weight (p < 0.001), and smallness for gestational age (p < 0.001). Congenital malformations were more commonly recorded in UC births than in controls (7.9% vs 1.7%, p < 0.001), whereas 3.4% of CD births had malformations recorded. Using multivariable logistic regression, CD births were more likely to be preterm (odds ratio [OR] = 2.3, 95% CI = 1.4–3.8) and have low birth weights (OR = 3.6, CI = 2.2–5.9) and smallness for gestational age (OR = 2.3, CI = 1.3–3.9). UC births were more likely to have congenital malformations reported (OR = 3.8, CI = 1.5–9.8).

CONCLUSIONS:
Maternal IBD is associated with increased odds of preterm delivery, low birth weight, smallness for gestational age (CD), and reporting of congenital malformations (UC).
Lymphonodular Hyperplasia of The Terminal Ileum Associated With Colitis Shows An Increased γδ+ T-Cell Density in Children
Authors: Kokkonen Jorma , Ruuska Tarja , Karttunen Tuomo J , Mäki Markku 
Published: March 2004

ABSTRACT

OBJECTIVE:
Recently we reported a close association between lymphonodular hyperplasia (LNH) of the bulb of the duodenum and increased densities of intraepithelial γδ+ T-cells in subjects with untreated food allergies. In this study we sought to determine whether children with LNH of the terminal ileum (TI) show a similar correlation.

METHODS:
The mucosal specimens taken by colonoscopy from the TIs of 22 children with LNH of the TI without colitis, 13 with right-sided colitis or pancolitis, nine with left-sided colitis, eight with Crohn's disease, and three endoscopically healthy subjects were studied for T-cell subsets with monoclonal antibodies using a three-layer peroxidase staining method.

RESULTS:
LNH of the TI was found in 32 of the 55 subjects (58%). In 22 it was the only endoscopic finding, but in nine of 13 subjects (69%) it was related to right-sided colitis or pancolitis. In patients with left-sided colitis or Crohn's disease it was diagnosed only rarely. In the whole study population, LNH of the TI showed a significant association with the increment in the density of γδ+ T-cells. The subjects with LNH of the TI and colitis starting from the cecum showed the highest values, discriminating them statistically from any other study group. Accordingly their γδ+/CD3+ ratio was high. Even in the subjects with LNH of the TI without colitis, the increment in γδ+ T-cells was significant as compared with the subjects with left-sided colitis. Upregulations of D-related expression on the mucosa of the TI were similar regardless of the presence of LNH or colitis or an increment in γδ+ T-cells.

CONCLUSION:
Our preliminary observations showed increased densities of intraepithelial γδ+ T-cells and elevated γδ+/CD3+ ratios in subjects with LNH on the mucosa of the TI, especially if related to colitis starting at the cecum, but not in subjects with typical left-sided colitis or granulomatous Crohn's disease. The study also provides further evidence suggesting the significance of food-borne antigens in the pathogenetic mechanism of right-sided colitis or pancolitis. The finding also indicates the significance of classifying colitis into γδ-positive and -negative diseases, and has implications for the treatment of these entities.
Synergistic Inhibitory Effect of Cyclosporin A and Vitamin D Derivatives on T-Lymphocyte Proliferation in Active Ulcerative Colitis
Authors: Stio Maria , Treves Cristina , Celli Alessandra , Tarantino Ottaviano , d'Albasio Giuseppe , Bonanomi Andrea Giovanni 
Published: March 2004

ABSTRACT

OBJECTIVE:
1,25-Dihydroxyvitamin D3 [1,25(OH)2D3], the hormonal active form of vitamin D3, could represent a potentially therapeutic agent in autoimmune diseases. Cyclosporin A (CsA) shows immunoregulatory properties, which, in many respects, seem to be similar to those of 1,25(OH)2D3. Our aim was to investigate the possible synergistic effect exerted by CsA in combination with 1,25(OH)2D3 or its nonhypercalcemic analogues, EB 1089 and KH 1060, on the proliferative response of T lymphocytes obtained from active ulcerative colitis patients.

METHODS:
The T lymphocyte-enriched population was treated with phytohemagglutinin and CsA (doses from 1 ng to 1000 ng/ml) alone or in association with 1,25(OH)2D3 or EB 1089 or KH 1060 (0.1, 1, 10 nM final concentration). Cell proliferation was determined by [3H]thymidine incorporation and analyzed on day 5 of culture.

RESULTS:
After incubation with CsA, T lymphocyte proliferation was significantly inhibited in comparison with the vehicle-treated cultures. However, T lymphocytes from ulcerative colitis patients were significantly more sensitive to CsA than those from healthy controls. The inhibition in T lymphocyte proliferation, after treatment of the cultures with CsA associated with either 1,25(OH)2D3 or EB 1089 or KH 1060, was synergistic at well-defined concentrations.

CONCLUSIONS:
Taking into account the lowest CsA dose (1 ng/ml), the highest synergistic inhibition in the proliferation of T lymphocytes prepared from ulcerative colitis patients was found combining CsA and 10 nM of 1,25(OH)2D3 or 10 nM of EB 1089 or KH 1060 at the three concentrations. The results obtained, associating the lowest CsA dose and the lowest KH 1060 concentration, may suggest an alternative therapeutic approach in these patients, reducing the dose, and consequently the toxicity, of CsA.
Prevalence of Autonomic Dysfunction in Cirrhotic and Noncirrhotic Portal Hypertension
Authors: Rangari Manisha , Sinha S , Kapoor Dharmesh , Mohan Jagdish C , Sarin Shiv K 
Published: March 2004

ABSTRACT

OBJECTIVE:
Autonomic dysfunction is common in patients with cirrhosis of the liver, but more so in patients with decompensated state, and is associated with increased mortality. We evaluated the presence and extent of autonomic dysfunction in patients with extrahepatic portal venous obstruction (EHPVO) and noncirrhotic portal fibrosis (NCPF), diseases with relatively preserved liver functions.

METHODS:
Heart rate variability in response to standing, deep breathing, and Valsalva maneuver and blood pressure response to sustained handgrip and standing were studied in 18 patients with EHPVO (13 mol/L, 5 F, mean age 15.2 ± 6 yr), 12 patients with NCPF (5 mol/L, 7 F, mean age 26.4 ± 8 yr), 15 patients with cirrhosis (7 mol/L, 8 F, mean age 12.6 ± 6 yr), and 17 healthy controls (11 mol/L, 6 F, mean age 18.6 ± 3 yr). Time-domain parameters of heart rate variability on 24-h ambulatory monitoring were assessed in all the patients.

RESULTS:
Autonomic dysfunction was observed in 67% of EHPVO, 25% of NCPF, and 80% of cirrhotic subjects but none of the healthy controls (p < 0.05). Four of five time-domain heart rate variability indices showed significant abnormalities in patients with EHPVO (p < 0.05) and cirrhosis (p < 0.05), when compared with patients with NCPF and healthy controls.

CONCLUSIONS:
Autonomic dysfunction is frequently encountered in patients with EHPVO and cirrhosis, and the presence of autonomic dysfunction in patients with noncirrhotic portal hypertension suggests a primary role of portal hypertension per se in the dysfunction.
Tumor Necrosis Factor Genetic Polymorphisms and Response To Antiviral Therapy in Patients With Chronic Hepatitis C
Authors: Rosen Hugo R , McHutchison John G , Conrad Andrew J , Lentz Jennifer J , Marousek Gail , Rose Steven L , Zaman Atif , Taylor Kent , Chou Sunwen 
Published: March 2004

ABSTRACT

OBJECTIVE:
Hepatitis C virus (HCV) is the major causal agent of non-A, non-B hepatitis and the leading indication for liver transplantation worldwide. The emerging field of immunogenetics has confirmed the significant role of heritability in host immune responses to infectious pathogens. Both the major and non-major histocompatibility complex genes are increasingly identified as candidate genes hypothesized to influence the susceptibility to, or the course of, a particular disease. We hypothesized that polymorphisms within the major histocompatibility complex class III region that encode for tumor necrosis factors (TNF)-α and TNF-β might be predictive of response to antiviral therapy in patients with chronic hepatitis C.

METHODS:
A total of 155 subjects, including 110 HCV-seropositive individuals undergoing antiviral therapy and 45 ethnically similar HCV-negative controls, were studied. The HCV-positive patients had undergone antiviral treatment with either interferon monotherapy (n = 73) or in combination with ribavirin (n = 37) and were categorized as either nonresponders, sustained responders, or relapsers. Sixty (55%) patients had genotype 1 (1a or 1b). Genomic DNA was extracted, followed by polymerase chain reaction amplification and sequencing for two promoter TNF-α variants (at positions –238 and –308), as well as restriction fragment length analysis for four polymorphic loci within the TNF-β gene (NcoI, TNFc, aa13, aa26).

RESULTS:
Although there was a trend toward higher frequency of the A allele in the TNF 238 promoter among HCV-infected patients (12% vs 4%), there were no significant differences in the distribution of the genotypic polymorphisms between patients and controls. Patients with the TNF 238 A allele had higher pretreatment viral loads as compared with patients homozygous for the wild type allele (7.2 × 106 ± 4.2 × 106 copies/ml vs 3.8 × 106 ± 0.34 × 106 copies/ml, p = 0.03). However, there was no association between TNF genetic markers, including multiple haplotypic combinations, and response to therapy. In addition, there was no correlation with these polymorphic loci and histological severity of liver disease.

CONCLUSIONS:
Although previous work has suggested potential roles for TNF in the pathogenesis of HCV infection, we were unable to identify any link between TNF genetic polymorphisms and histological severity or response to antiviral therapy.
The Cost-Effectiveness of Hepatitis A Vaccination in Patients With Chronic Hepatitis C Viral Infection in The United States
Authors: Arguedas Miguel R , Heudebert Gustavo R , Fallon Michael B , Stinnett Aaron A 
Published: March 2004

ABSTRACT

OBJECTIVE:
Hepatitis A vaccination is recommended for patients with chronic hepatitis C. Our aim was to analyze the cost-effectiveness of hepatitis A vaccination in these patients. The specific strategies evaluated were: no vaccination, targeted vaccination, and universal vaccination.

METHODS:
Clinical estimates were based on published data. Costs estimates were based on published data and institutional Medicare reimbursement rates. Health-related quality-of-life weights were derived from published data and expert estimates. The target population consisted of patients 45 yr of age with chronic hepatitis C followed every 6 months until death. We adopted a societal perspective.

RESULTS:
Compared with no vaccination, targeted vaccination was associated with an incremental cost-effectiveness ratio of $51,000 per quality-adjusted life-year. The incremental cost-effectiveness ratio of universal vaccination compared with targeted vaccination was $3,900,000 per quality-adjusted life-year. The results were particularly sensitive to the incidence of hepatitis A, probability of fulminant hepatic failure, and costs of hepatitis A antibody screening and vaccination.

CONCLUSIONS:
Targeted vaccination for hepatitis A in patients with chronic hepatitis C may be a cost-effective strategy to decrease the morbidity and mortality associated with hepatitis A superinfection. Universal vaccination is not a cost-effective alternative to targeted vaccination in this target population.
Hepatitis C Infection in African Americans: Its Natural History and Histological Progression
Authors: Wiley Thelma E , Brown Jennifer , Chan Juliana 
Published: March 2004

ABSTRACT

OBJECTIVE:
The aim of this retrospective analysis was to determine the natural history of hepatitis C virus infection in African Americans versus non-African Americans by evaluating the clinical, virological, and histological findings.

METHODS:
We examined in a retrospective manner the demographics, mode of infection, virological features, and histological progression of HCV infection in African Americans versus non-African Americans. There were 355 patients who met criteria based on adequate liver biopsy specimens and exclusion of other hepatic diseases.

RESULTS:
African Americans (n = 112) were significantly more likely to be infected with genotype 1 virus (88%) than were non-African Americans (n = 243; 67%; p ≤ 0.001). Baseline HCV RNA levels were similar, although baseline ALT values were significantly lower in African Americans (80.0 μl ± 5.5 vs 112.1 μl ± 6.2; p ≤ 0.001). African Americans were significantly older at the time of presentation and were significantly more likely to be women (p ≤ 0.02). In African Americans, there was a trend toward less cirrhosis (22% vs 30%; p ≤ 0.1) and significantly less piecemeal necrosis on liver biopsy. Non-African Americans had significantly higher fibrosis scores, ALT values, and piecemeal necrosis ratings, and tended to progress more rapidly to cirrhosis. This difference in histological progression between the two groups was not explained by differences in alcohol consumption.

CONCLUSION:
The lower ALT, piecemeal necrosis scores, and slower progression of fibrosis in African Americans may reflect less immunological recognition of HCV-infected liver cells.
AGRICULTURAL FINANCE REVENUE FUTURES CONTRACT
Authors: GUINVARC'H MARTIAL V. , JANSSEN JACQUES , CORDIER JEAN E. 
Published: March 2004

To respond to financial compound risk of farmers, two multiplicative derivative contracts, called respectively revenue futures contract and revenue put option, are proposed. The paper presents the theoretical management strategy of such a contract under the constraint that price and crop yield futures contracts are quoted. A financial intermediary can thus develop a risk-free management strategy to build a revenue futures contract. This paper opens perspectives on risk management for farmers, on completeness of markets and on new financial intermediation.