bluuebunny/crossref_metadata_2025_split huggingface dataset:
ENDOSCOPE CONTAMINATION FROM HBV‐ AND HCV‐POSITIVE PATIENTS AND EVALUATION OF A CLEANING/DISINFECTING METHOD USING STRONGLY ACIDIC ELECTROLYZED WATER
Authors: Sakurai Yukihiro , Nakatsu Masami , Sato Yuko , Sato Kinuko 
Published: March 2003

Background:  It is well known that strongly acidic electrolyzed water (SAEW) has a potent bactericidal effect. We examined residual viruses on endoscopes that were used in hepatitis B virus (HBV)‐positive and hepatitis C virus (HCV)‐positive patients and evaluated the effectiveness of SAEW in cleaning/disinfecting the endoscopes.Methods:  A random sample of endoscopes used in 109 endoscopies on HBV‐positive patients and 107 endoscopies on HCV‐positive patients, who underwent upper gastrointestinal endoscopy for various reasons was taken to determine the degree of HBV and HCV contamination. Samples were taken using 10 mL of physiological saline injected through the forceps channel of each endoscope and collected at the distal end to be assayed using polymerase chain reaction (PCR). After examination, each endoscope was treated with air aspiration, then 200 mL of tap water that contained an enzyme detergent was absorbed, and SAEW was aspirated after cleaning with a brush. After each procedure, PCR was used for comparison and to identify any residual viruses.Results:  In saline collected after air aspiration, viruses were detected in 39/109 endoscopes used in HBV patients and in 20/107 endoscopes used in HCV patients. In the saline aspirated with tap water containing an enzyme detergent, HBV was detected in 12/109 endoscopes and HCV was detected in 6/107 endoscopes. However, neither HBV nor HCV was detected after the endoscopes were cleaned manually with a brush and disinfected with SAEW.Conclusion:  Endoscopes contaminated with HBV and HCV are effectively cleaned and disinfected by SAEW.
Fourier‐transform infrared spectrometric analysis for detecting colorectal carcinoma
Authors: Sheng Jianqiu , Shen Shijie , Li Shirong , Wu Xia , Gao Ge , Li Shiyong , Chen Zhimin 
Published: March 2003

OBJECTIVE: To assess the value of Fourier‐transform infrared (FT‐IR) spectroscopic analysis in detecting colorectal carcinoma. METHODS: Fifty pairs of specimens of exfoliated cells from patients with colorectal carcinoma, who had undergone colorectal resection, were analyzed by using FT‐IR spectrometry. Exfoliated cells were obtained by scraping off: (i) the foci of the colorectal carcinoma; and (ii) the normal mucosa more than 5 cm away from the foci. Cell specimens were fixed and smeared onto two slides: a gold‐coated slide for the infrared spectrometry and a conventional one for histopathological evaluation. The spectra from 28 pairs of specimens were analyzed by logistic regression with multiple factors to establish a statistical model for predicting the probability of colorectal cancers, and then the spectra of the remaining 22 pairs were judged according to the model. Their corresponding diagnostic accuracy was calculated. RESULTS: Substantial differences were found in the spectral properties of cancer and non‐cancer cells, which were evident in the frequency region of 1000–1350/cm. A shift of the phosphodiester groups of nucleic acids was noted: compared with the spectral features of non‐cancerous cells, the distance between VsPO2– and VasPO2– was shorter in cancerous cells. The C–O stretching bonds of cell proteins were significantly changed in the frequency region of 1140–1180/cm. In non‐cancerous cells, the peak intensity of 1155/cm was stronger than that of 1174/cm, whereas in cancerous cells the peak intensity of 1155/cm was weaker than that of 1174/cm; the peak intensity ratio of 1174/cm : 1155/cm was increased in cancerous cells. The spectral characteristics of the spectrometric data from the 22 pairs of specimens were consistent with those of the base‐model data. The other 22 pairs of specimens were analyzed according to the model, indicating that Fourier‐transform infrared spectrometry can be used to discriminate cancerous cells from non‐cancerous cells with a sensitivity of 90.91%, a specificity of 86.36%, a positive prediction value of 86.96% and a negative predictive value of 90.48%. CONCLUSIONS: Fourier‐transform infrared spectrometry is of value in detecting colorectal cancer cells and it could be used as a rapid method for the clinical screening of malignant cells.
New reliable and valid motor assessment scale for stroke patients: Hemiplegic motor behavior tests
Authors: Ohtsuru Izumi , Eto Fumio , Wada Naoki , Saotome Ikuko , Furuichi Teruhito 
Published: March 2003

Background:Various motor function tests have been reported and applied for the assessment of impairment and disability in stroke patients with hemiplegia. However, those staging criteria are ambiguous and show little evidence of reliability and validity. New criteria have therefore been designed that allow practical use of staging; namely, a well‐defined set of hemiplegic motor behavior tests (HMBT) based on simplified staging criteria. The purpose of the present paper was to assess the reliability and validity of this method as applied to hemiplegic stroke patients.Methods:The MBT were divided into three areas (upper extremities; hand and fingers; and lower extremities) on a six‐point ordinal grading scale (stages 1–6). Two raters evaluated the patients independently within 24 h, and the same raters assessed patients twice within 24 h. Intrarater and interrater reliability was evaluated using weighted kappa statistics on each item. The internal consistency of the scale was evaluated using Cronbach’s alpha. The study included 110 patients with hemiplegia. The HMBT scores were compared with the Barthel Index (BI) score and Modified Rankin Scale (MRS) score in 88 stroke patients. Correlations were calculated by Spearman rank correlation coefficients.Results:Intrarater and interrater agreements were high; weighted kappa values for different items ranged from 0.985 to 0.998 and from 0.975 to 0.983, respectively. The internal consistency was excellent (Cronbach’s alpha ≥ 0.863). Correlation coefficients of the HMBT with the BI for the different items ranged from 0.565 to 0.810; with the MRS these values ranged from –0.700 to –0.828, respectively.Conclusion:The HMBT, with clarified and simplified staging criteria, were confirmed to be highly reliable and valid.
Effect of joint flexibility on walking economy in middle‐aged and older people
Authors: Katamoto Shizuo 
Published: March 2003

Purpose: The purpose of the present study was to clarify the effect of joint flexibility on walking economy.Methods: Forty‐one healthy people (20–79 years) were divided into old (n =
13, 67 ± 5 years), middle (n = 11, 54 ± 3 years) and young groups
(n = 17, 23 ± 3 years). Each group was asked to measure maximal walking speed, flexibility (trunk, ankle and hip joint), oxygen uptake during treadmill walking (60, 80 and 100 m/min) with and without stretching.Results: All variables measured (except flexibility of ankle joint) in older groups (n
= 24) were significantly lower than those in the young (P < 0.05–0.001).
However, there was no difference in mean values between the two older groups. Although
stretching improved flexibility in all groups (P < 0.01–0.001),
oxygen uptake during walking decreased only in the older groups (P < 0.05–0.01).
Maximal walking speed in the older groups positively correlated only with flexibility
of hip joint (r = 0.52; P < 0.01) and negatively with oxygen uptake
during walking (r = –0.37 to –0.41 (P < 0.05)). The
only flexibility that showed significant correlations with oxygen uptake during walking
was that of the hip joint in the older groups (older: r = –0.44 to
–0.55; P < 0.05–0.01; young: r = –0.11 to 0.08).Conclusion: These data suggest that the increase of flexibility, especially flexibility of the hip joint, induces improvement of walking economy in older adults, but not in young adults, and that increasing the flexibility of the hip joint could contribute a beneficial effect to maintaining and improving walking ability in middle‐aged and older adults.
Plasma insulin and glucose levels in elderly female subjects with Alzheimer’s disease
Authors: Umegaki Hiroyuki , Ushida Chika , Ikari Hiroyuki , Ogawa Osamu , Nakamura Akira , Suzuki Yusuke , Endo Hidetoshi , Akatsu Hiroyasu , Yamamoto Takayuki , Iguchi Akihisa 
Published: March 2003

Background:  The function of insulin in the central nervous system has been intensively investigated recently. Epidemiological studies have shown that hyperinsulinemia or diabetes mellitus is a risk factor for Alzheimer’s disease. Several studies have reported plasma levels of insulin and glucose in subjects with Alzheimer’s disease, however, the results were conflicting. A recent study suggested that fasting plasma insulin levels in subjects with Alzheimer’s disease depend on apolipoprotein E genotype, specifically, subjects with Alzheimer’s disease who were not apolipoprotein‐E4‐homozygotes had higher plasma insulin levels. The purpose of this study was to clarify plasma levels of insulin and glucose in subjects with Alzheimer’s disease.Methods:  We performed a 75 g oral glucose tolerance test (OGTT) in elderly female subjects with Alzheimer’s disease (AD) and age‐matched female non‐demented subjects (mean age of the subjects involved was 82.9 ± 8.1 years). All subjects were non‐apolipoprotein E4‐homozygotes, and scores for mini‐mental state examination of all AD subjects were less than 16.Results:  When fasting plasma levels of insulin and glucose in all recruited subjects were compared, those of glucose and insulin were significantly lower in AD subjects, possibly due to their lower body mass index (BMI). When only subjects with normal glucose metabolism in OGTT were included, BMI was comparable. Although plasma levels of fasting glucose and insulin were still lower in AD subjects, the difference lacked statistical significance.Conclusion:  We failed to show that subjects with AD who were not apolipoprotein‐E4‐homozygotes had higher fasting plasma insulin levels compared with non‐demented subjects.
Association of amino acid variation (Trp64Arg) in the beta3‐adrenergic receptor gene with bone mineral density
Authors: Ogawa Sumito , Emi Mitsuru , Shiraki Masataka , Hosoi Takayuki , Orimo Hajime , Ouchi Yasuyoshi , Inoue Satoshi 
Published: March 2003

Background:  Recent studies have revealed that a mis‐sense mutation replacing tryptophan with arginine at codon 64 (Trp64Arg) of the beta3‐adrenergic receptor (β3‐AR) gene was associated with insulin resistance in non‐diabetic subjects and to earlier onset of non‐insulin dependent diabetes mellitus. To analyze a possible involvement of β3‐AR in bone metabolism, we investigated the association between bone mineral density (BMD) and the Trp64Arg polymorphism.Methods:  A large cohort of Japanese postmenopausal women comprised the study population. The genotypic frequencies in this cohort were Trp/Trp, 61.8%; Trp/Arg, 33.2%; and Arg/Arg, 5.0%.Results:  When the subjects were separated into two groups, one bearing at least one Trp allele at codon 64 (Trp/Trp and Trp/Arg) and the other with none (Arg/Arg), the former subjects had significantly higher Z scores for total‐body BMD (mean ± SD, 0.432 ± 0.93 versus −0.135 ± 0.93; P = 0.033).Conclusions:  These data suggested an association between this single‐nucleotide polymorphism (SNP) in the β3‐AR gene and BMD, and therefore a possible involvement of the Arg allele (or the absence of Trp64) in postmenopausal osteoporosis among Japanese women.
Cost of surgical site infections following coronary artery bypass surgery
Authors: Jenney Adam W. J. , Harrington Glenys A. , Russo Philip L. , Spelman Denis W. 
Published: March 2003

Background:  Little information is available on the financial impact of surgical site infections (SSI) after major surgery. In order to calculate the cost of SSI following coronary artery bypass graft surgery (CABGs), a 2‐year retrospective case‐control study was undertaken at Alfred Hospital, a university‐affiliated tertiary referral centre.Methods:  One hundred and eight patients with SSI (cases) after CABGs and 108 patients without SSI (controls) were matched for gender, age, risk index (Centers of Disease Control and Prevention, National Nosocomial Infection Surveillance (NNIS) System) and number of principal comorbidities. The patient’s postoperative length of stay (LOS), in both the intensive care unit (ICU) and the non‐ICU (general) ward, was obtained from the medical records and the cost of a day in each was provided by the hospital’s finance department. The cost of antibiotics prescribed for SSI was provided by the hospital’s pharmacy department.Results:  Postoperatively the cases were in ICU for a total of 313 days whereas the controls spent 165 days in ICU, a mean of 2.89 versus 1.53 days, respectively (P = 0.035). In general wards, cases were inpatients for a total of 1651 days and controls for 589 days. This is a mean of 10.8 days for cases and 4.7 days for controls (P = 0.0001). The extra LOS for 108 cases (compared to the controls) was costed at $1 299 082, a mean cost of $12 028 per patient. The total cost of antibiotics prescribed for these SSI was $42 270 (a cost per case of $391). The total excess cost related to increased LOS and antibiotic treatment was $12 419 per patient. In the subgroup analysis for deep sternal site infections the mean excess cost was $31 597 per patient.Conclusions:  Postoperative SSI result in significant patient morbidity and consume considerable resources. In the present study, patients with SSI following CABGs had significant prolongation of hospitalization (both in ICU and general wards). The present study illustrates the potential cost savings of introducing interventions to reduce SSI rates. This is the first time such a study has been undertaken in Australia.
Effectiveness of intra‐operative wound infiltration with long‐acting local anaesthetic
Authors: Kuan Yew‐Ming , Smith Steve , Miles Campbell , Grigg Michael 
Published: March 2003

Background: Postoperative pain relief is of importance to both patients and surgeons. One of the simpler techniques is infiltration of the surgical incision with long acting local anaesthetic. The literature is confusing, with numerous reports attesting to the value of this approach and a similar number disputing the demonstrable benefits. Methods: A prospective, ‘blinded’, randomized trial was undertaken involving 18 females undergoing uncomplicated bilateral sapheno‐femoral ligation. They received intraoperative bupivacaine infiltration into one or the other of their groin incisions. Postoperatively these patients were asked to assess a number of variables relating to their postoperative pain, each patient thereby acting as their own control. Results: There was no significant difference in the postoperative pain experience between groins infiltrated with bupivacaine and those not infiltrated. Two patients developed wound infections and both of these occurred on the sides which had been infiltrated with bupivacaine, however this was not statistically significant. There was no difference found in pain experience with respect to pre‐ versus post‐incision infiltration. Conclusion: Intraoperative wound infiltration with bupivacaine is widely employed as a method of minimizing postoperative pain. This study was unable to demonstrate a benefit of employing the technique in terms of a reduction in the patient’s perception of pain. By having each patient act as their own control, we have avoided one of the major deficiencies of previous studies, namely, interpatient variability in assessment and perception of pain.
POSSUM: A re‐evaluation in patients undergoing surgery for rectal cancer
Authors: Isbister William H. , Al Sanea Nasser 
Published: March 2003

Background:  The problem of directly comparing morbidity and mortality rates between institutions without some sort of adjustment for case mix is well documented. Scoring systems have been developed to allow comparisons to be made. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is one such system. It was designed to predict operative mortality and morbidity in differing settings and to be independent of case mix. The present study examines the use of POSSUM in colorectal practice in Saudi Arabia.Methods:  Patients referred to King Faisal Specialist Hospital between 1990 and 1998 for primary management of an histologically proven rectal cancer were identified. POSSUM mortality and morbidity scores and Portsmouth‐Physiological and Operative Severity Score (P‐POSSUM) mortality scores were calculated separately for each patient, and predicted rates were compared with observed rates in the patients studied.Results: There were 70 men (mean age: 55.6 years; range: 25−87) and 75 women (mean age: 52.8 years; range: 26−84). One hundred and six patients underwent ‘curative’ surgery. Abdominoperineal resection was the most frequently performed procedure. Major anastomotic leakage following anterior resection occurred in two of fifty patients. One patient developed a pulmonary embolism but no patient developed postoperative myocardial infarction. Two patients died. The median and mean physiological and operative severity scores were 13 (range: 12−37) and 17 (range: 8−37) and 14.68 and 18.36, respectively. The overall POSSUM‐predicted (using median scores) morbidity and mortality rates were 35.4% and 6.7%. The P‐POSSUM‐predicted (using mean scores) mortality rate was 3.5%. Observed morbidity and mortality rates were 54.5% and 1.4%.Conclusion:  POSSUM failed to predict outcomes accurately in patients undergoing surgery for rectal cancer in Saudi Arabia. P‐POSSUM also overpredicted mortality but to a lesser extent. Patient's ‘wellness’ and the previously identified inability of POSSUM to accurately predict death in low‐risk populations may explain these findings. Care must be exercised in using the POSSUM formulae for risk adjustment in different settings.
Preoperative prediction of long‐term outcome following laparoscopic fundoplication
Authors: O'Boyle Colm J. , Watson David I. , DeBeaux Andrew C. , Jamieson Glyn G. 
Published: March 2003

Background:  Although long‐term outcomes following laparoscopic fundoplication for gastro‐oesophageal disease have now been reported as very satisfactory, a small, but important, minority of patients are unhappy with the outcome, often due to recurrent reflux symptoms or new‐onset dysphagia. In this study, we sought to establish whether various parameters that can be determined before surgery, can predict the long‐term outcome of surgery.Methods:  Data collected prospectively were evaluated to determine factors that were associated with outcome at 5 years following laparoscopic fundoplication. Inclusion criteria were complete preoperative assessment data and 5‐year follow‐up data. Data examined included information on preoperative age, sex, weight, home address, health insurance status, duration of reflux symptoms, previous surgery, operating surgeon, endoscopy and 24‐h pH monitoring. In addition, lower oesophageal sphincter resting and residual relaxation pressures were evaluated before and after surgery. The postoperative symptoms of heartburn and dysphagia, as well as overall satisfaction 5 years following surgery was determined using a 0−10 visual analogue scale. The association of the pre‐ and perioperative factors and outcome at 5 years was determined by univariate and linear regression analysis.Results:  Two hundred and sixty‐two patients from an overall experience of over 1000 laparoscopic anti‐reflux procedures met the entry criteria. There was no association between patient address, age, weight, duration of symptoms, the presence of endoscopically proven oesophagitis, operating surgeon, the necessity for conversion to an open procedure, change in lower oesophageal sphincter residual relaxation pressure and the outcome parameters. Using univariate analysis, a higher heartburn score was associated with previous abdominal surgery, female sex, no private health insurance, and a normal preoperative 24‐h pH study. A higher dysphagia score was associated with a normal preoperative pH study, a postoperative increase in lower oesophageal sphincter resting pressure of more than 6 mmHg, and previous abdominal surgery. Overall satisfaction with the outcome at 5 years was higher among male patients, private patients, patients who had a hiatus hernia, and patients who had an abnormal preoperative pH study. Linear regression analysis confirmed that private insurance, male sex, and the absence of previous abdominal surgery, were the strongest predictors of an improved heartburn score, whereas male sex and private health insurance were the strongest predictors of greater satisfaction with the overall outcome.Conclusions:  There are parameters that can be assessed before or during laparoscopic Nissen fundoplication that correlate with late outcome parameters. In particular, male patients and those from higher socioeconomic groups appear to have a better long‐term outcome.
Study of serum calcium and trace elements in chronic cholelithiasis
Authors: Verma Ganga R. , Pandey Ajay K. , Bose Shashank M. , Prasad Rajendra 
Published: March 2003

Background:  High biliary calcium and trace elements (copper, zinc and iron) in patients with chronic cholelithiasis can be associated with gallstones.Methods:  Estimations of calcium, copper, zinc and iron were done in the serum, gall bladder bile and gallstones of 48 patients with chronic cholelithiasis and in 20 age‐ and sex‐matched controls. Biliary levels of calcium and trace elements and bile/serum ratio of calcium and trace elements were compared in the two groups.Results:  Serum calcium was significantly less (P= 0.009) than controls, but biliary calcium was higher in the patients with chronic cholecystitis. All trace elements were found to be significantly higher (P≤ 0.036) in the bile of patients with chronic cholelithiasis. The bile/serum ratio of calcium, copper and zinc was significantly greater (P≤ 0.03) in patients of chronic cholelithiasis. Gall bladder bile in patients with chronic cholelithiasis was slightly more alkaline. Pigment stones contained significantly more calcium, copper and iron than cholesterol stones (P≤ 0.001).Conclusion:  Higher biliary calcium and trace elements as well as a defective pH of gall bladder bile in patients with chronic cholelithiasis could be the underlying factor in the pathogenesis of gallstones.
Hepatic artery thrombosis and intraoperative hepatic artery flow rates in adult orthotopic liver transplantation
Authors: Lin Martin , Crawford Michael , Fisher Jodi , Hitos Kerry , Verran Deborah 
Published: March 2003

Introduction: Thrombosis of the hepatic artery following orthotopic liver transplantation (OLT) can be a devastating com­plication impacting on recipient outcome. The utility of routine intraoperative flow measurements of the hepatic artery in predicting subsequent hepatic artery thrombosis (HAT) is presented in this study.Methods: Data on all adult OLT recipients between July 1995 and May 2000 were analysed. This included the routine intra­operative flow measurements of both the hepatic artery and portal vein using a Doppler flow meter.Results: Thirteen out of 198 (6.6%) instances of OLT were complicated by HAT. The mean and median flow rates of the hepatic artery in the OLT with HAT were 262 mL/min and 220 mL/min, respectively. These were significantly lower than the respective values of 436 mL/min and 400 mL/min in the OLT without HAT (P = 0.0036). This was independent of recipient age, sex, weight and intraoperative portal flow rates. However there was extensive overlap for the intraoperative hepatic artery flow rates obtained between the HAT and non‐HAT groups. The risk of HAT was increased by a factor of 6 if the intraoperative hepatic artery flow rate was less than 200 mL/min. The average allograft survival was significantly lower in the HAT group at 373 daysvsthe non‐HAT group at 763 days (P = 0.026).Conclusion: The routine use of intraoperative flow measurements of the hepatic artery may be a useful adjunct in identifying the hepatic artery reconstruction, which is at risk of subsequent HAT.