bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simple and Efficient Recognition of Migraine With 3‐Question Headache Screen
Authors: Cady Roger K. , Borchert Leona D. , Spalding William , Hart Carolyn C. , Sheftell Fred D. 
Published: April 2004

Objective.—To correlate the results of a new 3‐question headache screen to 3 established methods of diagnosing migraine: the International Headache Society diagnostic criteria, physician's clinical impression, and presence of recurring disabling headaches.Background.—A simple tool to recognize patients who experience migraine may facilitate diagnosis of this debilitating and frequently undiagnosed condition.Methods.—Primary care physicians and neurologists in the United States enrolled 3014 adults with a diagnosis of migraine based on one of the following: International Headache Society criteria, an investigator's clinical impression, or presence of recurring disabling headaches. Each patient completed a 3‐question headache screen: (1) Do you have recurrent headaches that interfere with work, family, or social functions? (2) Do your headaches last at least 4 hours? (3) Have you had new or different headaches in the past 6 months? A diagnosis of migraine was suggested by a yes answer to questions 1 and 2 and a no answer to question 3.Results.—The 3‐question headache screen identified migraine in 77% of the study population; including 78% of the patients enrolled based on International Headache Society criteria, 74% based on clinical impression, and 68% because of recurring disabling headaches.Conclusions.—Positive 3‐question headache screen results agreed well with migraine diagnoses based on International Headache Society criteria, clinical impressions, and presence of recurring disabling headaches. These findings support use of the 3‐question headache screen to recognize migraine.
Correlation between ST Elevation and Q Waves on the Predischarge Electrocardiogram and the Extent and Location of MIBI Perfusion Defects in Anterior Myocardial Infarction
Authors: Zafrir Barak , Zafrir Nili , Gal Tuvia Ben , Adler Yehuda , Iakobishvili Zaza , Rahman M. Atiar , Birnbaum Yochai 
Published: April 2004

Background: The common electrocardiographic subclassification of anterior acute myocardial infarction (AMI) is not reliable in presenting the exact location of the infarct. We investigated the relationship between predischarge electrocardiographic patterns and the extent and location of perfusion defects in 55 patients with first anterior AMI. Methods: Predischarge electrocardiogram was examined for residual ST elevations and Q waves which were correlated with technetium‐99m‐sestamibi function and perfusion scans. Results: Patients with ST elevations in V2–V4 and Q waves in leads V3–V5 had worse global perfusion scores. Perfusion defects in the apex inferior segment were significantly less frequent in patients with Q waves in leads I and aVL (11% vs 54%, P = 0.027; and 22% vs 60%, P = 0.011, respectively). Patients with Q wave in aVF had more frequently involvement of the apex inferior segment (80% vs 40%; P = 0.035). Patients with Q wave in lead II had significantly more frequent perfusion defects in the inferior wall. ST elevation in V3 and V4 was associated with perfusion abnormalities of the infero‐septal segments. ST elevation in V5 and V6 and Q wave in V5 were associated with regional perfusion defects in apical inferior segment (73% vs 30%, P = 0.002), extending into the mid inferior segment (55% vs 18%, P = 0.005 for Q wave in V5). Q wave in lead aVL is associated with less apical and inferior involvement. Q waves in leads II and aVF are a sign of inferior extension of the infarction. Conclusions: Residual ST elevation in leads V3 and V4 are more frequently associated with involvement of the apical‐inferoseptal segment rather than the anterior wall. Residual ST elevation and Q waves in V5 are related to a more inferior rather than a lateral involvement.
Effects and Significance of Premature Beats on Fractal Correlation Properties of R‐R Interval Dynamics
Authors: Peltola Mirja A. , Seppänen Tapio , Mäkikallio Timo H. , Huikuri Heikki V. 
Published: April 2004

Background: Premature beats (PBs) have been considered as artifacts producing a bias in the traditional analysis of heart rate (HR) variability. We assessed the effects and significance of PBs on fractal scaling exponents in healthy subjects and patients with a recent myocardial infarction (AMI). Methods: Artificial PBs were first generated into a time series of pure sinus beats in 20 healthy subjects and 20 post‐AMI patients. Thereafter, a case‐control approach was used to compare the prognostic significance of edited and nonedited fractal scaling exponents in a random elderly population and in a post‐AMI population. Detrended fluctuation analysis (DFA) was used to measure the short‐term (α1) and long‐term (α2) fractal scaling exponents. Results: Artificial PBs caused a more pronounced reduction of α1 value among the post‐AMI patients than the healthy subjects, for example, if >0.25% of the beats were premature a >25% decrease in the α1 was observed in post‐AMI patients, but 4% of the premature beats were needed to cause a 25% reduction in α1 in healthy subjects. Both edited (1.01 ± 0.31 vs 1.19 ± 0.27, P < 0.01) and unedited α1 (0.71 ± 0.33 vs 0.89 ± 0.36, P < 0.05) differed between the patients who died (n = 42) and those who survived (n = 42) after an AMI. In the general population, only unedited α1 differed significantly between survivors and those who died (0.96 ± 0.19 vs 0.83 ± 0.27, P < 0.05). Conclusions: Unedited premature beats result in an increase in the randomness of short‐term R‐R interval dynamics, particularly in post‐AMI patients. Premature beats must not necessarily be edited when fractal analysis is used for risk stratification.
Maximum P Wave Duration and P Wave Dispersion in Adult Patients with Secundum Atrial Septal Defect: The Impact of Surgical Repair
Authors: Guray Umit , Guray Yesim , Mecit Burcu , Yilmaz M. Birhan , Sasmaz Hatice , Korkmaz Sule 
Published: April 2004

Background: Patients with atrial septal defect (ASD) have an increased risk for atrial fibrillation (AF). Previously it was shown that maximum P wave duration and P wave dispersion in 12‐lead surface electrocardiograms are significantly increased in individuals with a history of paroxysmal AF. We studied P maximum and P dispersion in adult patients with ASD during normal sinus rhythm. In addition, the impact of surgical closure of ASD on these variables within 1 year after surgery was evaluated. Methods: Thirty‐four patients (21 women, 13 men; mean age: 35 ± 11 years) operated on for ostium secundum type ASD and 24 age‐matched healthy subjects (13 women, 11 men; mean age: 37 ± 10 years) were investigated. P maximum, P minimum, and P dispersion (maximum – minimum P wave duration) were measured from the 12‐lead surface electrocardiography. Results: P maximum was found to be significantly longer in patients with ASD as compared to controls (115.2 ± 9 vs 99.3 ± 14 ms; P < 0.0001). In addition, P dispersion of the patients was significantly higher than controls (37 ± 9 vs 29.8 ± 10 ms; P = 0.003). P minimum was not different between the two groups (P = 0.074). After surgical repair of ASD, 10 patients (29%) experienced one or more episodes of paroxysmal AF. Patients with postoperative AF were older (45 ± 6 vs 30 ± 10 years; P = 0.001), and had a higher preoperative pulmonary artery peak systolic pressure as compared to those without postoperative AF (51 ± 11 vs 31 ± 9 mmHg; P < 0.0001). No significant difference in the pulmonary‐to‐systemic flow ratio was observed preoperatively between the two groups (P = 0.56). P maximum and P dispersion were significantly higher in patients with postoperative paroxysmal AF at baseline and at postoperative first month, sixth month, and first year as compared to those without it (for P maximum P = 0.027, P = 0.014, P = 0.001, P < 0.0001, respectively; for P dispersion P = 0.037, P = 0.026, P = 0.001, P < 0.0001, respectively). In addition, in patients with postoperative AF, no significant changes were detected in both of these P wave indices during postoperative follow‐up. However, in the other group, P maximum and P dispersion were found to be significantly decreased at postoperative 6 months and 1 year as compared to baseline. P minimum was similar throughout the postoperative follow‐up as compared to baseline in both groups. Conclusions: Mechanical and electrical changes in atrial myocardium may cause greater P maximum and P dispersion in patients with ASD. Surgical closure of the ASD can regress these pathological changes of atrial myocardium with a result in decreased P maximum and P dispersion. However, higher P maximum and P dispersion at baseline, which have not decreased after surgery, may be associated with postoperative paroxysmal AF, especially for older patients.
A comparative study on the use of a HA/collagen/chondroitin sulphate biomaterial (Biostite®) and a bovine‐derived HA xenograft (Bio‐Oss®) in the treatment of deep intra‐osseous defects
Authors: Scabbia Alessandro , Trombelli Leonardo 
Published: April 2004

AbstractObjectives: This parallel‐group, randomized, clinical trial was designed to evaluate the clinical outcome of deep intra‐osseous defects following reconstructive surgery with the use of a synthetic hydroxyapatite/equine Type I collagen/chondroitin sulphate biomaterial (Biostite®), as compared to a bovine‐derived hydroxyapatite xenograft (Bio‐Oss®).Material and methods: Twenty‐four systemically healthy subjects with moderate to advanced periodontitis, 11 females and 13 males, aged 30–64 years, seven smokers, were selected. Patients presented with one interproximal deep intra‐osseous defect (intra‐osseous component4 mm) as clinically and radiographically evaluated. Immediately before surgery and 12 months after surgery, pocket probing depth (PPD), clinical attachment level (CAL) and radiographic depth of the defect (DEPTH) were evaluated.Results: Thirteen defects were treated with Biostite® (test) and 11 defects with Bio‐Oss® (control). In the test group, PPD amounted to 7.8±1.3 mm before surgery, and decreased significantly to 3.6±1.6 mm 12 months following surgery, while in the control group PPD significantly decreased from 7.5±2.0 mm pre‐surgery to 3.1±1.0 mm post‐surgery. At 1 year, CAL gain and DEPTH gain were 2.9±1.9 and 2.5±1.4 mm, respectively, in the test group, and 4.0±2.4 mm and 3.1±1.8 mm, respectively, in the control group. No statistically significant differences for PPD reduction, CAL gain and DEPTH gain were detected between the groups.Conclusions: The results of the present study indicate that both Biostite® and Bio‐Oss® grafting biomaterials have determined a clinically and statistically significant improvement in terms of CAL gain, PPD reduction and radiographic DEPTH gain when used for the treatment of deep intra‐osseous defects.
The association between neutrophil numbers and interleukin‐1α concentrations in gingival crevicular fluid of smokers and non‐smokers with periodontal disease
Authors: Petropoulos Georgios , McKay Ian J. , Hughes Francis J. 
Published: April 2004

AbstractObjectives: To test whether neutrophil numbers are directly correlated with interleukin‐1α (IL‐1α) concentrations in gingival crevicular fluid (GCF) of patients with periodontitis, and to investigate the effects of smoking on these parameters.Materials and Methods: A total of 99 GCF samples from 33 patients (14 smokers) suffering from severe chronic periodontitis were collected using Durapore™ filter strips. Polymorphonuclear leucocyte (PMN) numbers were counted using a Coulter cell counter and IL‐1α levels were determined by ELISA. Total GCF protein was measured by Bio‐Rad assay as a surrogate measure of GCF volume.Results: Mean IL‐1α concentrations were significantly reduced in smokers compared with non‐smokers (non‐smokers: 3.29±2.02 pg/μg protein, smokers 1.59±1.13 pg/μg protein). There was no association between PMN numbers and IL‐1α concentrations found when analysed either by site or by patient. PMN numbers were not significantly different between the two groups (non‐smokers: 1.16 × 106±1.04 × 106; smokers: 7.30 × 105±8.07 × 105). Smoking did not affect mean total protein concentration of samples.Conclusions: Smoking significantly decreased IL‐1α concentrations in GCF without affecting GCF volume sampled. The lack of association between IL‐1α concentration and neutrophil numbers suggests that the reduced IL‐1α concentrations seen in smokers is independent of any possible effect of smoking on neutrophil chemotaxis, and further suggests that smoking may directly inhibit IL‐1α production.
Interleukin‐4 gene polymorphisms in Japanese and Caucasian patients with aggressive periodontitis
Authors: Gonzales J. R. , Kobayashi T. , Michel J. , Mann M. , Yoshie H. , Meyle J. 
Published: April 2004

AbstractObjectives: Recently, interleukin (IL) 4 gene polymorphisms have been analyzed in association with periodontitis. Genetic differences between Caucasian and Japanese patients with periodontitis have previously been detected. The aim of the present study was to analyze IL‐4 genotypes in Caucasian and Japanese patients with aggressive periodontitis (AgP).Material and Methods: One hundred and twenty‐four subjects were included in the study, 31 Japanese and 30 Caucasian patients with generalized AgP, plus 30 Japanese and 33 Caucasian healthy controls. IL‐4 polymorphisms were determined by polymerase chain reaction. A logistic regression was used to investigate the possible association of the genotypes with the disease in both populations. Odds ratio (OR) estimates were analyzed for allele frequencies.Results: No significant association of IL‐4 polymorphisms with the risk of AgP was determined in either population. However, the allele frequencies showed different results between populations. The carriage of the polymorphism in intron 2 was higher in Caucasian patients compared with controls (OR: 2.0, 95% confidence interval: [1.0;4.2]. Furthermore, the frequency of the IL‐4 promoter/intron 2 composite genotype (PP+/IP+) in patients and controls, respectively, was found to be approximately 25% and 60% higher in the Japanese population than in the Caucasian population.Conclusion: There was no evidence of an association of IL‐4 genotypes and AgP in either population, although the frequencies of the IL‐4 genotypes in the Japanese and the Caucasians were different.
Periodontitis and atherogenesis: causal association or simple coincidence?
Authors: D'Aiuto Francesco , Parkar Mohammed , Andreou Georgios , Brett Peter M. , Ready Derren , Tonetti Maurizio S. 
Published: April 2004

AbstractObjectives: The aim of this study was to assess the systemic effects of treating severe widespread periodontitis in a population of otherwise healthy individuals by examining treatment associated changes in markers of inflammation that are also implicated in cardiovascular atherosclerotic diseases. The potential impact of specific polymorphisms in cytokine genes known to influence both periodontitis and cardiovascular diseases was also examined.Materials and Methods: A convenience sample of patients affected with severe generalised periodontitis was enrolled into a prospective single blind longitudinal intervention trial with a 6 months follow‐up. Serum C‐reactive protein (CRP) and interleukin‐6 (IL‐6) levels were assessed by high‐sensitivity assays. Serological and clinical periodontal parameters were evaluated at baseline, 2 and 6 months after completion of non‐surgical periodontal therapy.Results: In the 94 subjects that completed this pilot trial improvements in all clinical periodontal parameters were achieved. These were accompanied with significant reductions in serum IL‐6 and CRP concentrations. In a multivariate model, serum CRP levels were significantly associated with the outcome of periodontal treatment after correcting for potential covariates (age, body mass index, gender, smoking) and polymorphisms in the IL‐6 (−174 C/G) and IL‐1A (−889) genes. A median decrease in serum CRP of 0.5 mg/l (95% CI 0.4–0.7 mg/l) was observed 6 months after completion of periodontal therapy in this population. Subjects with above average response to periodontal therapy (<30 residual pockets and <30% of sites bleeding on probing) accounted for the observed improvement in serum CRP.Conclusions: Control of periodontitis, achieved with non‐surgical periodontal therapy, significantly decreased serum mediators and markers of acute phase response. The significance of the serum response was associated with the half of the population that responded better to non‐surgical periodontal therapy. The results of this pilot study indicate that severe generalised periodontitis causes systemic inflammation. This is consistent with a causative role of periodontitis in atherogenesis.
Conceptualisation, development, and evaluation of a measure of unplanned pregnancy
Authors: Barrett G , Smith S C , Wellings K 
Published: April 2004

Study objective:To develop a measure of unplanned pregnancy that is valid, reliable, and appropriate in the context of contemporary demographic trends and social mores and can be used in a variety of situations, including the production of population prevalence estimates.Design:A two stage study design: qualitative (inductive) methods to delineate the construct of pregnancy planning, and quantitative/psychometric methods to establish the means of measurement.Setting:Eight health service providers (comprising 14 clinics, including antenatal, abortion, and one general practitioner) across London, Edinburgh, Hertfordshire, Salisbury, and Southampton in the UK.Participants:Samples comprised a mixture of pregnant (continuing pregnancy and opting for abortion) and recently pregnant (post-abortion and postnatal) women. At the qualitative stage, 47 women took part in depth interviews (20 of whom were re-interviewed after the birth of their baby). Items were pre-tested with 26 women, and two psychometric field tests were carried out with, respectively, 390 and 651 women.Main results:A six item measure of unplanned pregnancy was produced. Psychometric testing demonstrated the measure’s high reliability (Cronbach’s α = 0.92; test-retest reliability = 0.97) and high face, content, and construct validity. Women’s positions in relation to pregnancy planning are represented by the range of scores (0–12).Conclusions:A psychometric measure of unplanned pregnancy, the development of which was informed by lay views, is now available. The measure is suitable for use with any pregnancy regardless of outcome (that is, birth, abortion, miscarriage) and is highly acceptable to women.
Applying a research ethics committee approach to a medical practice controversy: the case of the selective COX-2 inhibitor rofecoxib
Authors: James M J , Cleland L G 
Published: April 2004

The new class of anti-inflammatory drugs, the COX-2 inhibitors, have been commercially successful to the point of market dominance within a short time of their launch. They attract a price premium on the basis that they are associated with fewer adverse gastric events than traditional anti-inflammatory drugs. This marketing continues even though a pivotal safety study with one of the COX-2 inhibitors, rofecoxib, showed a significant increase in myocardial infarction with rofecoxib use compared with a traditional anti-inflammatory drug. This finding has led to a series of publications containing pooled analyses of existing data that both support and refute the possibility of increased cardiovascular risk with COX-2 inhibitors.These medical journal publications have served to obfuscate rather than provide guidance for medical practitioners. Consideration of a research ethics committee approach to this issue suggests that it would deal with the controversy in a straightforward manner—namely, it would simply inform research participants of the trial results with rofecoxib. The certainty of this research ethics committee approach raises the issue of whether it should be applied in normal medical practice outside of the research environment. A consideration of the legal tests for disclosure of information suggests that therapeutic medical practice should mirror that within the research environment, in this case.
Systemic cytomegalovirus infection complicating ulcerative colitis: a case report and review of the literature
Authors: Hamlin P J , Shah M N , Scott N , Wyatt J I , Howdle P D 
Published: April 2004

Abstract
Cytomegalovirus is a common infection worldwide and in the immunocompromised individual it can be a major cause of morbidity and mortality. In patients with inflammatory bowel disease cytomegalovirus infection has been described in both immunocompetent and immunocompromised individuals. A 34 year old man with an exacerbation of his colitis was diagnosed as having both cytomegalovirus colitis and hepatitis. The diagnosis was made on the classical appearance of “owl’s eye” inclusion bodies on colonic and hepatic biopsies and, in addition, viral serology and polymerase chain reaction (PCR) analysis of the cytomegalovirus DNA copy number. Fourteen days of treatment with ganciclovir led to a prompt improvement in the symptoms of colitis, resolution of the pyrexia, normalisation of the liver function tests, and clearance of the virus, as measured by a negative cytomegalovirus DNA PCR.
Cytomegalovirus infection is a potentially fatal complication of treatment induced immunosuppression in patients with inflammatory bowel disease. As in this case, infection may be systemic and not confined to the intestine. Prompt diagnosis using histology, serology, and PCR analysis allows prompt introduction of therapy and an improved prognosis.
Metformin induced acute pancreatitis precipitated by renal failure
Authors: Mallick S 
Published: April 2004

Abstract
Metformin is a biguanide commonly used in type 2 diabetes and considered to be a safe drug with minimal side effects. Approximately 2% of cases of acute pancreatitis may be caused by drugs, but it is not a known complication of metformin therapy. To date only one case of pancreatitis has been reported in association with metformin, but that was secondary to metformin poisoning (overdose). This is the first reported case of pancreatitis caused by a therapeutic dose of metformin (although in this case renal failure precipitated the metformin toxicity). Severe lactic acidosis is a rare but life threatening complication of metformin, which occurs particularly in patients with renal failure.
Management of inflammatory bowel disease
Authors: Nayar M , Rhodes J M 
Published: April 2004

Abstract
Ulcerative colitis and Crohn’s disease result from an interaction between genetic and environmental factors. Only one gene, NOD2/CARD15, has been clearly identified; a minority of people with alteration of this gene develop Crohn’s disease. The NOD2/CARD15 protein is thought to be involved in defence against intracellular bacteria. This supports the idea that Crohn’s disease and ulcerative colitis result from altered immunological responses to the normal intestinal flora. Life expectancy is normal in ulcerative colitis and nearly so in Crohn’s disease, but both conditions cause considerable morbidity. Approximately 80% of patients with Crohn’s disease eventually require surgery, and about 25% of patients with ulcerative colitis require colectomy. Treatment of ulcerative colitis is generally by corticosteroids for acute disease and mesalazine for maintenance, but the range of therapies for Crohn’s disease is expanding. Alternative therapies include immunosuppressives, enteral nutrition, antibiotics, anti-TNF antibody (infliximab), corticosteroids, and surgery. High dosages of corticosteroids may provide symptomatic relief in Crohn’s disease but do not affect the long term natural history of the disease, and management strategies should avoid using steroids whenever possible.