bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design of the Collaborative AtoRvastatin Diabetes Study (CARDS) in patients with Type 2 diabetes
Authors: Colhoun H. M. , Thomason M. J. , Mackness M. I. , Maton S. M. , Betteridge D. J. , Durrington P. N. , Hitman G. A. , Neil H. A. W. , Fuller J. H. ,   the CARDS Investigators
Published: March 2003

AbstractBackgroundThere are few data on the role of lipid lowering in the primary prevention of coronary heart disease (CHD) in diabetic patients. This paper describes the design of a collaborative clinical trial between Diabetes UK, the NHS Research and Development Directorate and Pfizer UK, that addresses this question.MethodsThe Collaborative AtoRvastatin Diabetes Study (CARDS) is a multicentre, randomized, placebo‐controlled, double‐blind clinical trial of primary prevention of cardiovascular disease in patients with Type 2 diabetes. The primary objective is to investigate whether treatment with the hydroxymethylglutaryl coenzyme A reductase inhibitor, atorvastatin, reduces the incidence of major cardiovascular events. At entry patients have at least one other risk factor for CHD in addition to diabetes, namely current smoking, hypertension, retinopathy, or micro‐ or macroalbuminuria. At randomization patients have been selected for a serum low‐density lipoprotein (LDL) cholesterol concentration ≤ 4.14 mmol/l (160 mg/dl) and triglycerides ≤ 6.78 mmol/l (600 mg/dl). Randomization was completed in June 2001. Patients will be followed until 304 primary endpoints have accrued (expected date early 2005). The trial includes 2838 men and women aged 40–75 years. This report describes the design and administration of the study and reviews the evidence to date of the effectiveness of lipid‐lowering therapy in Type 2 diabetes.ConclusionsThe case for lipid‐lowering therapy for the primary prevention of CHD in diabetes has not been demonstrated. CARDS will provide essential information on the extent of any benefits and adverse effects of lipid‐lowering therapy in diabetic patients without prior CHD.Diabet. Med. 19, 201–211 (2002)
Vascular effects of glibenclamide vs. glimepiride and metformin in Type 2 diabetic patients
Authors: Abbink E. J. , Pickkers P. , Van Rosendaal A. Jansen , Lutterman J. A. , Tack C. J. , Russel F. G. M. , Smits P. 
Published: March 2003

AbstractAims Glibenclamide attenuates the protective responses to opening of vascular ATP‐sensitive potassium (KATP) channels during ischaemia. Therefore, glibenclamide treatment of Type 2 diabetes mellitus may have hazardous cardiovascular effects when used under conditions of ischaemia. Glimepiride and metformin seem to lack such characteristics. Based on these data, we hypothesized that, in contrast to glibenclamide, chronic treatment of Type 2 diabetic patients with glimepiride or metformin will not impair the vasodilator function of KATP opening in vivo.Methods Two groups of 12 Type 2 diabetes mellitus patients participated in a double‐blind randomized cross‐over study consisting of two 8‐week periods, in which treatment with orally administered glibenclamide (15 mg/day) was compared with either glimepiride or metformin (6 mg and 1500 mg/day, respectively). At the end of each treatment period, the increase in forearm blood flow (FBF, venous occlusion plethysmography) in response to intra‐arterial administered diazoxide (KATP opener), acetylcholine (endothelium‐dependent vasodilator) and dipyridamole (adenosine‐uptake blocker) and to forearm ischaemia was measured.Results There were no significant differences in vasodilator responses to diazoxide, acetylcholine, dipyridamole and forearm ischaemia after glibenclamide compared with glimepiride and metformin.Conclusions Chronic treatment of Type 2 diabetes mellitus with glimepiride or metformin has similar effects on vascular KATP channels compared with chronic glibenclamide treatment.Diabet. Med. 19, 136–143 (2002)
Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans
Authors: Choi K. M. , Lee J. , Kim D. R. , Kim S. K. , Shin D. H. , Kim N. H. , Park I. B. , Choi D. S. , Baik S. H. 
Published: March 2003

AbstractAims This study was conducted to compare the prevalence and cardiovascular risk factors of different categories of glucose tolerance in the elderly Korean population using World Health Organization (WHO) and American Diabetes Association (ADA) criteria.Methods This study included 1456 non‐diabetic subjects over the age of 60 years, selected from a cross‐sectional study, which was conducted in 1999 in Seoul, Korea. Fasting and post‐challenge 2‐h plasma glucose, insulin levels, body mass index (BMI), waist–hip ratio (WHR), blood pressure, and lipid profiles were examined. Prevalence of glucose tolerance categories and the level of agreement (κ statistics) were obtained using WHO 2‐h criteria and ADA fasting criteria. Comparison of cardiovascular risk factors among several concordant and discordant glucose intolerance groups was done.Results The prevalence rates of newly diagnosed diabetes of elderly men defined by WHO 2‐h criteria and ADA fasting criteria were 11.8% and 4.8%, respectively. That of elderly women was 8.1% by WHO 2‐h criteria and 3.1% by ADA fasting criteria. The prevalence of impaired glucose tolerance (IGT) by WHO criteria was also higher than that of impaired fasting glucose (IFG) by ADA criteria (23.5% vs. 10.0% men, 23.7% vs. 7.5% women). The level of agreement between ADA fasting criteria and WHO 2‐h criteria was low (weighted κ = 0.228 men, weighted κ = 0.301 women). The concordant diabetic women by both ADA fasting criteria and WHO 2‐h criteria showed higher BMI, WHR, diastolic blood pressure, total cholesterol and triglyceride levels than concordant normal subjects. However, the isolated post‐challenge hyperglycaemia (IPH) women group was not different significantly from the concordant normal women group except in BMI.Conclusions Our results clearly show that the 1997 ADA fasting criteria are less sensitive for diagnosing diabetes than oral glucose tolerance test (OGTT)‐based WHO criteria in elderly Koreans. Also, there is a poor agreement of different categories of glucose tolerance between ADA and WHO criteria; therefore, the OGTT remains a valuable test in diagnosing diabetes and classifying various categories of glucose intolerance, especially in elderly Koreans.
Platelet contractile force (PCF) and clot elastic modulus (CEM) are elevated in diabetic patients with chest pain
Authors: Carr M. E. , Krishnaswami A. , Martin E. J. 
Published: March 2003

AbstractAims Platelet function and clot structure may be altered in diabetes. We have noted increased platelet contractile force (PCF) and clot elastic modulus (CEM) in patients presenting to the emergency department with chest pain. Twenty‐six of the chest pain patients were diabetic. Here, we compare the PCF, CEM and platelet aggregation in diabetic chest pain patients, non‐diabetic patients with chest pain and asymptomatic controls.Patients and methods PCF, CEM and collagen whole blood aggregations were measured in 100 chest pain patients and 25 asymptomatic controls.Results Platelet concentrations for diabetic patients, non‐diabetic patients and controls were identical. PCF was significantly (P
< 0.05) elevated in diabetic chest pain patients (9.42
±
0.59 kdynes) vs. controls (7.40
±
0.32 kdynes). CEM in diabetic patients (29.96
±
2.19 kdynes/cm2) was significantly elevated relative to that in non‐diabetic chest pain patients (25.22
±
0.84 kdynes/cm2) and normal controls (23.18
±
0.74 kdynes/cm2). Collagen‐induced whole blood aggregation was decreased (P
< 0.05) in diabetic chest pain patients vs. controls. PCF values (10.23
±
0.76 kdynes) in diabetic patients with haemoglobin A1c > 7% were higher than in any other group.Conclusion PCF and CEM are elevated in diabetic chest pain patients. The significance of these laboratory findings awaits additional clinical studies.
Plant distribution and dispersal mechanisms at the Hassayampa River Preserve, Arizona, USA
Authors: Drezner Taly Dawn , Fall Patricia L. , Stromberg Juliet C. 
Published: March 2003

AbstractThis study focuses on the relationships between plant dispersal syndromes and plant distributions at the community scale. Species composition and cover are reported from 29 10 × 20‐m vegetation plots along five topographic cross‐sections in the riparian zone of the Hassayampa River Preserve, Arizona. We find that spatial patterns of dispersal guilds vary within the flood plain of this semiarid region river. Our main results are: (1) wind‐dispersed species are fairly evenly distributed at all elevations and distances from the river, whereas cover of animal‐dispersed species increases with elevation above, and at greater distances from, the river; (2) wind‐dispersed species are proportionally more abundant in the pioneer Populus–Salix community, whereas plants in the late‐seral Prosopis community are predominantly animal‐dispersed; (3) most of the species classified as obligate‐wetland and facultative‐wetland are wind‐dispersed, whereas facultative‐upland and obligate‐upland species are mostly animal‐dispersed; and (4) there are significantly fewer wind‐dispersed species in areas of high total vegetation cover. These results may reflect successional patterns resulting from periodic flooding. Low areas close to the river flood more frequently and with greater intensity than areas farther from the river. Many pioneer species that establish in disturbed areas are wind‐dispersed. Over successional time, pioneer species cede to more drought tolerant species that are predominantly animal‐dispersed.
Reproductive phenology of a wet forest understorey in the Western Ghats, South India
Authors: Krishnan Rani M. 
Published: March 2003

AbstractThe reproductive phenology of 60 understorey species was monitored at monthly intervals for 20 months in a medium elevation wet evergreen forest in the Southern Western Ghats. The life forms monitored were herbs (including terrestrial orchids), shrubs and small trees. Flowering and fruiting were non‐uniform with a dry season flowering peak and wet season fruiting peak. Flowering in the understorey correlated negatively with rainfall. No significant correlation was detected for fruiting. Life forms had flowering and fruiting peaks at different times of the year.
Seed dispersal facilitation and geographic consistency in bird–fruit abundance patterns
Authors: Burns K. C. 
Published: March 2003

AbstractAvian seed dispersal mutualisms are characterized frequently by stochastic interactions between birds and fruits; however, many studies report coarse‐scale correlations in annual abundances of birds and fruits at particular locales (i.e. ‘phenological synchrony’). This study tested the geographical consistency of phenological synchrony in a meta‐analysis of data from 14 biogeographic locations. Data from a single site in British Columbia, Canada, were then used to test the dispersal facilitation hypothesis, which postulates that synchronous bird–fruit abundance patterns result from deterministic seed dispersal processes (i.e. avian fruit consumption). Results showed that phenological synchrony is a geographically consistent pattern. However, fruit production occurred after peak periods of bird abundances in British Columbia. Although phenological patterns were asynchronous at this site, observational and experimental fruit removal patterns supported the dispersal facilitation hypothesis. Avian fruit consumption covaried with bird abundances, suggesting selection may favour earlier fruit production and increased phenological synchrony. Environmental data suggest that earlier fruit production is constrained by cold spring temperatures, which inhibit the activity of pollinators and earlier dates of fruit maturation. Overall, the results show that phenological synchrony is a geographically consistent pattern in seed dispersal mutualisms. However, decoupled bird–fruit abundance patterns may occur despite deterministic processes favouring phenological synchrony.
The geographic distribution of pubescence in the sea daisy, Borrichia aborescens, on Bahamian Islands
Authors: Morrison Lloyd W. 
Published: March 2003

Abstract Borrichia aborescens (L.) DC. is a salt‐tolerant perennial herb that is common on small islands in the central Bahamas. Two morphotypes are present: one with densely pubescent leaves and one with glabrous leaves. I conducted surveys in three archipelagos to document the geographical distribution of pubescence in this species and to infer the underlying mechanisms. B. aborescens was also grown from seed in a greenhouse. The pubescent form of B. aborescens was relatively more abundant on small islands than on nearby large ‘mainland’ islands. In two of the three archipelagoes, pubescence increased with distance on small islands. The pubescent form was relatively more abundant on small islands exposed to the open ocean compared to small islands that were protected by mainland islands or reefs on all sides. On a large mainland island, the pubescent form decreased in relative abundance inland from the coast. B. aborescens cultivated in a greenhouse revealed the effect of a genetic factor on the expression of pubescence. The observed patterns of variation are consistent with a physiological explanation for the adaptive benefit of pubescence. Trichomes may prevent physical blockage of the stomata by accumulation of salt in areas near breaking waves and salt spray.
Natural evolution of sleepiness. A 5‐year follow‐up study in a middle‐aged population
Authors: Martikainen Kirsti , Partinen Markku , Hasan Jóel , Urponen Hélka , Vuori IIkka , Laippala Pékka 
Published: March 2003

The prevalence and natural evolution of sleepiness were investigated in a 5‐year follow‐up study in a middle‐aged population in Finland. In the original study a structured sleep questionnaire was completed by 1190 subjects and a 5‐year follow‐up questionnaire was returned by 626.The prevalence of sleepiness, meaning here an unintentional tendency to fall asleep weekly in the course of everyday living, was 9.6% in the first survey and 10.6% 5 years later in the same cohort; 3.7% had been sleepy in both surveys. Sleep fragmentation, leg jerking and awakenings during sleep were common findings among sleepy subjects in both surveys. Shift‐workers and those who had irregular working hours ran a risk of chronic sleepiness. Sleepiness was also associated with poor subjective health, obesity, depression, nervousness and tension. In particular, chronically sleepy subjects had an increased risk of sleepiness‐related traffic accidents and premature retirement. Contrary to common findings from sleep laboratories, neither snoring nor self‐ or spouse‐reported breathing pauses during sleep were significantly associated with long‐term sleepiness in a non‐selected middle‐aged population. It is suggested that more attention should be paid to subjects suffering from excessive daytime sleepiness even if they do not have a history of respiratory or other known organic sleep disorder.
Clinical patterns of acute stroke among the three health‐care systems in France
Authors: Giroud M. , Lemesle M. , Madinier G. , Menassa M. , Billiar Th. , Dumas R. 
Published: March 2003

Data from 959 consecutive patients registered with the Dijon Stroke Registry were used to compare the characteristics of the patients who were admitted to the public hospital within the first days after their first stroke with those admitted to the private hospitals or who remained at home. Seven hundred and one patients (73%) were admitted to the public hospital, 185 (19%) were admitted to private hospitals and 73 (8%) remained in the community. The results show that the clinical patterns of the stroke are quite different among the three health‐care systems.The clinical patterns of stroke managed in the public hospital are characterized by: a younger age (63‐years‐old vs, 77 and 76‐years‐old), earlier coma (29% vs 2.8 and 1.5%), more severe deficit (71% vs 15 and 5%), more hemorrhagic mechanism (23 vs 4.5% and 1.7%), more associated ischemic heart disease (31% vs 18 and 15%), more cardiac arrhythmia (38% vs 11 and 8%), higher case fatality rate (39% vs 8 and 2%).Therefore, we have identified three clinical patterns among the three health‐care facilities. These three clinical patterns are quite different on the point of view of the clinical severity, and the associated co‐morbidities. The socio‐economic status is not a criteria in the choice of the health‐care facility. This observed distribution is not the consequence of a voluntary policy.
Problems associated with switch to modafinil – a novel alerting agent in narcolepsy
Authors: Guilleminault C. , Aftab F. A. , Karadeniz D. , Philip P. , Leger D. 
Published: March 2003

Modafinil is a novel medication recently approved for the treatment of narcolepsy and idiopathic hypersomnia. Commonly, patients had already been prescribed medications for their syndrome.This report outlines difficulties encountered in the clinical practice of switching patients to modafinil. Naïve subjects accepted modafinil best. Subjects withdrawn from amphetamine had the most problems and failure to withdraw. Venlafaxine hydrochloride combined well with modafinil to control cataplectic attacks. Usage of a progressive withdrawal protocol may ease the difficulties observed.
Systematic review of proton magnetic resonance spectroscopy of the striatum in parkinsonian syndromes
Authors: Clarke C. E. , Lowry M. 
Published: March 2003

It has been suggested that proton magnetic resonance spectroscopy (MRS) of the striatum can differentiate between parkinsonian syndromes. The present study aims to examine this claim by performing a systematic review of the existing literature.A MEDLINE search was performed between 1966 and October 1999, along with searches of conference abstracts and reference lists of papers identified.Eleven groups have used MRS to examine metabolite ratios in the striatum in Parkinsonian syndromes. A number of these have shown reduced N‐acetylaspartate/choline (NAA/Cho) and/or N‐acetylaspartate/creatine (NAA/Cr) ratios in either idiopathic Parkinson’s disease (IPD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP) or corticobasal degeneration. However, the heterogeneity in the results precludes the use of any of these findings in differential diagnosis at the present time. The only group to use absolute metabolite concentrations rather than ratios showed that the decreased NAA/Cho ratio in IPD was because of an increase in choline which is of uncertain biological significance.Further large multicentre trials are required using absolute quantitation of tissue metabolite concentrations and a standardized technique. The patients entering such studies must be rigorously assessed to establish the diagnosis of the type of parkinsonism as accurately as possible. Any discriminatory abnormality must be tested in a large prospective study of newly presenting parkinsonian patients with long‐term clinical follow up and ultimate pathological confirmation of the diagnosis as far as possible.
Post‐infectious central and peripheral nervous system diseases complicating Mycoplasma pneumoniae infection Report of three cases and review of the literature
Authors: Pfausler B. , Engelhardt K. , Kampfl A. , Spiss H. , Taferner E. , Schmutzhard E. 
Published: March 2003

Three patients with a central and peripheral nervous system disease complicating a Mycoplasma pneumoniae (M. pn.) infection are presented. Patient 1 suffered from bilateral optic neuritis as well as acute Guillain–Barré syndrome recovering after plasmapheresis. The two other patients suffered from severe haemorrhagic leukoencephalitis (Hurst) which only could be contained by aggressive decompressive craniectomy with duraplasty. All three illnesses were clearly shown to be associated with M. pn. infection.Our three patients represent the full scale of central nervous (CNS) (cerebral and myelitic) as well as peripheral nervous system (PNS) (GBS, optic neuritis) manifestation of a disease caused by the same pathogenetic – post‐infectious – mechanism; pathogenic CNS and PNS epitopes might be shared in post‐infectious neurological disease following M. pn. infection.
Headache Medication-Use Among Primary Care Headache Patients in A Health Maintenance Organization
Authors: Von Korff M. , Black LK , Saunders K , Galer BS 
Published: March 2003

Objective. Medication-use among headache patients 2 and 5 years after a primary care headache visit is assessed, and the pattern of medication-use compared before and after the introduction of subcutaneous sumatriptan among migraineurs. Setting and patients. The study was carried out among headache patients visiting a primary care physician at the Group Health Cooperative of Puget Sound in 1989-90. Methods. We report medication-use patterns 2 and 5 years later for the 530 subjects completing both a 2-year (1991-92) and a 5-year (1994-95) follow-up interview. Medication-use was determined by self-report for the month prior to the interview. Medication-use to control or prevent headache is shown for all headache patients and for those meeting International Headache Society criteria for migraine at the 2-year and the 5-year follow-up. Results. The overall pattern of medication-use was similar at the 2-year and the 5-year follow-up, before and after the introduction of subcutaneous sumatriptan (March, 1993). There was a modest but statistically significant decline in the use of opioid and sedative-hypnotic medications, and in the use of ergotamine. At 5 years, 11% of migraineurs reported use of sumatriptan in the prior month. The large majority of study patients used symptomatic medications, usually non-prescription analgesics, sedativehypnotics, and opiates. Only one-fifth of the migraineurs reported use of a prophylactic medication for headache. Conclusions. Continuing use of symptomatic headache medications was characteristic of patients with migraine and other common forms of headache. The introduction of subcutaneous sumatriptan was not associated with notable change in this pattern, although a modest reduction in use of sedativehypnotics and opiates was observed. Overall, the pattern of use of headache medications was similar before and after the introduction of subcutaneous sumatriptan.
Parents with learning disabilities: service audit and development
Authors: Woodhouse Anne E. , Green Gill , Davies Sara 
Published: March 2003

SummaryIncreasing referrals of parents with learning disabilities or with possible learning disabilities to a small clinical psychology department prompted an audit and service review. Numbers of referrals had increased from two in 1995 to 13 in 1997. Only three out of the 32 children of referred parents were not subject to some form of intervention resulting from the 1989 Children Act. Twenty‐three distinct teams of professionals were identified as being involved with the referred families. The clinical psychology department had limited resources, and consequently, developed a service that allowed for the restriction in finance and personnel. The service was developed within a four‐tier model. This included workshops and a consultation service for professionals involved with these families, a parenting assessment service, legal work, and a parents' group that addressed parenting skills and personal development. The present authors believe that this model serves as a useful framework for other small departments, but that a dedicated special parenting service for vulnerable parents remains the ideal.