bluuebunny/crossref_metadata_2025 huggingface dataset:
Phytoplankton Community Composition in the Tri‐Lakes Area of Central Wisconsin, USA
Authors: Bell R. A.
Published: March 2003

Tri‐Lakes (Upper and Lower Camelot, Sherwood, Arrowhead) in Adams County, WI, USA are man‐made impoundments draining substantial agricultural lands and surrounded by considerable shoreline residential development. The planktonic algal community, as sampled from June to November 2000, was sparse‐to‐moderately dense, fairly diverse (69 genera from six divisions basin‐wide), and unremarkable in taxonomic composition. All sites sampled displayed the general algal successional trends expected from northern‐temperate, mildly eutrophic waters. These included sparse but taxonomically diverse communities in the spring; a late spring pulse of diatoms; a late summer pulse of green algae; and a steadily increasing component of Cyanobacteria leading to their community dominance by the end of the growing season. Upper Lake Camelot (55 genera) best represented this pattern. Lower Lake Camelot (53 genera) had a large green algal pulse but only a small diatom pulse. Lake Sherwood was the most taxonomically diverse body (63 genera) and had the most extreme pulses of diatoms and greens. Lake Arrowhead had the lowest taxonomic diversity (39 genera), was the most dominated by Cyanobacteria, and had only minor pulses of diatoms and greens. The algal communities indicate a mesotrophic to slightly eutrophic lake status. Continued agricultural and residential inputs of fertilizers and pesticides will likely exacerbate the cyanobacterial dominance leading to further reductions in aquatic health and aesthetic values. Previous chemical treatment and macrophyte removal have achieved limited success, and might have altered algal community dynamics. Remediation approaches that might improve water quality include: reducing upstream inputs via sediment traps or lagoons; reducing in‐lake nutrients via sediment removal; reducing residential inputs via improved septic/sanitation systems; and shoreline vegetation filter strips.
MAA Synthesis and Accumulation in Polar Macroalgae are Controlled by Abiotic Factors
Authors: Hoyer K. , Karsten U. , Wiencke C.
Published: March 2003

Mycosporine‐like amino acids (MAAs) are regarded as powerful sunscreens protecting the algae against harmful UV radiation. The MAA protection efficiency was tested in algal samples by measuring the optimum quantum yield of photosynthesis using photosystem II fluorescence. It could be demonstrated that the recovery of photosynthesis after exposure to enhanced UV radiation is faster in individuals with high MAA content. MAAs can be synthesized in several polar macroalgae in response to different radiation conditions. Although MAA induction patterns are very species‐specific, some similarities can be found. Field studies indicate that plants from different growth habitats providing distinct radiation climate can be grouped into three physiological categories depending on their MAA content. The first group (I) includes mainly deep‐water species, typically lacking MAAs. The second group (II), algal species found in a broad range of water depths (eu‐ and sublittoral), which are able to flexibly synthesize and accumulate MAAs. The third group (III) includes supra‐ and eulittoral taxa, which always contain high MAA concentrations. In laboratory studies, we showed that taxa of group II and III responded in three different ways based on MAA accumulation when exposed to different radiation conditions (PAR, PAR + UVA, PAR + UVA + UVB). Either they: (a) exhibit highest total MAA concentration under the full artificial spectrum; (b) increase their MAA concentration after exposure to PAR and PAR + UVA or (c) MAA concentration declines after exposure to the full spectrum. Our studies have indicated that when coupled with UVR, exposure to temperature fluctuations ranging from 0 to 10 °C also affect MAA biosynthesis.
Molecular Characteristics of Caulerpa (Chlorophyta) Populations in Taiwan
Authors: Yeh W.‐J. , Lin S.‐C. , Chen G.‐Y.
Published: March 2003

Tropical and subtropical Caulerpa species are epidemic to northern and southern Taiwan seashore. We here describe the molecular characteristics of rRNA gene, including the internal transcribed spacers (ITS) in this genus and a comparison was made with associated species sequences registered in the GenBank. A total of nine specimens (C. racemosa var. microphysa, macrophysa, peltata, laetevirens, C. serrulata and C. elongata) were investigated. Samples were collected and distinguished first from morphological characteristics. The genomic DNA was individually extracted using CTAB protocol. To amplify the 18S rRNA, ITS1, 5.8S rRNA, ITS2 and 28S rRNA sequences, a primer pair NS7 and ITS4, sequences located in nuclear rRNA region, was used. The range of 980–1100 bp DNA fragment from genomic DNA of individual plant was generated from polymerase chain reaction (PCR). Amplified fragments were sequenced automatically with ABI sequencer. The sequences were aligned with those of other Caulerpa species retrieved from the GenBank. The phylogenetic tree was constructed using Clustal method. The comparison of whole sequence and 18S rRNA and ITS1 region among these specimens shows that the interspecies divergence within C. racemosa var. microphysa, macrophysa, peltata and laetevirens is larger than those of intraspecies of C. taxifolia, C. serrulata and C. elongata. It is supposed that they (C. racemosa var. microphysa, macrophysa, peltata and laetevirens) should be in the position of different species in Caulerpa genus from the present rRNA sequences analysis. The sequences of 5.8S region are shown more conserve than that of 18S region. The identity of ITS1 and ITS2 regions in present species are low, comparing with C. taxifolia, C. maxicana.
Numerous Transitions to Land in Green Plants: The ‘Other’ Land Plants
Authors: Lewis L. A.
Published: March 2003

In addition to the more conspicuous embryophyte group, numerous other green plant lineages have made successful transitions to land. Phylogenetic analyses using molecular data indicate that these lineages are primarily derived from freshwater ancestors, and include free‐living and lichen photobiont algae in the class Trebouxiophyceae, and several distinct lineages of free‐living algae in the class Chlorophyceae. In all cases, these independently derived land plants must possess adaptations for environments with reduced water availability, oxidative stress, and different light regimes than experienced by their aquatic ancestors. In the most extreme cases, these algae are living in very arid habitats. Given the monophyly of green plants and the evolution of independent terrestrial lineages from aquatic ancestors, these lineages represent natural experiments in the transition of green photosynthetic organisms to terrestrial living, and offer a rich source of taxa that can be compared experimentally with the embryophytes.
Correlates for Erectile and Ejaculatory Dysfunction in Older Dutch Men: A Community‐Based Study
Authors: Blanker Marco H. , Bohnen Arthur M. , Groeneveld Frans P.M.J. , Bernsen Roos M.D. , Prins Ad , Thomas Siep , Bosch J.L.H. Ruud
Published: March 2003

OBJECTIVES: We estimated correlates for erectile dysfunction (ED) (defined as a report of erections of severely reduced rigidity or no erections) and ejaculatory dysfunction (EjD) (defined as a report of ejaculations with significantly reduced volume or no ejaculations) in a large community sample of older men.

DESIGN: A community‐based study.

SETTING: Krimpen aan den IJssel, a municipality near Rotterdam, The Netherlands.

PARTICIPANTS: A total of 1,688 (50% of the eligible) men age 50 to 78.

MEASUREMENTS: Presence of ED and EjD (International Continence Society sex questionnaire), urinary tract symptoms (international prostate symptom score), prostate enlargement (transrectal ultrasonography), urinary flow obstruction (uroflowmetry), obesity (body mass index), chronic obstructive pulmonary disease (COPD), diabetes mellitus, and cardiovascular problems. Determined marital status, educational level, and smoking and drinking habits. Population attributable risk (PAR) was estimated for correlates that yielded from multiple logistic regression models on ED and EjD.

RESULTS: Multiple logistic regression analyses yielded the following correlates for significant ED: age, smoking, obesity, urinary tract symptoms, and treatment for cardiovascular problems and COPD. Age, erectile function, urinary symptoms, and previous prostate operations proved to be correlates for significant EjD. Urinary symptoms and obesity have the highest PAR for ED, whereas decreased erectile function has the highest PAR for EjD.

CONCLUSIONS: Age, obesity, and urinary tract symptoms are the most‐important correlates of significant ED in the population. Cardiac problems, COPD, and smoking are other independent correlates. Significant EjD is largely related to age, decreased erectile function, and previous prostate surgery.
Effect of Nonsteroidal Anti‐Inflammatory Drug Use on the Rate of Gastrointestinal Hospitalizations Among People Living in Long‐Term Care
Authors: Lapane Kate L. , Spooner Josh J. , Mucha Lisa , Straus Walter L.
Published: March 2003

OBJECTIVES: Gastrointestinal (GI) complications are the most‐common serious adverse reactions associated with nonsteroidal anti‐inflammatory drugs (NSAIDs). We quantified the effect of specific NSAIDs on the rate of GI hospitalizations among older people living in long‐term care.

DESIGN: Retrospective cohort study.

SETTING: All Medicare/Medicaid certified nursing homes in four states (Maine, Minnesota, New York, and South Dakota).

PARTICIPANTS: We identified 125,516 newly admitted residents from a database of all residents (1992–1996) of all Medicare/Medicaid certified nursing homes in four states. Using the federally mandated Minimum Data Set, which includes information on all drugs received (prescription and over‐the‐counter), we identified patients who received at least one prescription for aspirin (n = 19,101) or NSAIDs (n = 9,777). The control population consisted of all institutionalized persons who did not receive these drugs.

MEASUREMENTS: From Health Care Financing Administration inpatient claims, we identified the first hospitalization for GI perforation, ulcer, or hemorrhage that occurred during the year of follow up (ICD9‐CM discharge codes: 531–534, 578). Cox proportional hazards models provided adjusted estimates of rate ratios.

RESULTS: NSAID exposure increased the GI‐event‐related hospitalization rate in both men (rate ratios (RR) = 2.64; 95% confidence interval (CI) = 1.17–5.99) and women (RR = 3.23; 95% CI = 1.85–5.65). The rate of GI hospitalizations for both men and women taking sulindac, naproxen, or indomethacin was higher than for nonusers. The risk of GI‐event‐related hospitalizations was greatest among women exposed to diflunisal (RR = 6.08; 95% CI = 2.27–16.26) or oxaprozin (RR = 6.03; 95% CI = 2.49–14.58).

CONCLUSIONS: Despite the high background rate of GI events, most NSAIDs increased the risk of GI hospitalization. Careful attention to choice of agent and dosing is needed in prescribing NSAIDs in this frail, older population.
Functional Status and Self‐Rated Health in 2,262 Nonagenarians: The Danish 1905 Cohort Survey
Authors: Nybo Hanne , Gaist David , Jeune Bernard , McGue Matt , Vaupel James W. , Christensen Kaare
Published: March 2003

OBJECTIVES: To describe the functional capacity and self‐rated health of a large cohort of nonagenarians.

DESIGN: A cross‐sectional survey of all Danes born in 1905 (92–93 years of age), carried out August to October 1998.

SETTING: Participants' homes.

PARTICIPANTS: Two thousand two hundred and sixty‐two nonagenarians, corresponding to a participation rate of 63% (of these, 20% participated by proxy).

MEASUREMENTS: Activities of daily living (ADLs) and self‐rated health were assessed by interview. Five items from Katz's ADLs (bathing, dressing, transfer, toileting, and eating) were used to construct a three‐level five‐item ADL scale (not disabled (no disabilities), moderately disabled (1–2 disabilities), severely disabled (3–5 disabilities)). From responses to a more extensive list of questions on ADLs (26 items), we identified scales of strength and agility by means of factor analysis. Furthermore, a 26‐item ADL scale was made. Physical performance tests (chair stand, timed walk, lifting a 2.7 kg box, maximum grip‐strength, and flexibility tests) were performed among nonproxy responders.

RESULTS: According to the five‐item ADL scale, 50% of the men and 41% of the women were categorized as not disabled, while 19% and 22%, respectively, were categorized as severely disabled. The five‐item ADL scale correlated highly with the 26‐item ADL scale (r = 0.83). The ADL scales showed moderate‐to‐good correlation with each other (r = 0.74–0.83), and with the physical performance tests (r = 0.31–0.58). Only 3.7% of the women and 6.3% of the men walked (normal pace) with a speed of at least 1 meter per second, which is the minimum walking speed required to cross signaled intersections in Denmark. A total of 56% considered their health to be excellent or good. Of the participants, 74% were always or almost always satisfied with their lives, even though only 45% reported that they “felt well enough to do what they wanted.” The analyses showed that no single ADL item seemed to be of particular importance for how the participants rated their health.

CONCLUSION: The Danish 1905 cohort survey is the largest and the only nationwide survey of a whole birth‐cohort of nonagenarians. A total of 2,262 fairly nonselected nonagenarians participated. The level of both self‐reported disability and functional limitations measured by physical performance tests among nonagenarians was high. Despite their lower mortality, women were more disabled than men and did not perform as well as men in the physical performance tests. Nevertheless, the majority of the participants considered their health to be good and were satisfied with their lives.
The Relationship of APOE Genotype to Cognitive Functioning in Older African‐American and Caucasian Community Residents
Authors: Fillenbaum Gerda G. , Landerman L. Richard , Blazer Dan G. , Saunders Ann M. , Harris Tamara B. , Launer Lenore J.
Published: March 2003

OBJECTIVES: To determine whether cognitive decline associated with the apolipoprotein E (APOE) ɛ4 allele is different in older African Americans than it is in Caucasians.

DESIGN: Performance on a brief screen of cognitive functioning was examined at baseline (N = 1,891) and 4 years later (N = 1,389) to determine the extent to which the presence of APOEɛ4 affected level of and change in performance, and whether this differed as a function of race, age, initial score, and change in score.

SETTING: Five adjacent counties in the Piedmont area of North Carolina.

PARTICIPANTS: In 1986, a stratified random household sample of community residents age 65 and older (n = 4,162; 54% African‐American, 45% Caucasian, 1% other race) formed the Duke Established Populations for Epidemiologic Studies of the Elderly. Of those available at the sixth annual wave, 76% were genotyped, with 1,891 providing baseline data on this wave, and the available survivors (n = 1,389) providing longitudinal data 4 years later.

MEASUREMENTS: The Short Portable Mental Status Questionnaire (SPMSQ), a brief screen of cognitive functioning, was administered to all subjects on both occasions. We examined score at baseline and cognitive decline (i.e., increase of 2+ errors) at follow‐up. Control measures included demographic characteristics, health behaviors, health and functional status, and medication use. APOE status was coded as ɛ4 present versus absent.

RESULTS: APOEɛ4 was significantly and uniquely related to lower score at baseline and significantly increased the odds of cognitive decline by 59%. There was no statistically significant interaction between APOEɛ4 and age, race, initial SPMSQ score, or SPMSQ score at follow‐up.
Compliance with CPAP Therapy in Older Men with Obstructive Sleep Apnea
Authors: Russo‐Magno Patricia , O'Brien Aidan , Panciera Toni , Rnp  , Rrt  , Rounds Sharon
Published: March 2003

OBJECTIVES: Factors specifically affecting compliance with continuous positive airway pressure (CPAP) in older patients with obstructive sleep apnea (OSA) have not been described. The purpose of this study is to determine which factors are associated with compliance and noncompliance in older patients, a growing segment of the population.

DESIGN: A retrospective chart review of older male patients prescribed CPAP therapy for OSA over an 8‐year period.

SETTING: Veterans Affairs Medical Center.

PARTICIPANTS: All patients age 65 and older for whom CPAP therapy had been prescribed for treatment of OSA in the past 8 years.

MEASUREMENTS: Records of all older male patients prescribed CPAP therapy for OSA over the last 8 years were reviewed. Compliance was defined by time‐counter readings averaging 5 or more hours of machine run‐time per night.

RESULTS: Of 33 older male patients with OSA studied, 20 were found to be compliant and 13 noncompliant with nasal CPAP therapy. The mean age (± SEM) at the time of diagnosis of OSA in the compliant group was 68 (±1) years, whereas that of the noncompliant group was 72 (±1) years (P < .05). Of the compliant patients, 95% attended a CPAP patient education and support group, whereas only 54% of noncompliant patients attended (P = .006). Resolution of initial symptoms of OSA with CPAP therapy was significantly associated with compliance. Symptom resolution occurred in 90% of compliant patients and in only 18% of noncompliant patients (P < .0002). Factors that were significantly associated with noncompliance with CPAP were cigarette smoking, nocturia, and benign prostatic hypertrophy (BPH). Of noncompliant patients, 82% complained of nocturia, whereas only 33% of compliant patients complained of nocturia (P = .02). BPH was diagnosed in 62% of noncompliant patients and in only 15% of compliant patients (P = .004). Diuretic use was more common in the compliant group and, therefore, was not a cause of increased nocturia in noncompliant patients.

CONCLUSION: In older male patients with OSA, compliance with CPAP therapy is associated with attendance at a patient CPAP education and support group. Resolution of symptoms with therapy also appears to be associated with enhanced compliance. In addition, we found an association between nocturia and the existence of BPH in older men with OSA who are not compliant with nasal CPAP. Larger observational studies should be performed to confirm these findings, and, if so confirmed, then further studies to determine whether treatment of BPH in older men with OSA improves compliance with CPAP.
Insulin Action After Resistive Training in Insulin Resistant Older Men and Women
Authors: Ryan Alice S. , Hurlbut Diane E. , Lott Mary E. , Ivey Fred M. , Fleg Jerome , Hurley Ben F. , Goldberg Andrew P.
Published: March 2003

OBJECTIVES: To determine the effects of resistive training (RT) on insulin action and assess the determinants of the changes in insulin action.

DESIGN: Longitudinal study.

SETTING: Outpatient setting.

PARTICIPANTS: Eighteen older men and older postmenopausal women (65–74 years) with normal (6 men and 5 women) or impaired glucose tolerance (4 men and 3 women).

INTERVENTION: Six months of progressive whole‐body RT.

MEASUREMENTS: Upper and lower body strength was assessed by the one repetition maximum test. Total body fat and fat‐free mass (FFM) were determined by dual‐energy x‐ray absorptiometry before and after 6 months of RT. Insulin sensitivity was estimated from the relationship of glucose utilization (M) to the concentration of insulin (I) during the last 30 minutes of 3‐hour hyperinsulinemic‐euglycemic clamps (240 pmol·m−2·min−1) (M/I) before and after RT.

RESULTS: RT significantly improved upper and lower‐body muscular strength (P < .005). FFM increased after RT in the entire group (P < .0l) with no significant change in body fat. Although the change in M was larger in men (13%) than women (3%), the difference was not significant. The change in M was a function of initial M (r=−0.53, P < .05). There was a trend (0.060 ± 0.006 vs 0.066 ± 0.006 μmol·kg−1·min−1/pmol/l, n = 18) for M/I to increase after RT in the combined group of men and women (P= .06). There were no significant relationships between changes in M or M/I with changes in body composition or strength.

CONCLUSION: A 6‐month RT program tends to improve insulin action in insulin‐resistant older adults. These results suggest that RT may be useful in ameliorating insulin resistance that often occurs with physical inactivity, obesity, and loss of muscular strength in older insulin resistant men and women.
Effects of Resistance Training on Insulin‐Like Growth Factor and its Binding Proteins in Men and Women Aged 60 to 85
Authors: Borst Stephen E. , Vincent Kevin R. , Lowenthal David T. , Braith Randy W.
Published: March 2003

OBJECTIVES: We have reported that resistance training (RT) elevates insulin‐like growth factor (IGF‐I) in healthy young adults. Our goals were to determine whether RT produces a similar effect in the healthy older persons and to determine the effects of low‐ versus high‐intensity RT on hormonal status.

SETTING: Center for Exercise Science, University of Florida, Gainesville.

PARTICIPANTS: Sixty‐two men and women (mean age = 68.1).

INTERVENTION: A 6‐month, 3‐day/week program of low‐intensity RT (LEX), high‐intensity RT (HEX), or no exercise (CON).

MEASUREMENTS: Before and after training, blood was drawn for hormone analysis. IGF‐I, IGF binding protein‐1 (IGFBP‐1), and IGFBP‐3 were measured at rest. Testosterone and cortisol were measured at rest and immediately after exercise.

RESULTS: RT caused significant increases in 1‐repetition maximum (1RM) strength and peak oxygen consumption (V02peak), which we have reported separately. Currently, we report that RT had no effect on the resting serum concentrations of IGF‐I, IGFBP‐1, IGFBP‐3, testosterone, or cortisol. Acute resistance exercise caused no change in circulating testosterone in men or women but did cause a significant elevation of cortisol in the HEX group. This increase in cortisol was blunted as a result of training.

CONCLUSIONS: We conclude that the increases in strength and endurance caused by RT were not mediated by increases in circulating IGF‐I, IGFBPs, or testosterone.
Good Deaths, Bad Deaths, and Preferences for the End of Life: A Qualitative Study of Geriatric Outpatients
Authors: Vig Elizabeth K. , Davenport Nathaniel A. , Pearlman Robert A.
Published: March 2003

OBJECTIVES: Patient involvement in decision‐making has been advocated to improve the quality of life at the end of life. Although the size of the oldest segment of the population is growing, with greater numbers of older adults facing the end of life, little is known about their preferences for the end of life. This study aimed to explore the attitudes of older adults with medical illness about the end of life, and to investigate whether current values could be extended to end‐of‐life preferences.

DESIGN: Descriptive study with interviews using open‐ and closed‐ended questions.

SETTING: Patients attending two university‐affiliated geriatric clinics were interviewed in a private conference room near the clinic they attended or in their homes.

PARTICIPANTS: Sixteen older men and women identified by their physicians as having nonterminal heart disease or cancer.

MEASUREMENTS: The interview contained open‐ended questions such as: “What are the most important things in your life right now?” and “What would you consider a good/bad death?” The interview also contained closed‐ended questions about symptoms, quality of life, and health status. Additional questions elicited preferences for the end of life, such as location of death and the presence of others. The open‐ended questions were tape‐recorded, transcribed, and analyzed using qualitative methods. The closed‐ended questions were analyzed using descriptive statistics.

RESULTS: Patients with heart disease and cancer provided similar responses. Participants' views about good deaths, bad deaths, and end‐of‐life scenarios were heterogeneous. Each participant voiced a unique combination of themes in describing good and bad deaths. Because each participant described a multifaceted view of a good death, for instance, no theme was mentioned by even half of the participants. Participants provided differing explanations for why given themes contributed to good deaths. Currently valued aspects of life were not easily translated into end‐of‐life preferences. For example, although the majority of participants identified their family as being important, many gave reasons why they did not want their family members present when they died.

CONCLUSIONS: Because of the heterogeneity of views and the difficulty in inferring end‐of‐life preferences from current values, older adults should be asked not only questions about general values, but also specific questions about their end‐of‐life choices and the reasons for these choices. A thorough understanding of an individual's end‐of‐life preferences may help health professionals working with older adults develop patient‐centered care plans for the end of life.
Percentage of Body Fat and Body Mass Index Are Associated with Mobility Limitations in People Aged 70 and Older from NHANES III
Authors: Davison Kirsten Krahnstoever , Ford Earl S. , Cogswell Mary E. , Dietz William H.
Published: March 2003

OBJECTIVES: To assess the association between functional limitations and body composition indices, including percentage of body fat, muscle mass, and body mass index (BMI).

DESIGN: A cross‐sectional, population‐representative sample.

SETTING: All noninstitutionalized people living in the United States (National Health and Nutrition Examination Survey). Data were collected between 1988 and 1994.

PARTICIPANTS: One thousand five hundred twenty‐six women and 1,391 men aged 70 and older.

MEASUREMENTS: Independent variables included BMI, muscle mass, and percentage of body fat; the latter two were assessed using predictive equations. The dependent variable, functional limitations, was defined as difficulty in performing at least three of five functional living tasks, such as carrying a 10‐pound bag of groceries.

RESULTS: Women in the highest quintile for percentage of body fat and women with a BMI of 30 or greater were two times more likely to report functional limitations than women in the comparison groups. Similar, but weaker, relationships were found among men; men in the highest quintile for body fat and men with a BMI of 35 or greater were 1.5 times more likely to report limitations. Low muscle mass (sarcopenia) and sarcopenia in combination with high percentage of body fat (sarcopenic obesity) were not associated with a greater likelihood of reporting functional limitations.

CONCLUSIONS: Prevention of excessive accumulation of body fat and maintenance of a BMI in the normal range may reduce the likelihood of functional limitations in old age.
Intraoperative loading attenuates nausea and vomiting of tramadol patient‐controlled analgesia. (Show‐Chwan Memorial Hospital, Changhua, Taiwan) Can J Anaesth 2000;47:968–973.
Authors: Pang Wei‐Wu , Mok Martin S. , Huang Shyuan , Hung Chih‐Peng , Huang: Min‐Ho
Published: March 2003

Sixty adult patients scheduled for elective abdominal surgery were enrolled into this prospective, randomized, double‐blinded study. The patients were anesthetized in a similar manner. At the beginning of wound closure, the patients were randomly allocated to receive tramadol (Group 1) or normal saline (Group 2). Pain control and adverse effect assessments were done in the PACU and every 6 h for 48 h post drug by an independent observer. The loading dose was 290 ± 45 mg in Group 1 and 315 ± 148 mg in Group 2. In PACU, more nausea and vomiting both in terms of incidence and severity were observed in patients with postoperative loading than in those with intraoperative loading of tramadol. Conclude that administering the loading dose of tramadol during surgery decreases the nausea and vomiting associated with a high dose of tramadol and improves the quality of tramadol PCA in the relief of postoperative pain.

Comment by Lian‐Kah Ti, M.D. The clinical application and conclusions of this study have to be questioned. It was not surprising that a loading dose of tramadol could effectively be given intraoperatively. What was surprising was that the authors chose not to give any analgesics either preoperatively or intraoperatively for relatively major surgery in an older population, potentially risking morbidity. Indeed, analgesics were withheld in the control group until the patients were extubated, awake, responsive, and complained of pain. Another source of concern was the large loading dose used. Based on their own experience, the authors gave doses of 300 mg of tramadol, which far exceeded the maximum recommended single dose of 100 mg as stated in the manufacturer's instruction for use. The authors did not report any intraoperative hemodynamic consequences from the loading dose, although they noted that the amount of isoflurane required was decreased. The authors concluded that the decreased nausea and vomiting seen in the patients receiving tramadol intraoperatively resulted from the patients being anesthetized at the point when peak plasma levels were achieved. An alternative explanation could be that the patients in the control group had greater postoperative pain (initial VAS of 5.9), and that pain itself resulted in the increased nausea and vomiting. Therefore, the value of this study is doubtful.
Blockade of the Superior Hypogastric Plexus Block for Visceral Pelvic Pain
Authors: Bosscher Hemmo
Published: March 2003

Abstract: Visceral pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain independent of its etiology. Five major pathways by which pelvic pain is transmitted can be identified. One of them, the superior hypogastric plexus, an extension of the preaortic plexus, is easily assessable to blockade by local anesthetics and neurolytic agents. Several techniques have been described. Long‐lasting pain relief with this procedure has been achieved in patients with pelvic cancer pain. However, there is a discrepancy between diagnostic and therapeutic blockade in patients with nonmalignant pain. Because a diagnostic blockade can give significant pain relief in a large variety of patients, it is worthwhile to investigate new methods that provide lasting neural blockade of the superior hypogastric plexus and long‐lasting relief of this devastating condition.
Complex regional pain syndrome type I treated with topical capsaicin: a case report. (Erasmus University Medical Center, Rotterdam, The Netherlands) Arch Phys Med Rehabil. 2001;82:851–852.
Authors: Ribbers Gerald M. , Stam Henk J.
Published: March 2003

This report described the case of a multitrauma patient who underwent an amputation of the left arm and had a complicated left crural fracture with a delayed union. He was treated in an inpatient setting for preprosthetic training for a myoelectric prosthesis and to regain walking abilities. After consolidation of the crural fracture, complex regional pain syndrome type I (CRPS I) developed in the left foreleg, which hindered mobilization. Topical capsaicin 0.075% was prescribed and a stress‐loading mobilization schema was instituted. No other treatment modalities directed at CRPS I were added. After 6 weeks, no signs or symptoms of CRPS I were present and capsaicin was discontinued. Capsaicin is a well‐accepted and documented treatment modality in neuropathic pain states such as postherpetic neuralgia. However, it has rarely been described in CRPS I. Capsaicin is discussed within the framework of recent insights in the neurobiology of nociception, and it is concluded that it may provide a theory‐driven treatment for CRPS I, especially in the acute stage, which facilitates physical therapy and prevents peripheral and spinal sensitization.
Effects of Tourniquet Ischemia on Current Perception Thresholds in Healthy Volunteers
Authors: Baron Georgeann C. , Irving Gordon A.
Published: March 2003

Abstract: The neuroselective effects of tourniquet isch‐ emia/compression in healthy volunteers were evaluated using the automated electrodiagnostic sensory Nerve Conduction Threshold (sNCT) test. The sNCT evaluation generates reliable, painless Current Perception Threshold (CPT) measures. Standardized CPT measures using constant alternating current sinusoid waveform stimulus at 3 different frequencies 5 Hz, 250 Hz, and 2 kHz (NeurometerEG CPT/C Neurotron, Inc. Baltimore, MD) were obtained from 10 individuals at baseline and after 5, 10, 15, and 20 minutes of tourniquet ischemia and 30 minutes post‐tourniquet release. The data were analyzed to determine the significance of any changes in CPTs. Increases in CPTs after 15 and 20 minutes of tourniquet ischemia at 2000 Hz and 250 Hz reached statistical significance. There were no significant changes in 5 Hz CPT measures. The results of this study demonstrate the ability of the sNCT test to quantify previously described differential neuroselective effects of tourniquet ischemia on sensory nerve function. Demonstration of statistically significant increases in CPT values at 2000 Hz and 250 Hz secondary to tourniquet ischemia, with no change in 5 Hz CPT values, is consistent with the understanding that 2000 Hz sine wave stimuli activate the large myelinated sensory fibers, 250 Hz sine wave stimuli activate small myelinated sensory fibers, and 5 Hz sine wave stimuli activate small unmyelinated sensory fibers.
Rescue by peripheral blood mononuclear cells in dogs from bone marrow failure after total‐body irradiation
Authors: ZANDER A. R. , GRAY K. N. , HESTER J. P. , JOHNSTON D. A. , SPITZER G. , RAULSTON G. L. , MCCREDIE K. B. , JARDINE J. H. , Wu J. , GLEISER C. , CUNDIFF J. , DICKE K. A.
Published: March 2003

In order to determine the minimum dose of buffy coat cells necessary to achieve hematopoietic rescue following supralethal irradiation, mongrel dogs under general anesthesia were subjected to leukacytapheresis using three different techniques of cell separation. The buffy coats were frozen with dimethylsulfoxide and stored at −196 degrees C until transfused. Sixteen dogs were irradiated with 800 rads and were supported with antibiotics and transfusions of irradiated homologous blood. They were transfused with the frozen and thawed buffy coat cells, and, if they survived, they were followed for 100 days, sacrificed, and their tissues studied. The mean yield of mononuclear cells during leukocytapheresis ranged from 4.1 +/− 2.0 × 10(9) (mean +/− SD) to 6.0 +/− 4.0 × 10(9) for the three leukacytapheresis methods; one technique was not as satisfactory as the other two. Six of the 16 dogs fully recovered with evidence of marrow rescue; however, only one had a dose of mononuclear cells less than 11.1 × 10(9). These data indicate that seven to 17 leukacytapheresis procedures would be required to reconstitute a 70 kilogram patient. These preliminary findings suggest that, because the yields of transplantable cells with current technology are not adequate, the transplantation potential of buffy coat cells exposed to mobilizing agents should be evaluated.
Specific removal of antibodies with an immunoadsorption system
Authors: Branda R.F. , Klausner J.S. , Miller W.J. , Soltis R.D.
Published: March 2003

A continuous flow immunoadsorption system consisting of a cell separator, protein A‐sepharose columns, and a semi‐automatic elution component was developed to specifically remove circulating IgG. This system provides extensive absorption with an essentially unlimited column bed volume. Six dogs were treated a total of 19 times. In no case did fever, sepsis, or respiratory distress result from the treatment. Serial blood counts and tests of liver and renal function remained in the normal range. Ex vivo perfusion of one plasma volume caused an acute drop in IgG levels of approximately 50 percent. This was reflected in a similar decrease in specific antibody levels to sheep erythrocytes, bovine serum albumin, and canine parvovirus. Antibody kinetics following immunoadsorption were variable, but in several cases, antibody levels remained lowered. This immunoadsorptive system appears to be a safe and effective alternative to plasma exchange for removal of IgG antibodies.
Transfusion of frozen erythrocytes from a donor with sickle trait
Authors: Kelleher J.F. , Luban N.L.
Published: March 2003

We describe a nonanaphylactic hemoglobinuric reaction caused by transfusion of frozen red cells, deglycerolyzed by standard technique, obtained from a donor with undiagnosed sickle trait. Although significant hemoglobinemia and hemoglobinuria were noted, the recipient experienced no adverse clinical reactions. The benign clinical course supports the hypothesis that red cell antigen‐antibody complexes, rather than free hemoglobin or red cell stroma, are responsible for the life‐threatening complications of acute hemolytic transfusion reactions. This report also emphasizes the importance of screening donors of red cells for cryopreservation for sickle trait and the necessity of modifying deglycerolization technique should it be necessary to freeze red cells with AS hemoglobin.
A human alloanti‐N enhanced by acid media
Authors: Reid M.E. , Ellisory S.S. , Barker J.M.
Published: March 2003

The serum from a 47‐year‐old man who had not been transfused previously was tested with reagent red cells selected from different commercial manufacturers to confirm the presence of an alloanti ‐N. Agglutination of homozygous N‐positive red cells at 22 degrees C ranged from score 3 to 12. This variable reactivity was found to be due to pH, and the optimal reactivity was in test media below pH 7.
The rare red cell phenotype Gerbich negative in Japanese
Authors: Okubo Y. , Yamaguchi H. , Seno T. , Kikuchi M. , Abe S. , Ishijima A. , Daniels G.L.
Published: March 2003

Two Japanese propositi with the rare Gerbich ‐negative (Ge‐) phenotype were found by screening serum of donors for antibodies. These are the first two examples of Ge negative in Japanese. Both had the Gerbich type of Ge‐negative phenotype (Ge: −1, −2, −3,), showed some depression of Kell system antigens, and had anti‐Ge in their sera. The parents of each of the propositi were first cousins, and one of the propositi had two Ge‐negative siblings.
Hemostatic imbalances produced by plasma exchange
Authors: Domen RE , Kennedy MS , Jones LL , Senhauser DA
Published: March 2003

Ten patients who underwent intensive therapeutic plasma exchange were studied prospectively to determine the nature and extent of changes induced in their coagulation mechanisms. The patients' plasma was replaced with serum albumin and normal saline. Significant changes were noted acutely in the prothrombin time, activated partial thromboplastin time, plasma fibrinogen, and platelet counts. Chronically, significant decreases were found in plasma fibrinogen concentrations and platelet counts. Intensive plasma exchange with fluids devoid of coagulation factors results in defects in the normal hemostatic mechanism.
Effect of cryopreservation on lymphocyte markers evaluated by monoclonal antibodies
Authors: Glassman A. B. , Christopher J. B.
Published: March 2003

Lymphocytes were frozen at a density of 5 to 10 × 10(6) cells per ml at 1 degree C per minute in a programmable liquid nitrogen freezer. T‐ subsets were determined by using monoclonal antibodies. A fluorescein‐ conjugated polyvalent antisera with B‐cell specificity was used to define B‐cells. No significant change in numbers of total T‐lymphocytes or ‐subsets was identified in the frozen lymphocytes when compared to fresh controls. Liquid nitrogen cryopreservation is an acceptable method of storing lymphocytes for subsequent determination of T‐subsets using monoclonal antibodies.
An erythrocyte Pr auto‐antibody with sialoglycoprotein specificity in a patient with purine nucleoside phosphorylase deficiency
Authors: McGinniss Mary H. , Wasniowska Kazimiera , Zopf David A. , Straus Stephen E. , Reichert Cheryl M.
Published: March 2003

A warm auto‐antibody with specificity in the Pr blood group system was demonstrated in the serum and red cell eluate of a patient with purine nucleoside phosphorylase (NP) deficiency. The antibody reacted with all cells tested except En(a‐) red cells which lack glycophorin A, the major erythrocyte sialoglycoprotein. However, anti‐Ena was ruled out by absorption of the antibody with En(a‐) red cells. The antibody demonstrated similar serologic characteristics to Pra antibodies, except that those previously described were inactive with protease‐ treated red cells, while in this case, reactivity was destroyed by papain and ficin but maintained in the presence of trypsin. Inhibition analysis with purified glycoprotein fragments localized the predominant reactive antigen on the MN sialoglycoprotein between amino acid residues 40 and 61. Serologic tests demonstrated its presence in decreased amount on at least one other erythrocyte membrane structure. The serum from another patient with NP deficiency contained an autoantibody similar to the one described here. It may be of interest to explore the association of auto‐antibodies to erythrocyte sialoglycoprotein antigens in NP and other immune deficiency states.
AIDS, ETHICS, AND THE BLOOD SUPPLY
Authors: Miller William V. , Simon Ernest R.
Published: March 2003

Although the conference was not held to determine policy, certain issues emerged which should be of interest to all involved with the initiation of anti‐HTLV‐III testing. First, there was a consensus that an implementation period during which donors will not be notified of the test results is essential. During this period, test proficiency, data confidentiality safeguards, and positive donor counseling procedures can be established. Also, during this period alternative test sites can be established; this was considered a critical step to maintain the safety of the blood supply. Second, there was a perceived need for legislation to protect the confidentiality of sensitive test data, whether in the laboratory or as part of a deferral list system, from subpoena. Third, there was not agreement about whether inventory should be tested; donors who provided that inventory did not know it was to be tested, and might not have consented if the implications of testing had been known. But, inventory testing is clearly in the interest of the recipient. Finally, there was an awareness in the blood banking community of their new role in monitoring a public health menace, and a beginning acceptance of this role emerged.
Glycogen metabolism in stored granulocytes
Authors: Lane T. A. , Lamkin G. E.
Published: March 2003

Optimal function of transfused granulocytes (PMNs) requires adequate glycogen metabolism. Previous studies in our laboratory suggested that stored PMNs had decreased glycogen. We report here the glycogen content and chemotaxis of stored PMNs, and the ability of fresh and stored PMNs to use glycogen as the fuel source for chemotaxis. PMNs were prepared from 8 fresh units of blood drawn into citrate‐phosphate‐dextrose‐ adenine, suspended at 2 or 8 × 107 PMN per ml in autologous plasma with or without 15 mM sodium bicarbonate, and stored at 22 to 24°C in transfer packs for 48 hours. Glycogen was measured on resting PMNs, and after challenge with opsonized zymosan and F‐Met‐Leu‐ Phe (FMLP). The chemotaxis of fresh and stored PMNs was measured in the presence or absence of extracellular glucose.

Fresh PMNs contained 10.3 ± 0.5 (mean ± SEM) μg of glycogen per 106 PMN. Glycogen decreased by 4.2 ± 0.9 μg per 106 PMN after challenge with opsonized zymosan and by 1.1 ± 0.6 μg per 106 PMN after FMLP. After 48 hours of storage, neutrophil glycogen increased by 18 percent, except in units stored at a concentration of PMN of 8 × 107 per ml without sodium bicarbonate. In PMNs from these units stored without bicarbonate, glycogen decreased by 9 percent (p < .05), and there was a 19 and 55 percent decrease in the ability of PMN from these units to metabolize glycogen after exposure to opsonized zymosan and FMLP, respectively (p < 0.05). In addition, in PMNs from units stored at a concentration of PMN of 8 × 107 per ml without bicarbonate, there was a 47 and 70 percent decrease in chemotaxis at 24 and 48 hours, respectively (p < 0.05). The chemotaxis of PMNs from all units was decreased, when measured in the absence of glucose (fresh PMNs, 10.3% decrease in chemotaxis without glucose; 24 hours storage 24 ± 2% decrease; 48 hours storage, 32 ± 3% decrease).

We conclude that 1) storage of PMNs for 24 hours is accompanied by increased glycogen content, except in units stored at high concentration; 2) glycogenolysis stimulated by phagocytosis or a chemotactic stimulus is attenuated after storage; and 3) chemotaxis of PMNs suspended in glucose‐free medium is also somewhat decreased after storage. From these data, we also conclude that the functional and metabolic changes which accompany storage of PMNs, either at low or high cell concentration, are not due to insufficient glycogen stores and that, while defective glycogenolysis may slightly impair the chemotaxis of stored PMNs, it is not the major cause of impaired chemotaxis in PMNs after storage.
Pre‐transfusion testing problems caused by anti‐lymphocyte globulin and their solution
Authors: Ballas S. K. , Draper E. K. , Dignam C. M.
Published: March 2003

Anti‐lymphocyte globulin (ALG) is an antibody to human lymphocytes used to decrease T‐cells in renal transplant patients. We recently encountered serologic problems in testing blood from patients treated with ALG. Thirty‐nine patients undergoing acute kidney rejection developed positive direct and indirect antiglobulin tests following the administration of equine ALG. Sera from these patients reacted with all red cells (RBCs) tested using both polyspecific and monospecific anti‐ IgG anti‐human sera. Eluates prepared from the patients' RBCs showed similar reactivity. The ALG panagglutinin did not react by manual hexadimethrine bromide (Polybrene) technique. The ALG panagglutinin could be neutralized by anti‐human globulin. In our hands, these techniques were useful in distinguishing ALG panagglutinin from co‐ existing alloantibodies.
The effect of temperature and mode of agitation on the resuspension of platelets during preparation of platelet concentrates
Authors: WELCH M. , CHAMPION A. B.
Published: March 2003

ABSTRACT: A problem arose in a blood bank in which about 10 percent of platelet concentrates (PC) observed at day 1 had a large number of macroscopic aggregates. The aggregates were clumps of platelets that did not go into suspension during preparation of PC. These units were set aside for observation. A maximum of 25 percent were stored on a circular rotator; the remainder were stored on either an elliptical rotator or horizontal shaker. By the end of storage, 6 percent of the units still had a large number of clumps. This percentage was reduced to 2.4 percent, when all clumped units were stored on a circular rotator. The number of clumped units observed at day 1 and at the end of storage were reduced dramatically when the temperature of the laboratory (18–19°C), centrifuge (20°C) and storage environmental chamber (22°C) were increased to 24°C. The units with clumps at day 5 were reduced from 225 (out of 8316) to 25 (out of 7137).