bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive equations and the reliability of the impulse oscillatory system in Japanese adult subjects
Authors: SHIOTA Satomi , KATOH Masako , FUJII Mitsuhiro , AOKI Shigeyuki , MATSUOKA Rokuro , FUKUCHI Yoshinosuke 
Published: June 2005

Background:  The impulse oscillation system (IOS) measures respiratory impedance (Zrs) in terms of resistance (Rrs) and reactance (Xrs) at multiples of 5 Hz. These measurements can be used clinically to help diagnose and monitor respiratory disorders, independent of effort.Methodology:  The predictive equation for resistance at 5 and 20 Hz and impedance at 5 Hz (R5, R20, X5), for the first time, in 299 Japanese adult subjects was determined. In addition, the within single day variation and between day variation were determined.Results:  The predictive equation for R5, R20 and X5 revealed a clear difference with respect to the subject's smoking history (lifelong non‐smoker, n = 166, adjusted r = 0.55, 0.46 and 0.57, respectively, vs. smoker, n = 133, adjusted r = 0.47, 0.42 and 0.47, respectively). This difference was less obvious with respect to gender (female, n = 120, adjusted r = 0.42, 0.20 and 0.47, respectively, vs. male, n = 179, adjusted r = 0.46, 0.37 and 0.47, respectively). The predictive equations were dependent on the log of height (H) for both R5 and R20, and on age and log of height for X5. The equations were: R5 (KPa/L/s) = −3.841167 × logH + 8.671580; R20 (KPa/L/s) = −2.546561 × logH + 5.841867; and X5 (KPa/L/s) = −0.000097 × Age + 1.018597 × logH − 2.343672. For these parameters there were no statistically significant differences for within day repeatability or between day variations (P > 0.05), suggesting a high degree of reproducibility for IOS measurements.Conclusion:  It was possible to determine a predictive equation and confirm a high degree of reliability of IOS parameters in Japanese adult subjects.
Addition of macrolide in treating adult hospitalized community‐acquired pneumonia
Authors: LOH Li‐Cher , QUAH Soong‐Yuen , KHOO Sert‐Kim , VIJAYASINGHAM Pillai , THAYAPARAN Tarmizi 
Published: June 2005

Objectives:  Current clinical practice guidelines, including those in south Asia, recommend the addition of a macrolide to a broad‐spectrum antibiotic for the treatment of severe hospitalized community‐acquired pneumonia (CAP). The aim of this study was to observe the influence of macrolide addition on clinical outcomes of hospitalized adult patients with CAP.Methodology:  Over a 16‐month period between 2002 and 2004, 141 eligible patients were prospectively recruited from an urban‐based teaching hospital in Malaysia.Results:  Of the 141 patients, 63 (44.7%) patients (age (standard deviation (SD)) 56 (20.0) years; 50.8% male) received a macrolide‐containing antibiotic regimen, while 78 (55.3%; age (SD) 57 (20.2) years; 52.6% male) were on a single broad‐spectrum antibiotic only. In total, 39 (27.7%) and 102 (72.3%) patients had severe and ‘non‐severe’ pneumonia, respectively. Irrespective of whether they had severe or non‐severe pneumonia, there were no significant differences in mortality (non‐severe pneumonia, 6.5% vs. 5.4%, P = 0.804; severe pneumonia, 17.6% vs. 18.2%, P = 0.966), need of ventilation (non‐severe pneumonia, 8.7% vs. 3.6%, P = 0.274; severe pneumonia, 23.5% vs. 13.6%, P = 0.425) or median length of hospital stay (non‐severe pneumonia, 5.5 vs. 5 days, P = 0.954; severe pneumonia, 7 vs. 6 days, P = 0.401) between the two treatment regimens.Conclusion:  This observational, non‐randomized study suggests that addition of a macrolide may not convey any extra clinical benefits in adult hospitalized patients with CAP.
Successful withdrawal of inhaled corticosteroids in childhood asthma
Authors: PERERA B. Jayasiri C. 
Published: June 2005

Objective:  Although inhaled corticosteroids are useful and effective in the prophylaxis of childhood asthma, there is a dearth of information regarding the duration of treatment. The present study was undertaken to assess the possibility of successful withdrawal of inhaled corticosteroids in childhood asthma following good control of the disease.Methodology:  The study was carried out at the Asiri Hospital, Colombo, Sri Lanka and was a prospective observational clinical study. The participants were consecutive children with documented moderately severe and severe asthma seen over a period of 4 years from January 1990 and followed up to December 2003. Patients were allocated randomly to receive either beclomethasone dipropionate or budesonide. Initial dose of the selected drug was 300, 400 or 600 µg/ day, depending on the child's age. After a period of stabilization, the dose was reduced from the starting dose to a maintenance level of 200, 300 or 400 µg/day, respectively. Once sustained control had been maintained for a period ranging from 9 to 18 months, gradual withdrawal was attempted. The dosage was reduced by 50–100 µg each time, at intervals of 3 months. Long‐term follow up was maintained following withdrawal of inhaled corticosteroids. Breakthrough wheezing, acute severe attacks, hospitalization for wheezing and absence from school were used to assess the response.Results:  Eighty‐six children were recruited into the study. Eighty children responded well. The initial period on a high dose of corticosteroid was 8.4 months (range 4–12 months) and the average period of maintenance dosing was 11.7 months (range 9–18 months). The average time taken for withdrawal was 12.6 months (range 9–18 months). Successful withdrawal was achieved in 73 children. In this group, the mean total duration of treatment was 27.4 months (range 20–44 months). Up to December 2003, the subjects had been observed for an average period of 97.1 months (range 86–121 months) following withdrawal of inhaled corticosteroids. Of the 73 children in whom corticosteroids were withdrawn, 57 (78%) have remained well without any episodes of wheezing, and 14 (19%) have had mild episodes of wheezing that were easily controlled by bronchodilators. No patient needed hospitalization, long‐term treatment or systemic corticosteroids. In two (3%) patients, it was necessary to restart inhaled corticosteroids because of troublesome recurrences.Conclusion:  It is possible to gradually withdraw inhaled corticosteroids in a significant proportion of asthmatic children once good control has been sustained on a maintenance dose for a considerable period.
Prevalence and clinical features of cough variant asthma in a general internal medicine outpatient clinic in Japan
Authors: SHIRAHATA Kumiko , FUJIMOTO Keisaku , ARIOKA Hiroko , SHOUDA Ryousuke , KUDO Kouichirou , IKEDA Shu‐ichi 
Published: June 2005

Objective:  The aims of the present study were to examine the prevalence and clinical features of cough variant asthma (CVA) among patients with chronic and persistent cough at an outpatient clinic in Japan, and the efficacy of treatment with an inhaled corticosteroid.Methodology:  This prospective study was conducted at a general internal medicine outpatient clinic in Japan over a 12‐month period. CVA was diagnosed as chronic cough without wheezing or any apparent cause, that had persisted for more than 8 weeks, with a normal CXR and spirometry but with bronchial hyperresponsiveness to methacholine, and relief of cough after bronchodilator treatment. We also examined the effects of inhaled beclomethasone propionate on symptoms and differences in PEF between early morning and evening.Results:  Of 55 patients suffering from chronic cough, 23 satisfied the criteria for CVA. Their cough occurred more frequently at night and early in the morning. Early morning PEF was significantly lower than evening PEF with a mean variability of 11.5 ± 4.1%. Treatment with beclomethasone propionate improved coughing and significantly increased early morning PEF, reducing variability to less than 10%.Conclusions:  These findings suggest that CVA is most common among patients with chronic cough not due to any apparent cause. The efficacy of inhaled corticosteroid suggests that early intervention is effective in the treatment of CVA.
Serum IL‐18 levels in tuberculosis: Comparison with pneumonia, lung cancer and healthy controls
Authors: AKGUN Metin , SAGLAM Leyla , KAYNAR Hasan , YILDIRIM A. Kadir , MIRICI Arzu , GORGUNER Metin , MERAL Mehmet , OZDEN Kemalettin 
Published: June 2005

Objective:  The aim of the present study was to document the serum IL‐18 levels in patients with pulmonary tuberculosis (P‐TB), extrapulmonary tuberculosis (EP‐TB), pneumonia, lung cancer and in healthy controls, and to investigate whether it may assist in the differential diagnosis of P‐TB.Methodology:  A total of 116 patients were included in the study. The study population consisted of patients with P‐TB, EP‐TB, pneumonia and lung cancer and controls. P‐TB patients were graded according to sputum positivity and extent of disease. Serum levels of IL‐18 (ELISA) were compared between groups and with other clinical measures of disease.Results:  Compared with the controls, all groups of patients had increased serum levels of IL‐18. The highest mean concentration of IL‐18 was observed in P‐TB. Serum levels of IL‐18 in the patients with P‐TB correlated well with the extent of disease.Conclusions:  Although increased serum levels of IL‐18 were not specific for TB, the increased levels may favour active TB in radiologically advanced disease where CXR findings are difficult to interpret, and sputum smears or cultures are not helpful.
Levels of tumour necrosis factor‐α and IL‐1α in newly diagnosed and multidrug resistant tuberculosis
Authors: ÇAĞATAY Tülin , KIRAN Bayram , YURT Sibel , GÜLBARAN Ziya , KOSAR Filiz , ÇAĞATAY Penbe 
Published: June 2005

Background:  The pro‐inflammatory cytokines tumour necrosis factor (TNF)‐α and IL‐1α play key roles in host defence against tuberculosis (TB) but there is little knowledge of their levels in multidrug resistant TB (MDR‐TB). The aim of the present study was to investigate the levels of TNF‐α and IL‐1α and their relationship with the levels of T helper (CD4+), T suppressor (CD8+) and total lymphocytes (CD45+) in newly diagnosed TB (N‐TB) and MDR‐TB.Methodology:  This study assessed 19 N‐TB patients (M/F : 17/2) and 11 MDR‐TB patients (M/F : 10/1). Serum TNF‐α and IL‐1α were assessed by ELISA. Lymphocyte expression of CD45, CD4, CD8, CD3, CD23, CD19 and CD95 were determined by flow cytometry.Results:  The levels of TNF‐α, IL‐1α, and CD4, CD4/CD8, CD45, CD19, CD23 and CD95 positive lymphocytes were lower in MDR‐TB than in N‐TB patients (P < 0.05). Statistically, there was a positive correlation between TNF‐α and IL‐1α (r = 0.92) for both MDR‐TB and N‐TB. For both groups, both TNF‐α and IL‐1α correlated with CD4+ lymphocytes (r = 0.48). TNF‐α and IL‐1α showed negative correlations with CD8+ lymphocytes (r = −0.81, r = −0.73) (P < 0.01) in MDR‐TB patients.Conclusion:  The lower levels of cytokines and numbers of T helper lymphocytes in MDR‐TB compared with N‐TB implies that the immune profiles of the two groups are different, and may be important in the natural history of the disease.
Clinical usefulness of serum pyridinoline cross‐linked carboxyterminal telopeptide of type I collagen for diagnosis of bone metastases in patients with primary lung cancer
Authors: YOKOYAMA Toshihiko , YAMAMOTO Masashi , SHIMA Kouichiro , SUZUKI Katsuo , SAKO Chieko , ITO Genshi , KUME Mitsuyoshi , MAEDA Masao 
Published: June 2005

Objective:  Recently, various blood and urine markers of bone metabolism have been developed and applied to the diagnosis of bone metastases. However, the cut‐off values for each parameter have not yet been completely defined. In this study, the usefulness of serum pyridinoline cross‐linked carboxyterminal telopeptide of type I collagen (I CTP) was assessed for detecting bone metastases from primary lung cancer and the most efficient cut‐off value for I CTP based on the receiver operating characteristic curve was calculated.Methodology:  Over a 1‐year period, serum I CTP and serum alkaline phosphatase (ALP) were assayed for 87 primary lung cancer patients, including 21 bone metastases‐positive cases at Nagoya Ekisaikai Hospital, Nagoya, Japan.Results:  I CTP was significantly higher in patients with bone metastases than in the group without bone metastases. In contrast, there was no significant difference in serum ALP between the two groups. The most efficient cut‐off value for I CTP computed in this study was 6.4 ng/mL. This was higher than the recommended value (4.5 ng/mL) based on the data from the summated values obtained for lung cancer, breast cancer and prostate cancer, as well as the maximum value for healthy controls (4.9 ng/mL).Conclusion:  These results suggest that measurement of serum I CTP is a useful test for diagnosing bone metastases from lung cancer. Each type of cancer has a different pattern of bone turnover at the site of bone metastases. Considering that lung cancer mainly metastasizes to bone in an osteolytic pattern, it is proposed to set a higher cut‐off value for lung cancer patients than the currently recommended value.
Patterns of care for COPD by Japanese physicians
Authors: FUKUHARA Shunichi , NISHIMURA Masaharu , NORDYKE Robert J. , ZAHER Carol A. , PEABODY John W. 
Published: June 2005

Objective:  COPD treatment guidelines are available worldwide, yet it is not known how widely they are followed. This study evaluated the clinical care of COPD patients in Japan as compared to guideline recommendations.Methods:  A sample of general and specialist physicians was selected from private outpatient clinics and public hospitals in Japan. Physicians were provided two clinical vignettes (COPD and asthma) and asked to make a diagnosis. They were next asked to define diagnostic tests and treatment recommendations specifically for a COPD patient. Responses were compared to recommendations from current COPD guidelines.Results:  For the COPD unknown vignette, 6.2% of physicians diagnosed COPD while 54% diagnosed chronic bronchitis or emphysema. For COPD diagnosis, 81.9% of physicians recommended a CXR, 49.1% spirometry, and 17.7% a computed tomography scan. The most frequently recommended medication for a newly diagnosed COPD patient was theophylline (37.2%) followed by expectorants (32.1%) and inhaled anticholinergics (25.9%). Inhaled beta‐agonists were recommended by fewer than 20% of all physicians.Conclusion:  Care for COPD patients by selected Japanese physicians diverges from published practice guidelines. COPD is an infrequently used diagnostic label; diagnostic evaluation is characterized by a high use of computed tomography scans, particularly by specialists; and bronchodilator use was low.
Outcomes and health‐related quality of life following hospitalization for an acute exacerbation of COPD
Authors: WANG Qiuyue , BOURBEAU Jean 
Published: June 2005

Objective:  The purpose of this study was to understand the outcomes for patients admitted to hospital for an acute exacerbation of COPD, and to determine the factors influencing quality of life and health service utilization of patients with COPD.Methodology:  Hospital outcomes of 282 patients with moderate and severe COPD, for an acute exacerbation, were retrospectively evaluated. After 24 months of follow up, health‐related quality of life (QoL) and health service utilization (emergency room (ER) visit and readmission) in 54 patients admitted previously, were surveyed by questionnaires.Results:  Of 282 COPD patients admitted for an acute exacerbation, 28 patients (9.9%) died during hospitalization, 241 patients (85.5%) were discharged home, and only 13 patients (4.6%) needed long‐term care facilities. Although over 50% of the patients had survived over 2 years after discharge, their QoL was poor. Patients who frequently went to the ER or were admitted, were those with poor QoL, severe dyspnoea and frequent exacerbation. COPD exacerbation and dyspnoea were the main factors influencing QoL of the patients. Age, comorbidity, QoL, FEV1, frequency of COPD exacerbation, long‐term oxygen therapy, and family doctor were the factors determining the likelihood of patients visiting the ER. Frequency of COPD exacerbation, family doctor and living alone were the factors determining which patients were likely to be admitted to hospital.Conclusion:  The outcomes and QoL of patients admitted for an acute exacerbation of COPD were poor. The major factors influencing QoL were frequency of COPD exacerbation and severity of dyspnoea. Improvement of social and medical networks (e.g. reducing the number of patients living alone and providing family doctors for patients) may reduce health care service utilization.
Inflammatory profile in nasal secretions of infants hospitalized with acute lower airway tract infections
Authors: PITREZ Paulo M. C. , BRENNAN Siobhain , SLY Peter D. 
Published: June 2005

Objective:  The aim of this study was to determine whether the regulatory immune response (interleukin (IL)‐10 response) differed between children hospitalized with acute respiratory infections and wheezing.Methodology:  Infants with signs and symptoms of acute viral respiratory infection, admitted during winter 2000 to Princess Margaret Hospital for Children, Perth, WA, Australia, were enrolled in this study. Nasopharyngeal aspirates were collected in the first 48 h of admission. Total cell count and differential cell counts were assessed. Samples were tested for the presence of respiratory viruses. The concentrations of the anti‐inflammatory cytokine IL‐10, and pro‐inflammatory cytokines IL‐8, interferon‐γ, and IL‐11 were determined by ELISA.Results:  Children with acute bronchiolitis (AB; n = 36), recurrent wheeze (RW; n = 17) and upper respiratory infection (URI; n = 18) were enrolled. Respitory syncytial virus was the most commonly detected virus in all groups. IL‐10 concentrations were significantly increased in AB (median, 0.019 ng/mL) when compared to URI (median, 0.006 ng/mL) or to RW (median, 0.007 ng/mL; P < 0.05). Neutrophils were the predominant cells in the cytological analysis in all subjects.Conclusion:  These data argue that host‐response factors are important in determining the clinical phenotype, independent of the causative virus.
Cough symptoms in children aged 5–14 years in Sydney, Australia: non‐specific cough or unrecognized pertussis?
Authors: CAGNEY Michelle , MacINTYRE C. Raina , McINTYRE Peter , TORVALDSEN Siranda , MELOT Vincent 
Published: June 2005

Objective:  The aim of this study was to estimate the community prevalence of coughing symptoms, consistent with surveillance definitions for pertussis, and doctor‐diagnosed pertussis in children aged 5–14 years.Methodology:  A telephone survey of a cross‐sectional community sample of parents regarding their child's cough symptoms in the previous 12 months was undertaken in a representative Australian urban region.Results:  In 2020 interviews, parents reported that 22% of children had a cough lasting 2 weeks or longer in the preceding 12 months, and 14% (283) had additional symptoms meeting the Centers for Disease Control (CDC) case definition for pertussis. A cough meeting the case definition was significantly more commonly reported by parents of children aged 5–9 years (17%; P < 0.001) but reported exposure to diagnosed pertussis in such cases was significantly more common in children aged 10–14 years (4.3%; odds ratio 12.8; P < 0.01). Parents of 90% of children meeting the CDC case definition sought medical advice. A diagnosis of pertussis was reported in only 1.2% of cases, which extrapolates to an annual incidence of doctor‐diagnosed pertussis of 347/100 000 (95% confidence interval, 140–714 per 100 000). This contrasts with 29/100 000 notified cases in the same age group, time period and geographic area.Conclusion:  Cough episodes meeting a clinical case definition for pertussis commonly used in surveillance are reported by a high proportion of carers of school‐aged children in Australia. The majority of children who met the CDC and Australian case definitions for pertussis and sought medical attention were not identified as potentially having pertussis, suggesting underdiagnosis of pertussis. Even if less than half of this is true pertussis, the potential impact in terms of transmission of pertussis in the community is likely to be high. The reported incidence of doctor‐diagnosed disease estimated from this survey was at least five and up to 20 times the official notification rate. More work needs to be done in raising awareness among medical practitioners of pertussis as a differential diagnosis in older children and adolescents with cough.
EFFECT OF ENDOSCOPIC VARICEAL LIGATION FOR ESOPHAGEAL VARICES: VASCULAR STRUCTURE IMAGES BY MINIATURE ULTRASOUND PROBE
Authors: Nakano Shigeru , Hachiya Akihiko 
Published: June 2005

Background:  The effect of eradication of esophageal varices on the collateral veins beside the esophagogastric junction in portal hypertensive patients remains unclear.Methods:  The intramural and extramural vascular structures of the cardia and lower esophagus of 35 patients with portal hypertension were examined by endoscopic ultrasonography (EUS) before and after treatment of esophageal varices with endoscopic variceal ligation (EVL), in which ligations were repeatedly performed until complete obliteration of the varices. The vascular structures were classified into the gastric, palisade/perforating (p/p), and truncal zones, and were quantitatively evaluated.Results:  No esophageal varices remained in the p/p nor in the truncal zones after EVL. EVL significantly reduced the total cross‐sectional area (CSA) of the submucosal vessels and number of perforating veins in the gastric zone (P < 0.01, P < 0.01), and the total CSA of the peri‐esophageal collateral veins (peri‐ECV) and number of perforating veins in the p/p zone (P < 0.001, P < 0.001). Furthermore, the total CSA of the peri‐ECV was larger among patients with perforating veins in the p/p zone than among those without, both before and after EVL.Conclusions:  EVL obliterated esophageal varices, and indirectly influenced the intramural and extramural vascularities in the region of the esophagogastric junction, which may contribute to prevention of variceal recurrence.
STUDY OF THE TUMOR VESSELS IN DEPRESSED‐TYPE EARLY GASTRIC CANCERS USING NARROW BAND IMAGING MAGNIFYING ENDOSCOPY AND CDNA ARRAY ANALYSIS
Authors: Endo Takao , Nosho Katsuhiko , Arimura Yoshiaki , Yamashita Kentaro , Yamamoto Hiroyuki , Itoh Hideto , Shimumura Yasuhisa 
Published: June 2005

Background:  Since endoscopic mucosal resection has been applied to differentiated gastric cancers with invasion limited to the mucosal layer, the diagnosis of their differentiation is important. The degree of differentiation varies depending on the size and location of the tumors. Correct diagnosis by biopsy can be difficult because depressed‐type early gastric cancers sometimes contain mixed histology.Methods:  Fifteen patients with depressed‐type early gastric cancers were observed by magnifying endoscopy with a narrow band lighting system. The fine mucosal vascular pattern was recorded and compared with the histological differentiation and features of vessels by staining with CD34. In some patients, cDNA array analysis was performed to determine differences among histological types.Results:  Tumor vascular patterns were classified into two categories. Grid‐like network patterns not only characterized differentiated type but were also associated with high microvascular density. Short twig‐like patterns typified the undifferentiated type and a low vascular density. Differentiated types highly expressed some angiogenic factors, such as VEGFc and Flt‐4.Conclusions:  Tumor vessel pattern of depressed‐type early gastric cancer obtained by narrow band imaging magnifying endoscopy reflects both the histological features and the degree of expression of angiogenic factors.