bluuebunny/crossref_metadata_2025 huggingface dataset:
Perioperative cardiac arrest and its mortality in children. A 9‐year survey in a Brazilian tertiary teaching hospital
Authors: GOBBO BRAZ LEANDRO , BRAZ JOSÉ REINALDO CERQUEIRA , MÓDOLO NORMA SUELI PINHEIRO , NASCIMENTO PAULO DO , BRUSHI BRUNO AUGUSTO MOURA , RAQUEL DE CARVALHO LÍDIA
Published: March 2006

Background:  The incidence of perioperative cardiac arrest and mortality in children is higher than in adults. This survey evaluated the incidence, causes, and outcome of perioperative cardiac arrests in a pediatric surgical population in a tertiary teaching hospital between 1996 and 2004.

Methods:  The incidence of cardiac arrest during anesthesia was identified from an anesthesia database. During the study period, 15 253 anesthetics were performed in children. Data collected included patient demographics, surgical procedures (elective, urgent, or emergency), ASA physical status classification, anesthesia provider information, type of surgery, surgical areas, and outcome. All cardiac arrests were reviewed and grouped by the cause of arrest and death into one of four groups: totally anesthesia‐related, partially anesthesia‐related, totally surgery‐related, or totally child disease or condition‐related.

Results:  There were 35 cardiac arrests (22.9 : 10 000) and 15 deaths (9.8 : 10 000). Major risk factors for cardiac arrest were neonates and children under 1 year of age (P < 0.05) with ASA III or poorer physical status (P < 0.05), in emergency surgery (P < 0.05), and general anesthesia (P < 0.05). Child disease/condition was the major cause of cardiac arrest or death (P < 0.05). There were seven cardiac arrests because of anesthesia (4.58 : 10 000) – four totally (2.62 : 10 000) and three partially related to anesthesia (1.96 : 10 000). There were no anesthesia attributable deaths reported. The main causes of anesthesia attributable cardiac arrest were respiratory events (71.5%) and medication‐related events (28.5%).

Conclusions:  Perioperative cardiac arrests were relatively higher in neonates and infants than in older children with severe underlying disease and during emergency surgery. The fact that all anesthesia attributable cardiac arrests were related to airway management and medication administration is important in prevention strategies.
Epidural analgesia in a patient with an intrathecal catheter and subcutaneous pump to deliver baclofen
Authors: PIPER NATALIA A. , FLACK SEAN H. , LOESER JOHN D. , LYNN ANNE M.
Published: March 2006

Baclofen is used for the treatment of spasticity. Small doses administered intrathecally achieve high cerebrospinal fluid concentrations with reduced side‐effects. Pediatric anesthesiologists are often reluctant to consider epidural analgesia in children receiving baclofen via an intrathecal catheter and subcutaneous pump. This reluctance is based on concerns for damaging the intrathecal catheter and introducing infection. In addition, the acute cessation of intrathecal baclofen can precipitate a life‐threatening withdrawal state. We report a case of successful epidural analgesia in a patient receiving intrathecal baclofen and discuss the steps we took to minimize the chance of harm with this technique. We conclude that an intrathecal catheter and subcutaneous pump to deliver baclofen should not preclude the use of an epidural catheter for perioperative analgesia.
Evaluation of in vitro antimicrobial activity of Thai basil oils and their micro‐emulsion formulas against Propionibacterium acnes
Authors: Viyoch J. , Pisutthanan N. , Faikreua A. , Nupangta K. , Wangtorpol K. , Ngokkuen J.
Published: March 2006

Synopsis

The aim of this study was to evaluate the efficacy of Thai basil oils and their micro‐emulsions, on in vitro activity against Propionibacterium acnes. An agar disc diffusion method was employed for screening antimicrobial activity of the essential oils of Ocimum basilicum L. (sweet basil), Ocimum sanctum L. (holy basil) and Ocimum americanum L. (hoary basil) against P. acnes. Minimum inhibitory concentration (MIC) values of the basil oils were determined using an agar dilution assay. The obtained results indicated that the MIC values of sweet basil and holy basil oils were 2.0% and 3.0% v/v, respectively, whereas hoary basil oil did not show activity against P. acnes at the highest concentration tested (5.0% v/v). Gas chromatography‐mass spectrometry analysis revealed that methyl chavicol (93.0%) was the major compound in sweet basil oil, and eugenol (41.5%), γ‐caryophyllene (23.7%) and methyl eugenol (11.8%) were major compounds in holy basil oil. Hoary basil oil contained high amounts of geraniol (32.0%) and neral (27.2%) and small amounts of methyl chavicol (0.8%). The Oil‐in‐water (o/w) micro‐emulsions of individual basil oils with concentrations corresponding to their MIC values were formulated. The stable o/w micro‐emulsion system for basil oil consisted of 55.0% v/v water phase, 10.0% v/v oil phase (2.0 or 3.0% v/v sweet basil or 3.0% v/v holy basil oil plus 7.0% v/v isopropyl myristate), 29.2% v/v polysorbate 80 and 5.8% v/v 1,2‐propylene glycol. Hydroxyethylcellulose at a concentration of 0.5% w/v was used as thickening agent. According to the disc diffusion assay, the formulations containing sweet basil oil exhibited higher activity against P. acnes than those containing holy basil oil, and the thickened formulations tended to give a lower activity against P. acnes than the non‐thickened formulations. The prepared micro‐emulsions were stable after being tested by a heat–cool cycling method for five cycles. These findings indicate the possibility to use Thai sweet and holy basil oil in suitable formulations for acne skin care.
Increased health care utilization and increased antiretroviral use in HIV‐infected individuals with mental health disorders
Authors: Mijch A , Burgess P , Judd F , Grech P , Komiti A , Hoy J , Lloyd JH , Gibbie T , Street A
Published: March 2006

Objectives

The aims of the study were to describe the prevalence and associations of mental health disorder (MHD) among a cohort of HIV‐infected patients attending the Victorian HIV/AIDS Service between 1984 and 2000, and to examine whether antiretroviral therapy use or mortality was influenced by MHD (defined as a record of service provision by psychiatric services on the Victorian Psychiatric Case Register). It was hypothesized that HIV‐positive individuals with MHD would have poorer treatment outcomes, reduced responses to highly active antiretroviral therapy (HAART) and increased mortality compared with those without MHD.

Methods

This is a retrospective cohort of 2981 individuals (73% of the Victorian population diagnosed with HIV infection) captured on an HIV database which was electronically matched with the public Victorian Psychiatric Case Register (VPCR) (accounting for 95% of public system psychiatry service provision). The prevalence, dates and recorded specifics of mental health disorders at the time of the electronic match on 1 June 2000 are described. The association with recorded MHD, gender, age, AIDS illness, HIV exposure category, duration and type of antiviral therapy, treatment era (prior to 1986, post‐1987 and pre‐HAART, and post‐HAART) on hospitalization and mortality at 1 September 2001 was assessed.

Results

Five hundred and twenty‐five individuals (17.6% of the Victorian HIV‐positive population) were recorded with MHD, most frequently coded as attributable to substance dependence/abuse or affective disorder. MHD was diagnosed prior to HIV in 33% and, of those diagnosed after HIV, 93.8% were recorded more than 1 year after the HIV diagnosis. Schizophrenia was recorded in 6% of the population with MHD. Hospitalizations for both psychiatric and nonpsychiatric illness were more frequent in those with MHD (relative risk 5.4; 95% confidence interval 3.7, 8.2). The total number of antiretrovirals used (median 6.4 agents vs 5.5 agents) was greater in those with MHD. When adjusted for antiretroviral treatment era, HIV exposure category, CD4 cell count and antiretroviral therapy, survival was not affected by MHD.

Conclusions

MHD is frequent in this population with HIV infection and is associated with increased healthcare utilization but not with reduced survival.
Intrathoracic fat in HIV‐infected patients
Authors: Blanco JL , Biglia A , Martinez E , Sánchez M , De Lazzari E , Leon A , Milinkovic A , Larrousse M , Lonca M , Laguno M , Mallolas J , Gatell JM
Published: March 2006

Background

The impact of HIV infection or antiretroviral therapy on the intrathoracic fat compartment is unknown.

Methods

Consecutive clinically stable HIV‐infected adult patients, irrespective of exposure to antiretroviral therapy, and non‐HIV‐infected healthy volunteers, both without clinical evidence of body fat changes consistent with lipodystrophy and adjusted for age, gender and body mass index, were recruited for this study. Thoracic and abdominal fat was assessed by computed tomography and compared between patients and controls.

Results

There were nine women (33%) and 18 men (67%) in each group. Nineteen patients (70%) had been taking antiretrovirals for a median of 8 months (interquartile range: 6–11). Among the HIV‐infected patients, intrathoracic fat (median; interquartile range) did not differ significantly between treated (6.7 cm2; 4.5–8.3 cm2) and untreated (6.9 cm2; 5.7–10.9 cm2) individuals (P=0.288). However, intrathoracic fat content (median; interquartile range) was higher in HIV‐infected patients (6.8 cm2; 5.6–10.5 cm2) than in controls (5.6 cm2; 3.9–6.7 cm2) (P=0.025). Intrathoracic fat was positively correlated with intra‐abdominal fat both in patients (rho=0.6, P=0.002) and in controls (rho=0.7, P=0.004).

Conclusion

In HIV‐infected adults without clinical evidence of lipodystrophy, intrathoracic fat content was higher than in healthy persons and positively correlated with intra‐abdominal fat content.
Maternal hepatotoxicity with nevirapine as part of combination antiretroviral therapy in pregnancy
Authors: Lyons F , Hopkins S , Kelleher B , McGeary A , Sheehan G , Geoghegan J , Bergin C , Mulcahy FM , McCormick PA
Published: March 2006

Objectives

To describe the maternal tolerability of nevirapine as part of combination antiretroviral therapy in pregnancy at three HIV centres in Dublin, Ireland and to determine risk factors for development of significant hepatotoxicity.

Methods

A retrospective study was carried out of all women prescribed nevirapine as part of combination antiretroviral therapy in pregnancy at three HIV centres in Dublin, Ireland (October 2000 to February 2003). Toxicities experienced were graded according to the Division of AIDS toxicity guidelines for adults. Statistical analysis was performed to determine whether there were differences between those that did and those that did not experience significant hepatotoxicity.

Results

A total of 123 women initiated nevirapine as part of combination antiretroviral therapy in the study period. Eight women developed significant hepatotoxicity, including two women who died from fulminant hepatitis. Women who experienced more severe hepatotoxicity had higher pretreatment CD4 counts (P=0.01).

Conclusions

In this cohort, women who experienced more severe hepatotoxicity had higher pretreatment CD4 counts, lending additional weight to the need for caution in using nevirapine as part of combination antiretroviral therapy in women not requiring antiretroviral therapy for their own health.
Regulation of adiponectin in adipocytes upon exposure to HIV‐1
Authors: Sankalé J‐LG , Tong Q , Hadigan CM , Tan G , Grinspoon SK , Kanki PJ , Hotamisligil GS
Published: March 2006

Objectives

Adipose dysregulation, dyslipidemia, and insulin resistance are hallmarks of HIV‐related lipodystrophy. The precise mechanisms behind these disturbances are unknown. In HIV‐infected patients, we previously demonstrated a strong relationship between lipodystrophy and levels of adiponectin, an adipose peptide implicated in regulation of glucose and lipid metabolisms. In this study we investigated the effect of HIV on adipocytes, to determine whether HIV can directly infect adipocytes and/or alter the regulation and secretion of the adipocyte‐derived hormone adiponectin.

Methods

Human subcutaneous preadipocytes and adipocytes were exposed to HIV‐1 under various conditions. Adiponectin was measured in supernatants and cell lysates.

Results

Although adipocytes expressed CD4, the major HIV receptor, they could not be infected in vitro. However, exposure to HIV dramatically increased the secretion of adiponectin from human adipocytes, in the absence of infection. This was exacerbated with sustained exposure to HIV in a transwell assay. Further, human peripheral mononuclear cells also produced adiponectin, but this was largely dependent upon T‐cell activation.

Conclusions

We propose that the stimulation of adiponectin production by HIV can perturb adiponectin regulation, leading to substantially decreased levels upon viral suppression by antiretroviral therapy. These data suggest a potential molecular mechanism of adiponectin regulation in HIV‐infected patients.
Facial assessments: identifying the suitable pathway to facial rejuvenation
Authors: Weinkle S
Published: March 2006

Objectives  There are now numerous ways in which a patient can rejuvenate their facial appearance, including various types of expensive, invasive, surgical procedures, and an ever increasing gamut of products that can be inserted or injected beneath the skin to restore a youthful look to the face. The importance of facial assessments in identifying the most suitable treatment option is discussed here.

Results  Before a patient commits to any one of these corrective options, it is the responsibility of the physician to conduct a thorough assessment of the patient's face. All of the facial characteristics should be examined closely: underlying bone and musculature, shape, proportion, and features including folds, wrinkles, fine lines, volume deficits and changes in pigmentation. The degree of ptosis in the facial tissues should be assessed by light palpation. Following assessment of the face, digital photographs should be taken of the patient's full face and profile, allowing the physician to indicate areas, on a visual display, that need correction and there are now computer programs which can ‘morph’ the features of a facial photograph, providing an approximation of the post‐treatment result. Shape and proportion are neglected facets in the assessment of the face prior to corrective treatment. A treatment or technique which rejuvenates a ‘thin’ face may not work so successfully on a ‘round’ face and vice versa. Most importantly, the physician should aim to understand the patient's objective and subjective perceptions of their face and ascertain the results that are desired by the patient before evaluating what can be achieved. Appropriate corrective options can then be discussed in detail, highlighting the risks, side effects, costs, invasiveness, logistics and anticipated outcomes of each.

Conclusion  A comprehensive assessment of the patient's face allows the physician to formulate a regimen of treatments that will reach or exceed the expectations of the patient.
The contribution of category‐based and contextual suppression towards retrieval‐induced forgetting1
Authors: TSUKIMOTO TAKASHI , KAWAGUCHI JUN
Published: March 2006

Abstract:  This study examines whether both context‐related and category‐related memory impairment can be found using a retrieval‐induced forgetting procedure. One group of participants was tested using a standard retrieval‐practice paradigm, whereas for the no‐practice group the retrieval practice was replaced by irrelevant filler activity. The results showed that the within‐participant baseline items were recalled more poorly by the practice group than by the no‐practice group, whereas the practice group showed the standard retrieval‐induced forgetting effect. Thus, retrieval practice impaired recall for both within‐category and baseline items, although it impaired the former to a greater extent. This finding suggests that it is necessary to consider not only categorical relationships between items, but also context information shared by items when exploring retrieval‐induced forgetting.
Impact of compensatory secondary control on the recollection of emotions and the self in respect to past adversity1
Authors: NAKAJIMA YUKA , MUTO TAKASHI
Published: March 2006

Abstract:  This study investigated a specific cognitive appraisal functioning as a form of compensatory secondary control that allows the individual to reevaluate positive aspects of adversity experienced in the past, and enhances emotional resources for further personal development through primary control. The impact of four kinds of present‐time appraisals on recollection of 11 types of emotions that 50 third‐year students initially experienced during preparations for university entrance examinations taken two and a half years earlier were examined. Cognitive appraisal of the experience of the adversity was found to function as compensatory secondary control. Positive emotions were overestimated whereas negative emotions were underestimated when the participants retrospectively evaluated their experience of exam preparation positively. Participants who regarded their exam preparations as a fruitful experience also positively evaluated the past struggle in that situation. These findings suggest a partial explanation for the role of cognitive appraisal in the directive, particularly analogous function of autobiographical memory in the individual's approach to immediate or future problems.
Br/Cl signature of hydrothermal fluids: liquid–vapour fractionation of bromine revisited
Authors: LIEBSCHER A. , LÜDERS V. , HEINRICH W. , SCHETTLER G.
Published: March 2006

Br/Cl ratios of hydrothermal fluids are widely used as geochemical tracers in marine hydrothermal systems to prove fluid phase separation processes. However, previous results of the liquid–vapour fractionation of bromine are ambiguous. Here we report new experimental results of the liquid–vapour fractionation of bromine in the system H2O–NaCl–NaBr at 380–450°C and 22.9–41.7 MPa. Our data indicate that bromine is generally more enriched than chlorine in the liquid phase. Calculated exchange coefficients KD(Br‐Cl)liquid‐vapour for the reaction Brvapour + Clliquid = Brliquid + Clvapour are between 0.94 ± 0.08 and 1.66 ± 0.14 within the investigated P–T range. They correlate positively with DClliquid‐vapour and suggest increasing bromine–chlorine fractionation with increasing opening of the liquid–vapour solvus, i.e. increasing distance to the critical curve in the H2O–NaCl system. An empirical fit of the form KD(Br‐Cl)liquid‐vapour = a*ln[b*(DClliquid‐vapour−1) + e1/a] yields a = 0.349 and b = 1.697. Based on this empirical fit and the well‐constrained phase relations in the H2O–NaCl system we calculated the effect of fluid phase separation on the Br/Cl signature of a hydrothermal fluid with initial seawater composition for closed and open adiabatic ascents along the 4.5 and 4.8 J g−1 K−1 isentropes. The calculations indicate that fluid phase separation can significantly alter the Br/Cl ratio in hydrothermal fluids. The predicted Br/Cl evolutions are in accord with the Br/Cl signatures in low‐salinity vent fluids from the 9 to 10°N East Pacific Rise.
Diving to extremes: are New Zealand sea lions (Phocarctos hookeri) pushing their limits in a marginal habitat?
Authors: Chilvers B. L. , Wilkinson I. S. , Duignan P. J. , Gemmell N. J.
Published: March 2006

When studying diving behaviour, it is important to know whether a species is operating at or close to its maximum physiological capacity, because if it is, it will be less capable of compensating for normal environmental or human‐induced fluctuations in its environment. New Zealand (NZ) sea lionsPhocarctos hookeriare among the world's rarest pinnipeds with a restricted distribution and abundance to the most southerly limit of their known range, NZ's sub‐Antarctic. Female NZ sea lions are the deepest and longest diving of the otariids, foraging further from their breeding rookeries than any other sea lion. In this study, the diving behaviours of 18 female NZ sea lions from Enderby Island, Auckland Islands, were recorded during early lactation over two austral summers, 2003 and 2004. While at sea, sea lions dived almost continuously, spending on average 52.7% of their time submerged (>6 m). The mean dive depth (±se) for all dives was 129.5±5.3 m (range 94.6±1.1 to 178.9±1.6 m). The mean duration of dives was 4.0±0.1 min with an average of 40±2.9% of all dive times spent in the deepest 85% of the dive. Although there was high variation in diving behaviour among individuals, overall, animals were found to be diving beyond their estimated aerobic dive limits on 68% of all dives. Given that female NZ sea lions have a high percentage of dives that are beyond their theoretical aerobic limits, we ask whether this represents a miscalculation in aerobic limits, is it a species highly adapted to carry an anaerobic load or a species that is physically stretched to their limits? A species that is presumably under physiological stress just to maintain its current low static population numbers is also likely to be more susceptible to external impacts and this needs consideration for their management.
Planktonic microbial community composition across steep physical/chemical gradients in permanently ice‐covered Lake Bonney, Antarctica
Authors: GLATZ R. E. , LEPP P. W. , WARD B. B. , FRANCIS C. A.
Published: March 2006

Lake Bonney is a chemically stratified, permanently ice‐covered Antarctic lake that is unusual because anomalous nutrient concentrations in the east lobe suggest that denitrification occurs in the deep suboxic waters of the west lobe but not the east lobe, resulting in high concentrations of nitrate and nitrite below the east lobe chemocline. Environmental factors that usually control denitrification rates (e.g. organic carbon, nitrate, oxygen) do not appear to explain the nitrate distribution in the east lobe, suggesting that other factors (e.g. trace metals, salts, microbial community structure, etc.) may be involved. In order to explore the potential importance of microbial community composition, samples collected from multiple depths in both lobes were compared on the basis of 16S rRNA gene diversity. 16S rRNA polymerase chain reaction (PCR) clone libraries generated from five depths were subjected to restriction fragment length polymorphism (RFLP), rarefaction, statistical and phylogenetic analyses. Bacterial and archaeal 16S rRNA gene sequences were determined for clones corresponding to unique RFLP patterns. The bacterial community below the chemocline (at 25 m) in the east lobe was the least diverse of the five depths analysed and was compositionally distinct from the communities of the overlying waters. The greatest compositional overlap was observed between 16 and 19 m in the east lobe, while the east lobe at 25 m and the west lobe at 13 and 16 m had relatively distinct communities. Despite very little compositional overlap between the suboxic, hypersaline depths of the east and west lobes (25 m and 16 m, respectively), sequences closely related to the denitrifying Marinobacter strain ELB17 previously isolated from the east lobe were found in both libraries. Most of the Lake Bonney sequences are fairly distinct from those reported from other Antarctic environments. Archaeal 16S rRNA genes were only successfully amplified from the two hypersaline depths analysed, with only one identical halophilic sequence type occurring in both libraries, indicating extremely low archaeal diversity. Overall, microbial community composition varies both between lobes and across depths within lobes in Lake Bonney, reflecting the steep gradients in physical/chemical parameters across the chemocline, as well as the anomalous nutrient chemistry of the system.
Chilean high‐altitude hot‐spring sinters: a model system for UV screening mechanisms by early Precambrian cyanobacteria
Authors: PHOENIX V. R. , BENNETT P. C. , ENGEL A. S. , TYLER S. W. , FERRIS F. G.
Published: March 2006

Before the build‐up of stratospheric ozone, Archean and early Proterozoic phototrophs existed in an environment subjected to highly elevated levels of ultraviolet (UV) radiation. Therefore, phototrophic life would have required a protective habitat that balanced UV attenuation and photosynthetically active radiation (PAR) transmission. Here we report on aspects of the phototroph geomicrobiology of El Tatio geothermal field, located at 4300 m in the Andes Mountains of northern Chile (22 °S), as an analogue system to early Precambrian environments. El Tatio microbes survive in a geochemical environment of rapidly precipitating amorphous silica (sinter) and unusually high solar radiation (including elevated UV‐B flux) due to the high‐altitude, low‐latitude location. Cyanobacteria produce 10‐mm‐thick surface mats containing filaments encased in amorphous silica matrices up to 5 µm thick. Relative radiation absorbance of these silica matrices was UV‐C > UV‐B > UV‐A > PAR, suggesting the silica provides a significant UV shield to the cyanobacteria. Cyanobacteria also occur in cryptoendolithic communities 1–10 mm below siliceous sinter surfaces, and in siliceous stromatolites, where viable cyanobacteria are found at least ∼10 mm below the sinter surface. UV‐B was dramatically attenuated within ∼1 mm of the sinter surface, whereas UV‐C (a frequency range absent today but present in the early Precambrian) was attenuated even more efficiently. PAR was attenuated the least, and minimum PAR levels required for photosynthesis penetrated 5–10 mm into the sinter. Thus, a favourable niche occurs between approximately 1–10 mm in siliceous sinters where there is a balance between PAR transmission and UV attenuation. These deposits also would have strongly attenuated Archean and early Precambrian levels of UV and thus, by analogy, cyanobacteria of early Precambrian shallow aquatic environments, inhabiting silicified biofilms and silica stromatolites, would have similarly been afforded protection against high‐intensity UV radiation.
Comparison of the effects of aprotinin and tranexamic acid on blood loss and red blood cell transfusion requirements during the late stages of liver transplantation
Authors: Ickx Brigitte E. , Van Der Linden Philippe J. , Melot Christian , Wijns Walter , De Pauw Luc , Vandestadt Jean , Hut Florence , Pradier Olivier
Published: March 2006

BACKGROUND:  During liver transplantation (LT), profound activation of the fibrinolytic system can contribute significantly to perioperative bleeding. Prophylactic administration of antifibrinolytic agents has been shown to reduce blood loss and the need for allogeneic transfusion in these conditions.

STUDY DESIGN AND METHODS:  This prospective randomized trial included 51 cirrhotic patients undergoing LT. Patients were randomly assigned to receive either 280 mg of aprotinin (AP) followed by 70 mg per hour or 40 mg per kg tranexamic acid (TA) followed by 40 mg per kg per hour, administered from the end of the anhepatic phase until 2 hours after reperfusion of the graft, and the effects on blood loss and red blood cell (RBC) transfusion requirements were compared. Transfusion policy was standardized in all patients. In addition, the biological effects of the two drugs, as assessed by coagulation and fibrinolytic markers obtained during surgery, were evaluated in a subgroup of patients from each treatment group and compared with an historical control group that did not receive antifibrinolytic drugs.

RESULTS:  There was no significant difference between the two groups in perioperative blood losses (AP, 6200 [4620‐8735] mL; TA, 5945 [4495‐8527] mL; median [range]) or in RBC transfusions requirements (AP, 9 [6.75‐15.25] units; TA, 10 [6.5‐13.5] units). Inhibition of fibrinolysis was observed with both drugs compared with the control group. Coagulation appeared to be activated more with AP, however, whereas fibrinolysis was inhibited more by TA.

CONCLUSION:  Blood losses and RBC transfusion requirements were comparable regardless of the drug administered. TA may be as valuable as AP for controlling fibrinolysis in LT.
Left Ventricular Lead Proximity to an Akinetic Segment and Impact on Outcome of Cardiac Resynchronization Therapy
Authors: ARZOLA‐CASTANER DANIEL , TAUB CYNTHIA , KEVIN HEIST E. , FAN DALI , HAELEWYN KYLE , MELA THEOFANIE , PICARD MICHAEL H. , RUSKIN JEREMY N. , SINGH JAGMEET P.
Published: March 2006

Background: Previous studies report that the optimal pacing site for cardiac resynchronization therapy (CRT) is along the left ventricular (LV) lateral and postero‐lateral (PL) wall. However, little is known regarding whether pacing over an akinetic site impacts the contractile response and long‐term outcome from CRT.

Methods and Results: A total of 38 patients with ischemic cardiomyopathy were studied for their acute hemodynamic and 12‐month clinical response to CRT. The intraindividual percentage change in dP/dt (%ΔdP/dt), over baseline, was derived from the mitral regurgitation (MR) Doppler profile with CRT on versus off. Two‐dimensional echocardiography was used for myocardial segmentation and determinination of akinetic sites. LV lead implant site was determined using angiographic and radiographic data and categorized as being “on” (group 1) or “off” (group 2) an akinetic site. Long‐term response was measured as a combined endpoint of hospitalization for heart failure and/or all cause mortality at 12 months. Time to primary endpoint was estimated by the Kaplan‐Meier method. Clinical characteristics and acute hemodynamic response was similar in both (group 1 [n = 14]; %ΔdP/dt 48.8 ± 67.4% vs group 2 [n = 24]; %ΔdP/dt 32.2 ± 40.1%, P = 0.92). No difference in long‐term outcome was observed (P = 0.59). In contrast, lead placement in PL or mid‐lateral (ML) positions was associated with a better acute hemodynamic response when compared to antero‐lateral (AL) positions (PL, %ΔdP/dt 45.7 ± 50.7% and ML, %ΔdP/dt 45.1 ± 58.8% vs AL, %ΔdP/dt 2.9 ± 30.9%, respectively, P = 0.014).

Conclusion: LV lead proximity to an akinetic segment does not impact acute hemodynamic or 12‐month clinical response to CRT.
The Relationship Between Heart Rate Recovery and Heart Rate Variability in Coronary Artery Disease
Authors: Evrengul Harun , Tanriverdi Halil , Kose Sedat , Amasyali Basri , Kilic Ayhan , Celik Turgay , Turhan Hasan
Published: March 2006

Background: Reduced heart rate recovery (HRR) in coronary artery disease (CAD) is predictive of increased cardiovascular mortality and is related to reduced parasympathetic tonus.

Objective: To investigate HRR and heart rate variability (HRV) measured at steady state condition and the relationship between these two parameters in CAD.

Materials and Methods: In our study, we enrolled 33 (28 males, mean age 52.4 ± 9.6 years) patients with CAD who did not have heart failure, atrial fibrillation, pacemaker, and any disease state that could affect the autonomic functions and 38 age‐matched healthy subjects (21 males, mean age 48.3 ± 7.8 years). All the patients underwent submaximal treadmill exercise testing (Bruce protocol). HRR was calculated by subtracting the heart rate values at the 1st, 2nd, and 3rd minutes of the recovery phase from the peak heart rate (HRR1, HRR2, HRR3). Before exercise testing, short‐term steady state HRV analyses of all subjects were obtained with the time‐ and frequency‐domain methods and were correlated to HRR. For frequency‐domain analysis, low‐frequency HRV (LF, 0.004–0.15 Hz), high‐frequency HRV (HF, 0.15–0.5 Hz), and LF/HF ratio were measured for 5 minutes in the morning. For time‐domain analysis, standard deviation of the normal‐to‐normal NN intervals (SDNN), square root of the mean squared differences of successive N‐N intervals (RMSSD), and proportion derived by dividing the number of interval differences of successive N‐N intervals greater than 50 ms by the total number of N‐N intervals (pNN50) were obtained. Only HRR3 was used for the correlation analysis.

Results: In CAD groups, the HF, an indicator of parasympathetic activation, was significantly reduced, whereas the LF and LF/HF values, which are indicators of sympathetic activity, were increased (P = 0.0001 for each parameter). The time‐domain parameters SDNN, RMSSD, and pNN50 were significantly reduced in the patient group (P = 0.0001, P = 0.009, and P = 0.0001, respectively). Similar to the HRV parameters, the HRR1, HRR2, and HRR3 values were significantly reduced in the patient group (P = 0.0001 for each parameter). We observed a significant negative correlation between HRR3 and LF (r =−0.67, P = 0.0001) and between HRR3 and LF/HF (r =−0.62, P < 0.0001), while there was a significant positive correlation between HRR3 and HF, SDNN, RMSSD, and pNN50 (r = 0.69, P = 0.0001; r = 0.41, P = 0.0001; r = 0.31, P = 0.008; and r = 0.44, P = 0.0001).

Conclusions: HRR and HRV are significantly reduced in CAD. The reduction in HRR is parallel to the changes in HRV parameters. HRR, which can be measured easily in the recovery phase of exercise testing, can be used to detect the depression of parasympathetic tonus and to evaluate the basal autonomic balance in this patient group.
Intradialytic complications during hemodialysis
Authors: DAVENPORT Andrew
Published: March 2006

With the advent of developments and advances in hemodialysis machine technology, dialysate water purification, and dialyzers, the clinical spectrum of intradialytic complications has changed over the decades. In the pioneering days of hemodialysis, patients could develop allergic reactions to dialyzer membranes, sterilizing and reprocessing agents, coupled with machines that could not accurately control ultrafiltration rates, and chemically and bacterially contaminated dialysate. Whereas today, although cardiovascular problems remain the most common intradialytic complication, these are mainly due to the time restraints of trying to cope with excessive dialytic weight gains and achieve target dry weight on a thrice weekly schedule, coupled with an aging elderly dialysis population with increasing co‐morbidity.
IgG‐Antiphospholipid Antibodies in Follicular Fluid of IVF‐ET Patients are Related to Low Fertilization Rate of Their Oocytes
Authors: Matsubayashi Hidehiko , Sugi Toshitaka , Arai Tadashi , Shida Masako , Kondo Akane , Suzuki Takahiro , Izumi Shun‐ichiro , McIntyre John A.
Published: March 2006

Problem

Patients undergoing in vitro fertilization and embryo transfer (IVF‐ET) failures show an increased incidence of antiphospholipid antibodies (aPL) in their blood. The physiological manifestations of aPL in this patient group are nonetheless controversial. Pathological effects of aPL on embryos in vitro have been documented. We questioned whether aPL if found in follicular fluids (FFs) could result in embryonic damage.

Method of study

Blood from 44 patients with three or more IVF‐ET failures were tested by enzyme‐linked immunosorbent assays (ELISA) for the presence of immunoglobulin (Ig)G, IgM and IgA aPL. Both the 29 aPL‐positive and 15 aPL‐negative patients gave permission for FF collection during their next IVF‐ET attempt for additional aPL determinations.

Results

Patients with no aPL in their blood, had no aPL in their FFs. Patients with IgG and/or IgM aPL in their blood had IgG but not IgM in their respective FFs.

Conclusions

The presence of IgG aPL in FFs and increased infertility length were significantly related to lower fertilization rates, independently. Follicular fluid IgG aPL appears as a risk factor in association with successful IVF‐ET outcomes.
Multiple Thrombophilic Gene Mutations Rather than Specific Gene Mutations are Risk Factors for Recurrent Miscarriage
Authors: Coulam Carolyn B. , Jeyendran Rajasinqam S. , Fishel Laurence A. , Roussev Roumen
Published: March 2006

Problem

Recurrent miscarriage is a heterogeneous condition. While the role of acquired thrombophilia has been accepted as an etiology of recurrent miscarriage, the contribution of specific inherited thrombophilic genes to this disorder has remained controversial. We compared the prevalence of 10 thrombophilic gene mutations among women with a history of recurrent miscarriages and fertile control women.

Method of study

A total of 150 women with a history of two or more recurrent pregnancy losses and 20 fertile control women with no history of pregnancy losses had buccal swabs taken for DNA analyses of 10 gene mutations [factor V G1691A, factor V H1299R (R2), factor V Y1702C, factor II prothrombin G20210A, factor XIII V34L, β‐fibrinogen −455G>A, PAI‐1 4G/5G, HPA1 a/b (L33P), MTHFR C677T, MTHFR A1298C]. The prevalence of these mutations was compared between women experiencing recurrent miscarriage and controls.

Results

No differences in the frequency of specific gene mutations were detected when women with recurrent miscarriage were compared with control women. However, the prevalence of homozygous mutations and total gene mutations among patients with recurrent miscarriage was significantly higher than among controls. Homozygous mutations were found in 59% of women with a history of recurrent pregnancy loss contrasted to 10% of control women. More than three gene mutations among the 10 genes studied were observed in 68% of women with recurrent miscarriage and 21% of controls.

Conclusion

Inherited thrombophilias are associated with recurrent miscarriage. This association is manifest by total number of mutations rather than specific genes involved.
Uterine (CD56+) Natural Killer Cells Recruitment: Association with Decidual Reaction Rather than Embryo Implantation
Authors: Ordi Jaume , Casals Gemma , Ferrer Berta , Creus Montserrat , Guix Cristina , Palacín Antonio , Campo Elias , Balasch Juan
Published: March 2006

Problem

Whether decidual leukocyte recruitment and/or increase is primarily hormonally regulated or induced mainly by blastocyst implantation is a matter of debate. Thus, this study investigated the number and distribution of leukocyte populations, with emphasis on natural killer (NK) cells of uterine and peripheral type, within decidual tissue from women with decidualized endometrium both related and unrelated to pregnancy and those with ectopic decidua associated with intrauterine pregnancy, as well as in tubal implantation sites.

Method of study

Immunohistochemical characterization of immune cells using antibodies to CD3, CD4, CD8, CD20, CD68, CD16, CD56, CD57, in formalin‐fixed, paraffin‐embedded tissue, and a quantitative analysis of these subpopulations was conducted in tissue blocks from four groups of patients: (i) 20 women with decidualized endometrium due to progestin therapy (i.e. not associated with gestation) (group Prog‐D); (ii) 20 women with intrauterine pregnancy‐associated ectopic decidua (seven in the Fallopian tube, five in the ovary, five in the uterine cervix, and three in the omentum) (group Ect‐D); (iii) 20 women with spontaneous abortion who had an histologic sample of the decidua at the uterine implantation site (group Uter‐D); and (iv) 20 consecutive patients who had had an ectopic tubal pregnancy (group Tub‐Preg). Twenty gynecologic specimens with marked inflammatory reaction were used as controls (group Con).

Results

CD3+, CD4+, CD8+, CD68+ cells were detected in all tissue samples investigated. In contrast, CD20+ cells were detected in all samples in group Con, but only in 75%, 25%, 55% and 70% of groups Prog‐D, Ect‐D, Uter‐D and Tub‐Preg, respectively. In all tissue samples investigated, CD57+ and CD16+ cells were detected. Conversely, CD56+ cells were completely absent in 15 of 40 cases (37.5%) lacking decidual reaction (group Tub‐Preg, 7/20; group Con, 8/20) but were present in all cases showing decidual reaction. In contrast with CD56+ cells, CD57+ NK cells were more abundant in group Con than in the four study groups.

Conclusions

CD56+ NK cells are closely related to decidua irrespective of its eutopic or ectopic location rather than to the implantation site. This suggests that the recruitment and/or increase of uterine NK cells into the uterus is not dependent on the physical presence of an implanting embryo but instead is controlled hormonally.
Structure, function and disease susceptibility of the bovine major histocompatibility complex
Authors: TAKESHIMA Shin‐Nosuke , AIDA Yoko
Published: March 2006

The major histocompatibility complex (MHC) of cattle is known as the bovine leukocyte antigen (BoLA) and is located on chromosome 23. BoLA has been linked to variation in resistance to disease including bovine leukemia virus‐induced lymphoma and mastitis. Moreover, BoLA appears to influence other traits such as milk yield, growth and reproduction, which are not often measured in humans, and variations in individual immune response to antigen. The BoLA appears to be organized in a similar way to the MHC region in humans, but there are notable differences. A major rearrangement within the class II region has led to the division of the BoLA into two distinct subregions of chromosome 23 separated by about a third of the chromosome’s length. The class IIa subregion contains functionally expressed DR and DQ genes, while the class IIb subregion contains the genes of undefined status such as DYA, DYB, DMA, DMB, DOB, DOA, TAP1, TAP2, LAP2 and LMP7. In addition, one pair of human class II genes (DP) does not appear to have an equivalent in cattle, and there is one pair of DY genes that seem to be found only cattle, sheep and goats. In humans, three classical, polymorphic class I genes (HLA‐A, ‐B and ‐C ) are each present on all haplotypes. However, in cattle, none of the four (or more) classical class‐I genes identified are consistently expressed, and haplotypes differ from one to another in both the gene number and composition. These variations in both class I and II are likely to play an important role in cattle immune responses. This review summarizes current knowledge of the structural and functional features and disease association of BoLA genes.
Comparative genomics of the poultry major histocompatibility complex
Authors: SHIINA Takashi , HOSOMICHI Kazuyoshi , HANZAWA Kei
Published: March 2006

This review summarizes the latest findings regarding the avian major histocompatibility complex (MHC), focusing particularly on the genomics of MHC in the Japanese quail (Cotrnix japonica) and other birds, as well as haplotype, genomics, function and disease resistance in the chicken (Gallus gallus). This information provides important insight into the breeding of disease resistance in poultry, natural selection of disease resistance in wild birds, and the effects of recombination and hitchhiking on the evolution of multiple MHC gene families.
Synergistic fibrolysis in the rumen by cellulolytic Ruminococcus flavefaciens and non‐cellulolytic Selenomonas ruminantium: Evidence in defined cultures
Authors: SAWANON Suriya , KOBAYASHI Yasuo
Published: March 2006

To investigate the rumen bacterial interaction between cellulolytic Ruminococcus flavefaciens and non‐cellulolytic Selenomonas ruminantium, fiber digestibility and fermentation products were determined in defined cultures consisting of these two species. Avicel, orchardgrass hay, rice straw and alfalfa hay were used as substrates for 72 h incubation to monitor digestibility, volatile fatty acids, succinate, lactate and bacterial number. In monoculture, R. flavefaciens digested the fiber sources at 21–32%, while S. ruminantium strains did not. When R. flavefaciens was cocultured with one of three different strains (GA192, S137 and S150) of S. ruminantium, fiber digestion exceeded the value recorded by R. flavefaciens alone. In particular, cocultures with S. ruminantium S137 showed significantly higher digestibility for all the fiber sources than R. flavefaciens alone (P < 0.05). Propionate production and growth of S. ruminantium was notable in all cocultures but not in monocultures. Succinate was accumulated in monoculture of R. flavefaciens, while the accumulation was not observed in cocultures. These results indicate that R. flavefaciens provides fiber hydrolysis products to S. ruminantium as growth substrates. In addition, S. ruminantium could activate R. flavefaciens by rapidly consuming the products. Such cross‐feeding between cellulolytic and non‐cellulolytic bacteria could enhance fiber digestion, although the extent of the enhancement may depend on strain combinations.
Feed intake, lactation performance, blood metabolites and fertility in early lactation dairy cows grazing a timothy pasture
Authors: OHGI Tsutomu , HARA Satoshi , OZEKI Tadao , FUJITA Mamiko , SAKAI Osamu , KASHUYA Hirotaka , DOUKOSHI Akira , NISHIMURA Kazuyuki
Published: March 2006

The present study was conducted to investigate feed intake, milk yield, milk composition, blood metabolites and fertility in early lactation dairy cows grazing a timothy pasture. Fourteen multiparous Holstein cows that calved between 20 May and 19 July were used over a 3‐year period. The stocking rate was 3.6–4.3 cow/ha. Concentrates were fed separately at 9.5–11.5 kg/day per cow (dry matter basis) from 1 to 13 weeks postparturition. Herbage intake was estimated using chromium oxide as an indigestible marker. The mean contents of crude protein, total digestible nutrients and neutral detergent fiber of pasture during the 3‐year study period were 22.3%, 71.8% and 51.7%, and those of total diet were 18.9%, 77.3% and 40.3%, respectively. The mean herbage dry matter intake was 13.0 kg/day from 2 to 13 weeks postparturition during the study, total dry matter intake was 23.7 kg/day, the total digestible nutrients sufficiency rate was 105%, milk yield was 39.7 kg/day, and milk fat percentage was 3.30%. The decrease in bodyweight postparturition was slight. Urea nitrogen concentrations in serum were below 18.3 mg/dL. The mean days to first estrus and days open were 36 and 104 days, respectively. These results indicate that energy deficiency, decrease in bodyweight and fertility in early lactation barely occur when high producing dairy cows are fed enough grazing grass and suitable concentrates.
Behavioral changes in laying hens after introduction to battery cages, furnished cages and an aviary
Authors: SHINMURA Tsuyoshi , EGUCHI Yusuke , UETAKE Katsuji , TANAKA Toshio
Published: March 2006

A variety of investigations into alternative systems and furnished cages for laying hens have been conducted, mainly in the European Union. However, comparative studies about the behavior of laying hens just after introduction to these housing systems are few. Therefore, this study aimed to investigate the changes of location and behavior of laying hens just after introduction to three housing systems. In total, 181 White Leghorns were used. Thirty‐six birds were allocated to 12 battery cages with three birds per cage (613 cm2/bird); 36 birds were allocated to nine furnished cages with four birds per cage (1170 cm2/bird); and 109 birds were allocated to an aviary (1130 cm2/bird). Direct observations using scanning techniques were conducted over 2 weeks for 4 h/day from the day following the introduction. Scan samples of location and behavior were taken at 10 min intervals. The proportion of birds that stayed at each location in the furnished cages was stable during the observation period. In the aviary, 78% of birds were observed on the floor on the first day, and thereafter the proportion linearly decreased (P < 0.01). The proportions of birds eating in both the battery and furnished cages were stable, indicating that the caged birds would adjust to these environments within a short period. Display of aggression was lower in both the cages (both 0.3 ± 0.1%) than in the aviary (3.5 ± 1.0%, P < 0.001), which indicates the early establishment of social order in both cage systems. In the aviary, the birds were observed eating less frequently than in both the cages on the first day, and the proportion thereafter linearly increased (P < 0.01), and the use of tiered wire floors with feeders accompanied this (P < 0.01). Comfort behaviors, including dust bathing, were noted less in the aviary than in the furnished cages throughout the observation period (both P < 0.05). These results suggest that adjustment of aviary birds to their new environment had been delayed compared with caged birds because of the prerearing conditions and the environmental complexity of the aviary.