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Aim: To evaluate the preventive and therapeutic effects of Lactobacillus casei Zhang on impaired glucose tolerance (IGT) by using fructose-induced hyperinsulinemia rats. Methods: Rats were fed 25 % fructose solution for hyperinsulinemia with L. casei Zhang for prevention or therapy. Serum levels of insulin, glucagon-like peptide-2 (GLP-2), osteocalcin, malondialdehyde (MDA), total intestinal bile acids and hepatic glycogen contents were determined by assay kits. The major bacteria from feces and liver expression of adiponectin receptor 2 (AdipoR2), liver X receptor-α (LXR-α), peroxisome proliferator-activated receptor gamma (PPAR-γ) and vitamin K epoxide reductase complex subunit 1 mRNA were assessed by RT-PCR. Pancreas injury was evaluated by histological analysis. Results: Lactobacillus casei Zhang significantly increased numbers of Lactobacillus and Bifidobacterium and decreased Clostridium in the intestine ( p < 0.01). Meanwhile, liver glycogen contents were significantly decreased ( p < 0.05). In preventive group, accompanied by significantly lower insulin and GLP-2 levels ( p < 0.05), L. casei Zhang prevented rats from an increase in oral glucose tolerance area under curve (AUC) which was significant in hyperinsulinemia group ( p < 0.05). In therapeutic group, L. casei Zhang administration possessed improved glucose tolerance ( p < 0.05), which were associated with increased osteocalcin level ( p < 0.01), improved intestinal bile acids secretion ( p = 0.060), decreased serum MDA levels ( p < 0.05) and upregulation of LXR-α, PPAR-γ and AdipoR2 gene expression, as well as an increase in Bacteroides fragilis ( p < 0.05). Conclusions: Lactobacillus casei Zhang administration exert both preventive and ameliorative effect on oral glucose tolerance AUC in IGT rats but may be via different mechanisms. L. casei Zhang could prevent rats from increased AUC through GLP-2 lowering, while the ameliorative effect in high-fructose-fed post-adolescent rats may be via B. fragilis enriched vitamin K2-dependent osteocalcin mechanism in which AdipoR2, LXR-α and PPAR-γ signaling were involved. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of two dietary patterns in which carbohydrates and proteins were eaten mostly at lunch or dinner on body weight and composition, energy metabolism, and biochemical markers in overweight/obese men. Methods: Fifty-eight men (30.0 ± 7.4 years; 30.8 ± 2.4 kg/m) followed a covert hypocaloric balanced diet (−10 % of daily energy requirements) during 8 weeks. Subjects were randomly assigned to three groups: control diet (CT); diurnal carbohydrate/nocturnal protein (DCNP); and nocturnal carbohydrate/diurnal protein (NCDP). Main analyzed outcomes were weight loss, body composition, diet-induced thermogenesis (DIT), and glucose/lipid profile. Results: In all groups, a significant decrease in body weight, BMI, and fat mass (kg and %) was verified, without differences between groups. Interestingly, within group analyses showed that the fat-free mass (kg) significantly decreased in NCDP and in CT after 8-week intervention, but not in DCNP. A detrimental increase in fasting glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA) was verified only in DCNP, while NCDP and CT groups presented a non-significant reduction. Moreover, significant differences between DCNP and the other groups were detected for fasting insulin and HOMA. After the adjustments, NCDP presented a significantly higher DIT and energy expenditure after lunch, compared with DCNP, but after dinner, there were no differences among groups. Conclusion: Eating carbohydrates mostly at dinner and protein mostly at lunch within a hypocaloric balanced diet had similar effect on body composition and biochemical markers, but higher effect on DIT compared with control diet. Moreover, eating carbohydrates mostly at lunch and protein mostly at dinner had a deleterious impact on glucose homeostasis. [ABSTRACT FROM AUTHOR]

Purpose: This cohort study investigated the association between sugar-sweetened beverage (SSB) and diet soda consumption and the incidence of type 2 diabetes in Japanese men. Methods: The participants were 2,037 employees of a factory in Japan. We measured consumption of SSB and diet soda using a self-administered diet history questionnaire. The incidence of diabetes was determined in annual medical examinations over a 7-year period. Hazard ratios (HRs) with 95 % confidence intervals (CIs) for diabetes were estimated after adjusting for age, body mass index, family history, and dietary and other lifestyle factors. Results: During the study, 170 participants developed diabetes. The crude incidence rates (/1,000 person-years) across participants who were rare/never SSB consumers, <1 serving/week, ≥1 serving/week and <1 serving/day, and ≥1 serving/day were 15.5, 12.7, 14.9, and 17.4, respectively. The multivariate-adjusted HR compared to rare/never SSB consumers was 1.35 (95 % CI 0.80-2.27) for participants who consumed ≥1 serving/day SSB. Diet soda consumption was significantly associated with the incident risk of diabetes ( P for trend = 0.013), and multivariate-adjusted HRs compared to rare/never diet soda consumers were 1.05 (0.62-1.78) and 1.70 (1.13-2.55), respectively, for participants who consumed <1 serving/week and ≥1 serving/week. Conclusions: Consumption of diet soda was significantly associated with an increased risk for diabetes in Japanese men. Diet soda is not always effective at preventing type 2 diabetes even though it is a zero-calorie drink. [ABSTRACT FROM AUTHOR]

Background: Although physical exercise is recommended for asthmatics, evidence on the effects of exercise on clinical key factors is still missing. Objectives: We performed a systematic review and meta-analysis to determine the effect of exercise training (EXT) on quality of life (QoL), bronchial hyperresponsiveness (BHR), exercise-induced bronchoconstriction (EIB), lung function and exercise capacity, plus the factors affecting changes in QoL and exercise capacity in asthmatics after a period of EXT. Data Sources: A computerized search was conducted in MEDLINE, EMBASE, and CINAHL (last search on 15 November 2012), without language restriction, and references of original studies and reviews were searched for further relevant studies. Study Selection: Two independent investigators screened full-text studies with asthmatic subjects undertaking EXT (defined as training for ≥7 days, ≥2 times per week, ≥5 training sessions in total) that assessed at least one of the following outcomes: QoL, airway hyperreactivity, forced expiratory volume in one second (FEV), peak expiratory flow (PEF), inflammatory parameters, exercise capacity, or exercise endurance. Potentially relevant studies were excluded if only respiratory muscle training, breathing exercises or yoga was performed, if asthmatic subjects with co-morbidities were investigated, if only data of mixed patient groups without separate results for asthmatics were presented, if training regimens were not sufficiently specified, if no numerical outcome data were presented, and if new long-term medication was introduced in addition to physical training. Of 500 potentially relevant articles, 13.4 % (67 studies including 2,059 subjects) met the eligibility criteria and were included for further analyses. Study Appraisal and Synthesis Methods: Data extraction and risk of bias assessment was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis of all randomized controlled trials (RCTs) was performed to determine the effect of EXT on asthma symptoms, BHR, EIB, FEV, exercise capacity and exercise endurance compared with control training. In addition, relative pre/post changes were analysed in all RCTs and controlled trials. Finally, multiple linear regression models were used to identify effects of relative changes in airway hyperreactivity (BHR or EIB), lung function (FEV or PEF) and training hours on QoL and exercise performance. Results: In a total of 17 studies including 599 subjects, meta-analyses showed a significant improvement in days without asthma symptoms, FEV and exercise capacity while BHR only tended to improve. The analysis of relative within-group changes after EXT showed, however, significant improvements in QoL (17 %), BHR (53 %), EIB (9 %), and FEV (3 %) compared with control conditions. Multiple linear regression models revealed that changes in airway hyperreactivity and lung function significantly contributed to the change in QoL, while mainly the changes in airway hyperreactivity contributed to the change in exercise capacity. Conclusion: EXT was shown to improve asthma symptoms, QoL, exercise capacity, BHR, EIB, and FEV in asthmatics and improvements in BHR explained part of the improvement in QoL and exercise capacity. Thus, physical activity should be recommended as a supplementary therapy to medication. However, more well controlled studies should be performed assessing the relationship of physical activity, QoL, airway hyperreactivity, lung function and especially airway inflammation as well as medication intake. [ABSTRACT FROM AUTHOR]

We analyze the pick beginning date and frost damage risk trends of Jiukeng, Longjing-43, and Wuniuzao tea trees with time, using meteorological data from 12 station pairs over the period 1971-2010 in the Longjing tea-producing area. The pick beginning date of Jiukeng, Longjing-43, and Wuniuzao varieties had no statistically significant trends before 1990. The pick beginning date of Jiukeng variety had statistically significant decreasing trends after 1990, and there were no statistically significant trends in the start date after 1990 for Longjing-43 and Wuniuzao varieties. The average pick beginning dates of Longjing-43 and Wuniuzao varieties before 1990 are later than those after 1990 by 3.8-4.8 and 2.0-3.1 days, respectively. We used the trend of difference between beginning date of tea plucking (BDTP) and 0 °C terminal date to analyze frost damage risk trends. Eleven counties had no statistically significant frost damage risk trends for Jiukeng, Longjing-43, and Wuniuzao varieties, leaving only one county with statistically significant trends. [ABSTRACT FROM AUTHOR]

The paper investigates the question of whether or not determinations of the distance between the Sun and the Galactic center R are affected by the so-called 'bandwagon effect', leading to selection effects in published data that tend to be close to expected values, as was suggested by some authors. It is difficult to estimate numerically a systematic uncertainty in R due to the bandwagon effect; however, it is highly probable that, even if widely accepted values differ appreciably from the true value, the published results should eventually approach the true value despite the bandwagon effect. This should be manifest as a trend in the published R data: if this trend is statistically significant, the presence of the bandwagon effect can be suspected in the data. Fifty two determinations of R published over the last 20 years were analyzed. These data reveal no statistically significant trend, suggesting they are unlikely to involve any systematic uncertainty due to the bandwagon effect. At the same time, the published data show a gradual and statistically significant decrease in the uncertainties in the R determinations with time. [ABSTRACT FROM AUTHOR]

Aim: Knowledge about nurses' error perception is crucial for establishing a sustainable risk management. This paper presents categories and frequencies of errors as identified by nurses. The cross-sectional study results provide further knowledge for professional and organizational development. Subject and methods: Data from 1,100 German nurses working in 30 hospitals and 46 nursing homes were collected using a self-administered questionnaire. This paper firstly presents results from a content analysis of nurses' descriptions of errors and, secondly, results on frequencies of predefined nursing errors (closed-ended, ordinal frequency estimation). Thirdly, it compares the answers of hospital nurses with those of nurses employed in nursing homes and finally it compares answers of participant groups defined by sex or migration background. Results: In the open-ended section, errors described by 60.5 % of the participants concerned medical diagnosis/therapy. 20.7 % had experienced errors in hands-on care, while errors in communication with patients were noted by 3.7 %. In contrast, when offering predefined activities in the questionnaire's closed-ended part, indicated frequencies of errors stressed issues of hands-on care and documentation. Significant differences exist between participants from both settings regarding direct care and relationship building. Sex and migration background were related to frequency estimations. Conclusions: Findings point to shortened professional perspectives in the debates on risk and safety. This might lower nurses' compliance in risk management systems. The influence of health professionals' sex and migration background on their error perception needs further exploration. Field specific approaches for error prevention are needed. [ABSTRACT FROM AUTHOR]

Background: Health authorities around the world advise citizens to increase their intake of foods rich in dietary fibre because of its inverse association with chronic disease. However, a few studies have measured the impact of increasing mixed dietary fibres directly on the composition of the human gut microbiota. Aims of the study: We studied the impact of high-level mixed dietary fibre intake on the human faecal microbiota using an in vitro three-stage colonic model. Methods: The colonic model was maintained on three levels of fibre, a basal level of dietary fibre, typical of a Western-style diet, a threefold increased level and back to normal level. Bacterial profiles and short chain fatty acids concentrations were measured. Results: High-level dietary fibre treatment significantly stimulated the growth of Bifidobacterium, Lactobacillus- Enterococcus group, and Ruminococcus group ( p < 0.05) and significantly increased clostridial cluster XIVa and Faecalibacterium prausnitzii in vessel 1 mimicking the proximal colon ( p < 0.05). Total short chain fatty acids concentrations increased significantly upon increased fibre fermentation, with acetate and butyrate increasing significantly in vessel 1 only ( p < 0.05). Bacterial species richness changed upon increased fibre supplementation. The microbial community and fermentation output returned to initial levels once supplementation with high fibre ceased. Conclusions: This study shows that high-level mixed dietary fibre intake can up-regulate both colonic fermentation and the relative abundance of saccharolytic bacteria within the human colonic microbiota. Considering the important role of short chain fatty acids in regulating human energy metabolism, this study has implications for the health-promoting potential of foods rich in dietary fibres. [ABSTRACT FROM AUTHOR]

Purpose: Traditional medicine has been appropriately identified as the most productive soil for the cultivation and harvesting of modern medicines. Herein, we postulate that safranal, an active constituent of Crocus sativus, owing to its strong antioxidant and anti-apoptotic potential, could be a valuable molecule in alleviating myocardial ischemia-reperfusion (IR) injury. Methods: To evaluate this hypothesis, safranal (0.1-0.5 mL/kg/day, i.p.) or saline were administered to rats for 14 days, and on 15th day, one-stage ligation of left anterior descending coronary artery for 45 min was performed, followed by 60 min reperfusion. Results: We concluded that safranal not only significantly decreased infarct size, but also improved left ventricular functions and the overall hemodynamic status of the myocardium. Interestingly, safranal enhanced phosphorylation of Akt/GSK-3β/eNOS and suppressed IKK-β/NF-κB protein expressions in IR-challenged myocardium. Our findings also imply that safranal exhibits strong anti-apoptotic potential, as evidenced by upregulated Bcl-2 expression and downregulated Bax and caspase3 expression with decreased TUNEL positivity. Moreover, safranal dose-dependently normalized myocardial antioxidant and nitrotyrosine levels, cardiac injury markers (LDH and CK-MB), and decreased TNF-α level in IR-insulted myocardium. Histopathological and ultrastructural findings correlated with the functional and biochemical outcomes showing preserved myocardial architecture and decreased inflammatory cells and edema. Conclusions: Taken together, these results provide convincing evidence of safranal as an invaluable molecule in myocardial IR setting probably due to its fortified antioxidant and anti-apoptotic potential. [ABSTRACT FROM AUTHOR]

Background: Studies have demonstrated that vitamin C supplementation enhances the immune system, prevents DNA damage, and decreases the risk of a wide range of diseases. Other study reported that leukocyte vitamin C level was low in diabetic individuals compared with nondiabetic controls. Aim of the work: To study the effect of vitamin C on oxidative stress, blood lipid profile, and T-cell responsiveness during streptozotocin (STZ)-induced type I diabetes mellitus. Methods: Thirty male Sprague-Dawley rats were randomly split into three groups. The first served as a control group ( n = 10) in which rats were injected with the vehicle alone. The second ( n = 10) and the third groups ( n = 10) were rendered diabetic by intraperitoneal (i.p.) injection of single doses of STZ (60 mg/kg body weight). The third group was supplemented with vitamin C (100 mg/kg body weight) for 2 months. Results: T lymphocytes from the diabetic rats were found to be in a stunned state, with a decreased surface expression of the CD28 costimulatory molecule, low levels of phosphorylated AKT, altered actin polymerization, diminished proliferation and cytokine production, and, eventually, a marked decrease in abundance in the periphery. Vitamin C was found to significantly decrease the elevated levels of blood hydroperoxide, glucose, cholesterol, triglycerides and low-density lipoprotein (LDL) in diabetic rats. Furthermore, it was found to restore CD28 expression, AKT phosphorylation, actin polymerization, and polyfunctional T cells (IFN-γ- and IL-2-producing cells that exhibit a high proliferation capacity). Conclusion: Vitamin C treatment restores and reconstitutes polyfunctional, long-lived T cells in diabetic rats. [ABSTRACT FROM AUTHOR]

Purpose: A diet rich in berries is believed to play a distinct role in the prevention of metabolic diseases associated with obesity. So far, there have been no published clinical observations evaluating the influence of Aronia melanocarpa on hemostasis. The aim of our study was to investigate the effects of A. melanocarpa extract (AM) supplementation on platelet aggregation, clot formation, and lysis in patients with metabolic syndrome (MS). Methods: Middle-aged non-medicated subjects with MS ( n = 38) and 14 healthy volunteers were included in this study. Patients with MS were treated with 100 mg of AM three times daily for 2 months. Results: We observed a significant reduction in the concentration of TC, LDL-C, and TG after AM supplementation. Beneficial changes in coagulation parameters were also observed. After 1 month of AM administration, we noticed significant inhibition of platelet aggregation. However, this effect became less pronounced after 2 months of supplementation. In the case of coagulation induced by endogenic thrombin, a significant decrease in the overall potential for coagulation was induced after 1 or 2 months of supplementation. Moreover, after 1 month of AM extract supplementation, we observed a beneficial reduction in the overall potential for clot formation and fibrinolysis. Conclusions: We observed the normalization of hemostasis parameters in MS patients after both 1 and 2 months of AM administration. After 1 month of AM supplementation, we found favorable changes in regards to the overall potential for plasma clotting, clot formation, and lysis, as well as in the lipid profiles of subjects. [ABSTRACT FROM AUTHOR]

Given the established link between alcohol consumption and risk taking behavior, it is plausible that neighborhoods with higher density of drinking establishments will be associated with increased prevalence of HIV. We conducted an ecological study comparing neighborhoods in Luderitz, Namibia, to evaluate this relationship. We observed increased prevalence of HIV comparing high densities of registered and unregistered shebeens, bars, and total number of drinking establishments, as compared with low densities, were associated with increased prevalence of HIV (PR = 3.02, 95% CI: 2.04-4.47; PR = 1.71, 95% CI: 1.42-2.07; PR = 1.55, 95% CI: 1.19-2.02). Our observation of increased prevalence associated with higher densities of drinking establishment's merits consideration. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of the daily intake of a fruit & vegetable soup with high in vitro bioaccessibility of carotenoids on β-carotene and lycopene serum concentrations. Methods: Fourteen healthy young men (24 ± 1 years) received 300 mL/day of a carrot, tomato, and broccoli soup, containing 3.9 mg β-carotene and 4 mg lycopene, for 4 weeks followed by a 4-week washout period. The serum carotenoid response and oxidative markers were analyzed after 3 and 4 weeks of soup consumption and after a 4-week washout. Results: The in vitro bioaccessibility of β-carotene and lycopene was 55 and 43%, respectively, in the soup. Serum β-carotene concentrations were significantly higher than baseline (0.33 ± 0.05 μmol/L) after 3 weeks (0.69 ± 0.06 μmol/L) and 4 weeks (0.78 ± 0.10 μmol/L) of soup consumption ( P < 0.001). Serum lycopene was also significantly higher compared with baseline levels (0.26 ± 0.08-0.56 ± 0.04 μmol/L and 0.60 ± 0.04 μmol/L, after 3 and 4 weeks, respectively) ( P < 0.001). Although the highest concentration of both carotenoids was found after 4 weeks, the levels were not statistically different from the levels at 3 weeks. A 4-week washout significantly decreased serum carotenoid concentrations, although only β-carotene returned to baseline. Glutathione peroxidase (GPx) increased significantly after soup supplementation compared with baseline, while superoxide dismutase was significantly lower only after 3 weeks. Glutathione reductase, lipid, protein, and DNA oxidative markers remained unchanged. Conclusions: The soup contributed to increasing the concentration of each carotenoid by more than 100% after 3 and 4 weeks of consumption, the maximum increase being observed after 4 weeks. Oxidative markers did not show any variation except for GPx. Serum lycopene half-life was longer than that of β-carotene, which may be important for studies evaluating both carotenoids. [ABSTRACT FROM AUTHOR]

Abstract: SiZer (SIgnificant ZERo crossing of the derivatives) is a graphical scale-space visualization tool that allows for statistical inferences. In this paper we develop a spatial SiZer for finding significant features and conducting goodness-of-fit tests for spatially dependent images. The spatial SiZer utilizes a family of kernel estimates of the image and provides not only exploratory data analysis but also statistical inference with spatial correlation taken into account. It is also capable of comparing the observed image with a specific null model being tested by adjusting the statistical inference using an assumed covariance structure. Pixel locations having statistically significant differences between the image and a given null model are highlighted by arrows. The spatial SiZer is compared with the existing independent SiZer via the analysis of simulated data with and without signal on both planar and spherical domains. We apply the spatial SiZer method to the decadal temperature change over some regions of the Earth. [Copyright &y& Elsevier]

Purpose: Acute antioxidant supplementation may modulate oxidative stress and some immune perturbations that typically occur following prolonged exercise. The aims of the present study were to examine the effects of acutely consuming dark chocolate (high polyphenol content) on plasma antioxidant capacity, markers of oxidative stress and immunoendocrine responses to prolonged exercise. Methods: Fourteen healthy men cycled for 2.5 h at ~60% maximal oxygen uptake 2 h after consuming 100 g dark chocolate (DC), an isomacronutrient control bar (CC) or neither (BL) in a randomised-counterbalanced design. Results: DC enhanced pre-exercise antioxidant status ( P = 0.003) and reduced by trend ( P = 0.088) 1 h post-exercise plasma free [F-isoprostane] compared with CC (also, [F-isoprostane] increased post-exercise in CC and BL but not DC trials). Plasma insulin concentration was significantly higher pre-exercise ( P = 0.012) and 1 h post-exercise ( P = 0.026) in the DC compared with the CC trial. There was a better maintenance of plasma glucose concentration on the DC trial (2-way ANOVA trial × time interaction P = 0.001), which decreased post-exercise in all trials but was significantly higher 1 h post-exercise ( P = 0.039) in the DC trial. There were no between trial differences in the temporal responses (trial × time interactions all P > 0.05) of hypothalamic-pituitary-adrenal axis stress hormones, plasma interleukin-6, the magnitude of leukocytosis and neutrophilia and changes in neutrophil function. Conclusion: Acute DC consumption may affect insulin, glucose, antioxidant status and oxidative stress responses, but has minimal effects on immunoendocrine responses, to prolonged exercise. [ABSTRACT FROM AUTHOR]

Background: There is mounting evidence that an imbalance in oxidant/antioxidant activities plays a pivotal role in fetal development. Aim of the study: To determine the effects of maternal intake of fat and fiber on fetal intrauterine development and antioxidant defense systems of rats. Methods: Virgin female Sprague-Dawley rats were randomly assigned to 4 groups according to diet: the low-fat, low-fiber group (LL); the low-fat, high-fiber group (LH); the high-fat, low-fiber group (HL); and the high-fat, high-fiber group (HH). The diets were fed 4 weeks prior to breeding through day 17.5 of pregnancy. Dietary intakes of fiber (wheat bran and oat) and fat were quantitatively varied, while intakes of energy and essential nutrients were kept constant among the diets. Results: Rats fed a fiber-rich diet had significantly improved fetal numbers, as well as enhanced activity of superoxide dismutase (SOD) and capacity of scavenging free radicals ( p < 0.05). Meanwhile, the placental malondialdehyde and protein carbonyl levels were affected by the diet fat and fiber levels ( p < 0.05). Compared with the LL group, the mRNA abundance of hypoxia-inducible factor 1α (HIF-1α) and thioredoxin-2 (Trx2) in the maternal liver and glutathione peroxidase 1 (GPx1) in the placenta and fetus were significantly downregulated in the HL group ( p < 0.05). Furthermore, rats fed a fiber-rich diet had significantly upregulated mRNA expressions of Cu,Zn-SOD, Mn-SOD, and HIF-1α in the maternal liver ( p < 0.05); Cu,Zn-SOD and Mn-SOD in the placenta ( p < 0.05); and Cu,Zn-SOD in the fetus ( p < 0.05). Conclusion: When energy intakes are equivalent, consumption of fiber in high- or low-fat diets benefits fetal development and growth, through improvements in maternal, placental, and fetal antioxidant defense capacities. [ABSTRACT FROM AUTHOR]

Background: Recent studies have reported that blocking IgE has a potentially beneficial role in the treatment of various allergic diseases. Previously, we found that PG102, a water-soluble extract prepared from the edible fruits of Actinidia arguta, can effectively reduce IgE levels using murine models. Aims: To evaluate the efficacy of PG102 at lowering levels of total IgE in asymptomatic subjects with atopy. Methods: A total of 90 asymptomatic subjects with atopy were randomized equally to a PG102 group or a placebo control group and treated for 8 weeks in a double-blind manner. Total serum IgE, eosinophilic cation protein (ECP), eotaxin, thymus, and activation-regulated chemokine (TARC), IL-4, IL-5, and IL-13 levels were measured. Eosinophil counts were determined before and after treatment, and results were compared. In addition, possible adverse reactions were thoroughly checked in this first human trial. Results: Levels of total IgE significantly increased in the control group but showed no change in the PG102 group, and change differences between the control and PG102 groups were significant (+12.9%, vs.−5.7%, p = 0.015). Levels of ECP and eotaxin and eosinophil counts produced similar results. However, the other variables showed no significant changes after treatment. Conclusion: In this exploratory clinical trial, it was found that 8 weeks of treatment with PG102 effectively reduced the levels of total IgE in apparently asymptomatic subjects with atopy. [ABSTRACT FROM AUTHOR]

Purpose: Excess weight may be related to the development of adverse cardiometabolic risk factors in children. The aim of this study was to evaluate the effect of a lifestyle intervention program (nutrition and exercise counseling) on anthropometric parameters and metabolic syndrome (MS) components in Portuguese overweight/obese children. Methods: A total of 83 overweight/obese children aged 7-9 years were assigned to a 1-year individual or group-based treatment (GT); 61 children (z-score BMI (zBMI): 1.93 ± 0.28; 27 boys and 34 girls) completed the program. Anthropometric and biochemical parameters were assessed at baseline, at 6 months and at 1 year. Results: The overweight/obese children, compared to normal-weight ones, presented significantly higher blood pressure, total-cholesterol, total-cholesterol/high density lipoprotein cholesterol (HDL) ratio, triglycerides, Apolipoprotein B and C-reactive protein levels, while HDL and Apolipoprotein A-I were significantly lower. At baseline, the prevalence of MS was 16.4% in overweight/obese and 0% in normal-weight children. The number of components of MS was significantly higher in children with higher zBMI. Lifestyle intervention led to a significant improvement in zBMI, waist circumference/height ratio, HDL, triglycerides, Apolipoprotein A-I, and Apolipoprotein B levels. The prevalence of MS decreased to 14.8%. The GT intervention seems to be more successful, with a significant decrease in zBMI and an increase in HDL and a lower drop-out rate. Conclusions: Overweight/obese children have multiple risk factors associated with the MS. Lifestyle intervention, both individual and group-based treatment, led to an improvement in the degree of overweight/obesity and in MS components. [ABSTRACT FROM AUTHOR]

Purpose: The maintenance of an obtained lower weight level is often found to be difficult. The aim of this study was to determine weight maintenance after an initial weight loss by consumption of a meal replacement with a vegetable-oil emulsion associated with prolonged satiety. Methods: After a 6-week weight loss period with very low calorie diet (VLCD), subjects with >5% body weight (BW) loss were randomized to a 12-week weight maintenance follow-up period, comparing a partial meal replacement diet containing a vegetable-oil emulsion (test) or dairy fat (control). Anthropometric data and safety variables were collected at baseline and after 4, 8 and 12 weeks. Results: A significant weight loss was observed during the 12-week weight maintenance diet in the test and control group, respectively; 1.0 ± 2.1 kg ( p < 0.05) versus 1.3 ± 2.1 kg ( p < 0.05) with no significant difference between the groups. Body fat mass (BFM) decreased significantly ( p < 0.05) in the test group (−1.7%) compared to the control group (−0.8%). Conclusions: Addition of a vegetable-oil emulsion to a meal replacement weight maintenance program after an initial weight loss using VLCD was associated with decreased BFM by 0.9% without any change in BW between the two groups. [ABSTRACT FROM AUTHOR]

Purpose: Fructose feeding induces a moderate increase in blood pressure, insulin resistance, and hyperinsulinemia. This study investigated the role of α-adrenoceptor subtype in the control of renal hemodynamic responses to exogenously administered angiotensin II (Ang II) and a set of adrenergic agonists in a model of high fructose-fed rats. Methods: Sprague-Dawley rats were fed for 8 weeks with 20% fructose in drinking water (FFR). The renal cortical vasoconstriction to noradrenaline (NA), phenylephrine (PE), methoxamine (ME) and Ang II in the presence and absence of chloroethylclonidine (CEC) (α-adrenoceptor antagonist) was determined. Data, mean ± SEM or SD were subjected to ANOVA with significance at p < .05. Results: FFR showed significant increase in the systolic blood pressure, plasma glucose, and insulin levels when compared to control. FFR expressed reduced renal cortical vascular sensitivity to NA, PE, ME, and Ang II. Furthermore, renal cortical vasoconstriction response to NA, PE, ME, and Ang II was blunted in the presence of CEC in control. While in FFR, renal cortical vasoconstriction to NA, PE, and ME was enhanced by CEC. Renal cortical vasoconstriction to Ang II in FFR was reduced in the presence of CEC. Conclusions: In the presence of a hyperinsulinemic state resulting from chronic and high fructose feeding, an attenuated AT and α-adrenoceptors response to Ang II and adrenergic stimuli respectively, is expected. In addition, α-adrenoceptor is the functional subtype that mediates renal cortical vasoconstriction in control rat, while high fructose feeding did influence the functionality of α-adrenoceptor in mediating the renal cortical hemodynamic changes. [ABSTRACT FROM AUTHOR]

im: Our group has previously shown that the administration of pasta enriched along with the prebiotic inulin induces a significant reduction in triglyceride and glucose levels with a significant delay in gastric emptying (GE) rates. This protective effect may occur by affecting the release of a number of gut peptides involved in the control of gastrointestinal motility. The aim of the present study was to evaluate the effects of inulin-enriched pasta on the circulating levels of neurotensin (NT), somatostatin (SS), and corticotropin-releasing factor (CRF) in relation to the GE time in young healthy subjects. Methods: Twenty healthy young male volunteers completed a randomized double-blind crossover study consisting of a 2-week run-in period and two 5-week study periods (11% inulin-enriched/control pasta), with an 8-week wash-out period in between. Gut peptide concentrations were evaluated by radioimmunoassay. GE time was evaluated by ultrasonography. Results: The prebiotic treatment significantly increased the area under the curve (AUC) values of both NT and SS ( p < 0.05 Dunn's post-test). With regard to gastric motility, along with a significant delay in both the final time and T gastric emptying time, a positive correlation was found between T and SS AUC values ( r = 0.57, p = 0.009) in the inulin-enriched pasta group. Conclusion: These results support the hypothesis that inulin plays an active role in mechanisms affecting the release of these gut peptides, which may modulate the gastric emptying of digesta. [ABSTRACT FROM AUTHOR]

Background: There are substantial evidences suggesting that probiotics can protect the gastrointestinal tract against inflammatory or infectious episodes. The effects of oral treatment with viable or heat-killed cells of Saccharomyces boulardii ( Sb) on bacterial translocation, intestinal permeability, histological aspect of the ileum, and some immunological parameters were evaluated in a murine intestinal obstruction (IO) model. Results: Bacterial translocation and intestinal permeability in the IO group were significantly higher when compared to a Sham group ( p < 0.05). Pretreatment with both viable and heat-killed S. boulardii prevented these increases, and the data obtained for IO + Sb and IO + heat-killed Sb groups were similar to those observed in the Sham group ( p > 0.05). Histological analysis showed preservation of the ileum mucosa in mice that received both forms of the yeast when compared to the lesions observed in the IO group. The levels of serum interleukin (IL)-10 and intestinal secretory immunoglobulin A (sIgA) were higher in the animals that received both yeast treatments when compared to those from IO and Sham groups. Conclusion: Oral treatment with viable or heat-killed cells of S. boulardii maintained intestinal integrity and modulated the immune system in a murine IO model, preventing bacterial translocation and intestinal lesions. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate the effectiveness of an educational and physical program in reducing behavioral or somatic symptoms along with headache, neck and shoulder pain in a working community. A controlled, non-randomized trial was carried out in a working community and 384 employees were enrolled and divided into a study group (Group 1) and a control group (Group 2). The Group 1 received a physical and educational intervention, consisting of relaxation and posture exercises and the use of visual feedback. After 6 months, the intervention was administered to the Group 2. Both groups were then followed for an additional 6 months until the end of the trial. The presence of accompanying symptoms was investigated with a semi-structured interview using a checklist of 20 items, along with headache, neck, and shoulder pain parameters and the prevalence of generalized anxiety disorder and depression, in three clinical examinations at baseline, after 6 months and after 12 months. For each symptom, as well as the presence of any type of symptom, the differences between groups in the prevalence at the clinical examinations following the baseline were evaluated by applying logistic models. After 6 months, the probability of the presence of any type of symptom was significantly lower in the Group 1 (OR 0.69, 95% CI 0.56-0.85) with respect to the Group 2. After 12 months, the pooled estimation did not show any significant difference of symptom prevalence between groups (OR 0.80, 95% CI 0.64-1.00). In conclusion, this is the first longitudinal study relative to accompanying symptoms. Its results suggest the effectiveness of this cognitive program in reducing the burden of physical and psychiatric complaints in a large, working population. [ABSTRACT FROM AUTHOR]

lthough anxiety disorders and headaches are comorbid conditions, there have been no studies evaluating the prevalence of primary headaches in patients with generalized anxiety disorder (GAD). The aim of this study was to analyze the lifetime prevalence of primary headaches in individuals with and without GAD. A total of 60 individuals were evaluated: 30 GAD patients and 30 controls without mental disorders. Psychiatric assessments and primary headache diagnoses were made using structured interviews. Among the GAD patients, the most common diagnosis was migraine, which was significantly more prevalent among the GAD patients than among the controls, as were episodic migraine, chronic daily headache and aura. Tension-type headache was equally common in both groups. Primary headaches in general were significantly more common and more severe in GAD patients than in controls. In anxiety disorder patients, particularly those with GAD, accurate diagnosis of primary headache can improve patient management and clinical outcomes. [ABSTRACT FROM AUTHOR]

Data from several studies indicate an association of headache with anxiety disorders. In this study, we assessed and differentiated anxiety disorders in 100 headache patients by using the PSWQ (Penn State Worry Questionnaire) screening tool for generalised anxiety disorder (GAD) and the ACQ (Agoraphobic Cognitions Questionnaire) and BSQ (Body Sensation Questionnaire) for panic disorder (PD). Control groups were constructed: (1) on the basis of epidemiological studies on PD and GAD in the general population and (2) by including neurological patients. 37.0% of headache patients had a GAD. 27% of headache patients met the score for PD in the BSQ, 4.0% in the ACQ. Significant results were obtained in comparison to the general population ( p < 0.001) and with regard to GAD in comparison with a sample of neurological patients ( p < 0.005). The BSQ significantly correlated with the number of medication days ( p < 0.005). The results confirm the increased prevalence of GAD in headache patients. PD seems to increase the risk of medication overuse. [ABSTRACT FROM AUTHOR]

The relationship of migraine with cardiovascular diseases has been clarified by many studies, and currently, migraine is suggested to be a systematic vasculopathy. Inflammation, thrombosis and impaired vascular reactivity are the underlying pathophysiological mechanisms of the vasculopathy. In the present study, we aimed to investigate the relationship between prolactin levels and subclinical atherosclerosis risk factors such as soluble CD40 ligand (sCD40L) and high-sensitivity CRP (hsCRP) in migraine patients during interictal period. Fifty female migraine patients and age-matched 25 female control cases were enrolled in the study. Migraine diagnosis was settled according to the ICHD-II diagnostic criteria. A questionnaire was completed about the existence of vascular risk factors. Serum samples were used to measure sCD40L, hsCRP and prolactin levels. No difference was found between the prolactin levels of the migraine patients and the controls. The sCD40L levels were significantly higher in migraine patients ( p < 0.001). High-sensitivity CRP levels showed no difference between the groups. There was no correlation between prolactin, sCD40L, and hs-CRP levels in migraine patients. We consider that the migraine patients are prone to subclinical atherosclerosis, but this tendency is independent of prolactin levels. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate whether consumption of Lactobacillus plantarum HEAL 9 (DSM 15312) and Lactobacillus paracasei 8700:2 (DSM 13434) could affect naturally acquired common cold infections in healthy subjects. Methods: A randomised, parallel, double-blind placebo-controlled study was performed to investigate whether intake of this probiotic mixture could reduce the risk of common cold episodes, number of days with common cold symptoms, frequency and severity of symptoms, and cellular immune response in common cold infections. A total of 272 subjects were supplemented daily with either 10 cfu (colony forming units) of probiotics ( N = 135) or control ( N = 137) for a 12-week period. Results: The incidence of acquiring one or more common cold episode was reduced from 67% in the control group to 55% in the probiotic group ( p < 0.05). Also, the number of days with common cold symptoms were significantly ( p < 0.05) reduced from 8.6 days in the control group to 6.2 days, in the probiotic group, during the 12-week period. The total symptom score was reduced during the study period from a mean of 44.4 for the control group to 33.6 for the probiotic group. The reduction in pharyngeal symptoms was significant ( p < 0.05). In addition, the proliferation of B lymphocytes was significantly counteracted in the probiotic group ( p < 0.05) in comparison with the control group. Conclusion: In conclusion, intake of the probiotic strains Lactobacillus plantarum HEAL 9 (DSM 15312) and Lactobacillus paracasei 8700:2 (DSM 13434) reduces the risk of acquiring common cold infections. [ABSTRACT FROM AUTHOR]

Modification of lifestyle habits is a key preventive strategy for many diseases. The role of lifestyle for the onset of headache in general and for specific headache types, such as migraine and tension-type headache (TTH), has been discussed for many years. Most results, however, were inconsistent and data on the association between lifestyle factors and probable headache forms are completely lacking. We evaluated the cross-sectional association between different lifestyle factors and headache subtypes using data from three different German cohorts. Information was assessed by standardized face-to-face interviews. Lifestyle factors included alcohol consumption, smoking status, physical activity and body mass index. According to the 2004 diagnostic criteria, we distinguished the following headache types: migraine, TTH and their probable forms. Regional variations of lifestyle factors were observed. In the age- and gender-adjusted logistic regression models, none of the lifestyle factors was statistically significant associated with migraine, TTH, and their probable headache forms. In addition, we found no association between headache subtypes and the health index representing the sum of individual lifestyle factors. The lifestyle factors such as alcohol consumption, smoking, physical activity and overweight seem to be unrelated to migraine and TTH prevalence. For a judgement on their role in the onset of new or first attacks of migraine or TTH (incident cases), prospective cohort studies are required. [ABSTRACT FROM AUTHOR]

The aim of our study was to investigate whether genetic variants in the hypocretin receptor 1 ( HCRTR1) gene could modify the occurrence and the clinical features of migraine. Using a case-control strategy we genotyped 384 migraine patients and 259 controls for three SNPs in the HCRTR1 gene. Genotypic and allelic frequencies of the rs2271933 non-synonymous polymorphism resulted different ( χ = 9.872, p = 0.007; χ = 8.108, p = 0.004) between migraineurs and controls. The carriage of the A allele was associated with an increased migraine risk (OR 1.42, 95% CI 1.11-1.81). When we divided the migraine patients into different subgroups, the difference reached the level of statistical significance only in migraine without aura. The different genotypes had no significant effect on the examined clinical characteristics of the disease. In conclusion, our data supports the hypothesis that the HCRTR1 gene could represent a genetic susceptibility factor for migraine without aura and suggests that the hypocretin system may have a role in the pathophysiology of migraine. [ABSTRACT FROM AUTHOR]

ymmetric dimethylarginine (ADMA) has been found as correlated with endothelial dysfunction and oxidative stress. There are few studies regarding ADMA and nitric oxide (NO) levels in patients with migraine and alterations of ADMA and NO levels during migraine attack are not well-known. Therefore, in present study, we aimed to measure NO and ADMA levels in patients with migraine and compare them with the control group to investigate the correlation between migraine, oxidative stress and endothelial dysfunction. The migraine group consisted of 59 patients, including 22 suffering from migraine with aura and 37 suffering from migraine without aura. The control group consisted of 31 healthy volunteers without headache. The patients in migraine group were divided into subgroups based on whether attack period was present or not and whether it was migraine with or without aura. Plasma ADMA levels were measured using an enzyme-linked immunosorbent assay method. Migraine patients had higher concentrations of NO (35.6 ± 7.7, 31.0 ± 6.2 μmol/L, respectively, p = 0.005) and ADMA (0.409 ± 0.028, 0.381 ± 0.044 μmol/L, respectively, p = 0.001) levels when compared with the healthy controls. During migraine attack, NO and ADMA levels were found to be significantly higher in migraine group as compared to control group (respectively, p = 0.015, p = 0.014). Similarly, NO and ADMA levels in the patients with migraine in the interictal period were found to be significantly higher as compared to control group ( p = 0.011, p = 0.003). In conclusion, higher ADMA and NO levels of patients with migraine supported that oxidative stress and endothelial dysfunction may have a role in migraine pathogenesis. [ABSTRACT FROM AUTHOR]

The objective of this study was to test the validity, in the Chinese population, of the Lifting The Burden diagnostic questionnaire for the purpose of a population-based survey of the burden of headache in China. From all regions of China, a population-based sample of 417 respondents had completed the structured questionnaire in a door-to-door survey conducted by neurologists from local hospitals calling unannounced. They were contacted for re-interview by telephone by headache specialists who were unaware of the questionnaire diagnoses. A screening question ascertained whether headache had occurred in the last year. If they had, the specialists applied their expertise and ICHD-II diagnostic criteria to make independent diagnoses which, as the gold standard, were later compared with the questionnaire diagnoses. There were 18 refusals; 399 interviews were conducted in 202 women and 197 men aged 18-65 years (mean age 44.4 ± 12.6 years). In comparison to the specialists' diagnoses, the sensitivity, specificity, positive predictive value, negative predictive value and Cohen's kappa (95% CI) of the questionnaire for the diagnosis of migraine were 0.83, 0.99, 0.83, 0.99 and 0.82 (0.71-0.93), respectively; for the diagnosis of tension-type headache (TTH), they were 0.51, 0.99, 0.86, 0.92 and 0.59 (0.46-0.72), respectively. In conclusion, the questionnaire was accurate and reliable in diagnosing migraine (agreement level excellent), less so, but adequate, for TTH (sensitivity relatively low, false negative rate relatively high and agreement level fair to good). The non-specific features of TTH do not lend themselves well to diagnosis by questionnaire. [ABSTRACT FROM AUTHOR]

Objective: To study the effects of the dietary fat content on cardiovascular disease risk factors in humans when the fatty acid composition and types of carbohydrates are kept constant. Methods: A controlled dietary study in healthy volunteers with 2 dietary groups and a parallel design consisting of 2 dietary periods was conducted. First, participants received a 2-week wash-in diet rich in saturated fatty acids (SFA; 47% of total fatty acids) and were then randomly assigned to either a high-fat (40% of energy) or a low-fat diet (29% of energy) for 4 weeks. Both diets were isocaloric, rich in monounsaturated fatty acids (MUFA; 51% of total fatty acids) and had similar fatty acid and carbohydrate compositions. Results: Compared to the wash-in diet, the high-fat and low-fat diets significantly lowered LDL-cholesterol (−0.34 and −0.41 mmol/l, respectively; P < 0.001 for time effect in RM-ANOVA), and HDL-cholesterol (−0.13 and −0.18 mmol/l, respectively; P < 0.001 for time), without any differences between the high-fat and low-fat diets ( P = 0.112 and P = 0.085 for time × group interaction in RM-ANOVA, respectively). The size of the major LDL fraction, the LDL susceptibility to oxidation and the plasma concentrations of oxidized LDL (ox-LDL) were significantly reduced by both the high-fat and low-fat diet, again without significant differences between the diets. The ratio of ox-LDL/LDL-cholesterol, serum triacylglycerols and urinary F2-isoprostanes were not significantly affected by the diets. Conclusion: A high-fat and a low-fat diet, both rich in MUFA, had similar effects on lipid-related cardiovascular disease risk factors in metabolically healthy men and women. [ABSTRACT FROM AUTHOR]

Objective is to investigate the relationship between migraine and obstructive sleep apnea in the general population. A cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway, were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. 376 persons with high risk and 157 persons with low risk of sleep apnea aged 30-65 years were included for further investigations. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Migraine without aura (MO) and migraine with aura (MA) was diagnosed according to the International Classification of Headache Disorders. MO and MA occurred in 12.5 and 6.8% of the participants with obstructive sleep apnea. The logistic regression analyses showed no relationship between the two types of migraine and obstructive sleep apnea, with adjusted odds ratios for MO 1.15 (0.65-2.06) and MA 1.15 (0.95-2.39). Further, estimates using cutoff of moderate (AHI ≥ 15) and severe (AHI ≥ 30) obstructive sleep apnea, did not reveal any significant relationship between migraine and the AHI. Migraine and obstructive sleep apnea are unrelated in the general population. [ABSTRACT FROM AUTHOR]

Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children's condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. The total number of TrPs was significantly greater in children with CTTH as compared to healthy children ( P < 0.001). Active TrPs were only present in children with CTTH ( P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration ( r = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups ( P < 0.001) and muscles ( P < 0.001) were found: the referred pain areas were larger in CTTH children ( P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs ( P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children. [ABSTRACT FROM AUTHOR]

Purpose: Hitherto, studies on highly active antiretroviral therapy (HAART) initiation have shown partly inconsistent results. Our study investigated the clinical course and course of immune status after HAART initiation at CD4-cell-count/μl of treated patients between 250 and 349 (group 1), compared to 350-449 (group 2), on the basis of the cohort of the Competence Network for HIV/AIDS (KompNet cohort). Methods: Patients had to be HAART-naïve. Medication had to start at the earliest in 1996, being at least triple combination therapy. The primary endpoints of death, first AIDS-defining illness and first drop of CD4-cell-count/μl below 200 were evaluated as censored event times between the initiation of HAART ( t) and the date of the first event/date of last observation. Probabilities of event-free intervals since t were calculated by Kaplan-Meier estimation, compared by logrank tests. The results were adjusted for confounders using Cox regression. Additionally, incidences were estimated. Results: A total of 822 patients met the inclusion criteria (group 1: 526, group 2: 296), covering 4,133 patient years (py) overall. In group 1, 0.64 death cases/100 py were found, with the corresponding vale being 0.17 in group 2. In group 1, 1.38 AIDS-defining events/100 py occurred, whereas it was 0.78 in group 2. In group 1, 2.64 events of first drop of CD4-cell-count/μl below 200 occurred per 100 py, compared to 0.77 in group 2. Kaplan-Meier estimations showed borderline significant differences regarding death ( p = 0.063), no differences regarding first AIDS-defining illness ( p = 0.148) and distinct differences regarding the first drop of CD4-cell-count/μl below 200 ( p = 0.0004). Conclusions: The results gave a strong hint for a therapy initiation at higher CD4-cell-count/μl regarding the outcome of death in treated patients. A distinct benefit was shown regarding the first decline of CD4-cell-count/μl below 200. [ABSTRACT FROM AUTHOR]

Purpose: The impact of an antibiotic restriction program (ARP) on the patterns of antibiotic use in the treatment of community-acquired pneumonia (CAP) was examined. We also evaluated the association between the ARP and the length of hospital stay in regard to CAP treatment and cost savings associated with the implementation of the ARP. Methods: A retrospective cohort study of patients admitted with CAP was conducted during two 6-month periods, one prior to the ARP and one after the ARP. The health system's computerized patient record system (CPRS) was used to obtain demographics, length of hospital stays, readmission rates, blood culture results, co-morbidities, antibiotic use, and durations of therapy. A total of 130 patients met the inclusion criteria for the final analyses. Average drug costs, employee salaries, and the cost of laboratory procedures were used to assess cost savings associated with the ARP. Results: From a total of 132 antibiotics that were ordered to treat CAP in the pre-ARP period, 28 were restricted (21.2%). However, the number of restricted antibiotics ordered was significantly reduced to 12 out of 114 (10.2%) antibiotics ordered in the post-ARP period ( P = 0.024). In post-ARP implementation, the mean length of hospital stay was also significantly reduced from 7.6 to 5.8 days ( P = 0.017), and although not statistically significant, the 30-day readmission rates declined from 16.9 to 6.2% ( P = 0.097). The ARP was also associated with a saving of $943 per patient treated for CAP. Conclusions: In addition to a decrease in the antibiotic utilization and the mean length of hospital stay, the ARP may have yielded cost savings and reduced the readmission rates for those patients admitted and treated for CAP. [ABSTRACT FROM AUTHOR]

The article focuses on a study related to the use of etomidate by emergency department (ED) for rapid sequence intubation. It informs that etomidate is the most commonly used induction agent for ED rapid sequence intubation (RSI) in North America. It states that the study emphasizes on whether the use of etomidate for ED RSI in critically ill adults is associated with greater morbidity or mortality compared to the use of ketamine. Several charts related to the study are also presented.

Hyperventilation is often associated with stress, an established trigger factor for migraine. Between attacks, migraine is associated with a deficit in habituation to visual-evoked potentials (VEP) that worsens just before the attack. Hyperventilation slows electroencephalographic (EEG) activity and decreases the functional response in the occipital cortex during visual stimulation. The neural mechanisms underlying deficient-evoked potential habituation in migraineurs remain unclear. To find out whether hyperventilation alters VEP habituation, we recorded VEPs before and after experimentally induced hyperventilation lasting 3 min in 18 healthy subjects and 18 migraine patients between attacks. We measured VEP P100 amplitudes in six sequential blocks of 100 sweeps and habituation as the change in amplitude over the six blocks. In healthy subjects, hyperventilation decreased VEP amplitude in block 1 and abolished the normal VEP habituation. In migraine patients, hyperventilation further decreased the already low block 1 amplitude and worsened the interictal habituation deficit. Hyperventilation worsens the habituation deficit in migraineurs possibly by increasing dysrhythmia in the brainstem-thalamo-cortical network. [ABSTRACT FROM AUTHOR]

Fasting for approximately 1 month is an obligatory practice for Muslims during the month of Ramadan. We attempted to evaluate the effect of the Ramadan fasting on the frequency of migraine attacks among observant Muslim migraine sufferers using a cohort cross-over study. Thirty-two observant Muslim migraine sufferers filled a migraine diary during the Ramadan month and the following month (control). Two patients failed to complete the fast because of migraine suffering. During the Ramadan month, the patient expressed 9.4 ± 4.3 migraine days in average (range 3-20) when compared with 3.7 ± 2.1 migraine days in average (range 1-10) during the control month ( p < 0.001). This phenomenon was associated with longer duration of migraine, lower frequency of migraine attacks, and migraine with aura. It seemed to be less pronounced in patients experiencing throbbing headaches and in married patients. Previous prophylactic therapy did not dampen this. Physicians treating Muslim migraine patients should discuss potential Ramadan month exacerbation with their patients and provide counseling regarding the prevention of dehydration and caffeine withdrawal. Pharmacological prophylactic treatment should be considered. [ABSTRACT FROM AUTHOR]

Background: Klebsiella pneumoniae is the second most common species causing urinary tract infections (UTI). However, the host factors and virulence genes of K. pneumoniae related to UTI are poorly understood. The aim of this study was to analyze the capsular phenotype and virulence genes of K. pneumoniae isolates and host factors potentially relevant to community-acquired UTI. Methods: Fifty-four K. pneumoniae isolates from patients with community-acquired UTI, 76 isolates from healthy adults, and 29 from patients with community-acquired pneumonia were compared. The virulence genes ( rmpA, magA, uge, and wabG) and serotype (K1, K2, K5, K20, K54, or K57) were characterized by polymerase chain reaction (PCR). The modified string test was used to determine the hypermucoviscosity. Results: Diabetes mellitus was the most frequent underlying disease among UTI patients (53.7%, 29/54). No predominant K serotype was found in UTI strains. The hypermucoviscosity phenotype and rmpA gene were more often found in UTI isolates than in those from healthy adults (27.8 vs. 2.6%, P < 0.01; 29.6 vs. 11.8%, P < 0.01, respectively), whereas no significant difference in the frequency of magA, uge, wabG, or serotype genes was found. The prevalence of rmpA was significantly lower in isolates from patients with immunosuppression, chronic renal insufficiency, and urinary tract obstruction. Multivariate analysis showed that immunosuppression was negatively associated with the prevalence of rmpA. Conclusion: Hypermucoviscosity was highly correlated with the presence of the rmpA gene in UTI strains, and rmpA may have a role in community-acquired UTI, especially in hosts without immunosuppression. [ABSTRACT FROM AUTHOR]

There is a growing body of evidence implicating inflammatory cytokines and brain-derived neurotropic factor (BDNF) in the generation of migraine pain. No previous study evaluated BNDF levels during migraine attacks and there are conflicting results regarding tumor necrosis factor-alpha (TNF-alpha) serum levels. This study compared serum levels of TNF-alpha, soluble TNF receptors 1 and 2 (sTNF-R1 and sTNF-R2), and BDNF during migraine attacks and in headache-free periods. Nine patients with episodic migraine were clinically evaluated during a migraine attack and in a headache-free period. Blood sample of each patient in both occasions was collected and all serum was submitted to TNF-alpha, sTNF-R1, sTNF-R2, and BDNF determination by ELISA. There was no significant difference in the serum levels of TNF-alpha, sTNF-R1 and sTNF-R2 in migraine attack period and headache-free period. BDNF serum levels were significantly higher during migraine attack than in pain-free period. This is the first report showing that BDNF serum levels increase during migraine attack. This reinforces the view that BDNF may be implicated in the physiopathology of migraine. [ABSTRACT FROM AUTHOR]

The main purpose of this study was to analyze the differences in neck mobility between children with chronic tension type headache (CTTH) and healthy children, and to determine the influence of cervical mobility on headache intensity, frequency and duration. Fifty children, 13 boys and 37 girls (mean age 8.5 ± 1.6 years) with CTTH associated to peri-cranial tenderness (IHS 2.3.1) and 50 age- and sex matched children without headache (13 boys, 37 girls, mean age 8.5 ± 1.8 years, P = 0.955) participated. Cervical range of motion (CROM) was objectively assessed with a cervical goniometer by an assessor blinded to the children's condition. Children completed a headache diary for 4 weeks to confirm the diagnosis. Children with CTTH showed decreased CROM as compared to children without headache for flexion ( z = −6.170; P < 0.001), extension ( z = −4.230; P < 0.001), right ( z = −4.505; P < 0.001) and left ( z = −4.768; P < 0.001) lateral-flexions, but not for rotation (right z = −0.802; P = 0.425; left z = −1.254; P = 0.213) and also for total range of motion for flexion-extension ( z = −4.267; P < 0.001) and lateral-flexion ( z = −4.801; P < 0.001), but not for rotation ( z = −1.058; P = 0.293). Within CTTH children, CROM was not correlated with headache intensity, frequency or duration. Additionally, age ( P > 0.125) or gender ( P > 0.250) did not influence CROM in either children with CTTH or without headache. Current results support the hypothesis that the cervical spine should be explored in children with headache. Further research is also needed to clearly define the potential role of the cervical spine in the genesis or maintenance of CTTH. [ABSTRACT FROM AUTHOR]

The objectives of this study were: (1) to assess relative frequency of migraine in multiple sclerosis (MS) patients using the validated self-administered diagnostic questionnaire, and to compare the migraine rates in MS outpatients to age- and gender-matched historical population controls; (2) to compare clinical and radiographic characteristics in MS patients with migraine and headache-free MS patients. We conducted a cross-sectional study to assess the demographic profiles, headache features and clinical characteristics of MS patients attending a MS clinic using a questionnaire based on the American Migraine Prevalence and Prevention (AMPP) study. We compared the relative frequency of migraine in MS clinic patients and AMPP cohort. We also compared clinical and radiographic features in MS patients with migraine to an MS control group without headache. Among 204 MS patients, the relative frequency of migraine was threefold higher than in population controls both for women [55.7 vs. 17.1%; prevalence ratio (PR) = 3.26, p < 0.001] and men (18.4 vs. 5.6%; PR = 3.29, p < 0.001). In a series of logistic regression models that controlled for age, gender, disease duration, β-interferon use, and depression, migraine in MS patients was significantly associated ( p < 0.01) with trigeminal and occipital neuralgia, facial pain, Lhermitte's sign, temporomandibular joint pain, non-headache pain and a past history of depression. Migraine status was not significantly associated with disability on patient-derived disability steps scale or T2 lesion burden on brain MRI. Migraine is three-times more common in MS clinic patients than in general population. MS-migraine group was more symptomatic than the MS-no headache group. [ABSTRACT FROM AUTHOR]

Background: A better knowledge of methicillin-resistant Staphylococcus aureus (MRSA) persistence in hospitalised patients may impact on specific prevention strategies. We have investigated the persistence of MRSA-carriage in patients admitted and re-admitted to a university hospital. Patients and methods: Between January 2002 and October 2005 all MRSA-positive patients admitted to the university hospital of Hannover Medical School were assessed at first admission and all subsequent re-admissions. Patients re-admitted at least once were analysed for the persistence or loss of MRSA. The association of possible factors influencing the persistence of MRSA colonisation or infection (age group, gender, decolonisation therapy during first hospital stay due to MRSA positivity and colonisation of different anatomical sites) was analysed using univariate, multivariate and time-dependent analyses. Results: A total of 1,032 patients who had tested positive at least once for MRSA were admitted to our hospital during the study period, accounting for 2,038 admissions. Of these patients, 403 (39.1%) were admitted more than once (from two times to 21 times), and 238 (59.1%) of the re-admitted patients remained MRSA positive during all subsequent admissions. Fifty-five (13.6%) patients tested MRSA negative at their last admission, and 61 (15.1%) tested MRSA negative at at least two consecutive admissions. In 27 (6.7%) patients, the MRSA status differed more than once between subsequent admissions. Overall, the half-life time (HLT) of MRSA persistence was 549 days, with the duration of persistence dependent on the colonisation of different anatomical sites (HLT only wounds 117 days; HLT mouth, throat, bronchial secretions 627 days; HLT nose, wounds and other body sites 801 days; p < 0.01) and was prolonged if more than one body site was MRSA-positive (HR 2.18, 95% confidence interval 1.52-3.15). Conclusion: A detailed knowledge of the dynamics of the loss of MRSA infection could result in a reduction of the incidence of MRSA in the future. Multiple anatomical site carriage of MRSA appeared to predict a prolonged persistence in our cohort of patients re-admitted to a university hospital. [ABSTRACT FROM AUTHOR]

Background: The human immunodeficiency virus (HIV) epidemic and increasing use of immunosuppressive agents have increased the prevalence of both cryptococcosis and tuberculosis (TB). However, the status of co-infection with both pathogens remains unknown. Methods: This study retrospectively reviewed patient records of cryptococcosis and TB co-infection from 1993 to 2006. The temporal sequence of co-infection was defined as either concurrent or sequential. Data collected included patient demographics, HIV status, co-morbidities, clinical manifestations, treatment strategies, and outcome at 1-year follow-up. Results: There were 23 patients with cryptococcosis and TB co-infection, representing 5.4% of cryptococcosis or 0.6% of TB cases. Eleven (48%) patients were HIV-infected, and no underlying disease or immunocompromised state could be identified in six (26%) patients. Twelve (52%) patients presented with concurrent infection, but diagnosis of co-infection could be achieved simultaneously in only three (13%). Constitutional symptoms, particularly fever and weight loss, were the most common presenting symptoms, developing in more than two-thirds of the patients. The majority (83%) of the patients made a good recovery following dual antifungal and anti-TB therapy. There were three mortalities at the 1-year follow-up, which might be attributable to a delay in diagnosis and treatment of co-infection. The outcomes of HIV-infected and non-HIV-infected patients were not significantly different. Conclusions: Cryptococcosis and TB co-infection, although rare, develops in both immunocompromised and healthy individuals. Early diagnosis and treatment may improve patient prognosis. There should be a high index of suspicion in order to achieve a timely diagnosis in a TB endemic area. [ABSTRACT FROM AUTHOR]

This study set out to (1) estimate the prevalence of three forms of feeding intention among 2,178 pregnant women in six of Hong Kong’s regional hospitals and (2) identify the associated demographic, socioeconomic, obstetric and relational correlates. The research design was exploratory, cross-sectional, and quantitative. The Chinese version of a self-administered questionnaire was used to collect the demographic, socio-economic, and obstetric characteristics of the women. Couples’ relationships were investigated using the Dyadic Adjustment Scale. All women in the second trimester of their pregnancies who attended the target antenatal clinics within the data collection period of December 2004 to December 2006 were recruited. The prevalence rates of breastfeeding, mixed feeding and artificial feeding were 53.9%, 14.8%, and 31.3%, respectively. Women who had been born in Hong Kong, lived in accommodation that was ≥300 feet (~30 m), had made an early antenatal booking, had a planned pregnancy, were experiencing their first pregnancy, and had a lower level of conflict with their partners were significantly more likely to opt for breastfeeding. Women who had been born in Hong Kong and already had children were significantly more likely to choose mixed feeding, compared with the artificial group in a multinomial logistic regression model. These findings suggest that effective promotion of breastfeeding during the prenatal period must target the correlates of feeding intention. [ABSTRACT FROM AUTHOR]

In populations where the majority of pregnancies occur to unmarried women, exploring the quality of partner relationships and reproductive health is warranted. This study assesses differences in psychosocial characteristics, health behaviors, and birth outcomes between unmarried pregnant women who reported having a ‘good’ relationship with their baby’s father, compared to those who reported having a ‘fair’ or ‘poor’ relationship with their baby’s father. This research was part of a prospective study of low-income urban women. All unmarried women ( n = 3,633) enrolled during their first prenatal visit were asked questions designed to differentiate between being in a good, fair or poor relationship with the baby’s father. The worse the quality of the relationship, the worse the outcome, with dose–response associations between the quality of the relationship, emotional health, health behaviors, and birthweight. Compared to women in good relationships, those in poor relationships were more likely to have depressive symptoms (aPR 1.93; 95% CI: 1.65, 2.25), stress (aPR 1.24; 95% CI: 1.14, 1.35), use drugs (aPR 1.34; 95% CI: 1.11, 1.61) and smoke (aPR 1.28; 95% CI: 1.10, 1.49). Although infants born to mothers in poor relationships had the highest rate of low birth weight, the differences were not significant. Delving beyond marital status to assess the quality of partner relationships among unmarried mothers is important. Further research is needed to understand the complex interplay of individual, social and environmental factors promoting or hindering stable and supportive partner relationships among socially disadvantaged populations of pregnant women. [ABSTRACT FROM AUTHOR]

This paper brings together a multidisciplinary initiative to develop advanced statistical and computational techniques for analyzing, assessing, and extracting information from raster maps. This information will provide a rigorous foundation to address a wide range of applications including disease mapping, emerging infectious diseases, landscape ecological assessment, land cover trends and change detection, watershed assessment, and map accuracy assessment. It will develop an advanced map analysis system that integrates these techniques with an advanced visualization toolbox, and use the system to conduct large case studies using rich sets of raster data, primarily from remotely sensed imagery. As a result, it will be possible to study and evaluate raster maps of societal, ecological, and environmental variables to facilitate quantitative characterization and comparative analysis of geospatial trends, patterns, and phenomena. In addition to environmental and ecological studies, these techniques and tools can be used for policy decisions at national, state, and local levels, crisis management, and protection of infrastructure. Geospatial data form the foundation of an information-based society. Remote sensing has been a vastly under-utilized resource involving a multi-million dollar investment at the national levels. Even when utilized, the credibility has been at stake, largely because of lack of tools that can assess, visualize, and communicate accuracy and reliability in timely manner and at desired confidence levels. Consider an imminent 21st century scenario: What message does a multi-categorical map have about the large landscape it represents? And at what scale, and at what level of detail? Does the spatial pattern of the map reveal any societal, ecological, environmental condition of the landscape? And therefore can it be an indicator of change? How do you automate the assessment of the spatial structure and behavior of change to discover critical areas, hot spots, and their corridors? Is the map accurate? How accurate is it? How do you assess the accuracy of the map? How do we evaluate a temporal change map for change detection? What are the implications of the kind and amount of change and accuracy on what matters, whether climate change, carbon emission, water resources, urban sprawl, biodiversity, indicator species, human health, or early warning? And with what confidence? The proposed research initiative is expected to find answers to these questions and a few more that involve multi-categorical raster maps based on remote sensing and other geospatial data. It includes the development of techniques for map modeling and analysis using Markov Random Fields, geospatial statistics, accuracy assessment and change detection, upper echelons of surfaces, advanced computational techniques for geospatial data mining, and advanced visualization techniques. [ABSTRACT FROM AUTHOR]

The accurate interpretation of large numbers of neuropsychological tests within a flexible battery approach is a difficult and sometimes controversial process. We present a statistically based method of interpretation (Rohling's Interpretive Method or RIM) and evaluation of neuropsychological data that allows for varying numbers of tests along a varying number of cognitive domains, yet remains psychometrically based. This method requires informed clinical judgment in that the level of confidence for tests, cognitive domains, and global indices are used as the backdrop for interpretive decisions. Specific procedures for use are presented in a systematic, detailed fashion to allow the interested reader to replicate the method. Two case examples are presented: a straightforward case of cerebrovascular insult and a more complicated case of mixed etiology. Examples include a variety of different neuropsychological tests commonly used in a flexible battery approach. A discussion of the practicality, ease of use, and potential limitations of this method are further presented. [ABSTRACT FROM AUTHOR]

Purpose: Folate is an essential micronutrient for fetal development because of its role in de novo synthesis of DNA. The aim of this study was to compare neonatal serum folate levels of babies born to smoking and non-smoking mothers. Methods: Infants of consenting pregnant mothers presenting at ≥37 weeks of gestation were enrolled. Subjects were divided into two groups based on their mother's smoking habits. Blood samples were obtained at birth (from the umbilical cord) and 1 month after delivery for the determination of serum folate levels using a chemiluminescence method. Results: Among 140 consenting subjects, 108 (77%) brought their newborns to their scheduled visit 1 month after delivery, 68 of whom were non-smokers and 40 were smokers. Babies born to smoking mothers had significantly lower serum folate levels compared to those born to non-smoking mothers, both at birth (17.2 ± 5 vs. 24.3 ± 4.9; p < 0.01) and 1 month after delivery (11 ± 4.1 vs. 17.5 ± 4.3; p < 0.01). Conclusion: Our study is the first of its kind to demonstrate that smoking results in significant reductions in serum folate levels of newborns. These results suggest that folic acid supplementation may be required for expectant smoking mothers throughout pregnancy, not just during the first trimester. Similar supplementation may also be warranted for infants born to such mothers. [ABSTRACT FROM AUTHOR]