bluuebunny/crossref_metadata_2025_split huggingface dataset:
Skeletal muscle and nutritional assessment in chronic renal failure patients on a protein‐restricted diet
Authors: Cupisti A. , Licitra R. , Chisari C. , Stampacchia G. , D'Alessandro C. , Galetta F. , Rossi B. , Barsotti G. 
Published: December 2003

Abstract.Background.  The close relationship between protein–energy malnutrition and quality of life, morbidity and mortality, makes mandatory a careful evaluation of the nutritional status and muscle mass in chronic renal failure (CRF) patients.Methods.  Nutritional and skeletal muscle data were obtained from 28 nondiabetic patients with severe CRF (glomerular filtration rate, GFR < 15 mL min−1) on conservative treatment. Of them, 14 (8 males, 4 females) were on a conventional low‐protein (0.6 g kg−1 body weight) diet (LPD) and 14 (8 males, 4 females) were on a very low‐protein (0.3 g kg−1 body weight) diet supplemented with essential amino acids and ketoacids (Ketodiet); 28 healthy sex‐ and age‐matched subjects served as controls. We evaluated biochemistry, anthropometry, bioelectrical impedance vector analysis, and three noninvasive tests investigating some skeletal muscle features: (a) myoelectrical fatigue phenomenon was studied using a surface electromyography technique that provides data on conduction velocity (CV), median frequency of power spectrum (MDF) and average rectified value (ARV) of myofibre action potential, at 15 and 35 Hz stimulation frequency; (b) muscle oxidative metabolism was studied by serum lactate following aerobic exercise; and (c) muscle strength of the legs was studied using an isokinetic exercise test at two different angular velocities (60° and 180° s−1).Results.  No difference between patients and controls was detected regarding CV, MDF and ARV, at 35 and 15 Hz testing. Serum lactate was higher in patients than in controls at 1, 5, 10 and 30 min recovery. A decreased knee extension and flexion strength was detected in CRF patients both at low (60° s−1) and at high (180° s−1) angular velocity; muscle strength deficit negatively correlated to serum albumin (r = −0.52, P < 0.01), but no relationship was found with protein intake or residual renal function. No difference was found between LPD and Ketodiet patients regarding the studied muscular tests as well as the anthropometry and bio‐impedance data.Conclusions.  Implementation of a proper dietary regimen, including severe restriction of protein intake can preserve lean body mass and nutritional status of advanced CRF patients. Skeletal muscle shows unchanged sarcolemma excitability but abnormal oxidative metabolism and reduced segmental strength. Regular physical activity and a close clinical and dietary monitoring should be recommended for the predialysis patient care.
The value of malt distillers’ grains ensiled with molassed sugar beet pellets as a feed for dairy cows
Authors: McKendrick E. J. , Roberts D. J. , Offer N. W. 
Published: December 2003

AbstractIn one experiment twenty‐four Holstein Friesian cows, average 43 d post‐partum, were used in a changeover design experiment to evaluate the replacement of a cereal‐based concentrate supplement (C) by an ensiled mixture (MGBP) of malt distillers’ grains and molassed sugar beet pellets. The cows were offered grass silage ad libitum [dry matter (DM) content 170 g kg−1, crude protein (CP) concentration 160 g kg DM−1, metabolizable energy (ME) concentration 10·9 MJ kg DM−1] and either C or MGBP at one of three levels (3, 6, 9 kg DM d−1). The composition of C and MGBP were DM content: 853 and 296 g kg−1, CP concentration: 202 and 187 g kg DM−1, ME concentration: 12·6 and 10·8 MJ kg DM−1 respectively. The cows ate all the C supplement but the intakes of MGBP were 2·7, 4·9 and 6·4 kg DM d−1 for the 3, 6 and 9 kg DM d−1 levels of MGBP respectively. Total DM intakes (kg d−1) were 12·5, 15·6, 18·2 for treatments 3‐C, 6‐C and 9‐C and 13·1, 14·4 and 15·9 (s.e., 0·90) for treatments 3‐MGBP, 6‐MGBP and 9‐MGBP respectively. Milk yields (kg d−1) for treatments 3‐C, 6‐C and 9‐C were 19·9, 23·2 and 24·2, respectively, and for treatments 3‐MGBP, 6‐MGBP and 9‐MGBP were, 20·3, 21·3 and 23·0 respectively (s.e., 1·05). Milk fat contents (g kg−1) for treatments 3‐C, 6‐C and 9‐C were 42·8, 42·3, 43·5 respectively and for treatments 3‐MGBP, 6‐MGBP and 9‐MGBP were 39·5, 38·7 and 38·2 (s.e, 1·86), respectively, and milk protein contents (g kg−1) for treatments 3‐C, 6‐C and 9‐C were 30·5, 30·6, 31·8, respectively, and for 3‐MGBP, 6‐MGBP and 9‐MGBP were 30·0, 30·8 and 31·2 (s.e., 0·66) respectively. Milk yield and milk protein contents were significantly higher for the higher levels of supplementary feeding but there was no difference between the types of supplement. The milk fat contents were significantly lower on the MGBP than C supplements.In a second experiment fifteen Holstein Friesian cows, average 126 d post‐partum, were used in a changeover experiment to evaluate the replacement of all (treatment M) or half (treatment MS) of the grass silage (S) in their diet by a mixture of MGBP and straw. All cows received 5·1 kg DM d−1 of concentrate feed. Forage DM intakes were 8·3, 11·2 and 14·2 kg DM d−1 for the S, MS and M treatments respectively. Milk yields (kg d−1) for S, MS and M treatments were 17·0, 19·4 and 20·0 (s.e., 0·56) respectively. Corresponding contents of milk fat and protein (g kg−1) were 42·0, 41·4, 38·6 (s.e., 0·37) and 33·8, 34·1, 34·2 (s.e., 0·42).Ensiled mixtures of malt distillers’ grains and molassed sugar beet pellets can be used to replace some of the conventional concentrates or grass silage for dairy cows giving moderate yields without a loss of production.
Diabetes control in Swedish community dwelling elderly: more often tight than poor
Authors: Löfgren U.‐B. , Rosenqvist U. , Lindström T. , Hallert C. , Nystrom F. H. 
Published: December 2003

Abstract.Objective.  To determine glycaemic control in elderly patients with diabetes living in community dwelling.Design.  Descriptive, cross‐sectional and open. Prospective with regard to blood glucose.Setting.  Community‐dwelling in‐patients.Subjects.  From a total number of 351 patients in seven Swedish centres of community dwelling we identified and recruited all 45 patients with diabetes receiving treatment with insulin, and/or oral medication.Main outcome measures.  Blood glucose was measured fasting, 2 h after breakfast, in the evening and at night, for three consecutive days.Results.  Mean HbA1c was 5.9 ± 1.1% (range 3.6–8.6%). The patients were split in three HbA1c‐groups for analysis: lower‐ (3.6–5.3%), middle‐ (5.4–6.3%) and higher‐tertile (6.4–8.6%). The groups where similar with regard to age, time in community dwelling, ability to eat and move around independently, but body mass index was lower in the lower tertile (P < 0.003 and P < 0.04, compared with middle‐ and higher‐tertiles). We recorded 14 episodes with blood glucose ≤4.0 mmol L−1 in eight patients. Blood glucose ≤4.0 mmol L−1 was mostly recorded during night (n = 8) or in the morning (n = 3).Conclusions.  Swedish patients with diabetes in community dwelling are over‐ rather than under‐treated and have low HbA1c levels. Despite very regular eating habits and near total compliance with medication, hypoglycaemias are frequent and possibly linked to malnutrition.
Endemic goiter in pregnant women: utility of the simplified classification of thyroid size by palpation and urinary iodine as screening tests
Authors: Castañeda Rutila , Lechuga Diana , Ramos Rosa Isela , Magos Clementina , Orozco Maribel , Martıacute;nez Homero 
Published: December 2003

Objective
To validate urinary iodine (I) excretion and the simplified classification of goiter by palpation, comparing them with ultrasound of the thyroid gland as the gold standard, to identify endemic goiter in pregnant women.Population and setting
300 pregnant women identified in referral hospitals, in three geographic regions.Methods
Two endocrinologists, previously trained, evaluated thyroid size by palpation and by ultrasound. Urinary iodine excretion in a sample of urine was determined. Thyroid size below the 90th centile by ultrasound was considered normal.Results
Mean age of study women was 23 years old. The prevalence of low weight for gestational age was 39% and of anaemia 47%. Our sample distribution showed that 120 μg I/L was the best cut off for low urinary iodine excretion to identify endemic goiter in pregnant women (sensitivity 57% and specificity 70%, likelihood ratio of 1.4). The prevalence of goiter was 10% using ultrasound. Palpation had a sensitivity of identification goiter of 94% (95% CI 89–99%), a specificity of 80% (95% CI 75–85%), a likelihood ratio of 4.7, positive post‐test probability of 36.5% and negative post‐test probability of 99%.Conclusions
Low urinary iodine excretion identified up to 46% of women with goiter. This test by itself is not useful as a screening tool to identify pregnant women at risk of goiter. Identification of thyroid size by palpation was a better screening test. However, when both tests were combined in parallel, up to 100% of women with goiter were correctly identified. Our results suggest that the commonly used cut off point of 100 μg I/L to identify low urinary iodine excretion may under‐estimate the prevalence of iodine deficiency disorders when used during pregnancy.
Analgesia in labour and fetal acid–base balance: a meta‐analysis comparing epidural with systemic opioid analgesia
Authors: Reynolds Felicity , Sharma Shiv K. , Seed Paul T. 
Published: December 2003

Objective
To assess the effect of epidural versus systemic labour analgesia on funic acid–base status at birth.Design
A systematic review of trials, both randomised and non‐randomised, comparing epidural with systemic opioid analgesia.Population
Babies of 2102 mothers taking part in trials comparing epidural with systemic analgesia in five countries.Methods
From the published and unpublished figures obtained from authors, fetal pH data from 12 studies (eight randomised) (1098 babies in the epidural group + 1004 controls) and base excess from 8 studies (four randomised) (856 epidural + 842 controls) were subjected to random effect meta‐analysis.Main outcome measures
Umbilical artery pH and base excess values.Results
Fetal pH was higher in the epidural than in the control group in the randomised trials (difference +0.009, 95% CI +0.002 to +0.015), but when all studies were included, the difference was not significant (+0.004, 95% CI −0.005 to +0.014). Fetal base excess was higher in the epidural group in the four randomised studies (difference +0.779 mEq/L, 95% CI +0.056 to +1.502) and in all eight studies (difference +0.837 mEq/L, 95% CI +0.330 to +1.343).Conclusion
Umbilical artery pH is influenced by maternal hyperventilation. Base excess is therefore a better index of metabolic acidosis after labour. Epidural analgesia is associated with improved neonatal acid–base status, suggesting that placental exchange is well preserved in association with maternal sympathetic blockade and good analgesia. Although epidural analgesia may cause maternal hypotension and fever, longer second stage of labour and more instrumental vaginal deliveries, these potentially adverse factors appear to be outweighed by benefits to neonatal acid–base status.
Women awaiting hysterectomy: a qualitative study of issues involved in decisions about oophorectomy
Authors: Bhavnani Vanita , Clarke Aileen 
Published: December 2003

Objective
Women awaiting abdominal hysterectomy have a further decision to take—whether or not to undergo a prophylactic oophorectomy. Prophylactic oophorectomy (removal of healthy ovaries) is commonly undertaken as an adjunct to hysterectomy to prevent ovarian cancer in women who are already having a hysterectomy for menorrhagia, fibroids or severe menstrual pain. It causes an immediate ‘surgical menopause’—women no longer produce endogenous oestrogens and they are advised to take hormone replacement therapy (HRT). This descriptive study was undertaken as part of a larger pilot study.Design
Qualitative interviewing study.Setting
Hospital outpatient departments in southern England.Sample
Women on waiting lists for hysterectomy for benign conditions.Methods
In‐depth semi‐structured interviews were undertaken with 16 women awaiting hysterectomy to examine their views of prophylactic oophorectomy, menopause and HRT use. Interviews were transcribed. Nud*ist was used to organise the data. Analysis was undertaken by two researchers working independently who then met to agree themes.Results
Women held treatment preferences both about the removal or retention of their ovaries and about subsequent HRT use. Many of the women did not want oophorectomy because of a dislike of a sudden menopause. Those who were planning to have an oophorectomy tended to have more severe symptoms. Some women were fearful of ovarian cancer—one woman described it as a ‘silent killer’. A further theme was apparent in the discussion of ovaries as ‘redundant’ with further discussion of healthy versus problematic ovaries. Many women felt inadequately informed about their treatment options and were unaware of important longer term outcomes of oophorectomy such as an increased risk of osteoporosis or of coronary heart disease.Conclusion
It appears that many women emphasise the ‘natural’ when considering oophorectomy and the use of HRT. Women were uneasy both about a sudden menopause and about the risks of ovarian cancer. And although these women were all about to undergo surgery, they had experienced an apparent serious lack of information especially about long term risks and benefits on which they might base their decision.
Vaginal hysterectomy in nulliparous women without prolapse: a prospective comparative study
Authors: Agostini Aubert , Bretelle Florence , Cravello Ludovic , Maisonneuve Anne Sophie , Roger Valérie , Blanc Bernard 
Published: December 2003

Objective
To compare vaginal hysterectomy success and complication rates in nulliparous and primiparous or multiparous women.Design
A comparative prospective study.Setting
Department of Gynaecology, La Conception Hospital, Marseille, France.Population
Three hundred and forty‐five consecutive patients without genital prolapse requiring hysterectomy for benign conditions and without previous pelvic surgery or caesareans were treated prospectively by vaginal hysterectomy. Fifty‐two patients were nulliparous and 293 were primiparous or multiparous.Methods
Data of patients were collected prospectively.Main outcome measures
Operative time, length of hospital stay, oophorectomy, conversion to laparotomy, intra‐ and post‐operative complications.Results
The mean operative time was significantly longer in nulliparous patients [95 (55.2) vs 79.9 (34.9) minutes, P < 0.01]. The overall complication rate was significantly higher [7/52 (13.46%) vs 13/293 (4.44%), P= 0.02, RR = 3.03 (1.27–7.23)] as was the haemorrhage rate in nulliparous compared with the primiparous and multiparous women [4/52 (7.69%) vs 5/293 (1.7%), P= 0.03, RR = 4.51 (1.25–16.23)]. Vaginal hysterectomy was successfully performed in 96.2% (50/52) of the nulliparous and 99.7% (292/293) of the parous patients [P= 0.06, RR = 1.04 (0.98–1.09)].Conclusion
The success rate of vaginal hysterectomy in nulliparous women is high. However, the risk of complications seems higher than in the parous women. Laparoscopy assisted vaginal hysterectomy in nulliparous women needs further investigations.
Non‐invasive fetal electrocardiography in singleton and multiple pregnancies
Authors: Taylor Myles J.O. , Smith Mark J. , Thomas Matthew , Green Andrew R. , Cheng Floria , Oseku‐Afful Salome , Wee Ling Y. , Fisk Nicholas M. , Gardiner Helena M. 
Published: December 2003

Objectives
To document the duration of fetal cardiac time intervals in uncomplicated singleton pregnancies using a novel non‐invasive fetal electrocardiography (fECG) system and to demonstrate this technique's ability to acquire recordings in twin and triplet pregnancies.Design
Prospective cross sectional observational study.Setting
Antenatal wards and clinics, day assessment unit and centre for fetal care at a tertiary referral hospital, London, UK.Population or Sample
Three hundred and four singleton and multiple pregnancies, 15–41 weeks of gestation.Methods
Using electrodes sited on the maternal abdomen, a fetal electrocardiography (fECG) system was developed and tested on 304 pregnant women from 15 to 41 weeks of gestation, of whom 241 were uncomplicated singletons, 58 had twin and 5 had triplet pregnancies. The composite abdominal signals were stored on a laptop computer and the fECG derived off‐line using a digital signal processing technique. For singletons, linear regression was used to analyse PR, QRS, QT and QTc intervals, and construct time‐specific reference ranges.Main outcome measure
Duration of fECG time intervals as a function of gestational age. Success of signal seperation in singleton, twin and triplet pregnancies.Results
For singletons, a total of 250 recordings was obtained from 241 individuals with a signal separation success rate of 85% (213/250). Success rates were significantly poorer between 27 and 36 weeks of gestation (2 × k χ2, P < 0.0001), with 84% (31/37) of separation failures occurring during this period. P, Q, R and S waves were seen in all cases where fetal signals were separated and were used to generate fECG time interval reference ranges. In 22% (43/199) of analysed cases, no T waves were identified, 63% (27/43) of whom were ≤24 weeks of gestation. In twins and triplets, separate fetal signals were obtained in 78% (91/116) and 93% (14/15), respectively; P, Q, R and S waves were evident in all averaged fECGs, while T waves were identified in 59% (54/91) and 57% (8/14).Conclusions
This study provides reference ranges with gestation for fECG intervals derived non‐invasively from normal singleton pregnancies and demonstrates the feasibility of obtaining complete fECG recordings non‐invasively across a wide gestational range in pregnancies of all pluralities. The fECG time intervals described will enable the identification of pathological fECG recordings from high risk pregnancies where fECG abnormalities are suspected.
Validation of the Welch Allyn ‘Vital Signs’ blood pressure measurement device in pregnancy and pre‐eclampsia
Authors: Reinders A. , Cuckson A.C. , Jones C.R. , Poet R. , O'Sullivan G. , Shennan A.H. 
Published: December 2003

Objective
To establish the accuracy the Welch Allyn ‘Vital Signs’ blood pressure monitor in pregnancy and pre‐eclampsia according to a modified British Hypertension Society protocol.Design
Prospective observational study.Setting
Maternity Unit/Obstetric Ward, Guy's and St Thomas' Hospital, London, UK.Population
Forty‐three pregnant women of whom 12 had pre‐eclampsia.Methods
Nine sequential same‐arm measurements were taken from each woman by two trained observers, alternating between a mercury sphygmomanometer and the device. The last seven readings were analysed according to the British Hypertension Society protocol. The accuracy of the device was determined using the grading scale indicated by the British Hypertension Society protocol (grade A/B = pass, grade C/D = fail).Main outcome measures
Grading criteria of the British Hypertension Society Protocol.Results
The Welch Allyn ‘Vital Signs’ monitor achieved a grade A for both systolic and diastolic pressures in pregnant women who did not have pre‐eclampsia. In those women with pre‐eclampsia, it achieved a grade D and B for systolic and diastolic pressures, respectively. The mean differences between the observers and the device in women without pre‐eclampsia were −2.6 (6.4) and −1.5 (7.2) mmHg for systolic and diastolic pressures [and in pre‐eclamptic women −7.8 (6.3) and −5.5 (6.5)mmHg]. It therefore fulfils criteria set by the Association for the Advancement of Medical Instrumentation (mean <5 mmHg and standard deviation <8 mmHg) in pregnancy, but not in pre‐eclampsia.Conclusion
This is the first automated device suitable for robust clinical use that can be recommended for use in pregnancy. However, it should be borne in mind that—similar to other devices—it significantly under‐recorded readings obtained in pre‐eclamptic women.
The effects of a progesterone metabolite, 5β‐dihydroprogesterone, on oxytocin receptor binding in human myometrial membranes
Authors: Astle Shirley , Khan Raheela N. , Thornton Steven 
Published: December 2003

Objective
To determine the effect of the progesterone metabolite 5β‐dihydroprogesterone on human oxytocin receptor binding in myometrial membranes and on whole‐cell calcium current in single myometrial cells.Design
Receptor binding studies in human myometrial membranes prepared from biopsies taken before or after the onset of labour and in Chinese hamster ovary cells expressing the human oxytocin receptor. Whole cell patch‐clamp experiments were undertaken on isolated myometrial cells.Setting
University research laboratories and University hospital.Population
Patients undergoing caesarean section at term either prior to or following onset of labour.Methods
Myometrial biopsies were taken from women undergoing caesarean section. The binding affinities of oxytocin, 5β‐dihydroprogesterone and atosiban were determined in myometrial membranes and Chinese hamster ovary cells expressing the human oxytocin receptor. The effect of 5β‐dihydroprogesterone on inward current was also determined in isolated myometrial cells.Main outcome measures
Receptor binding affinity and electrophysiological inward current.Results
5β‐Dihydroprogesterone did not reduce oxytocin receptor binding in myometrial membranes or Chinese hamster ovary cells expressing the human oxytocin receptor. Nor did it influence calcium current under whole‐cell patch conditions in single myometrial cells. In contrast, atosiban inhibited binding in myometrial membranes prepared from samples taken either prior to or following labour (Ki= 112 and 108 nM, respectively). The affinity of atosiban for the oxytocin receptor was much lower than oxytocin (Ki= 5 and 6 nM in samples taken before or after labour, respectively) in myometrial membranes and in Chinese hamster ovary cells expressing the human oxytocin receptor (Ki= 63 M and 1 nM for atosiban and oxytocin, respectively).Conclusions
We conclude that 5β‐dihydroprogesterone is unlikely to regulate myometrial activity as a result of a direct effect on oxytocin receptor binding or inward calcium current.
Women's attitudes to HIV screening in pregnancy in an area of low prevalence
Authors: Jha Swati , Gee Harry , Coomarasamy Aravinthan 
Published: December 2003

Objectives
To identify factors that influence acceptance of the human immunodeficiency virus (HIV) screening test by pregnant women.Design
Prospective survey using questionnaires.Setting
An antenatal clinic at a tertiary referral hospital.Population
200 pregnant women of multiethic origin residing in a low prevalence area.Methods
Two hundred consecutive women attending the antenatal booking clinic were interviewed. We collected data on reasons for opting in or out and factors that could influence the rate of acceptance, such as ethnicity, age, parity, level of education, first language and marital or relationship status.Main outcome measure
Attitudes of pregnant women to HIV screening.Results
The rate of acceptance of HIV screening was 160/200(80%). The most frequent reasons for opting in were the perceived benefits of screening (92/160, 58%) and the fact that the test is now routinely offered (87/160, 54%). The most frequent reason for refusal of screening was perceived low risk of HIV (27/40, 68%). Logistic regression analysis showed that ethnicity, age, parity and level of formal education did not play a role in influencing uptake of the test. However, women whose first language was English were more likely to opt in compared with those whose first language was not English (P= 0.016) and those who were married or in a stable relationship were more likely to opt in than those who were not (P < 0.001).Conclusion
We have not reached the national target of 90% in our region. This appears to be due to a combination of factors, the main one being a perception of low risk. Greater knowledge of the ease of transmission of HIV may alter this perception, which may improve acceptance of the test.