bluuebunny/crossref_metadata_2025_split huggingface dataset:
Two‐hour post‐dose cyclosporine level is a better predictor than trough level of acute rejection of renal allografts
Authors: Pescovitz Mark D , Barbeito Ralph ,   for the Simulect US01 Study Group
Published: March 2003

Pescovitz, MD, Barbeito, R for the Simulect US01 Study Group. Two‐hour post dose cyclosporin level is a better predictor than trough level of acute rejection of renal allografts. Clin Transplant 2002: 16: 378–382. © Blackwell Munksgaard, 2002Cyclosporine (CyA) trough concentrations are poor predictors for acute rejection post‐transplant. Patients were part of a randomized trial of basiliximab (n=70) vs. anti‐thymocyte globulin (ATGAM) (n=65), both in combination with Neoral, mycophenolate mofetil, and steroids, undergoing first or second, cadaveric or live donor renal transplants. Whole blood samples were collected just before (C0) and at 2 h after CyA dosing on day 4 and at the end of weeks 1, 2, 4, and 8. The CyA was measured by florescence polarization immunoassay (TDx). Mean CyAC0andC2concentrations were calculated. Logistic regression analysis revealed that meanC2level was the only predictor of acute rejection (P ≤ 0.001). Higher meanC2levels predicted lower rejection probabilities. Linear regression analysis revealed that higher meanC2levels were not related to higher serum creatinine levels at either week 4 or 24 or to incidence of headache or tremor. The CyAC2levels predict the frequency of rejection postrenal transplant. TargetC2levels are in the range of 1500 ng/dL.
Bone marrow transfusions in cadaver renal allografts: pilot trials with concurrent controls
Authors: Light Jimmy , Salomon Daniel R , Diethelm Arnold G , Alexander J Wesley , Hunsicker Lawrence , Thistlethwaite Richard , Reinsmoen Nancy , Stablein Donald M 
Published: March 2003

Abstract: Background: The safety and immune tolerance potential of donor marrow infusion with cadaveric source renal transplants was evaluated in a series of non‐randomized multicenter pilot trials by the NIH Cooperative Clinical Trials in Transplantation (CCTT) Group.Patients and methods: Three strategies were tested: (1) immunosuppression with cyclosporin, azathioprine and prednisone with a single post‐transplant day 1 infusion of 5 × 107viable cells/kg, (2) OKT3 induction with triple drug therapy and marrow transfusion on day 1, or (3) same therapy as (2) but with an additional marrow transfusion on day 10–12.Results: Thirty‐eight marrow recipients and 35 contemporaneous controls were entered with a mean follow‐up of over 5 yr. Graft survival was initially better in the marrow recipients than the controls but was similar after 5 yr. Microchimerism rates were similar for the marrow infusion and control groups throughout the follow‐up period, regardless of the immunosuppression strategies.Discussion: Bone marrow infusions were well tolerated by a group of cadaver renal allograft recipients. There were no complications from the infusion(s), no episodes of graft‐vs.‐host disease (GVHD) and no increase in infections or other complications. There was a trend toward early improved graft survival in marrow recipients. Decreased rejection rates were observed in black recipients.
Impact of hepatitis B and C on graft loss and mortality of patients after kidney transplantation
Authors: Breitenfeldt Marie K , Rasenack Jens , Berthold Hans , Olschewski Manfred , Schroff Joachim , Strey Christoph , Grotz Wolfgang H 
Published: March 2003

Background: Mortality or graft loss after renal transplantation might be influenced by hepatitis virus infection.Methods: Sera from time of transplantation of 927 renal transplant recipients were tested for hepatitis C (HCV) and hepatitis B virus (HBV) in order to investigate the impact of hepatitis virus infection on graft loss and mortality over an observation period of 20 yr.Results: One hundred and twenty three of 927 patients were HCV positive, 30 patients HBV positive and seven patients HBV and HCV positive. The observation period was 9.2 ± 4.4 yr. Mortality was significantly higher in patients with hepatitis B (p=0.0005), as well as in patients with concomitant B and C hepatitis (p < 0.0001) and in those who acquired HCV infection after transplantation (n=30, p=0.0192) compared with non‐infected patients. Patients with replicating HBV infection (HBeAg positive) had the worst prognosis (p < 0.0001). In the multivariate analysis the presence of HBeAg (p < 0.0001), patients' age (p < 0.0001) and HCV infection after transplantation (p=0.0453) were predictors for death. Graft survival was significantly shorter in patients with concomitant hepatitis B and C (p=0.0087) as well as in HBeAg positive patients (p=0.002). HCV infection or HBs antigenemia did not have a significant impact on graft survival compared with non‐infected patients.Conclusion: HCV infection after transplantation is associated with a high mortality whereas chronic HCV infection before trans plantation does not have a significant impact on mortality. Patients with replicating HBV infection or concomitant HBV and HCV infection have a high risk of graft loss and mortality.
Life satisfaction and adverse effects in renal transplant recipients: a longitudinal analysis
Authors: Matas Arthur J , Halbert RJ , Barr Mark L , Helderman J Harold , Hricik Donald E , Pirsch John D , Schenkel Felicia A , Siegal Bonita R , Liu Honghu , Ferguson Ronald M 
Published: March 2003

Introduction: Previous cross‐sectional analyses have identified significant associations between quality of life (QOL), comorbidities and adverse effects in renal transplant recipients. This report examines the longitudinal relationship between adverse effects and QOL, with particular attention to the relative impact of adverse effects associated with immunosuppression.Methods: The Transplant Learning Center (TLC) is a program designed to improve QOL and preserve graft function in transplant recipients. Self‐selected enrollees filled out questionnaires at roughly 3‐month intervals. Each questionnaire included QOL scales developed for the program. Repeated measures multiple regression analysis was used to examine the relationship between the QOL scales, comorbidities, adverse effects, adjusting for other factors.Results: A total of 4247 TLC enrollees were included in the analysis, with a mean time since transplant of 5.1 yr. Comorbidities and adverse effects were common, with high blood pressure reported by 87% of respondents and unusual hair growth reported by 69.6%. In bivariate analysis, emotional/psychological problems and headaches had the largest impact on QOL. In multivariate analysis, emotional/psychological problems decreased sexual interest or ability, and headache had the largest adverse QOL effect.Conclusions: We have identified QOL issues that have been previously underemphasized in transplant recipients. These findings open new areas of research to further explore and define these issues. They provide new opportunities for interventions to address factors adversely impacting QOL and to develop strategies to improve QOL in these patients. Clinicians should actively solicit information about adverse effects of medications, particularly information about sexual and relationship issues, when evaluating renal recipients. These issues should be taken into account when making therapeutic decisions.
Modulation of synaptic plasticity by stress and antidepressants
Authors: Popoli Maurizio , Gennarelli Massimo , Racagni Giorgio 
Published: March 2003

Recent preclinical and clinical studies have shown that mechanisms underlying neuronal plasticity and survival are involved in both the outcome of stressful experiences and the action of antidepressants. Whereas most antidepressants predominantly affect the brain levels of monoamine neurotransmitters, it is increasingly appreciated that they also modulate neurotransmission at synapses using the neurotransmitter glutamate (the most abundant in the brain). In the hippocampus, a main area of the limbic system involved in cognitive functions as well as attention and affect, specific molecules enriched at glutamatergic synapses mediate major changes in synaptic plasticity induced by stress paradigms or antidepressant treatments. We analyze here the modifications induced by stress or antidepressants in the strength of synaptic transmission in hippocampus, and the molecular modifications induced by antidepressants in two main mediators of synaptic plasticity: the N‐methyl‐D‐aspartate (NMDA) receptor complex for glutamate and the Ca2+/calmodulin‐dependent protein kinase II (CaM kinase II).Both stress and antidepressants induce alterations in long‐term potentiation of hippocampal glutamatergic synapses, which may be partly accounted for by the influence of environmental or drug‐induced stimulation of monoaminergic pathways projecting to the hippocampus. In the course of antidepressant treatments significant changes have been described in both the NMDA receptor and CaM kinase II, which may account for the physiological changes observed. A central role in these synaptic changes is exerted by brain‐derived neurotrophic factor (BDNF), which modulates both synaptic plasticity and its molecular mediators, as well as inducing morphological synaptic changes. The role of these molecular effectors in synaptic plasticity is discussed in relation to the action of antidepressants and the search for new molecular targets of drug action in the therapy of mood disorders.
In vitro fertilization in patients with ovarian endometriomas
Authors: TINKANEN HELENA , KUJANSUU ERKKI 
Published: March 2003

Objective. The objective of the study was to establish whether operative treatment of recurrent ovarian endometriosis improves the prognosis of in vitro fertilization.Methods and material. A retrospective analysis of one hundred endometriosis patients admitted to Tampere University Hospital for IVF treatment. Forty‐five patients had an ovarian endometrioma during IVF treatment, 36 of the cases being recurrences after a previous operation. Fifty‐five patients had ovarian endometriomas operated without recurrence. The patient groups with or without endometriosis did not differ in age, duration of infertility, sperm parameters, amount of gonadotropins required per oocyte and number of retrieved oocytes.Results. The patients with ovarian endometriosis had more embryos (mean 3.9) than women without endometriomas (mean 2.8) (p<0.05) and the respective pregnancy rates per IVF cycle were 38% and 22%. Patients with endometriomas had a live birth rate of 27% compared with 20% in women with no endometriomas.Conclusions. The presence of a small endometrioma does not reduce the success of IVF treatment.
The risk of premalignant and malignant pathology in endometrial polyps
Authors: BAKOUR SHAGAF H. , KHAN KHALID S. , GUPTA JANESH K. 
Published: March 2003

Objective. To evaluate the risk of premalignant and malignant pathology among endometrial polyps.Design. Prospective cohort study.Setting. Minimal Access Surgical Training (MAST) center in a large teaching hospital.Methods. Among 248 patients seen in outpatient hysteroscopy clinic (1996–97), 62 had endometrial polyps. All patients had endometrial sampling for histological assessment. To determine the magnitude of malignant potential among polyps, we compared the pathological findings in polyps (cases) with non‐polypoidal specimens (controls).Results. Out of 62 polyps, histologically 53 (85.5%) were benign, seven (11.3%) had hyperplasia, and two (3.2%) were associated with malignancy. Hyperplasia was more frequent in endometrial specimens with polyps than in those without (11.3% vs 4.3%, p=0.04), but the incidence of carcinoma in the two groups was the same (3.2% vs 3.2%, p=1.0).Conclusion. In abnormal uterine bleeding, hyperplasia was, but cancer was not, more common in women with endometrial polyps compared to those without polyps.
A prospective randomized study comparing acupuncture with physiotherapy for low‐back and pelvic pain in pregnancy
Authors: WEDENBERG KAJ , MOEN BERIT , NORLING ÅSA 
Published: March 2003

Background. The aim of this study was to describe the effects of acupuncture in the treatment of low‐back and pelvic pain during pregnancy and compare it with physiotherapy.Methods. Sixty pregnant women were allotted to acupuncture or physiotherapy. The women estimated the severity of their pain using a visual analog scale (VAS) from 0 to 10 and disability in performing twelve common daily activities using a disability‐rating index (DRI) from 0 to 10.Results. In the acupuncture group all 30 women completed the study (two exclusions), in the physiotherapy group only 18. Before treatment the two study groups were rather similar with respect to pain and disability. After treatment the mean morning VAS had declined from 3.4 to 0.9 (p<0.01) in the acupuncture group and from 3.7 to 2.3 (NS) in the physiotherapy group. The corresponding evening values had declined from 7.4 to 1.7 (p<0.01) and 6.6 to 4.5 (p<0.01), respectively. The mean VAS values were lower after acupuncture than after physiotherapy both in the morning (p=0.02) and in the evening (p<0.01). After treatment also the mean DRI values had decreased significantly in the acupuncture group for 11 of 12 activities and the values were significantly lower for all activities than in the physiotherapy group where no significant changes had taken place. Overall satisfaction was good in both groups. There were no serious adverse events in any of the patients.Conclusions. Acupuncture relieved pain and diminished disability in low‐back pain during pregnancy better than physiotherapy.
Relationship between histopathological changes in post partum renal biopsies and renal function tests of African women with early onset pre‐eclampsia
Authors: KHEDUN SHAUN M. , NAICKER THAJASVARIE , MOODLEY JAGDISEA 
Published: March 2003

Background. To improve the diagnostic accuracy of concurrent renal disease in hypertension of pregnancy, biopsy evaluation is essential. In addition, establishing underlying renal disease is important for prognosis on future pregnancies. We therefore designed a study to determine the diagnostic yield of postpartum renal biopsy and the nature and frequency of complications associated with this procedure. Also, to determine relationships, if any, between renal function tests and ultrastructural and histopathological findings.Methods. Fifty renal biopsies were performed in the immediate postpartum period in black African women with early onset pre‐eclampsia. Each biopsy specimen was placed in a separate container and coded so that sampling was unknown to the electron microscopist. Each biopsy specimen was divided into three parts, and processed and stained for light, fluorescent and transmission electron microscopy using conventional techniques.Results. Renal tissue biopsies were adequate for diagnostic purposes in all cases. There were no complications in any of the 50 patients studied. Ultrastructural examination confirmed the light microscopy findings. In addition the ultrastructural findings showed intramembranous deposits, foot process fusion and mesangial deposits. In 16 patients with normal renal function tests; the biopsies evaluation from these patients showed ultrastructural changes. In the remaining 34 patients with abnormal renal function tests of varying severity; biopsy evaluation from these patients showed both ultrastructural and histopathological changes.Conclusion. Renal biopsy procedure is safe, and ultrastructural and histological findings obtained from postpartum renal biopsies are more informative than the routine renal function tests.
Effectiveness of ultrasonographic parameters for documenting the severity of anatomic stress incontinence
Authors: YALCIN OMER T. , HASSA HIKMET , OZALP SINAN 
Published: March 2003

Background. To assess the correlation between the severity of incontinence and some ultrasonographic parameters used to document the mobility of bladder neck.Methods. The severity of the incontinence and mobility the bladder neck were evaluated by pad test and perineal ultrasonography respectively in 74 patients with pure anatomic stress incontinence. During perineal ultrasonography, distances from the bladder neck to the lower tip (A) and to the posterior midpoint of symphysis pubis (B) were measured at rest and during stress. The first bladder neck mobility was obtained by two caliper method (Mu). After superimposing the symphysis pubis of the frozen images, the bladder neck positions at rest and during stress were plotted on an x‐y coordinate system by using computer programs and the corresponding X and Y values were calculated. The second bladder neck mobility was measured on this x‐y coordinate system (Mc). Paired t‐test and correlation analysis were used for statistical analysis of the data.Results. The mean Mc was significantly higher than the mean Mu (p<0.01). Compared to the values at rest, the mean distance A did not change significantly; however, the mean distance B increased, and X and Y values decreased significantly during stress (p<0.01). The amount of urine leaked per hour had significant positive correlation with distance B‐stress and Mc and significant negative correlation with Y‐rest, X‐stress and Y‐stress (p<0.05–0.001).Conclusion. These data suggested that the bladder neck mobility was underestimated when it was measured by two caliper method and the absolute positions or mobility of the bladder neck measured by computer on an x‐y coordinate system could effectively document the severity of the decreased support of bladder neck.
Maternal smoking and birthweight: effect modification of period, maternal age and paternal smoking
Authors: HAUG KJELL , IRGENS LORENTZ M. , SKJÆRVEN ROLV , MARKESTAD TROND , BASTE VALBORG , SCHREUDER PATRICIA 
Published: March 2003

Objective. To study the effect on birthweight of maternal smoking, and its modification by study period, maternal age and paternal smoking.Design. A retrospective questionnaire based national survey comprising a random sample (n=34,799) of all mothers giving birth in Norway 1970–91. Variables studied were parental smoking during pregnancy, birthweight, maternal age and infant's year of birth.Results. The overall difference in mean birthweight between non‐smoking and smoking mothers was 197 g. The difference in birthweight between non‐smoking and smoking mothers increased with maternal age from 182 g (<20 years of age) to 232 g (35+ years of age). There was no significant effect of paternal smoking on birthweight when the mother was a non‐smoker. When the mother was a smoker and the father was a non‐smoker, the birthweight, adjusted for maternal age, was reduced by 153 g (p<0.005). However, when both parents smoked, the birthweight, adjusted for maternal age, was reduced by 201 g (p<0.0005). Even though the prevalence of paternal smoking decreased by 38% during the study period, there was no significant increase in overall mean birthweight.Implication and relevance of results. The negative effect of maternal smoking on birthweight appears to increase with maternal age. For a non‐smoking pregnant woman to live with a smoking partner has little, if any, effect on birthweight. The negative effect of paternal smoking was only observed when the mother was smoking and might reflect two possible mechanisms: (1) that a smoking mother has a greater cigarette consumption when the partner also smokes, and (2) that a smoking mother is less concerned about passive smoking than a non‐smoking mother.
Three‐dimensional sonographic features of fetal central nervous system anomaly
Authors: HATA TOSHIYUKI , YANAGIHARA TOSHIHIRO , MATSUMOTO MINAKO , HANAOKA UIKO , UETA MARI , TANAKA YASUKO , KANENISHI KENJI , KUNO ATSUSHI , YAMASHIRO CHIZU , OHNISHI YOHICHI , TANAKA HIROKAZU , HAYASHI KEIJI 
Published: March 2003

Objective. To visualize an intracranial structure of the fetal central nervous system (CNS) anomaly using transabdominal three‐dimensional (3D) sonography.Methods. A total of 12 cases with fetal CNS anomalies (one unilateral ventriculomegaly; three hydrocephalus; three anencephaly; three holoprosencephaly; one Dandy‐Walker cyst; and one enlarged cisterna magna) from 17 to 37 weeks of gestation were studied with transabdominal 3D sonography (3.5 MHz).Results. In unilateral ventriculomegaly, insight view of dilated lateral ventricle, especially dilated atrium was depicted. In hydrocephalus, severely dilated bilateral ventricles and thin brain mantle were very clearly shown. In anencephalus, an absence of the brain and defect of the vault of the skull was clearly noted. In holoprosencephaly, absent interhemispheric fissure, common ventricle, and the extent of thalamic fusion were evident. In Dandy‐Walker cyst, cerebellar hemisphere was clearly depicted due to the agenesis of cerebellar vermis. In enlarged cisterna magna, posterior intracranial view of the fetus showed a large space of cisterna magna. Although the diagnosis of each CNS anomaly was made using conventional two‐dimensional sonography, 3D sonography proved most helpful delineating the exact nature and anatomic level of the anomaly.Conclusions. These results suggest that 3D sonography provides a novel means of visualizing fetal CNS anomalies in utero. However, it should be noted that our 3D sonography cannot depict intracranial brain structures in normal fetuses or some CNS anomaly such as intracranial tumor.
Birth outcomes in pregnant women treated with low‐molecular‐weight heparin
Authors: SØRENSEN HENRIK TOFT , JOHNSEN SØREN PAASKE , LARSEN HELLE , PEDERSEN LARS , NIELSEN GUNNAR LAUGE , MØLLER MARGRETE 
Published: March 2003

Background. Pregnancy and puerperium are associated with an increased risk of venous thromboembolism. Low‐molecular‐weight heparin is the anticoagulant of choice in pregnant women because, unlike warfarin, it does not cross the placenta. However, there are limited data on the risk of adverse birth outcomes following use of low‐molecular‐weight heparin in pregnancy.Patients and methods. We performed a population‐based cohort study to examine the safety of low‐molecular‐weight heparin use in pregnancy using data from the Pharmacoepidemiological Prescription Database, The Danish Medical Birth Registry and the Regional Hospital Discharge Registry in North Jutland County, Denmark. The birth outcomes in a cohort of 66 pregnant women treated with low‐molecular‐weight heparin between 1991–98 were compared with the birth outcomes of 17,259 pregnant women who did not receive any prescriptive drugs during pregnancy.Results. No increased risk of malformations, low birth weight or stillbirth was found. However, an increased risk of pre‐term delivery was found (odds ratio: 2.11, 95% confidence interval: 0.96–4.65), which could reflect inherited thrombophilia as an indication of low‐molecular‐weight heparin.Conclusion. We have provided additional evidence of the safety of low‐molecular‐weight heparin use in pregnancy.