bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bedtime uncooked cornstarch supplement prevents nocturnal hypoglycaemia in intensively treated type 1 diabetes subjects
Authors: Axelsen M. , Wesslau C. , Lönnroth P. , Lenner R. Arvidsson , Smith U. 
Published: March 2003

Abstract. Axelsen M, Wesslau C, Lönnroth P, Arvidsson Lenner R, Smith U (Sahlgrenska University Hospital, Göteborg University, Sweden). Bedtime uncooked cornstarch supplement prevents nocturnal hypoglycaemia in intensively treated IDDM subjects. J Intern Med 1999; 245: 229–36.Objectives. The present study tests two interrelated hypotheses: (1) that bedtime ingestion of uncooked cornstarch exerts a lower and delayed nocturnal blood glucose peak compared with a conventional snack; (2) that bedtime carbohydrate supplement, administered as uncooked cornstarch, prevents nocturnal hypoglycaemia without altering metabolic control in intensively treated type 1 diabetes (IDDM) patients.Design and subjects. The above hypotheses were tested separately (1) by pooling and analysing data from two overnight studies of comparable groups of patients with non‐insulin dependent diabetes mellitus (NIDDM) (14 and 10 patients, respectively), and (2) by a double‐blind, randomized 4‐week cross‐over study in 12 intensively treated IDDM patients.Setting. Sahlgrenska University Hospital, Göteborg, Sweden.Interventions. (1) Ingestion of uncooked cornstarch and wholemeal bread (0.6 g of carbohydrates kg−1 body weight) and carbohydrate‐free placebo at 22.00 h. (2) Intake of uncooked cornstarch (0.3 g kg−1 body weight) and carbohydrate‐free placebo at 23.00 h.Main outcome measures. (1) Nocturnal glucose and insulin levels; (2) frequency of self‐estimated hypoglycaemia (blood glucose [BG] levels < 3.0 mmol L−1) at 03.00 h, HbA1c and fasting lipids.Results. Bedtime uncooked cornstarch ingestion led to a lower (2.9 ± 0.5 vs. 5.2 ± 0.6 m
m, P = 0.01) and delayed (4.3 ± 0.6 vs. 2.0 ± 0.0 h, P < 0.01) BG peak, compared with a conventional snack, in NIDDM patients. Four weeks of bedtime uncooked cornstarch supplement, as compared with placebo, led to a 70% reduction in the frequency of self‐estimated hypoglycaemia at 03.00 h (P < 0.05), without affecting HbA1c or fasting lipids in IDDM patients.Conclusions. Uncooked cornstarch, ingested at bedtime, mimicked the nocturnal glucose utilization profile following insulin replacement, with a peak in blood glucose after 4 h. In IDDM patients, bedtime uncooked cornstarch supplement diminished the number of self‐estimated hypoglycaemic episodes, without adversely affecting HbA1c and lipid levels. Hence, bedtime uncooked cornstarch ingestion may be feasible to prevent a mid‐nocturnal glycaemic decline following insulin replacement in IDDM and, based on the nocturnal blood glucose profile, may also be preferable compared with conventional snacks.
Significance of graft occlusion and coronary atherosclerosis 5 years after coronary artery bypass grafting. A quantitative angiographic study with serial exercise testing
Authors: Korpilahti K. , Engblom E. , Hämäläinen H. , Syvänne M. , Hietanen E. , Arstila M. , Puukka P. , Rönnemaa T. 
Published: March 2003

Abstract.  Korpilahti K, Engblom E, Hämäläinen H, Syvänne M, Hietanen E, Arstila M, Puukka P, Rönnemaa T (Central Hospital of Vaasa, Turku University Central Hospital, Research and Development Centre of the Social Insurance Institution, Turku and Helsinki University Central Hospital, Finland). Significance of graft occlusion and coronary atherosclerosis 5 years after coronary artery bypass grafting. A quantitative angiographic study with serial exercise testing. J Intern Med 1999; 245: 545–552.Objective.  To evaluate the relative importance of graft occlusions and progression of atherosclerosis in coronary arteries as causes of the occurrence of angina pectoris and impairment of physical performance 5 years after coronary artery bypass surgery.Design.  A 5‐year follow‐up study.Setting.  University hospital in south‐western Finland.Subjects.  Altogether, 174 consecutive electively operated bypass patients.Main outcome measures.  Serial clinical evaluation and bicycle exercise tests (pre‐operatively, at 6 months, and at 1 and 5 years). Quantitative coronary angiography pre‐operatively and 5 years after the surgery.Results.  Subjects with patent grafts had fewer angina pectoris symptoms at the 5‐year follow‐up (24 vs. 52%, P = 0.001) and were treated less frequently with long‐acting nitrates (3 vs. 15%, P = 0.037) than subjects with graft occlusions. Fewer of them were in classes II–III of the functional classification of the Canadian Cardiovascular Society (39 vs. 74%, P = 0.001). The exercise test was interrupted less often because of chest pain (23 vs. 41%, P = 0.03) and improvement in exercise test variables during the follow‐up period was significantly greater in subjects with patent grafts (P < 0.002). Amongst patients without graft occlusions, those with new ≥ 50% diameter stenoses in coronary arteries were more often in functional classes II–III (59 vs. 32%, P = 0.03) than those without new stenoses, but the groups were similar with respect to angina pectoris and exercise tests variables. In patients with graft occlusions, those with and without new ≥ 50% diameter stenoses were similar with respect to functional class, angina pectoris and exercise test variables.Conclusions.  Angina pectoris and impairment of physical capacity 5 years after coronary artery bypass grafting are mainly due to occlusion of bypass grafts and not to progression of atherosclerosis in coronary arteries.
Streptokinase antibodies inhibit reperfusion during thrombolytic therapy with streptokinase in acute myocardial infarction
Authors: Juhlin P , Boström P.‐Å , Torp A , Bredberg A 
Published: March 2003

Abstract.Objectives. To evaluate the influence of pretreatment IgG against streptokinase on the outcome of streptokinase treatment in acute myocardial infarction.Setting. Coronary care unit.Design. From 88 patients admitted to the coronary care unit due to chest pain, blood samples were taken for determination of the pre‐existing titre of antibodies against streptokinase. The patients were treated and monitored according to standard protocols. Fifty of the patients received thrombolytic therapy with streptokinase due to acute myocardial infarction and were monitored with continuous dynamic vectorcardiography, making possible the continuous analysis of ST‐ and QRS‐vector changes and determination of the event of reperfusion. None of these 50 patients had been given streptokinase therapy previously.Results. According to the vectorcardiographic criteria 21(42%) patients had signs of early (within 2 h) reperfusion after streptokinase therapy. These patients had lower pre‐existing antibody titres than patients without signs of reperfusion (mean values 0.20 and 0.45 arbitrary units, P = 0.01). None of the patients with a titre higher than 0.50 arbitrary units (nine patients) had signs of early reperfusion. Of the 41 patients with a titre lower than 0.50 arbitrary units 52.5% had signs of early reperfusion.Conclusion. The present investigation indicates that pre‐existing streptokinase antibodies play an important role in reperfusion failure during thrombolytic therapy with streptokinase in acute myocardial infarction. Therefore, the determination of streptokinase antibodies may differentiate between those patients who may benefit from streptokinase treatment and those who should be treated with some other regime.
No increase in fracture incidence in patients treated for thyrotoxicosis in Malmö during 1970–74. A 20‐year population‐based follow‐up *
Authors: Hallengren B. , Elmståhl B. , Berglund J. , Christensen S. B. , Elmståhl S. , Johnell O. , Thorngren K.‐G. 
Published: March 2003

Hallengren B, Elmståhl B, Berglund J, Christensen SB, Elmståhl S, Johnell O, Thorngren K‐G (Malmö University Hospital, Malmö, and University Hospital, Lund, Lund University, Sweden). No increase in fracture incidence in patients treated for thyrotoxicosis in Malmö during 1970–74. A 20‐year population‐based follow‐up. J Intern Med 1999; 246: 139–144.Objectives. To study whether there is an increased fracture incidence following thyrotoxicosis.Design. A case–control study.Setting. Malmö University Hospital, Malmö, Sweden.Subjects: All patients (n = 333) from the population of Malmö who were treated for thyrotoxicosis for the first time during the 5‐year period 1970–74. A total of 618 controls were selected from the local municipality registry in Malmö. For each case the aim was to randomly select two age‐ and gender‐specific controls, alive in 1993 and born the same year and month as the case.Main outcome measures. Fracture incidenceResults.  Comparing survivors, there were no differences in the percentage of individuals with fractures (all, fragility, non‐fragility) between the patients and the controls. Comparing all individuals and including all fractures, the percentage of individuals with fractures in the entire female patient group (24.6%) was lower (P < 0.05) than in female controls (33.1%). There was a similar but non‐significant pattern between male patients and controls. The mean number of all fractures was lower in male patients than in controls (P < 0.05), but no significant difference was noted between female patients and controls. For fragility fractures, there were no significant differences in the percentage of individuals with fractures or in the mean number of fractures between female or male patients and controls.Conclusion. In conclusion we found no increased incidence of fragility fractures in patients with previous thyrotoxicosis as compared with controls. Our results do not support the suggestion that screening for osteoporosis should be performed in patients with previous thyrotoxicosis.
Long‐term effect of a new oral prostacyclin analogue, beraprost sodium, in isolated peripheral pulmonary artery stenosis in the adult
Authors: Yoshitomi Y. , Kojima S. , Kuramochi M. 
Published: March 2003

Yoshitomi Y, Kojima S, Kuramochi M, (Tohsei National Hospital, Shizuoka, Japan). Long‐term effect of a new oral prostacyclin analogue, beraprost sodium, in isolated peripheral pulmonary artery stenosis in the adult (Case Report). J Intern Med 1999; 246: 227–230.A 20‐year‐old woman was admitted with increasing breathlessness on exertion. A diagnosis of isolated peripheral pulmonary artery stenosis (PPS) was confirmed by right‐sided cardiac catheterization and pulmonary angiography. We tried treatment with a newly developed oral prostacyclin analogue, beraprost sodium. Her symptoms gradually improved 1 month after treatment. After 1 year, we observed a decrease in pulmonary arterial pressure (from 118/16 [mean 59] to 87/13 [mean 40] mmHg) and systolic right ventricular pressure (from 125 to 90 mmHg). This is the first report to describe the chronic effect of oral prostacyclin analogue on isolated peripheral pulmonary artery stenosis.
Improved fibrinolysis by intense lifestyle intervention. A randomized trial in subjects with impaired glucose tolerance
Authors: Lindahl B. , Nilsson T. K. , Jansson J.‐H. , Asplund K. , Hallmans G. 
Published: March 2003

Objective. To assess the effects of lifestyle intervention on cardiovascular risk factors in general and especially on fibrinolysis.Design. Randomized clinical study.Subjects. A total of 186 subjects with impaired glucose tolerance and obesity.Interventions. The intervention programme included a low‐fat, high‐fibre diet and regular physical exercise. Half of the participants (n = 93) took part in a one‐month learning and training session using different behavioural modification techniques and conducted in a full‐board wellness centre (intense intervention group). The other half (n = 93) was randomized a one‐hour counselling session with a specially trained nurse (usual care group). Follow‐up was carried out after 12 months.Main outcome measures. Body weight, oxygen consumption, plasminogen activator inhibitor type 1 (PAI‐1) activity, tissue plasminogen activator (tPA) antigen, fibrinogen and fasting plasma insulin measured at the start of the programme and at follow‐up after 1 year.Results. The intense intervention group had a mean weight decline by 1 year of 5.4 kg compared to 0.5 kg in the usual care group. Oxygen consumption in the intense group increased 10% vs. a 1% decline in the usual care group. In the intense group, PAI‐1 activity decreased 31% (– 10.1 U mL–1), which was significantly more than in the usual care group (12%; – 3.0 U mL–1). The corresponding reductions in tPA antigen were 14% (– 1.65 μg L–1) and 6% (– 0.69 μg L–1).Conclusions. The present randomized study shows that an intense lifestyle programme has sustained beneficial effects on fibrinolysis.
Trends in lipid levels and hypercholesterolemia in hypertensive and normotensive Finnish adults from 1982 to 1997
Authors: Kastarinen M. , Tuomilehto J. , Vartiainen E. , Jousilahti P. , Sundvall J. , Puska P. , Nissinen A. 
Published: March 2003

Abstract. Kastarinen M, Tuomilehto J, Vartiainen E, Jousilahti P, Sundvall J, Puska P, Nissinen A (University of Kuopio, Kuopio; National Public Health Institute, Helsinki; Kuopio University Hospital, Kuopio, Finland). Trends in lipid levels and hypercholesterolemia in hypertensive and normotensive Finnish adults from 1982 to 1997. J Intern Med 2000; 247: 53–62.Objectives. To assess the trends in lipid levels and awareness of hypercholesterolemia in hypertensive and normotensive population in Finland from 1982 to 97.Design. Four independent cross‐sectional population surveys conducted in 1982, 1987, 1992 and 1997.Setting. The provinces of North Karelia and Kuopio in eastern Finland and the region of Turku‐Loimaa in south‐western Finland.Subjects. Men and women aged 25–64 years, selected randomly from the national population register. The subjects were classified to four groups according to their blood pressure level and treatment status: normotensive, unaware hypertensive, aware but not treated hypertensive and treated hypertensive. The total number of participants was 24 083.Main outcome measures. We assessed the mean serum total cholesterol and HDL cholesterol concentrations, the prevalence of hypercholesterolemia (total cholesterol ≥6.5 mmol L–1 or the use of lipid‐lowering drugs), the prevalence of a high ratio of total cholesterol to HDL cholesterol (ratio ≥5) and the awareness of hypercholesterolemia amongst the four study groups.Results. Mean total cholesterol, the prevalence of hypercholesterolemia and the prevalence of a high ratio of total to HDL cholesterol decreased, whereas the awareness of hypercholesterolemia increased significantly in all study groups. The decline in mean total cholesterol was largest in treated hypertensive subjects of both sexes (13% in men, 14% in women). Mean HDL cholesterol increased significantly in all study groups except in the unaware hypertensive men, but it remained significantly lower in treated hypertensive patients in both sexes compared with the other groups (P < 0.001).Conclusions. The lipid profile of both the hypertensive and normotensive population has significantly improved in both the hypertensive and normotensive population in Finland from 1982–97. The introduction of newer antihypertensive drugs has not had any effect on the HDL cholesterol level amongst treated hypertensive patients at the population level.
Non‐linear effects of blood pressure and glycosylated haemoglobin on progression of diabetic nephropathy
Authors: Sawicki P. T. , Bender R. , Berger M. , Mühlhauser I. 
Published: March 2003

Abstract. Sawicki PT, Bender R, Berger M, Mühlhauser I (WHO‐Collaborating Centre for Diabetes, Heinrich‐Heine‐University of Düsseldorf, Germany). Non‐linear effects of blood pressure and glycosylated haemoglobin on progression of diabetic nephropathy. J Intern Med 2000; 247: 131–138.Objective. To describe the long‐term simultaneous impacts of blood pressure and glycosylated haemoglobin values on the risk of progression of diabetic nephropathy.Design. Prospective, multicentre, 6‐year follow‐up study.Setting. One reference centre (university department of internal medicine) and nine general hospitals.Subjects. A total of 601 type 1 diabetic patients on intensive insulin therapy with and without diabetic nephropathy.Main outcome measures. Progression of nephropathy was defined as change for the worse within five stages of nephropathy by at least one of these stages during the study period. By the use of logistic regression, the relationship between metabolic and blood pressure control and the risk of nephropathy progression was quantified.Results. The main determinants of nephropathy progression were glycosylated haemoglobin and blood pressure, which were both non‐linearly associated with the risk of progression. No significant threshold levels for any of the predictors of progression were identified.Conclusions. The results of this study underline the importance of optimizing metabolic and blood pressure control to arrest the progression of diabetic nephropathy without the evidence for a clinically relevant threshold effect.
Marked improvement in survival after acute myocardial infarction in middle‐aged men but not in women. The Northern Sweden MONICA study 1985–94
Authors: Peltonen M. , Lundberg V. , Huhtasaari F. , Asplund K. 
Published: March 2003

Abstract. Peltonen M, Lundberg V, Huhtasaari F, Asplund K (Umeå University Hospital, Kalix Hospital and Luleå‐Boden Hospital, Sweden). Marked improvement in survival after acute myocardial infarction in middle‐aged men but not in women. The Northern Sweden MONICA study 1985–94. J Intern Med 2000; 247: 579–587.Objectives. The aim of this study was to analyse time trends in survival after acute myocardial infarction with special emphasis on sex differences.Design. Within the framework of the population‐based WHO MONICA Project, all acute myocardial infarction events were recorded in the age group 25–64 years in northern Sweden during the period 1985–94. All first‐ever myocardial infarction patients were followed for information on vital status.Subjects. A total of 3397 men and 860 women with acute myocardial infarction, during the period between 1985 and 1994.Main outcome measures. Case fatality rates after first‐ever acute myocardial infarction.Results. When compared with the 1985–86 cohort, the age‐adjusted odds ratio for death within 1 year after acute myocardial infarction was 0.59 (95% CI 0.46–0.76) in the 1993–94 male cohort but 0.99 (95% CI 0.61–1.60) in the female 1993–94 cohort. Corresponding age‐adjusted proportions of death within 1 year were 33.3% and 22.9% in men and 27.5% and 27.3% in women in 1985–86 and 1993–94, respectively. The odds ratio for 3‐year case fatality amongst those who survived the first 28 days was 0.34 (95% CI 0.21–0.55) in 1991–92 compared with 1985–86 in men and 0.91 (0.43–1.94) in women.Conclusion. Both short‐ and long‐term survival after AMI have improved markedly in men over the last decade. There is a disturbing sex difference in that, during the same period, survival in women with AMI has not improved at all. This sex difference was not explained by differences in conventional prognostic factors.
Bezafibrate and simvastatin combination therapy for diabetic dyslipidaemia: efficacy and safety
Authors: Gavish D. , Leibovitz E. , Shapira I. , Rubinstein A. 
Published: March 2003

Abstract. Gavish D, Leibovitz E, Shapira I, Rubinstein A (Wolfson Medical Center, Holon, and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel). Bezafibrate and simvastatin combination therapy for diabetic dyslipidaemia: efficacy and safety. J Intern Med 2000; 247: 563–569.Objective. To determine the efficacy and safety of a statin–fibrate combination in diabetes patients.Design.   An open 21‐month trial in which each patient first received the single drug for 6 months and then a combination of the two for 1 year.Setting. Three lipid clinics in university‐based tertiary care hospitals.Patients. One hundred and forty‐eight patients with type 2 (non‐insulin‐dependent, NIDDM) diabetes mellitus under stable control for 3 months by means of diet and oral hypoglycaemic medication.Intervention. Patients from one clinic (n = 48) received bezafibrate slow release (400 mg day–1), and patients from the other two clinics (n = 100) received simvastatin 20 mg day–1. Six months later, all patients were switched to a daily combination of 400 mg bezafibrate slow release and 20 mg simvastatin for 1 year.Results. The combination of statin and fibrate led to a 23% reduction in total cholesterol, 42% reduction in triglycerides, 29% reduction in LDL‐c, 25% increase in HDL‐c, 10% decrease in fibrinogen and 19% reduction of Lp(a) levels, and a decrease in the cholesterol/HDL‐c ratio (from 8.9 to 5.4) in all 148 patients. Cardiovascular (CV) event rate was significantly reduced from 9.5% during the first 6 months of the study to less than 2% during the last year of the study (whilst on combination Rx). Side‐effects with all treatments included only two patients who developed myopathy when on the combined regimen and one on the single statin regimen. However, plasma creatinine phosphokinase (CPK) levels doubled (but remained within the normal range) in most of the patients on combination therapy, compared with only a mild increase in patients receiving a single medication.Conclusions. The statin and fibrate combination was found to be more efficacious than a single medication for treatment of diabetic dyslipidaemia, as evidenced by improvement in the lipoprotein profile, reductions in Lp(a), fibrinogen and CV event rate, and almost no clinically significant side‐effects.
Reduced thiamine phosphate, but not thiamine diphosphate, in erythrocytes in elderly patients with congestive heart failure treated with furosemide
Authors: Härdig L. , Daae C. , Dellborg M. , Kontny F. , Bøhmer T. 
Published: March 2003

Abstract. Härdig L, Daae C, Dellborg M, Kontny F, Bøhmer T (Sahlgrenska University Hospital/Östra, Göteborg, Sweden, and Aker University Hospital, Oslo, Norway). Reduced thiamine phosphate, but not thiamine diphosphate, in erythrocytes in elderly patients with congestive heart failure treated with furosemide. J Intern Med 2000; 247: 597–600.Objectives. To measure the concentrations of thiamine and thiamine esters by high‐pressure liquid chromatography (HPLC) in elderly patients treated with furosemide for heart failure and in a control group.Design. A cross‐sectional study of blood thiamine and thiamine ester concentrations.Subjects. Forty‐one patients admitted to hospital for heart failure and 34 elderly living at home. No vitamin supplementation was allowed.Results. Compared with the healthy controls, furosemide‐treated patients had significantly reduced whole blood thiamine phosphate (TP; 4.4 ± 2.2 vs. 7.6 ± 2.0 nmol L–1) and thiamine diphosphate (TPP; 76 ± 21.5 vs. 91 ± 19.8 nmol L–1) (mean ± SD). When the thiamine concentrations were related to the haemoglobin concentrations, which were reduced in the heart failure patients, the levels of TP (nmol g–1 Hb) were 0.38 ± 0.26 vs. 0.54 ± 0.17 (P < 0.0001), and of TPP were 6.35 ± 1.76 vs. 6.37 ± 1.29 (P = 0.95). There were no differences in T and TP concentrations in plasma between the two groups.Conclusions. The elderly patients with heart failure treated with furosemide have not reduced the storage form of thiamine, TPP, but only TP. This change is most likely not an expression of a thiamine deficiency, but rather of an altered metabolism of thiamine, which is not understood at present.