31051
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Abstract
Wilkie syndrome or superior mesenteric artery syndrome is a rare cause of duodenal obstruction in pediatric and adult age groups. Its manifestations are due to compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. We present one case of a 29-year-old female with a recent history of epigastric pain and severe weight loss due to duodenal obstruction from superior mesenteric syndrome. She was treated conservatively with jejunostomy tube feeding to regain loss of weight. Our case is unique in that the patient has also nutcracker syndrome.
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Affiliation(s)
- Michel K Barsoum
- Division of Cardiovascular Diseases, Section of Vascular Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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31052
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Crespo Pérez L, Angueira Lapeña T, Defarges Pons V, Foruny Olcina JR, Cano Ruiz A, Benita León V, Gónzalez Martín JA, Boixeda de Miquel D, Milicua Salamero JM. [A rare cause of gastric outlet obstruction: Bouveret's syndrome]. Gastroenterol Hepatol 2009; 31:646-51. [PMID: 19174082 DOI: 10.1016/s0210-5705(08)75813-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 06/10/2008] [Indexed: 12/21/2022]
Abstract
Bouveret's syndrome is a rare type of gallstone ileus in which a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by León Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, as well as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopic techniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed.
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Affiliation(s)
- Laura Crespo Pérez
- Servicio de Gastroenterología, Unidad de Endocscopia Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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31053
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Vork K, Broadwin R, Blaisdell R. Developing asthma in childhood from exposure to secondhand tobacco smoke: insights from a meta-regression. Cien Saude Colet 2009; 13:1313-25. [PMID: 18813631 DOI: 10.1590/s1413-81232008000400028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 06/28/2007] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kathleen Vork
- Air Toxicology and Epidemiology Branch, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA 94612, USA.
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31054
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Röske K, Hannöver W, Thyrian JR, John U, Hannich HJ. Smoking cessation counselling for pregnant and postpartum women among midwives, gynaecologists and paediatricians in Germany. Int J Environ Res Public Health 2009; 6:96-107. [PMID: 19440272 DOI: 10.3390/ijerph6010096] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 12/23/2008] [Indexed: 11/17/2022]
Abstract
The incorporation of guidelines for the treatment of tobacco smoking into routine care requires positive attitudes, counselling skills and knowledge about additional help available for smokers. The study assesses performance of smoking cessation intervention, attitudes, training status and knowledge about additional help for smokers in the care for pregnant and parenting women by midwives, gynaecologists and paediatricians. A survey of all midwives, gynaecologists and paediatricians registered for primary medical care in the federal state Saarland, Germany, was conducted. Participation in the postal questionnaires was 85 %. Depending on profession, 90 % to 100 % see smoking cessation counselling as their assignment, 17 % to 80 % screen for, 48 % to 90 % document smoking status, and 55 % to 76 % offer brief or extensive counselling. 61 % to 87 % consider training to enhance their knowledge and/or counselling skills necessary. The compliance of providers with the necessity to give support in smoking cessation is very high. However, the current status of cessation counselling does not sufficiently correspond to the evidence based requirements. Reports in medical press and advanced training courses should support health care providers and establish smoking as an inherent topic of the anamnesis and treatment of current and former pregnant or parenting smokers.
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31055
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Fukuda Y, Miura SI, Zhang B, Iwata A, Kawamura A, Nishikawa H, Shirai K, Saku K. Significance of urinary liver-fatty acid-binding protein in cardiac catheterization in patients with coronary artery disease. Intern Med 2009; 48:1731-7. [PMID: 19797828 DOI: 10.2169/internalmedicine.48.2410] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES We investigated the significance of urinary liver fatty acid-binding protein (U-L-FABP) monitoring during cardiac catheterization in patients with cardiovascular disease (CVD). Methods The subjects included 27 consecutive patients with stable angina (SAP group) or acute coronary syndrome (ACS group) who had undergone successful percutaneous coronary intervention (PCI), and 12 patients were also enrolled as controls (C group). Urinary and serum parameters were measured immediately before and after and 1 day after PCI. RESULTS The ratio of U-L-FABP to U-creatinine (U-Cr) (U-L-FABP/U-Cr) in the ACS group was significantly higher than those in both the SAP and C groups before PCI. In addition, none of the patients in the SAP group showed contrast-induced nephropathy (CIN) based on the levels of serum (S)-Cr and U-L-FABP/U-Cr after PCI. Although none of the patients in the ACS group showed CIN according to S-Cr, the level of U-L-FABP/U-Cr was continuously high throughout the study period. Moreover, since there were significant differences in U-L-FABP/U-Cr, U-N-acetyl-beta-D-glucosaminidase, S-uric acid and % medication with calcium channel blockers before PCI between the ACS and SAP groups, a multiple regression analysis was performed using these parameters. It showed that U-L-FABP/U-Cr was most closely associated with the classification of SAP and ACS (p<0.0001). The cut-off level for the greatest sensitivity and specificity for U-L-FABP for the diagnosis of ACS was 13.4 microg/g. Cr in all subjects (sensitivity 0.800, specificity 0.963). CONCLUSIONS To the best of our knowledge, this is the first report indicating that the measurement of U-L-FABP can be beneficial for in the diagnosis of ACS.
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Affiliation(s)
- Yusuke Fukuda
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka
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31056
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Meijer MJ, Mieremet-Ooms MAC, Sier CFM, van Hogezand RA, Lamers CBHW, Hommes DW, Verspaget HW. Matrix metalloproteinases and their tissue inhibitors as prognostic indicators for diagnostic and surgical recurrence in Crohn's disease. Inflamm Bowel Dis 2009; 15:84-92. [PMID: 18634035 DOI: 10.1002/ibd.20581] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recurrence of disease after surgically induced remission constitutes a major and largely unpredictable problem in Crohn's disease (CD). Matrix metalloproteinases (MMP) and the tissue inhibitors of metalloproteinases (TIMP) are involved in the (etio)pathogenesis of CD and may thereby also affect postsurgical outcome. We studied the predictive value of 1) allelic composition at MMP, TIMP, and TNF-alpha single nucleotide polymorphism loci, and 2) MMP and TIMP intestinal protein levels relative to important clinical variables for recurrence of CD after resection of diseased bowel. METHODS From 87 CD patients with a full medical record, surgically resected tissue was homogenized and analyzed for single nucleotide polymorphism (SNP) genotype and MMP-TIMP protein levels. The prognostic value of these parameters was determined using the uni- and multivariate Cox proportional hazards analyses. RESULTS The T allele at TIMP-1 SNP +372 T/C was found to be associated with an increased risk for surgical recurrence. Higher levels of TIMP-1, TIMP-2, and MMP-9 in noninflamed CD tissue, but not in inflamed tissue, and negative smoking status independently protected against diagnostic and/or surgical recurrence. CONCLUSIONS The TIMP-1 SNP +372 T allele with an increased risk of recurrence is in line with our previous results demonstrating increased CD susceptibility and low TIMP-1 protein expression associated with this allele. High TIMP and MMP-9 levels in noninflamed tissue are predictive of a favorable disease recurrence in CD. The contribution of MMP-9 and TIMPs to disease recurrence appears not to be mediated by smoking status, since no correlation with this parameter could be demonstrated.
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Affiliation(s)
- Martin J Meijer
- LUMC, Department of Gastroenterology-Hepatology, Leiden, The Netherlands
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31057
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Abstract
Cough is a common symptom that can be self-limiting or persistent. Ideally, treatment of the underlying cause(s) of cough with specific treatments should eliminate cough. This approach may not be successful if no cause can be established or if the treatment of the cause fails. Suppression of cough may be disease-specific or symptom-related. There has been a long tradition in acute cough usually due to upper respiratory tract infections to use symptom-related antitussives. In chronic cough, suppression of cough may be achieved by disease-specific therapies, but in many patients it may be necessary to use symptomatic antitussives. The efficacy of some over-the-counter symptomatic antitussives is often no better than that of a placebo. Currently available cough suppressants include the centrally acting opioids such as morphine, codeine, pholcodeine, and dextromethorphan. Early studies reported success in reducing cough in patients with chronic bronchitis or chronic obstructive pulmonary disease (COPD); however, a carefully conducted blinded controlled study showed no effect of codeine on cough of COPD. Success with these cough suppressants may be achieved at high doses that are associated with side effects. A slow-release preparation of morphine has been shown to have some degree of efficacy, but this should be reserved for the most severe chronic cough patient, and for patients with terminal cancer who may also benefit from its analgesic effects. There are case reports of the success of centrally acting drugs such as amitriptyline, paroxetine, gabapentin, and carbamezepine in chronic cough. New agents derived from basic research such as new opioids such as nociceptin or antagonists of transient receptor potential vanniloid-1 may turn out to have antitussive effects. Efficacy of symptomatic cough suppressants must be tested in double-blind randomized trials using validated measures of cough in patients with chronic cough not responding to specific treatments. Patients with chronic cough need effective antitussives that could be used either on demand or on a long-term basis.
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Affiliation(s)
- K F Chung
- National Heart and Lung Institute, Imperial College London, London, UK.
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31058
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Kwon WK, Choi ES, Kim JY, Park SR, Na HS, Park SH, Park HP, Jeon YT, Hwang JW. The effect of midazolam premedication on patient satisfaction during fiberoptic bronchoscopy under patient-controlled sedation. Korean J Anesthesiol 2009; 56:1-5. [PMID: 30625687 DOI: 10.4097/kjae.2009.56.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patient-controlled sedation (PCS) with propofol is a safe and effective method of attenuating discomfort during fiberoptic bronchoscopy. The purpose was to evaluate the usefulness of midazolam in addition to PCS for fiberoptic bronchoscopy. METHODS We randomly assigned 155 patients undergoing diagnostic bronchoscopy to two groups. Group M (n = 79) received 0.03 mg/kg of midazolam for premedication while group P (n = 76) received a loading dose (0.05 ml/kg) of PCS solution composed of 200 mg (20 ml) of propofol and 1 mg (2 ml) of alfentanil. Both groups received the PCS solution 0.2 ml/kg/hr with a bolus of 1 ml and a lockout time of 1 min. Vital signs, pulmonologist satisfaction, patient satisfaction and amnesia were evaluated. RESULTS After the insertion of the bronchoscope, there was a slight decrease of SpO2 and an increase of blood pressure and heart rate in both groups with no significant differences between the two groups. The group P required more bolus injections (1.6 +/- 1.7 in the group M vs 2.5 +/- 2.2 in group P; P < 0.05). There was no difference in the satisfaction of pulmonologists, but the satisfaction of patients was higher in the group M (P < 0.05). More patients in the group P (93%) remembered the procedure than in the group M (70%) (P < 0.05). CONCLUSIONS PCS is an effective method for sedating patients undergoing fiberoptic bronchoscopy and midazolam provides more patient satisfaction and amnesia.
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Affiliation(s)
- Won Kyoung Kwon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Eun Su Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Ji Young Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Sang Ri Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Hyo Seok Na
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Sang Hyun Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Hee Pyoung Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Young Tae Jeon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Jung Won Hwang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konkuk University, Seoul, Korea
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31059
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Ko KH, Tsai SH, Yu CY, Huang GS, Liu CH, Chang WC. Unusual complication of superior mesenteric artery syndrome: spontaneous upper gastrointestinal bleeding with hypovolemic shock. J Chin Med Assoc 2009; 72:45-7. [PMID: 19181598 DOI: 10.1016/s1726-4901(09)70020-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Superior mesenteric artery (SMA) syndrome is an unusual form of duodenal obstruction. Complications of SMA syndrome may sometimes develop and are usually associated with marked gastric dilatation, although most complications can be corrected by supportive treatment. In this article, we report a case of severe SMA syndrome with hypovolemic shock in a 24-year-old man. Multidetector-row computed tomography with reconstructed images was performed to establish the diagnosis. Spontaneous gastrointestinal bleeding is an extremely uncommon complication of SMA syndrome, and emergent surgical intervention was unavoidable in our patient. To our knowledge, no other such case has been reported in the English-language literature.
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Affiliation(s)
- Kai-Hsiung Ko
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
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31060
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Rudinsky SL, Matteucci MJ. Emergency department presentation of superior mesenteric artery syndrome: two cases in Marine Corps recruits. J Emerg Med 2008; 42:155-8. [PMID: 19111427 DOI: 10.1016/j.jemermed.2008.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 06/06/2008] [Accepted: 07/31/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Superior mesenteric artery (SMA) syndrome is a relatively rare etiology of proximal intestinal obstruction. Obstruction results from marked narrowing of the angle between the SMA and aorta, causing compression of the third portion of the duodenum, most commonly as a result of precipitous weight loss. Intermittent non-specific symptoms at presentation often result in a delayed diagnosis, thus the importance of being aware of this condition. OBJECTIVE To familiarize emergency physicians with the presentation of SMA syndrome and discuss its diagnosis and management in the emergency department (ED). CASE REPORT We present two cases of SMA syndrome identified in Marine Corps recruits presenting to our ED. CONCLUSION Emergency physicians should include SMA syndrome in the differential diagnosis of abdominal pain and vomiting in individuals with predisposing factors.
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Affiliation(s)
- Sherri L Rudinsky
- Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California, USA
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31061
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Abstract
RATIONALE Emerging evidence suggests that exposure to environmental tobacco smoke (ETS) may be linked with behavior problems in childhood, but previous research has relied primarily on parent report of exposure, and results are inconclusive. OBJECTIVES To investigate the relationship between exposure to ETS and child behavior problems among children with asthma. METHODS The sample included 220 children who were enrolled in an asthma intervention trial and regularly exposed to ETS at home. Serum cotinine was used to measure exposure to tobacco smoke, and behavior problems were assessed by parent report on the Behavior Assessment System for Children. Covariates in adjusted analyses included: sex, age, race, asthma severity, asthma medication, maternal education, prenatal tobacco exposure, maternal depression, and Home Observation for Measurement of the Environment score. RESULTS Child behavior problems increased with increasing exposure to ETS. A stratified analysis of boys and girls separately indicated higher exposure among girls, but behavior problems were statistically significantly associated with exposure only in boys. Increasing behavior problems included externalizing behavior problems (beta= 2.23, p =.02) such as hyperactivity and aggression, internalizing behavior problems (beta= 2.19, p= .01) such as depression, and behavior symptoms (beta= 2.55, p= .01). CONCLUSIONS Among children with asthma, exposure to ETS is related to increased child behavior problems among boys.
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31062
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Hashimoto H, Seno A, Ishizaki A, Terasaki S, Kimoto T. Superior mesenteric artery syndrome resulting from acute massive gastric dilatation caused by Helicobacter pylori-induced acute antral gastritis. Clin J Gastroenterol 2008; 1:153-156. [DOI: 10.1007/s12328-008-0023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 06/20/2008] [Indexed: 11/11/2022]
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31063
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Gelbaya TA, Kyrgiou M, Tsoumpou I, Nardo LG. The use of estradiol for luteal phase support in in vitro fertilization/intracytoplasmic sperm injection cycles: a systematic review and meta-analysis. Fertil Steril 2008; 90:2116-25. [DOI: 10.1016/j.fertnstert.2007.10.053] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 10/16/2007] [Accepted: 10/16/2007] [Indexed: 11/23/2022]
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31064
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Serna J, Cholquevilque JL, Cela V, Martínez-salazar J, Requena A, Garcia-velasco JA. Estradiol supplementation during the luteal phase of IVF-ICSI patients: a randomized, controlled trial. Fertil Steril 2008; 90:2190-5. [DOI: 10.1016/j.fertnstert.2007.10.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 10/03/2007] [Accepted: 10/03/2007] [Indexed: 11/22/2022]
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31065
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Castro SM, Kolli D, Guerrero-Plata A, Garofalo RP, Casola A. Cigarette smoke condensate enhances respiratory syncytial virus-induced chemokine release by modulating NF-kappa B and interferon regulatory factor activation. Toxicol Sci 2008; 106:509-18. [PMID: 18723827 PMCID: PMC2721674 DOI: 10.1093/toxsci/kfn175] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 08/18/2008] [Indexed: 12/31/2022] Open
Abstract
Exposure to cigarette smoke is a risk factor contributing to the severity of respiratory tract infections associated with respiratory syncytial virus (RSV). Stimulation of airway epithelial cells by either RSV or cigarette smoke condensate (CSC) has been shown to induce secretion of the proinflammatory chemokines. However, the effect of coexposure of airway epithelial cells to CSC and RSV on inducible chemokine production has not been previously investigated. The results of this study indicate that CSC costimulation significantly increased RSV-induced interleukin-8 (IL-8) and monocyte chemoattactant protein-1 gene and protein expression when compared with each stimulus alone. Promoter deletion studies identified the interferon stimulatory response element (ISRE) of the IL-8 promoter as a critical region responsible for the synergistic increase of IL-8 gene transcription during mixed exposure. CSC costimulation enhanced RSV-induced activation of interferon regulatory factor (IRF)-1 and IRF-7, which bind to the ISRE site. CSC also furthered RSV-induced activation of the transcription factor nuclear factor kappa B (NF-kappaB), as shown by increased NF-kappaB DNA binding to its specific site of the IL-8 promoter and increased NF-kappaB-driven gene transcription. Therefore, our data demonstrate that a combined exposure to CSC and RSV synergistically increases chemokine expression in airway epithelial cells, suggesting that CSC contributes to an exuberant immune response to RSV by stimulating overlapping signal transduction pathways.
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Affiliation(s)
| | | | | | - Roberto P. Garofalo
- Department of Pharmacology and Toxicology
- Department of Pediatrics, Microbiology
- Immunology
- Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, Texas 77555
| | - Antonella Casola
- Department of Pediatrics, Microbiology
- Immunology
- Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, Texas 77555
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31066
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Tanaka K, Miyake Y, Sasaki S, Ohya Y, Hirota Y. Maternal smoking and environmental tobacco smoke exposure and the risk of allergic diseases in Japanese infants: the Osaka Maternal and Child Health Study. J Asthma 2008; 45:833-8. [PMID: 18972305 DOI: 10.1080/02770900802339742] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE It remains controversial whether environmental tobacco smoke increases the risk of allergic diseases. The present prospective cohort study examined whether in utero exposure to maternal smoking and postnatal exposure to environmental tobacco smoke were associated with the development of wheeze, asthma, and atopic eczema in Japanese infants. METHODS Study subjects included 763 infants. Data were obtained through the use of questionnaires completed by the mother during pregnancy and at 2 to 9 and 16 to 24 months postdelivery. Information regarding maternal smoking during pregnancy and postnatal exposure to environmental tobacco smoke was collected at 2 to 9 months postdelivery, and information on allergic symptoms was collected when the infant was between 16 to 24 months of age. Cases were defined according to criteria of the International Study of Asthma and Allergies in Childhood for wheeze and atopic eczema. Additionally, doctor-diagnosed asthma and atopic eczema were identified. Adjustment was made for maternal age, family income, maternal and paternal education, parental history of asthma, atopic eczema, allergic rhinitis, indoor domestic pets, baby's older siblings, baby's sex, birth weight, and time of surveys. RESULTS The cumulative incidence of wheeze, atopic eczema, doctor-diagnosed asthma, and doctor-diagnosed atopic eczema was 22.1%, 18.6%, 4.3%, and 9.0%, respectively. Maternal smoking during pregnancy was not related to the risk of wheeze, whereas postnatal maternal smoking in the same room as the child increased the risk of wheeze. No significant association was observed between perinatal tobacco smoke exposure and the development of asthma and atopic eczema. CONCLUSIONS Our findings suggest that postnatal maternal smoking might be associated with an increased risk of wheeze in Japanese infants.
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Affiliation(s)
- Keiko Tanaka
- Department of Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
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31067
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Noiri E, Doi K, Negishi K, Tanaka T, Hamasaki Y, Fujita T, Portilla D, Sugaya T. Urinary fatty acid-binding protein 1: an early predictive biomarker of kidney injury. Am J Physiol Renal Physiol 2008; 296:F669-79. [PMID: 19019918 DOI: 10.1152/ajprenal.90513.2008] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In the development of novel therapeutic strategies for kidney disease, new renal biomarkers for early detection and accurate evaluation of renal injury are urgently required for both acute kidney injury (AKI) and chronic kidney disease (CKD). Fatty acid-binding protein 1 (FABP1) is expressed in renal proximal tubule cells and shed into urine in response to hypoxia caused by decreased peritubular capillary blood flow. To clarify the role of urinary FABP1 in kidney disease, we established human FABP1 transgenic mice and evaluated the responses of FABP1 to several AKI and CKD models. Moreover, there are accumulating clinical data that urinary FABP1 can detect human AKI earlier than serum creatinine and can distinguish the risk population for AKI. Investigation with "humanized" FABP1 transgenic mice and measurement of clinical samples allowed us to develop urinary FABP1 as a new renal biomarker. Further clinical studies are necessary to confirm the potential of urinary FABP1 for clinical application.
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Affiliation(s)
- Eisei Noiri
- 107 Lab., Depts. of Nephrology and Endocrinology, Univ. of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan 113-8655.
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31068
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Jedrychowski W, Perera FP, Maugeri U, Mróz E, Flak E, Mrozek-Budzyn D, Edwards S, Musiał A. Length at birth and effect of prenatal and postnatal factors on early wheezing phenotypes. Kraków epidemiologic cohort study. Int J Occup Med Environ Health 2008; 21:111-9. [PMID: 18715836 DOI: 10.2478/v10001-008-0013-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The main goal of the study was to assess the pattern of risk factors having an impact on the onset of early wheezing phenotypes in the birth cohort of 468 two-year-olds. A secondary objective was to investigate a possible association between early persistent wheezing and infant's length at birth. Approximately one third of the children in the study sample experienced wheezing in the first two years of life, and in about two third of cases (67%), the symptom developed within the first year of life. The early wheezing was easily reversible and in about 70% of the affected infants, the symptom receded in the second year of life. The adjusted relative risk ratio (RRR) of persistent wheezing increased with maternal atopy (RRR = 3.13; 95% CI: 1.35-7.27), house dampness (RRR = 3.94; 95% CI: 1.26-12.3), parity (RRR = 2.56; 95% CI: 1.51-4.32) and prenatal ETS exposure (RRR = 1.13; 95% CI: 1.05-1.22), but was inversely associated with the infant's length at birth (RRR = 0.87; 95% CI: 0.76-0.99). The data support the hypothesis that wheezing phenotypes in early childhood and possibly later in life may already be programmed in the prenatal and early postnatal period when the respiratory system is completing its growth and maturation.
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31069
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Gerald LB, Gerald JK, Gibson L, Patel K, Zhang S, McClure LA. Changes in environmental tobacco smoke exposure and asthma morbidity among urban school children. Chest 2008; 135:911-916. [PMID: 19017893 DOI: 10.1378/chest.08-1869] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Environmental tobacco smoke (ETS) exposure is associated with poor asthma outcomes in children. However, little is known about natural changes in ETS exposure over time in children with asthma and how these changes may affect health-care utilization. This article documents the relationship between changes in ETS exposure and childhood asthma morbidity among children enrolled in a clinical trial of supervised asthma therapy. METHODS Data for this analysis come from a large randomized clinical trial of supervised asthma therapy in which 290 children with persistent asthma were randomized to receive either usual care or supervised asthma therapy. No smoking cessation counseling or ETS exposure education was provided to caregivers; however, children were given 20 min of asthma education, which incorporated discussion of the avoidance of asthma triggers, including ETS. Asthma morbidity and ETS exposure data were collected from caregivers via telephone interviews at baseline and at the 1-year follow-up. RESULTS At baseline, 28% of caregivers reported ETS exposure in the home and 19% reported exposure outside of the primary household only. Among children whose ETS exposure decreased from baseline, fewer hospitalizations (p = 0.034) and emergency department (ED) visits (p < or = 0.001) were reported in the 12 months prior to the second interview compared to the 12 months prior to the first interview. Additionally, these children were 48% less likely (p = 0.042) to experience an episode of poor asthma control (EPAC). CONCLUSIONS This is the first study to demonstrate an association between ETS exposure reduction and fewer EPACs, respiratory-related ED visits, and hospitalizations. These findings emphasize the importance of ETS exposure reduction as a mechanism to improve asthma control and morbidity. Potential policy implications include supporting ETS reductions and smoking cessation interventions for parents and caregivers of children with asthma. Research to identify the most cost-effective strategy is warranted.
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Affiliation(s)
- Lynn B Gerald
- Health System Information Services, School of Public Health, University of Alabama at Birmingham, Birmingham, AL; Critical Care Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
| | - Joe K Gerald
- Lung Health Center, School of Medicine, Department of Medicine, Division of Pulmonary, Allergy
| | - Linda Gibson
- Lung Health Center, School of Medicine, Department of Medicine, Division of Pulmonary, Allergy; Critical Care Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Karna Patel
- Lung Health Center, School of Medicine, Department of Medicine, Division of Pulmonary, Allergy
| | - Sijian Zhang
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Leslie A McClure
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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31070
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Holdsworth C, Robinson JE. 'I've never ever let anyone hold the kids while they've got ciggies': moral tales of maternal smoking practices. Sociol Health Illn 2008; 30:1086-100. [PMID: 18564973 DOI: 10.1111/j.1467-9566.2008.01102.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Smoking in the home is, potentially, the next frontier in tobacco control in the developed world. As smoking regulations in public space are extended, attention is turning to private spaces and the contribution of parental, particularly maternal, smoking to children's health and socio-economic inequalities in family health. Yet relatively little is known about mothers' smoking practices within the home and the social meanings of smoking that are constructed by these practices. In this paper we explore how mothers who smoke construct moralities of their smoking behaviour, particularly in relation to where and with whom they smoke. Drawing on in-depth Biographic Narrative Interpretative Method, in interviews with 12 smoking mothers, and their partners, we consider how these moral tales involve comparisons with other smokers and the importance of community endorsement of smoking practices, particularly around children. We also consider the role of children in the home and how children are actively involved in the regulation of smoking behaviours. Finally, we consider the implications of these moral tales for interventions around smoke-free homes.
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Affiliation(s)
- Clare Holdsworth
- Department of Geography, University of Liverpool, Liverpool, UK.
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31071
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Abstract
Steroid hormones hold a major role in female fertility and their proper utilisation and monitoring in modern assisted reproduction protocols is important. Oocyte maturation and endometrial receptivity are the two major factors that appear to be related to a successful outcome in Assisted Reproductive Technology (ART). Many reports suggest that oocyte immaturity accounts for a considerable loss of efficiency in ART, mainly due to the poor quality of the obtained embryos and their inability to develop normally. Oestrogen appears to exert its effects on the cytoplasmic maturation of the oocyte, while progesterone has been shown to accelerate meiotic resumption. Moreover, ovarian stimulation appears to affect the normal luteal function and shifts in the window of implantation as a response to hormonal supplementation have also been observed. The ethical limitations in conducting in vivo studies of human implantation, have led to an indirect hormonal- and morphologic-oriented assessment of endometrial receptivity. The two main protocols of luteal support involve either progesterone supplementation or hCG administration, whereas the combined supplementation with oestradiol remains controversial. This brief review aims to summarize the current knowledge on steroidal actions during the above processes and to address their potential use in the improvement of current ART protocols.
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Affiliation(s)
- Dimitris Loutradis
- First Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Athens University Medical School, Athens, Greece.
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31072
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31073
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Mak YW, Loke AY, Abdullah AS, Lam TH. Household smoking practices of parents with young children, and predictors of poor household smoking practices. Public Health 2008; 122:1199-209. [DOI: 10.1016/j.puhe.2008.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 03/05/2008] [Accepted: 04/04/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Y W Mak
- Department of Nursing Studies, The University of Hong Kong, 4/F William MW Mong Block, LKS Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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31074
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Abstract
AIM To investigate the impact of parental region of birth on the risk of exposure to second-hand smoke for infants. METHODS The smoking habits, according to child health records, of parents of 14 431 infants in Uppsala county, Sweden, born during 1997-2001, were investigated with logistic regression in the presence of socio-economic and demographic confounders from national registers. RESULTS Fathers born outside of Sweden smoked more often than Swedish-born fathers irrespective of region of birth (adjusted odds ratios [ORs] 1.77-3.02). Mothers born in Africa (adjusted OR 0.29, 95% CI 0.15-0.58) and Asia (adjusted OR 0.53, 95% CI 0.40-0.70) smoked less often than Swedish-born mothers. Single parenthood, low income and mother's age <or=24 years increased the risk for parental smoking. CONCLUSION The present study indicates that the risk of smoking in immigrant parents of infants is influenced by the smoking patterns in the region of birth. Smoke cessation interventions targeting fathers are particularly important in immigrant-dense neighbourhoods in Sweden.
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Affiliation(s)
- Thomas Wallby
- Central Child Healthcare Unit, Uppsala Akademiska Hospital, Uppsala, Sweden.
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31075
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Hill MN, Ho WS, Hillard CJ, Gorzalka BB. Differential effects of the antidepressants tranylcypromine and fluoxetine on limbic cannabinoid receptor binding and endocannabinoid contents. J Neural Transm (Vienna) 2008; 115:1673-9. [PMID: 18974922 DOI: 10.1007/s00702-008-0131-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 10/04/2008] [Indexed: 11/12/2022]
Abstract
The goal of this study was to determine whether the endocannabinoid system is altered by chronic antidepressant treatment. The effects of 3-week administration of the monoamine oxidase inhibitor, tranylcypromine (10 mg/kg) and the selective serotonin reuptake inhibitor, fluoxetine (5 mg/kg) on cannabinoid CB(1) receptor densities and endocannabinoid contents were determined in limbic brain regions of the rat. Tranylcypromine significantly reduced tissue content of the endocannabinoid N-arachidonylethanolamine (anandamide) in the prefrontal cortex, hippocampus and hypothalamus and increased 2-arachidonoylglycerol content in the prefrontal cortex. Tranylcypromine treatment significantly increased CB(1) receptor binding density in the prefrontal cortex and hippocampus, but not in the hypothalamus. Treatment with fluoxetine increased CB(1) receptor density in the prefrontal cortex, but had no effect on endocannabinoid contents in any brain region examined. These data suggest that monoaminergic neurotransmission can regulate the endocannabinoid system and further indicates a role of the endocannabinoid system in affective illness and its treatment.
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31076
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Brahmanday GR, Gheorghe G, Jaiyesimi IA, Orazi A, Zekman R, Parikh R, Wills SM, Einhorn LH. Primary mediastinal germ cell tumor evolving into an extramedullary acute megakaryoblastic leukemia causing cord compression. J Clin Oncol 2008; 26:4686-8. [PMID: 18824716 DOI: 10.1200/jco.2008.17.5372] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31077
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Atef A, Zeid IA, Qotb M, El Rab EG. Effect of passive smoking on ciliary regeneration of nasal mucosa after functional endoscopic sinus surgery in children. J Laryngol Otol 2009; 123:75-9. [PMID: 18845033 DOI: 10.1017/S0022215108003678] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
HYPOTHESIS AND BACKGROUND Passive smoking in the paediatric age group is associated with an increased frequency of a number of childhood respiratory disorders. However, its effect on ciliary regeneration after functional endoscopic sinus surgery for chronic sinusitis has not previously been reported. MATERIAL AND METHODS We conducted a prospective, nonrandomised cohort study on 38 paediatric patients with chronic sinusitis. We compared two patient groups--passive smokers and those not subjected to passive smoking--as regards ciliary regeneration after functional endoscopic sinus surgery, using objective methodology. RESULTS AND CONCLUSION We found passive smoking to have a negative impact on sinus cilia regeneration following functional endoscopic sinus surgery.
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31078
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Lefaucheur JP. Principles of therapeutic use of transcranial and epidural cortical stimulation. Clin Neurophysiol 2008; 119:2179-84. [DOI: 10.1016/j.clinph.2008.07.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 06/28/2008] [Accepted: 07/02/2008] [Indexed: 11/28/2022]
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31079
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DeWitt JM. Bispectral index monitoring for nurse-administered propofol sedation during upper endoscopic ultrasound: a prospective, randomized controlled trial. Dig Dis Sci 2008; 53:2739-45. [PMID: 18274899 DOI: 10.1007/s10620-008-0198-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 01/01/2008] [Indexed: 12/14/2022]
Abstract
Bispectral index monitoring (BIS) is a quantitative assessment of brain cortical activity. The aim of this study was to determine if BIS-guided nurse-administered propofol sedation would decrease by > or = 20% both recovery time and propofol dose compared to standard propofol sedation for endoscopic ultrasound (EUS). Prospectively, eligible outpatients were randomized to BIS-guided or standard propofol sedation during EUS. Propofol was given by nurses in intermittent boluses with sedation targeted at a BIS score of < 65-75. For the control group, the nurse was blinded to BIS scores and sedation was titrated to a modified observer's assessment of alertness/sedation scale (MOAA/S) score < or = 3. Of 50 patients enrolled, data for 44 randomized to BIS-guidance (n = 24) and the control group (n = 20) were evaluated. Between the BIS-guided and control group there was no difference between the mean procedure duration, total propofol dose, recovery time, mean intraoperative MOAA/S, and mean BIS score. Compared to standard propofol sedation for EUS, BIS-guided propofol sedation offers no significant decrease in postprocedure recovery times or propofol doses.
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Affiliation(s)
- John M DeWitt
- Indiana University School of Medicine, Indianapolis, IN, USA.
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31080
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Abstract
The administration of propofol as a sedative in gastrointestinal endoscopies became very popular in many European countries during the last years. Nevertheless there are huge regional differences in the way that the drug is used. Switzerland, the country with highest propagation of gastroenterologist guided propofol sedation, serves as a case study of its safe use in daily practice. The experiences of this spread are summarized in this article.
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Affiliation(s)
- Ludwig T Heuss
- Division of Gastroenterology, University of Basel, St. Peter's Square 1, Basel CH-4003, Switzerland.
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31081
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Kim S, Lee S, Arsenault DA, Strijbosch RA, Shamberger RC, Puder M. Pediatric rib lesions: a 13-year experience. J Pediatr Surg 2008; 43:1781-5. [PMID: 18926207 DOI: 10.1016/j.jpedsurg.2008.02.061] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 02/16/2008] [Accepted: 02/18/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND Rib lesions in the pediatric population are rare but significant processes and are often neoplastic. METHODS All patients with primary rib lesions evaluated by the Department of Surgery at Children's Hospital Boston from 1992 to 2005 were studied. The patient's diagnosis, sex, symptoms and their duration, radiologic evaluation, biopsy status, surgical procedure, and follow-up were assessed. RESULTS Thirty-three patients, ages 3 to 23 years (median, 12.7 years), were evaluated. Sixteen patients (48%) had benign and 17 (52%) had malignant lesions. Within the benign cohort of 16 patients, there were 6 osteochondromas, 4 aneurysmal bone cysts, and 2 fibrous dysplasias as well as 1 of each of the following: enchondroma, periosteal chondroma, eosinophilic granuloma, and chondrophyte. Within the malignant cohort of 17 patients, 13 were diagnosed with Ewing's sarcoma, 3 with osteogenic sarcoma, and 1 with chondrosarcoma. The sex distribution for the malignant group was 11 (65%) females and 6 (35%) males. CONCLUSIONS Rib tumors are rare entities in the pediatric population. However, a significant number of rib lesions are malignant. Therefore, proper diagnosis and expeditious treatment are critical.
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31082
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Louis E, Reenaers C, Belaiche J. Does the phenotype at diagnosis (e.g., fibrostenosing, inflammatory, perforating) predict the course of Crohn's disease? Inflamm Bowel Dis 2008; 14 Suppl 2:S59-60. [PMID: 18816759 DOI: 10.1002/ibd.20559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Edouard Louis
- Department of Gastroenterology, CHU Liège; GIGA Research University of Liège, FNRS, Liège, Belgium
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31083
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Ogawa S, Mori T, Nako K, Ito S. Combination therapy with renin-angiotensin system inhibitors and the calcium channel blocker azelnidipine decreases plasma inflammatory markers and urinary oxidative stress markers in patients with diabetic nephropathy. Hypertens Res 2008; 31:1147-55. [PMID: 18716362 DOI: 10.1291/hypres.31.1147] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A calcium channel blocker (CCB), azelnidipine (AZ), is reported to inhibit oxidative stresses, particularly when administered under blockade of the renin-angiotensin system (RAS). The purpose of this study was to investigate whether AZ inhibits oxidative stresses more potently than other CCBs under blockade of RAS and exerts renoprotection in type 2 diabetic nephropathy. Subjects were hypertensive type 2 diabetics with nephropathy, taking RAS inhibitors. The patients were randomly assigned to two groups, an AZ group (n=21, 16 mg/d) and a nifedipine-CR (NF) group (n=17, 40 mg/d). The plasma levels of monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP), adiponectin and tumor necrosis factor-alpha (TNF(alpha)), the urinary excretion of 8-epi-prostaglandin F(2alpha) (8-epi-PGF(2alpha)) and 8-hydroxydeoxyguanosine (8-OHdG), and the urinary albumin-to-creatinine ratios (ACR) were determined before and after 16-week treatment. Neither metabolic parameters nor blood pressure levels differed between the two groups not only at baseline but also after the treatment. However, significant decreases in MCP-1, IL-6, hsCRP, TNF(alpha), 8-epi-PGF(2alpha), 8-OHdG and ACR levels, and a significant increase in the plasma adiponectin level were detected in the AZ group, but not in the NF group. The % change in the urinary oxidative stress markers correlated with that in ACR. Our results indicate that, in hypertensive patients with diabetic nephropathy, a combination therapy of RAS inhibitors and AZ is an effective therapeutic modality for decreasing not only blood pressure but also inflammations and oxidative stresses.
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Affiliation(s)
- Susumu Ogawa
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Aoba-ku, Sendai, Japan.
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31084
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Dewitt J, McGreevy K, Sherman S, Imperiale TF. Nurse-administered propofol sedation compared with midazolam and meperidine for EUS: a prospective, randomized trial. Gastrointest Endosc 2008; 68:499-509. [PMID: 18561925 DOI: 10.1016/j.gie.2008.02.092] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 02/27/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND The utility of nurse-administered propofol sedation (NAPS) compared with midazolam and meperidine (M/M) for EUS is not known. OBJECTIVE To compare recovery times, costs, safety, health personnel, and patient satisfaction of NAPS and M/M for EUS. DESIGN Prospective, randomized, single-blinded trial. SETTING Tertiary-referral hospital in Indianapolis, Indiana. PATIENTS Outpatients referred for EUS. INTERVENTIONS Sedation with M/M or NAPS. The patient and recovery nurse were blinded; however, the sedating nurse, endoscopist, and recording research nurse were unblinded to the sedatives used. A capnography, in addition to standard monitoring, was used. A questionnaire and visual analog scale assessed patient, endoscopist, and sedating nurse satisfaction. MAIN OUTCOME MEASUREMENTS Recovery times, costs, safety, health personnel, and patient satisfaction in both groups. RESULTS Eighty consecutive patients were randomized to NAPS (n = 40) or M/M (n = 40). More patients in the propofol group were current tobacco users; patient demographics, procedures performed, mean procedure length, and the overall frequency of adverse events were otherwise similar. Compared with M/M, NAPS was associated with a faster induction of sedation (2.3 vs 5.7 minutes, respectively; P = .001) and full recovery time (29 vs 49 minutes, respectively; P = .001), higher postprocedure patient satisfaction, and quicker anticipated return to baseline function. At discharge, total costs (recovery plus medications) were similar between the propofol ($406) and M/M groups ($399; P = .79). LIMITATION Low-risk patient population. CONCLUSIONS Compared with M/M, NAPS for an EUS offered a faster sedation induction and full recovery time, higher postprocedure patient satisfaction, and a quicker anticipated return to baseline function. Total costs were similar between the groups.
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Affiliation(s)
- John Dewitt
- Departments of Gastroenterology and Hepatology, Indiana University Medical Center and Regenstrief Institute, Inc, Indianapolis, Indiana, USA
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31085
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Saint-Blancard P, Harket A, Souleau B, Hardy K, Baccialone J, Jancovici R. Une tumeur germinale médiastinale associée à un sarcome granulocytaire. Presse Med 2008; 37:1246-9. [DOI: 10.1016/j.lpm.2007.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 04/27/2007] [Accepted: 06/06/2007] [Indexed: 11/24/2022] Open
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31086
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Mills AM, Rhodes KV, Follansbee CW, Shofer FS, Prusakowski M, Bernstein SL. Effect of household children on adult ED smokers' motivation to quit. Am J Emerg Med 2008; 26:757-62. [DOI: 10.1016/j.ajem.2007.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 10/22/2007] [Accepted: 10/23/2007] [Indexed: 11/20/2022] Open
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31087
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Akiyama T, Yamamoto A, Kashima T, Ishida T, Shinoda Y, Goto T, Nakamura K, Kawano H. Juxtacortical chondroma of the sacrum. J Orthop Sci 2008; 13:476-80. [PMID: 18843465 DOI: 10.1007/s00776-008-1248-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 03/18/2008] [Indexed: 11/26/2022]
Affiliation(s)
- Toru Akiyama
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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31088
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Martínez-Sellés M, Bueno H, Sacristán A, Estévez Á, Ortiz J, Gallegoa L, Fernández-Avilés F. Dolor torácico en urgencias: frecuencia, perfil clínico y estratificación de riesgo. Rev Esp Cardiol 2008. [DOI: 10.1157/13125517] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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31089
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Abstract
Respiratory infections are the most frequent health problem in childhood. There is little precise information on how many respiratory illness episodes can be expected in a normal child. This study was designed to create reference values for the frequency of respiratory infections as recordable by history. Respiratory illnesses were recorded in a prospective birth cohort of 1314 German children born in 1990 and tracked until age 12 yr (760 children). Parents recorded the child's illnesses in a diary and answered structured questions yearly up to age 12. Age of study subjects was categorized into infancy (0-2 yr), pre-school age (3-5 yr), and school age (6-12 yr). The mean cumulative number of respiratory infection episodes up to age 12 yr was 21.9 (s.d. 9.0) episodes. In infancy, the mean annual number was 3.4 (3.7) episodes; at pre-school age, 2.3 (2.6) episodes; and at school, age 1.1 (1.2) episodes. The mean cumulative time of episodes up to age 7 yr was 20.1 (15.2) wk. Forty-five percent of the infants in the upper episode incidence tertile continued to be in the upper tertile at school age. Based on a twofold standard deviation of the mean number, up to 11 respiratory infection episodes per year in infancy, 8 episodes per year at pre-school age, and 4 episodes per year at school age could be regarded as normal. Episodes within these reference values per se should not cause unwarranted concern or intervention because of suspected immunodeficiency.
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Affiliation(s)
- Christoph Grüber
- Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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31090
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Pascua M, Su C, Lewis JD, Brensinger C, Lichtenstein GR. Meta-analysis: factors predicting post-operative recurrence with placebo therapy in patients with Crohn's disease. Aliment Pharmacol Ther 2008; 28:545-56. [PMID: 18565159 DOI: 10.1111/j.1365-2036.2008.03774.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of placebo in randomized clinical trials (PC-RCTs) is often required to evaluate drug efficacy in maintenance of Crohn's disease (CD). AIM To determine pooled estimates of placebo rates of maintaining clinical remission and endoscopic recurrence following surgery for CD and identify factors that influenced placebo outcomes. METHODS We performed a systematic review and meta-analysis of PC-RCTs evaluating post-operative maintenance therapies for CD identified from MEDLINE from 1966 to 2005. RESULTS Twelve studies met our inclusion criteria. The pooled placebo rate of maintaining clinical remission was 56% (95% CI 47-64%; range 34-89%) during a median follow-up of 52 weeks (range 12-156 weeks), but significant heterogeneity existed among the studies (P < 0.001). Prior steroid therapy was the only factor found to be associated with maintaining remission (P = 0.04). The pooled placebo endoscopic recurrence rate was 58% (95% CI 51-65%; range 36-80%) during a median follow-up of 52 weeks (range 12-156 weeks), with significant heterogeneity noted (P = 0.0003). Prior surgery, concomitant small bowel and colonic disease, fistulizing phenotype, or prior immunomodulator therapy influenced endoscopic recurrence (P < 0.05). CONCLUSION Placebo rates in PC-RCTs evaluating post-operative clinical and endoscopic recurrence demonstrate significant variability, which is influenced by specific study characteristics.
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Affiliation(s)
- M Pascua
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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31091
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Watanabe S, Terazawa K, Asari M, Matsubara K, Shiono H, Shimizu K. An autopsy case of sudden death due to acute gastric dilatation without rupture. Forensic Sci Int 2008; 180:e6-e10. [PMID: 18757145 DOI: 10.1016/j.forsciint.2008.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 07/28/2008] [Accepted: 07/28/2008] [Indexed: 12/29/2022]
Abstract
We report the first autopsy case of fatal gastric dilatation without rupture. A 31-year-old woman who lived alone was found dead in her living room. Despite being very thin, she showed marked abdominal distention. Autopsy and histological findings revealed that a severely distended stomach, of which walls notably thin and displayed transmural necrosis, occupied the entire abdominal cavity. Severe congestion was observed in the intestine and cecum. Theses findings suggest that bulimia nervosa together with anorexia nervosa resulted in rapid dilation of the stomach. We conclude that the cause of death was acute circulatory failure from hypovolemic shock that occurred following compression of the inferior vena cava and superior mesenteric vein, and by loss of circulatory volume to the third space.
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Affiliation(s)
- Satoshi Watanabe
- Department of Legal Medicine and of Pharmacy & Pharmacology, Asahikawa Medical College, Midorigaoka-higashi 2-1-1-1, Asahikawa 078-8510, Japan.
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31092
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Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive disease with studies of disease progression generally focusing on measures of airflow and mortality. In nonsmokers, maximal lung function is attained around age 15 to 25 years, and after a variable plateau phase, subsequently declines at approximately 20 to 25 ml/year. Smoking may reduce the maximal FEV(1) achieved, shorten or eliminate the plateau phase, and may accelerate the rate of decline in lung function in a dose-dependent manner. Some smokers are predisposed to more rapid declines in lung function than others, and recent reports suggest that females may be at higher risk of lung damage related to smoke exposure than males. Progressive deterioration in dyspnea, functional status, and health-related quality of life (HRQL) in patients with COPD is well known, but the magnitude and rate of decline and its association with severity of airflow obstruction remains poorly defined. Many studies have identified pulmonary function, in particular the FEV(1), as the single best predictor of survival. An impaired diffusing capacity and overall impairment in functional status have also been associated with impaired survival in COPD. The National Emphysema Treatment Trial has provided additional insight into these features in a large, well-characterized group of patients with severe airflow obstruction and structural emphysema.
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31093
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Abstract
Despite what is known about gender inequalities and the links between smoking, smoke exposure, and poverty, mothers who fail to protect their children from exposure to environmental tobacco smoke (ETS), are often stigmatized as uncaring mothers by the media. Here I describe the process of talking to mothers of young children about the wider social context(s) within which the act of smoking takes place, and their reflections on the paradox of why many women caring for young children still expose their children to tobacco smoke in home environments. By articulating the complex interrelationship between smoking, the maintenance of social relationships, caring for children, and coping with poverty, the women present an alternative conceptualisation as to why and how mothers direct their agency to enable them to care for their children in poverty, which questions the timing, messages and ultimate effect of giving home smoking advice to mothers with young children.
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31094
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Abstract
BACKGROUND Epidemiological studies have shown increased prevalence of asthma over the last decades and a considerable variation in these rates between different countries, mainly developed. Changes in lifestyle of different populations could explain the increasing prevalence of asthma and its different rates in different communities. OBJECTIVES A case-control study was conducted to investigate some risks factors associated to asthma in schoolchildren in São José do Rio Preto, São Paulo, Brazil. CASUISTIC AND METHODS A total of 3793 self-administered written questionnaire (WQ) was filled in by parents of 6-7-year-old schoolchildren, applying the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. Additionally, was added a supplementary WQ evaluating risk factors: gender, personal history of rhinitis and atopic eczema, familial history of atopy, older siblings, day care, breastfeeding, and exposure to pets and to cigarette smoking. Children whose parents responded affirmatively to question 'Has your child had wheezing in the past 12 monthsquest;' were identified as having current asthma. RESULTS The prevalence of current asthma was 18.3%. In multivariate analysis the following risk factors were associated with asthma: rhinitis (OR = 10.6; 95% CI = 8.27-13.56), atopic eczema (OR = 1.54; 95% CI = 1.00-2.35), father with asthma (OR = 3.49; 95% CI = 1.83-6.67), mother with asthma (OR = 1.84; 95% CI = 1.11-3.05), current exposure to pets (OR = 1.83; 95% CI = 1.45-2.32) and passive tobacco smoking exposure (OR = 1.43; 95% CI = 1.12-1.83). CONCLUSIONS Our results show that genetic background, environmental factors and the presence of co-morbidities such as rhinitis and atopic eczema are associated to the genesis of asthma in Brazilian schoolchildren.
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Affiliation(s)
- F Palvo
- Graduate of the São José do Rio Preto Medical School, FAMERP, São Paulo, Brazil
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31095
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Hannöver W, Thyrian JR, Ebner A, Röske K, Grempler J, Kühl R, Hapke U, Fusch C, John U. Smoking during pregnancy and postpartum: smoking rates and intention to quit smoking or resume after pregnancy. J Womens Health (Larchmt) 2008; 17:631-40. [PMID: 18345997 DOI: 10.1089/jwh.2007.0419] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND A substantial number of women smoke while pregnant. The majority of those who quit return to smoking within 12 months. The aim of this study is to estimate smoking rates and to measure the urge to smoke and the motivation to change smoking behavior among women who recently delivered. METHODS Data presented stem from two studies. Study 1 is an epidemiological survey investigating the health of neonates. Study 2 presents screening data of an efficacy trial for a smoking cessation and relapse prevention intervention. Participants were recruited on maternity wards within 7 days after delivery. RESULTS Five hundred fifty-three (29.1%) women were never smokers, 145 (7.6%) were former smokers, 492 (25.9%) abstained during pregnancy, and 712 (37.4%) smoked throughout pregnancy. Of the smokers, 69% did not intend to quit smoking within the next 6 months. Of the women who quit during pregnancy, 80% did not want to resume smoking within the next 6 months or after weaning. CONCLUSIONS Smoking and relapse rates indicate a need for increased efforts to reduce smoking during pregnancy and postpartum. Reported intention to quit or resume does not reflect the high number of relapses. Indicators for relapse need to be found.
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Affiliation(s)
- Wolfgang Hannöver
- Institute for Medical Psychology, Ernst-Moritz-Arndt-University Greifswald, Germany.
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31096
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Abstract
OBJECTIVES The study aimed to explore the association between parental smoking behavior and caries experience in young children, taking into account the socioeconomic status and oral health-related behavior. METHODS Cross-sectional data from 1250 3-year-old and 1283 5-year-old children from four geographical areas in Flanders (Belgium) were analyzed. Children were examined at school by trained dentist-examiners, using standard criteria and calibrated examination methodology. Data on oral hygiene and dietary habits, oral health behavior, sociodemographic variables, and parental smoking behavior were obtained through structured questionnaires, completed by the parents. RESULTS Visible caries experience (i.e. d(3)mft > 0) was seen in 7% of 3-year olds and 31% of 5-year olds. In both age groups, 30% of the parents reported smoking behavior. Univariable logistic regression analysis with caries prevalence as the dependent variable, revealed that parental smoking was a significant independent variable. After controlling for age, gender, sociodemographic characteristics, oral hygiene, and dietary habits, the effect of family smoking status was no longer significant in 3-year-old children (OR = 1.98; 95% CI: 0.68-5.76). In 5-year olds the significant relationship between parental smoking behavior and caries experience persisted after adjusting for the other evaluated variables (OR = 3.36; 95% CI: 1.49-7.58). CONCLUSION The results of this study illustrate the existence of a significant association between parental smoking behavior and caries experience in 5-year-old children.
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Affiliation(s)
- R Leroy
- School of Dentistry, Oral Pathology and Maxillofacial Surgery, Catholic University Leuven, Leuven, Belgium.
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31097
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Wark P. Bronchitis (acute). BMJ Clin Evid 2008; 2008:1508. [PMID: 19445737 PMCID: PMC2907939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Acute bronchitis, with transient inflammation of the trachea and major bronchi, affects over 40/1000 adults a year in the UK. The causes are usually considered to be infective, but only around half of people have identifiable pathogens. The role of smoking or of environmental tobacco smoke inhalation in predisposing to acute bronchitis is unclear. A third of people may have longer-term symptoms or recurrence. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute bronchitis in people without chronic respiratory disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (amoxicillin [with or without clavulanic acid], cephalosporins, or macrolides), antihistamines, antitussives, beta(2) agonists (inhaled or oral), cephalosporins, expectorants, and analgesics.
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Affiliation(s)
- Peter Wark
- Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia
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31098
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Abstract
BACKGROUND The aspiration of the granulosa cells that surround the oocyte and the use of gonadotropin releasing hormone agonists (GnRHa) during assisted reproduction technology (ART) treatment can interfere with the production, during the luteal phase, of progesterone, which is necessary for successful implantation of the embryo. Providing hormonal supplementation during the luteal phase with either progesterone itself, or human chorionic gonadotropin (hCG), which stimulates progesterone production, may improve implantation and, thus, pregnancy rates. OBJECTIVES To determine (1) if luteal phase support after assisted reproduction increases the pregnancy rate, (2) the optimal hormone for luteal phase support, i.e. hCG, progesterone, or a combination of both, and (3) the optimal route of progesterone administration. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders & Subfertility Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1971 to Dec 2003), EMBASE (1985 to Dec 2003). We handsearched reference lists of relevant articles were scanned, and abstract books from scientific meetings up to December 2003. SELECTION CRITERIA Randomized controlled trials of luteal phase support after ART treatment, comparing hCG or progesterone with placebo or no treatment, comparing progesterone with hCG, progesterone plus hCG, or progesterone plus estrogen, or comparing different routes of progesterone administration. Quasi-randomized trials were excluded from the main analyses, but included in a secondary analysis for each comparison. DATA COLLECTION AND ANALYSIS For each comparison, data on live birth, ongoing and clinical pregnancy per embryo or gamete transfer procedure, miscarriage per clinical pregnancy, ovarian hyperstimulation syndrome (OHSS) per transfer, and multiple pregnancy per clinical pregnancy were extracted into 2 x 2 tables and subgrouped by use of GnRHa in the ovarian stimulation regimen. The odds ratio (OR) and risk difference (RD) were calculated. MAIN RESULTS Fifty-nine studies were included in the review. Luteal phase support with hCG provided significant benefit, compared to placebo or no treatment, in terms of increased ongoing pregnancy rates (odds ratio (OR) 2.38, 95% confidence interval (CI) 1.32 to 4.29) and decreased miscarriage rates (OR 0.12, 95% CI 0.03 to 0.50), but only when GnRHa was used. The odds of OHSS increased 20-fold when hCG was used in cycles with GnRHa. Progesterone use resulted in a small but significant increase in pregnancy rates (OR 1.34, 95% CI 1.01 to 1.79) when trials with and without GnRHa were grouped together, but no effect on the miscarriage rate was observed. No significant difference was found between progesterone and hCG or between progesterone and progesterone plus hCG or estrogen in terms of pregnancy or miscarriage rates, but the odds of OHSS were more than 2-fold higher with treatments involving hCG than with progesterone alone(OR 3.06, 95% CI 1.59 to 5.86). Comparing routes of progesterone administration, reductions in clinical pregnancy rate with the oral route, compared to the intramuscular or vaginal routes, did not reach statistical significance, but there was evidence of benefit of the intramuscular over the vaginal route for the outcomes of ongoing pregnancy and live birth. No significant difference in pregnancy rate was observed between vaginal progesterone gel and other types of vaginal progesterone. AUTHORS' CONCLUSIONS Luteal phase support with hCG or progesterone after assisted reproduction results in an increased pregnancy rate. hCG does not provide better results than progesterone, and is associated with a greater risk of OHSS when used with GnRHa. The optimal route of progesterone administration has not yet been established.
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Affiliation(s)
- Salim Daya
- Department of Obstetrics & Gynecology, Clinical Epidemiology & Biostatistics, 2407 Carrington Place, Oakville, Ontario, Canada, L6J 7R6
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31099
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Hill MN, Carrier EJ, McLaughlin RJ, Morrish AC, Meier SE, Hillard CJ, Gorzalka BB. Regional alterations in the endocannabinoid system in an animal model of depression: effects of concurrent antidepressant treatment. J Neurochem 2008; 106:2322-36. [PMID: 18643796 DOI: 10.1111/j.1471-4159.2008.05567.x] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It has been suggested that disturbances in endocannabinoid signaling contribute to the development of depressive illness; however, at present there is insufficient evidence to allow for a full understanding of this role. To further this understanding, we performed an analysis of the endocannabinoid system in an animal model of depression. Male rats exposed to chronic, unpredictable stress (CUS) for 21 days exhibited a reduction in sexual motivation, consistent with the hypothesis that CUS in rats induces depression-like symptoms. We determined the effects of CUS, with or without concurrent treatment with the antidepressant imipramine (10 mg/kg), on CP55940 binding to the cannabinoid CB(1) receptor; whole tissue endocannabinoid content; and fatty acid amide hydrolase (FAAH) activity in the prefrontal cortex, hippocampus, hypothalamus, amygdala, midbrain and ventral striatum. Exposure to CUS resulted in a significant increase in CB(1) receptor binding site density in the prefrontal cortex and a decrease in CB(1) receptor binding site density in the hippocampus, hypothalamus and ventral striatum. Except in the hippocampus, these CUS-induced alterations in CB(1) receptor binding site density were attenuated by concurrent antidepressant treatment. CUS alone produced a significant reduction in N-arachidonylethanolamine (anandamide) content in every brain region examined, which was not reversed by antidepressant treatment. These data suggest that the endocannabinoid system in cortical and subcortical structures is differentially altered in an animal model of depression and that the effects of CUS on CB(1) receptor binding site density are attenuated by antidepressant treatment while those on endocannabinoid content are not.
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Affiliation(s)
- Matthew N Hill
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
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31100
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Abstract
BACKGROUND Limited data exist regarding the safety of nurse-administered propofol sedation (NAPS) for advanced endoscopy. AIMS To evaluate the frequency of and the risk factors for complications associated with NAPS for upper endoscopic ultrasound (EUS). METHODS Consecutive upper EUS examinations using NAPS were retrospectively identified. Clinical data and adverse events were recorded. Univariate and multivariable repeated measures logistic regression models were used to identify independent risk factors for complications. RESULTS Among 806 EUS procedures, the mean procedure duration, time for sedation induction, and postprocedure recovery time were: 34 +/- 20 min, 3.6 +/- 1.4 min, and 27 +/- 23 min, respectively. A decline in systolic blood pressure (SBP) to <90 mm Hg occurred in 104 patients (13%). Six patients (0.7%) had a decline in oxygen saturation (SpO(2)) to <90%. Four patients (0.5%; 95% confidence interval [CI] 0.14-1.27) required assisted positive pressure ventilation. There were no major complications. The minor complication rate from sedation was 21% (95% CI 17.2-25.3). All of the complications were clinically insignificant. Overall complication risk was not related to age, dose, or procedure time. Sedation-related complication rates for advanced experience-level (> or =100 NAPS procedures) nurses were lower compared to the least-experienced (< or =30 NAPS procedures) nurses (17.2%vs 25.4%, odds ratio [OR] 0.61, 95% CI 0.41-0.92). CONCLUSIONS NAPS for upper EUS is safe and may be performed without major complications. Four patients (0.5%) required assisted ventilation. Minor complications occurred in 21% of patients, but were not associated with patient age, propofol dose, or procedure time.
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Affiliation(s)
- Hala Fatima
- Division of Gastroenterology, Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana 46202-5121, USA
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