bluuebunny/crossref_metadata_2025_split huggingface dataset:
Iodixanol inhibits exogenous surfactant therapy in rats with acute respiratory distress syndrome
Authors: Kesecioglu J. , Schultz M.J. , Haitsma J.J. , den Heeten G.J. , Lachmann B. 
Published: October 2002

Optimal alveolar distribution of exogenous surfactant is an important determinant of its beneficial effect. This distribution can be determined by suspending surfactant in a radiological contrast medium before intratracheal instillation, followed by radiological imaging. Iodixanol is reported to be a safe contrast medium that causes no lung injury when instilled intratracheally.In this study, the effects of surfactant suspended in saline were compared with surfactant suspended either in 4:1 saline-iodixanol (64 mg iodine·mL−1) or in 1:1 saline-iodixanol (160 mg iodine·mL−1), on oxygenation and lung mechanics in a rat model of adult respiratory distress syndrome (ARDS) induced by lung lavage.After the induction of ARDS, surfactant instillation improved oxygenation, total lung volume at inflation with a distending pressure of 35 cmH2O, lung volume at transpulmonary pressure of 5 cmH2O and Gruenwald index. The effects of surfactant suspended in 4:1 saline-iodixanol were similar to those of surfactant alone. However, instillation of surfactant suspended in 1:1 saline-iodixanol resulted in significantly lower values in all measured parameters. Surface tension was the lowest in surfactant suspended in saline alone and addition of iodixanol led to an increase in surface tension in a dose-dependent manner.In conclusion, iodixanol at the higher dose caused an inhibition of the exogenous surfactant effect, characterized as a lack of improvement in oxygen tension in arterial blood, low total lung compliance, volume at 5 cmH2O end-expiration and Gruenwald index. This effect of iodixanol was probably due to its high surface tension, especially if a high concentration was used. Surfactant suspended in a lower concentration of iodixanol seems a better alternative, allowing for radiological imaging of the distribution of surfactant when intratracheally instilled.
Fluticasone propionate attenuates platelet-activating factor-induced gas exchange defects in mild asthma
Authors: Acuña A.A. , Gabrijelcic J. , Uribe E.M. , Rabinovich R. , Roca J. , Barberà J.A. , Chung K.F. , Rodriguez-Roisin R. 
Published: October 2002

Inhaled glucocorticosteroids may reduce airway mucosal oedema in acute asthma. Inhaled platelet-activating factor (PAF) provokes pulmonary gas exchange disturbances, similar to those shown in severe asthma, which may be due to increased airway plasma leakage.This randomized, double-blind, placebo-controlled, crossover study investigated the effects of high doses of inhaled fluticasone propionate (FP) in 12 patients with mild asthma before and after PAF inhalation. Patients were studied before and 12 h after inhaling FP (6 mg) or placebo (P), and then at 5, 15 and 45 min after PAF challenge.Compared with vehicle, FP inhaled before PAF improved forced expiratory volume in one second and respiratory system resistance (Rrs), increased peripheral blood neutrophils and reduced eosinophil counts. After PAF, FP enhanced transient neutropenia at 5 min and facilitated the recovery of oxygen tension in arterial blood (FP: 93±4 mmHg; P: 83±4 mmHg) at 45 min, without influencing the increases inRrs.In conclusion, the improvement of platelet-activated factor-induced oxygen tension in arterial blood disturbances after fluticasone proprionate suggests that inhaled glucocorticosteroids may possess vasoconstrictor properties in the pulmonary circulation.
Evaluating the effects of asthma therapy on childhood growth: what can be learnt from the published literature?
Authors: Price J. , Hindmarsh P. , Hughes S. , Efthimiou J. 
Published: October 2002

The difficulties of assessing the effects of asthma therapy on childhood growth were explored in the first part of this review. In this part of the review growth studies with inhaled corticosteroids were selected that included a control group, measured height by stadiometry and were of ≥1 yr duration. The studies were classified as type 1 (placebo control), type 2 (nonsteroidal therapy control), type 3 (comparator inhaled corticosteroid control) or type 4 (“real-life” studies with dose adjustment). The design attributes of these studies were then compared with the recommendations described in the first part of this review. Of the 18 studies identified, 17 were susceptible to one or more important confounding factors. Nevertheless, the outcomes of all 18 studies were mostly consistent.At recommended doses, beclomethasone dipropionate and budesonide demonstrated a small degree of growth suppression over 1–2 yrs (study types 1 and 2), but there was little evidence of such an effect with fluticasone propionate. Studies comparing different inhaled corticosteroids at recommended doses indicated more rapid growth with fluticasone propionate than with beclomethasone dipropionate or budesonide. However, none of the inhaled corticosteroids appeared to affect final height.In conclusion, the results from the majority of published growth studies with inhaled corticosteroids must be interpreted with a degree of caution owing to their potential susceptibility to important confounding factors. Further well-designed studies are needed to establish whether different inhaled corticosteroids have different effects on growth in the long term.
Where to perform noninvasive ventilation?
Authors: Elliott M.W. , Confalonieri M. , Nava S. 
Published: October 2002

Noninvasive positive-pressure ventilation (NPPV) has been shown to be a means of reducing the need for endotracheal intubation, which when effective reduces the complication rate and improves outcome. Because paralysis and sedation are not needed and because the patient is not necessarily dependent upon a machine for respiration, ventilation outside the intensive care unit (ICU) is an option. A number of studies have shown that NPPV for acute exacerbations of chronic obstructive pulmonary disease (COPD) can be effective in the non-ICU environment, though usually in patients with less severe exacerbations. However, there have been no direct comparisons of the application of NPPV in different locations.The likelihood of success of the technique is an important factor in deciding where NPPV should be performed. Ready access to invasive ventilation is important when NPPV is not indicated from the outset or fails after an initial trial. In acute exacerbations of COPD, NPPV is less likely to be successful the more severe the exacerbation, as measured by the severity of acidosis. Good tolerance of NPPV, which translates into an improvement in pH and a fall in respiratory rate, predicts a successful outcome and is a useful way of monitoring progress.NPPV has been shown to be cost effective both in the ICU and when performed on general wards. A dedicated intermediate care unit with particular expertise in noninvasive modes of ventilation may provide the best environment, both in terms of outcome, but also cost effectiveness.The ideal location for noninvasive positive-pressure ventilation will vary from country to country and indeed from hospital to hospital, depending upon local factors. However, the most important factor is that staff be adequately trained in the technique and be available throughout the 24-h period.
A comparative study of Mini-Mental Test, Clock Drawing Task and Cognitive-FIM in evaluating functional outcome of elderly hip fracture patients
Authors: Adunsky A , Fleissig Y , Levenkrohn S , Arad M , Noy S 
Published: October 2002

Objective: To compare the clock drawing task with other cognitive tests used for the prediction of discharge functional outcome, in elderly hip fracture patients. Design: Cohort study. Setting: A department of geriatric-orthopaedic rehabilitation of a tertiary hospital. Patients: One hundred and forty-three consecutive patients undergoing inpatient comprehensive rehabilitation following hip fracture. Measurements: Cognitive status was assessed by the Clock Drawing Task, Mini-Mental State Examination (MMSE) and the Cognitive-FIM (cognFIM). Functional status outcome was evaluated by the Functional Independence Measure (FIM), using absolute and relative parameters of ef”cacy and ef”ciency. Results: Correlation coef”cients (Pearson correlation) between the three cognitive tests resulted in values ranging from 0.607 to 0.732 ( p < 0.001). Similar correlation coef”cients were observed for all cognitive tests when correlated with relative ef”cacy and ef”ciency outcome parameters ( p < 0.001), but not with absolute outcome parameters. Conclusions: Clock Drawing Test is similar to Mini-Mental and Cognitive-FIM with respect to the evaluation of functional status outcome following rehabilitation of hip fractures. The similar correlations with functional outcome parameters as well as the simplicity of administration favour the use of either Clock Drawing Task or MMSE in the initial assessment of elderly patients with hip fractures.
Measuring perceived activity limitations in lower extremity Complex Regional Pain Syndrome type 1 (CRPS I): test-retest reliability of two questionnaires
Authors: Perez Roberto SGM , Roorda Leo D , Zuurmond Wouter WA , Bannink Ilse IMJ , Vranken Jan H , de Lange Jaap J 
Published: October 2002

Objective: To assess the test–retest reliability of two questionnaires for measuring activity limitations in patients with Complex Regional Pain Syndrome type 1 (CRPS I) of the lower extremity. Design: Patients filled out the Walking Stairs Questionnaire and the Questionnaire Rising and Sitting Down twice during a one-week period. Setting: Outpatient pain clinic of a university hospital. Patients: Twenty-one outpatients with CRPS I of the lower extremity. Results: The Walking Stairs Questionnaire and the Questionnaire Rising and Sitting Down were reliable in terms of test–retest reliability as expressed by Spearman's r (range 0.79–0.90 and 0.85–0.89 respectively) and the ICC (range 0.78–0.84 and 0.84–0.87 respectively). Conclusion: Both questionnaires form a reliable tool for measuring activity limitations of patients with CRPS I of a lower extremity.
Early discharge and home rehabilitation after hip fracture achieves functional improvements: a randomized controlled trial
Authors: Crotty Maria , Whitehead Craig H , Gray Steven , Finucane Paul M 
Published: October 2002

Objective: To compare hospital and home settings for the rehabilitation of patients following hip fracture. Design: Randomized controlled trial comparing accelerated discharge and home-based rehabilitation ( n = 34) with conventional hospital care ( n = 32) for patients admitted to hospital with hip fracture. Setting: Three metropolitan hospitals in Adelaide, Australia. Subjects: Sixty-six patients with fractured hip. Interventions: Patients assigned to the home-based rehabilitation group were discharged within 48 hours of randomization. The project team therapists made visits to the patient’s home and negotiated a set of realistic, short-term and measurable treatment goals with both the patient and carer. Those randomized to usual care remained in hospital for conventional rehabilitation. Main outcome measures: Physical and social dependence, balance con”dence, quality of life, carer strain, patient and carer satisfaction, use of community services and incidence of adverse events such as re-admission and falls. Results: While there was no difference between the groups for all measures of quality of life, patients in the accelerated discharge and home-based rehabilitation group recorded a greater improvement in MBI from randomization ( p < 0.05) and scored higher on the Falls Ef”cacy Scale ( p < 0.05) at four months. There was no difference in falls rates. Patients in the home-based rehabilitation group had a shorter stay in hospital ( p < 0.05) but a longer stay in rehabilitation overall ( p < 0.001). The groups were comparable on the rate and length of admissions after discharge, use of community services, need for carer input and contact with general practitioner (GP) after discharge.
Vascular endothelial growth factor plasma levels in patients with systemic lupus erythematosus and primary antiphospholipid syndrome
Authors: Navarro C , Candia-Zúñiga L , Silveira L H , Ruiz V , Gaxiola M , Avila M C , Amigo M C 
Published: October 2002

The objective of this study was to assess the possible role of vascular endothelial growth factor (VEGF) in the pathogenesis of systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (PAPS). We studied 28 patients with SLE, 10 patients with PAPS, and 24 healthy controls. VEGF plasma levels were measured by ELISA. Immunolocalization of VEGF was done in renal tissue from SLE patients and cadaveric controls. Our results showed that VEGF plasma levels were increased in SLE patients compared with PAPS and controls. The correlation between clinical manifestations and VEGF levels revealed that SLE patients with renal failure had significantly increased plasma VEGF levels (134.1 + 91.0 pg= ml) compared with SLE patients with normal renal function (42.9 + 19.0 pg/ml), PAPS patients (41.9 + 26.6pg/ml), and controls (36.2+ 27.0 pg/ml; P 0.01). Immunostaining showed a strong expression of VEGF in SLE renal tissue samples. Our preliminary results indicate that VEGF is increased in plasma from patients with lupus nephritis and a moderate degree of renal failure and is overexpressed in renal tissue from these patients.
Association of vitamin D receptor gene BsmI polymorphisms in Chinese patients with systemic lupus erythematosus
Authors: Huang C-M , Wu M-C , Wu J-Y , Tsai F-J 
Published: October 2002

The purpose of this study was to evaluate whether vitamin D receptor (VDR) genes BsmI polymorphisms were markers for susceptibility to or severity of systemic lupus erythematosus (SLE) in Chinese patients in Taiwan. The study included 47 Chinese patients with SLE. In addition, 90 unrelated, healthy individuals living in central Taiwan served as control subjects. Each polymorphism was detected as a result of polymerase chain reaction (PCR)-based restriction analysis. A PCR product length was determined to be 580 bp (BB) whereas two fragments of 405 and 175 bp were determined to be excisable lengths (bb) by BsmI endonuclease. The relationship between Bsm polymorphisms and clinical manifestations of SLE was evaluated. We found that BB was significantly more common and bb less common in SLE than in control group (w2 54.2, P 0.0001). In addition, the frequency of B allele was also significantly more common in patients with SLE than in the healthy control subjects (w2 38.7, P 0.0001), giving an odds ratio of 7.14 (95% confidence interval 3.53–14.4). In the SLE patients, we did not detect any associations of VDR genotype with the clinical, laboratory profiles, or lupus nephritis (w2 2.34, P 0.3). This study indicated an increased distribution of VDR BB genotype and B allelic frequencies in the Chinese SLE patients in Taiwan. However, there were no associationsbetween the frequency of VDR allelic variations and clinical manifestations, laboratory profiles, or lupus nephritis.
Systemic lupus erythematosus in three ethnic groups. XII. Risk factors for lupus nephritis after diagnosis
Authors: Bastian H M , Roseman J M , Mcgwin G , Alarcón G S , Friedman A W , Fessler B J , Baethge B A , Reveille J D ,   Lumina Study Group
Published: October 2002

The purpose of this study was to determine the cumulative incidence of lupus nephritis (LN) and the factors predictive of its occurrencein a multiethnic systemic lupus erythematosus (SLE) cohort. We studied 353 SLE patients as de” ned by the American College of Rheumatology (ACR) criteria (65 Hispanics, 93 African-Americans and 91 Caucasians). First, we determined the cumulative incidence of LN in all patients. Next, we determined the predictors for LN in those with nephritis occurring after diagnosis. The dependent variable, LN, was de” ned by: (1) A renal biopsy demonstrating World Health Organization (WHO), class II–V histopathology; and/or (2) proteinuria≥ 0.5 g=24 h or 3 + proteinuria attributable to SLE; and/or (3) one of the following features also attributable to SLE and present on two or more visits, which were performed at least 6 months apart— proteinuria≥ 2 +, serum creatinine≥ 1.4 mg/dl, creatinine clearance ≤ 79 ml/min, 10 RBCs or WBCs per high power ” eld (hpf), oŗ 3 granular or cellular casts per hpf. Independent variables assessed at diagnosis, and if absent, at baseline, were from four domains: sociodemographic, clinical, immunologic and immunogenetic (including the complete antibody pro” le and MHC class II alleles), and health habits. Variables with P < 0.05 by chi square analyses were entered into domain-speci”c stepwise logistic regression analyses controlling for disease duration, with LN as the dependent variable. Signi” cant domain-speci”c regression variables (P ≤ 0.1) were then entered into an overall model. The cumulative incidence of LN was 54.3% in all patients, and 35.3% for those developing LN after diagnosis. LN after diagnosis occurred in 43.1% of 65 Hispanics, 50.5% of 93 African-Americans, and 14.3% of 91 Caucasians, P < 0.0001. The duration of follow-up for those with LN after diagnosis was 5.5§ 2.4 vs 4.0§ 2.9 years for those without LN. Hispanic (odds ratio (OR) = 2.71, 95% con” dence limits (CL) = 1.07–6.87, P < 0.04) and African-American ethnicities (OR = 3.13, 95% CL = 1.21–8.09, P < 0.02), not married or living together (OR = 3.45, 95% CL = 1.69–7.69, P < 0.0003), higher SLAM score (OR = 1.11, 95% CL = 1.02–1.19, P < 0.007), anti-dsDNA (OR = 3.14, 95% CL = 1.50–6.57, P < 0.0001) and anti-RNP (OR = 4.24, CL = 1.98–9.07, P < 0.0001) antibodies were shown to be signi” cant predictors of the occurrence of LN. Repeated analyses excluding the patients with missing HLA data showed that absence of HLA-DQB1*0201 was also a signi” cant predictor for the occurrence of LN (OR = 2.34, CL = 1.13–5.26, P < 0.04). In conclusion, LN occurred signi” cantly more often in Hispanics and African-Americans with SLE. Sociodemographic,clinical and immunologic/immunogenetic factors seem to be predictive of LN occurring after the diagnosis of SLE has been made.
Steady-state pharmacokinetic comparison of a new, once-daily, extended-release morphine formulation (Morphelan™) and OxyContin® twice daily
Authors: Eliot Lise , Geiser Rita , Loewen Gordon 
Published: October 2002

Context. Morphelan2 (morphine sulfate extended release), a new, once-daily, oral morphine sulfate formulation, releases morphine in a dual-release manner, providing an initial rapid delivery while maintaining therapeutic morphine concentrations throughout a 24-hour period with minimal fluctuation. Objective. The primary objective of this study was to compare steady-state pharmacokinetic (PK) profiles of morphine and oxycodone following administration of 60 mg of Morphelan, once daily and 20 mg of OxyContin1 (oxycodone hydrochloride controlled release) twice daily, respectively. Design, Setting, Participants, Intervention. Thirty-five healthy subjects were randomized to receive Morphelan once daily, or OxyContin twice daily for 7 days in this multiple-dose, open-label, parallel design study. Measures. Blood samples were obtained on day 7 to determine differences, if any, in the PK parameters that characterize the ability of the formulations to control the release of drug. Safety data were collected throughout the study. Results. Thirty-two subjects completed the study; 31 subjects were eligible for PK evaluation. The time to reach and maintain threshold concentrations of 50% or 75% of maximum was comparable for Morphelan and OxyContin. However, in comparison to OxyContin twice daily, once-daily Morphelan provided a statistically significantly reduced peak-to-trough fluctuation (%FI = 91% vs 77%, respectively, P= 0.05) and a lower number of fluctuations (2 vs 1, respectively) over a 24-hour period. Conclusions. Once-daily Morphelan provided an initial rapid release of opioid reaching and maintaining threshold concentrations of 50% and 75% of maximum comparable to OxyContin twice daily. However, Morphelan provided more consistent opioid concentrations throughout a 24-hour period, with less frequent dosing.
Trastuzumab in the treatment of HER2 positive breast cancer
Authors: Summerhayes Maxwell 
Published: October 2002

Objective. To provide a comprehensive review of the preclinical and clinical pharmacology and toxicology of the monoclonal antibody trastuzumab, with particular reference to its use in its approved indication, HER2/neu-overexpressing breast cancer. Data sources. A MEDLINE search was conducted using the terms ‘trastuzumab’ and ‘Herceptin’ for the period 1995-2001. The reference lists from retrieved articles were reviewed and other relevant papers identified. The abstract books from the annual meetings of the American Society of Clinical and Oncology and the European Society of Medical Oncology were also reviewed. Data extraction. The aim of the review was to be comprehensive and descriptive. All studies containing information deemed to be of interest were reviewed by the author; none were excluded on grounds of quality. Data summary. Trastuzumab is a chimeric monoclonal antibody with a hypervariable region of murine origin inserted into a human IgG1 skeleton. Trastuzumab recognizes p185HER2/neu, the 185-kDa product of the HER2/neu protooncogene. This gene is overexpressed in around 20% of breast cancers and encodes for a trans-membrane protein that has extensive structural homology with the EGFR. HER2/neu overexpression is prognostic of short relapse-free and overall survival and, possibly, of poor response to certain hormonal and cytotoxic treatments. Trastuzumab inhibits the growth of HER2/neu-overexpressing tumour cells grown in tissue culture or as xeno-grafts in mice. It also potentiates the action of certain cytotoxic drugs against such cells. These properties stimulated clinical trials of trastuzumab in women with HER2/neu-positive breast cancer. Used alone, in women with heavily pretreated HER2/neu-positive breast cancer, trastuzumab stabilized disease in 35% of cases and induced regression in a further 22%. Its use was associated with prolonged stabilization of quality of life. When used in combination with paclitaxel, or anthracycline-based chemotherapy, as a first-line treatment for metastatic breast cancer, it increased response rates, time to disease progression and survival. Unfortunately, when used in conjunction with anthracyclines, trastuzumab has been associated with an unacceptable incidence of cardiotoxicity. For this reason, it is currently approved for use alone or in combination with paclitaxel. When added to paclitaxel as a first-line treatment, it increased the median time to disease progression from 3.0 to 6.9 months (P= 0.0001) and the 1-year survival rate from 62% to 73%, with little toxicity except occasional and, generally, mild infusion reactions.