bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of Ischemic Mitral Regurgitation in Patients with Chronic Anterior Wall Myocardial Infarction: A Real Time Three‐Dimensional Echocardiography Study
Authors: Song Jong‐Min , Qin Jian Xin , Kongsaerepong Vorachai , Shiota Maiko , Agler Deborah A. , Smedira Nicholas G. , McCarthy Patrick M. , Marc Gillinov A. , Thomas James D. , Shiota Takahiro
Published: June 2006

Objective: We sought to elucidate the geometric determinants of ischemic mitral regurgitation (IMR) in patients with chronic anterior myocardial infarction (MI). Materials and Methods: In 16 patients with anterior MI only (Group A) and 18 patients with both anterior and inferoposterior MI (Group B), three parallel equidistant anteroposterior (AP) planes (medial, central, lateral) perpendicular to the mitral valvular commissure‐commissure plane were generated. The systolic tenting area of the mitral valve (MVTa) and the angles between the annular plane and leaflets (anterior, Aα; posterior, Pα) on the AP planes were measured. The left ventricular end‐systolic and end‐diastolic volumes, and end‐diastolic and end‐systolic mitral annular area (MAAs) were obtained. Result: The regurgitant orifice area (ROA) was significantly smaller in Group A than Group B (0.08 ± 0.09 vs 0.20 ± 0.18 cm2, P < 0.05). In the total of 34 patients, the medial MVTa (P < 0.001), MAAs (P < 0.05) and the spherical index (P < 0.05) were three independent determinants of ROA while the left ventricular volumes were not. MAAs was the only independent determinant of ROA in Group A, while the medial MVTa was in Group B. Pα (P < 0.05) and MVTa (P = 0.06) tended to be larger in the medial than the lateral side in Group B, while no differences were found in Group A. Conclusion: The geometry of the mitral valve apparatus was more important than the left ventricular volumes in determining the severity of IMR in patients with anterior MI. The posteromedial side tenting could play a critical role in causing significant IMR when the inferoposterior MI coexists with anterior MI.
Quantitation of Right Ventricular Volumes and Ejection Fraction by Three‐Dimensional Echocardiography in Patients: Comparison with Magnetic Resonance Imaging and Radionuclide Ventriculography
Authors: Nesser H. Joachim , Tkalec Wolfgang , Patel Ayan R. , Masani Navroz D. , Niel J. , Markt Bernhard , Pandian Natesa G.
Published: June 2006

Three‐dimensional echocardiography (3DE) provides volumetric measurements without geometric assumptions. Volume‐rendered 3DE has been shown to be accurate for the measurement of right ventricular (RV) volumes in vitro and in animal studies; however, few data are available regarding its accuracy in patients. This study examined the accuracy of 3DE for quantitation of RV volumes and ejection fraction (EF) in patients, compared to magnetic resonance imaging (MRI) and radionuclide ventriculography (RNV). Twenty patients underwent MRI, gated equilibrium RNV, and 3DE using rotational acquisition from both the transesophageal and transthoracic approaches. RV volumes and EF were calculated from the 3DE data using multislice analysis (true Simpson's rule). RV volumes calculated by MRI (end‐diastolic volume (EDV) 109.4 ± 34.3 mls, end‐systolic volume (ESV) 59.6 ± 31.0 mls, and EF 47.7 ± 17.1%) agreed closely with 3DE. For transesophageal echocardiography, EDV was 108.1 ± 29.7 mls (r = 0.86, mean difference 1.3 ± 17.8 mls); ESV was 62.5 ± 23.8 mls (r = 0.85, mean difference 2.8 ± 15.1 mls); and EF was 43.2 ± 11.7% (r = 0.84, mean difference 4.5 ± 9.7%). For transthoracic echocardiography, EDV was 107.7 ± 27.5mls (r = 0.85, mean difference 1.6 ± 18.2mls); ESV was 59.7 ± 22.1 mls (r = 0.93, mean difference 3.2 ± 19.6 mls); and EF was 45.2 ± 11.5% (r = 0.86, mean difference 2.0 ± 9.4%). There were close correlations, small mean differences and narrow limits of agreement between RNV‐derived EF (43.4 ± 12.1%) and both transesophageal (r = 0.95 mean difference 0.2 ± 3.7%) and transthoracic 3DE (r = 0.95, mean difference 1.8 ± 5.4%). Three‐dimensional echocardiography is a promising new method of calculating RV volumes and EF, comparing well with MRI and RNV. The accuracy of transthoracic 3DE was comparable to that of the transesophageal approach. Three‐dimensional echocardiography has the potential to be useful in the clinical assessment of RV disorders.
Pulmonary Vein Edema in a Patient Undergoing Coronary Artery Bypass Graft Surgery and Concomitant Radiofrequency Ablation for Chronic Atrial Fibrillation
Authors: Shah Amit D. , Wokhlu Nina , Anderson Mark , Shindler Daniel
Published: June 2006

The syndrome of pulmonary vein stenosis characterized by pulmonary hypertension, dyspnea on exertion, and right heart failure, is a well‐described complication of percutaneous ablation approaches, but has not been described with surgical approaches. We describe the case of a patient who developed localized edema at the pulmonary vein‐left atrial junction after undergoing intraoperative radiofrequency ablation for chronic atrial fibrillation as part of CABG for severe triple vessel disease. The pulmonary vein edema resolved within 10 months suggesting that it may be a clinically silent and self‐resolving phenomenon.
Tricuspid Valve Malfunction and Ventricular Pacemaker Lead: Case Report and Review of the Literature
Authors: Iskandar Said B. , Ann Jackson S. , Fahrig Stephen , Mechleb Bassam K. , Garcia Israel D.
Published: June 2006

Pacemaker implantation can be associated with several complications, including myocardial perforation with or without pericardial effusion, venous thrombosis, vegetations of the tricuspid valve (TV) or pacing lead, and tricuspid regurgitation (TR). The TR is thought to be derived from deformity or perforation of the TV by the pacing lead or secondary to atrioventricular discordance with asynchronous ventricular pacing. Severe TR can be deleterious to the patient because it raises the central venous pressure by increasing the right sided preload. Chronically, the increase in right sided blood volume can result in an increase in the right atrial pressure leading to a decrease in venous return and low cardiac output. Severe TR from leaflet adhesion to the pacemaker lead has not been reported before. With the aging of the population and the expanding use of pacemakers and implantable cardioverter defibrillators (ICD) in clinical practice, this complication may be seen more frequently. We present a patient diagnosed with severe TR, years after his pacemaker implantation. His TR was thought to be caused by adhesion of the tricuspid valve to his pacemaker lead.
An Asymptomatic Case with Single Atrium
Authors: Asuman Kaftan H. , Tanriverdi Halil , Kuru Ömür , Sinan Bir Levent
Published: June 2006

Single atrium or common atrium is a rare, isolated defect. We report here an adult patient with single atrium detected by transthoracic echocardiography.
An Unusual Cause of Pulmonary Vein Stenosis: A Case Report and Review of the Literature
Authors: Rosetti Mihaela , Tighe Dennis A. , Chandok Dinesh , Gammie James S. , Griffith Bartley P. , Folland Edward D.
Published: June 2006

We describe the case of a patient with the Carney syndrome and several resections for recurrent left atrial myxomas who underwent autotransplantation of the heart with resection of the left and right atria and reconstruction of both atria with bovine pericardium. She subsequently presented with severe shortness of breath, ascites, and peripheral edema. She was found to have stenosis of all four pulmonary veins and severe pulmonary hypertension. We describe the echocardiographic findings and review the literature on assessment of acquired pulmonary vein stenosis.
Investigations of Ternary Phase Relations in a CeO2–Gd2O3–ThO2 System
Authors: Grover Vinita , Tyagi Avesh Kumar
Published: June 2006

The phase relations in a CeO2–Gd2O3–ThO2 system have been established, for the first time, after slowly cooling the samples from 1400°C. Ceria has been used as a surrogate material in place of plutonia. About 70 compositions in Th1−xGdxO2−x/2, Ce1−xGdxO2−x/2, (Th0.5Ce0.5)1−xGdxO2−x/2, (Ce0.5Gd0.5)1−xThxO1.75+x/4, and (Th0.5Gd0.5)1−xCexO1.75+x/4 systems were prepared. X‐ray diffraction data revealed the presence of different phase regions, namely cubic fluorite‐type solid solution, C‐type solid solution, and biphasic regions containing C‐ and F‐type solid solutions, and two F‐type solid solutions could be delineated. This ternary system showed the existence of a wide cubic phase field. ThO2 was found to dissolve up to about 40 mol% GdO1.5. The GdxTh1−xO2−x/2 system has a biphasic region consisting of C‐ and F‐type solid solutions, whereas GdxCe1−xO2−x/2 system supported only a single phase (F or C) throughout. A striking observation was that the anion‐excess gadolinia, i.e., Gd1−xCexO1.5+x/2, was found to retain the C‐type lattice, even after heat treatment, unlike pure gadolinia.
Synthesis and Characterization of Mixed‐Metal Oxide Nanopowders Along the CoOx–Al2O3 Tie Line Using Liquid‐Feed Flame Spray Pyrolysis
Authors: Azurdia Jose , Marchal Julien , Laine Richard M.
Published: June 2006

We report here the use of liquid‐feed flame spray pyrolysis (LF‐FSP) to produce a series of nanopowders along the CoOx–Al2O3 tie line. The process is a general aerosol combustion synthesis route to a wide range of lightly agglomerated oxide nanopowders. The materials reported here were produced by aerosolizing ethanol solutions of alumatrane [Al(OCH2CH2)3N] and a cobalt precursor, made by reacting Co(NO3)2·6H2O crystals with propionic acid. The compositions of the as‐produced nanopowders were controlled by selecting the appropriate ratios of the precursors. Nine samples with compositions (CoO)y(Al2O3)1−y, y=0−1 along the CoOx–Al2O3 tie line were prepared and studied. The resulting nanopowders were characterized by X‐ray fluorescence, BET, scanning electron microscopy, high‐resolution transmission electron micrographs, X‐ray diffraction (XRD), thermogravimetric analysis (TGA), and FTIR. The powders typically consist of single‐crystal particles <40 nm diameter and specific surface areas (SSAs) of 20–60 m2/g. XRD studies show a gradual change in powder patterns from δ‐Al2O3 to Co3O4. The cobalt aluminate spinel phase is observed at stoichiometries (21 and 37 mol%) not seen in published phase diagrams, likely because LF‐FSP processing involves a quench of >1000°C in microseconds frequently leading to kinetic rather than thermodynamic products. Likewise, the appearance of Co3O4 rather than CoO as the end member in the tie line is thought to be a consequence of the process conditions. TGA studies combined with diffuse reflectance FTIR spectroscopic studies indicate that both physi‐ and chemi‐sorbed H2O are the principal surface species present in the as‐processed nanopowders. The only sample that differs is Co3O4, which has some carbonate species present that are detected and confirmed by a sharp mass loss event at ∼250°C. The thermal behavior of the high cobalt content samples differs greatly from the low cobalt content samples. The latter behave like most LF‐FSP‐derived nanopowders exhibiting typical 1%–4% mass losses over the 1400°C range due mostly to loss of water and some CO2. The high cobalt content samples exhibit a sharp mass loss event that can be attributed to the decomposition of Co3O4 to CoO.
Low‐Fire Processing and Properties of Ferrite+Dielectric Ceramic Composite
Authors: Peng Te‐Ming , Hsu Rung‐Tsung , Jean Jau‐Ho
Published: June 2006

A low‐fire Ni–Cu–Zn ferrite+dielectric ceramic composite and its multilayer integrated laminate, which can be densified at temperatures below 900°C, is prepared. To densify Ni–Cu–Zn ferrite at low temperatures, the dielectric needs to contain an effective sintering flux of Bi2O3or PbO to the Ni–Cu–Zn ferrite. This enables densification of the resulting ceramic composite or multilayer integrated dielectric/ferrite laminate at temperatures close to those of pure ferrite and dielectric. The dielectric constant decreases but the initial permittivity increases with increasing amount of ferrite existing in the ferrite+dielectric ceramic composite.
Dielectric Relaxation of La3+‐Modified Bi3TiNbO9 Aurivillius Phase Ceramics
Authors: Zhou Zhiyong , Dong Xianlin , Huang Shiming , Yan Haixue
Published: June 2006

Single Aurivillius phase Bi3−xLaxTiNbO9 (LBTN‐x, x=0.00, 0.50, 0.75, and 1.00) ceramics were prepared by the conventional solid‐state reaction method. When x≤0.50, the ceramics are normal ferroelectrics, while LBTN‐0.75 and LBTN‐1.00 showed typical relaxor behavior, which could probably be attributed to the disordering induced by the La3+ partly substituting for Bi3+ in Bi2O2 layers. The dielectric relaxation of LBTN‐0.75 and LBTN‐1.00 were fitted using the Vögel–Fulcher relationship, and the results suggest that both of them are analogous to a spin glass with thermally activated polarization fluctuations above a freezing temperature.
Brain imaging in psychiatry – a study of 435 psychiatric in‐patients at a university clinic
Authors: Mueller C. , Rufer M. , Moergeli H. , Bridler R.
Published: June 2006

Objective:  The use of brain imaging in psychiatry still lacks clear guidelines. We investigated the referral practice, outcome and predictive factors of neuroimaging in a Swiss psychiatric university clinic.

Method:  Medical files were reviewed retrospectively for 435 consecutively hospitalized patients who were subjected to neuroimaging. The association between the sociodemographic and clinical characteristics and the scan results was analyzed using bivariate and multivariate analyses.

Results:  Of overall examinations, 69.4% were normal, 16.3% equivocal and 14.3% abnormal; 2.9% of scans ordered for screening only showed pathology. Neurologic signs and advanced age of patients predicted abnormal scan findings, whereas other variables such as EEG results showed no significant association.

Conclusion:  Our results support the need for clear indications for using brain imaging in psychiatric in‐patients. Focal neurologic signs and advanced patient age seems to predict abnormal scan results. However, these criteria are not sufficiently sensitive to predict significant scan findings in all patients.
LOXL as a target to increase the elastin content in adult skin: a dill extract induces the LOXL gene expression
Authors: Cenizo Valérie , André Valérie , Reymermier Corinne , Sommer Pascal , Damour Odile , Perrier Eric
Published: June 2006

Abstract:  The lysyl oxidases lysyl oxidase (LOX) and lysyl oxidase‐like (LOXL) are responsible for elastin cross‐linking. It was shown recently that LOXL is essential for the elastic fibres homeostasis and for their maintenance at adult age. We first determined whether or not elastin, LOX and LOXL are less expressed during adulthood. The LOX and LOXL mRNA level, quantified by real‐time reverse transcriptase‐polymerase chain reaction decreased in adult skin fibroblasts compared with fibroblasts from children. In contrast, the elastin mRNA level remains stable at all ages. The goal of this study was to induce elastogenesis at the adult age. Therefore, both enzymes, and in particular LOXL, of which expression is the most affected by age, could be targeted to induce elastogenesis in adult skin. We screened a library of about 1000 active ingredients to find activators capable to stimulate specifically the LOXL gene expression in adult dermal fibroblasts. The positive effect of selected active ingredients was confirmed on fibroblasts grown on monolayers and on dermal and skin equivalent cultures. One extract, obtained from dill (LYS'LASTINE V, Engelhard, Lyon, France), stimulates the LOXL gene expression in dermal equivalents (+64% increase in the LOXL mRNA level when compared with control). At the same time, the elastin detection is increased in dermal equivalents and under the dermal–epidermal junction of skin equivalents, without increase of the elastin mRNA. In conclusion, LOXL can be considered as a new target to reinduce elastogenesis. Its stimulation by a dill extract is correlated with increased elastin detection, suggesting an increase in elastogenesis efficiency.
IgG reactivity against non‐conformational NH2‐terminal epitopes of the desmoglein 3 ectodomain relates to clinical activity and phenotype of pemphigus vulgaris
Authors: Müller Ralf , Svoboda Vera , Wenzel Elke , Gebert Susanne , Hunzelmann Nicolas , Müller Hans‐Helge , Hertl Michael
Published: June 2006

Abstract:  Pemphigus vulgaris (PV) is an autoimmune disease caused by immunoglobulin G (IgG) autoantibodies against the desmosomal adhesion molecules, desmoglein (Dsg)3 and Dsg1. The aim of the study was to relate IgG reactivity of 123 PV sera and 40 control sera against NH2‐terminal non‐conformational epitopes of Dsg3 and Dsg1 with disease activity and clinical phenotype by enzyme‐linked immunosorbent assay. The results show that (i) the overall reactivity and the titres of IgG reactive with the Dsg3 ectodomain, Dsg3(1–566), significantly correlated with the disease activity of the PV patients; (ii) IgG reactivity against the NH2‐terminus of Dsg3, Dsg3(1–161), was associated with active PV while there was no direct correlation between the IgG titres and the disease activity; (iii) IgG reactivity against the NH2‐terminus of Dsg3, Dsg3(1–161), was associated with mucosal and mucocutaneous PV; (iv) IgG titres against a small stretch of the NH2‐terminus of Dsg3, Dsg3(25–88), were associated with active PV; and (v) IgG in the PV sera detected non‐conformational epitopes in addition to the previously identified conformation‐dependent epitopes of the Dsg3 and Dsg1 ectodomains.
A single sub‐erythematous exposure of solar‐simulated radiation on the elicitation phase of contact hypersensitivity induces IL‐10‐producing T‐regulatory cells in human skin
Authors: Stoebner Pierre E. , Rahmoun Massilva , Ferrand Christophe , Meunier Laurent , Yssel Hans , Pène Jérôme
Published: June 2006

Abstract:  Solar ultraviolet (UV) radiation has hazardous effects on human health that are, in part, associated with its immunosuppressive effects via the induction of interleukin (IL)‐10 production. Although IL‐10 is produced by both T helper type 2 (Th2) cells and T‐regulatory type 1 (Tr1) cells, the relative contribution of either subset in UV radiation‐induced immunosuppression has not been established. Here, we show that T cells isolated from non‐treated allergic contact dermatitis (ACD) reactions, 48 h following nickel challenge and propagated for 7–10 days in the presence of IL‐2, were mainly CD4+ and produced IL‐10, but little interferon‐γ. A single sub‐erythematous solar‐simulated radiation (SSR) prior to antigen challenge exposure resulted in a clinical attenuation of the intensity of ACD reactions which was associated with a significant increase in both the magnitude of IL‐10 production by skin‐infiltrating T cells and the frequency of IL‐10‐producing Tr1 cells. Skin‐infiltrating T cells in SSR‐exposed, as well as non‐exposed, ACD reactions showed a perturbed T‐cell receptor (TCR)‐Vβ repertoire, without overexpression of a particular TCR‐Vβ gene product, indicating the presence of high frequencies of nickel non‐specific T cells in ACD reactions. These results show that a single sub‐erythematous SSR induces immunosuppression via the cutaneous infiltration of IL‐10‐producing Tr1, and to a lesser extent, Th2 cells.
Measurements and evaluations in low back pain patients
Authors: Malliou P. , Gioftsidou A. , Beneka A. , Godolias G.
Published: June 2006

With the present review of literature, the authors intended to compare the definition terms, selection criteria, and measurement tools or methods used in different studies related to chronic low back pain (CLBP) patients. The relevance of including all the above information is that any health‐care professional can use them to evaluate their treatment methods with CLBP patients or use them in study designs according to their objectives. These measurements concern pain measurements, measures that were used to describe the CLBP pain, questionnaires used to measure the CLBP patients' responses to pain, the pain effects on their living activities, and also measurements of the physical abilities and functional performance. A computerized literature search in English MEDLINE was conducted using “low back pain,” and “flexibility, “strength,”“evaluation,”“functional level,” and “measurements” as search words. Identified abstracts were scanned, and useful articles were acquired for further review. Interms of CLBP definitions, the authors concluded that is best defined as a lumbar, sacral, or lumbosacral spinal pain that is continuous or essentially continuous but low level punctuated by exacerbations of pain, each of which is characterized as “acute.” In order to establish the criteria for selecting participants in a study design related to CLBP, pain characteristics and clinical diagnoses have to be taken into consideration for obtaining homogeneity of groups. Finally, the selection of measurement tools and evaluation methods is related to the study's goals, the specialization of the researchers, and their validity.
Swimmers' painful shoulder arthroscopic findings and return rate to sports
Authors: Brushøj C. , Bak K. , Johannsen H. V. , Faunø P.
Published: June 2006

Shoulder pain is the most common musculo‐skeletal complaint in competitive swimmers. It remains one of the shoulder pain syndromes in overhead athletes where no golden standard of treatment exists. Eighteen competitive swimmers who all had undergone shoulder arthroscopy for therapy‐resistant shoulder pain were retrospectively evaluated with respect to operative findings and ability to return to their sport after the operation.

The most common finding at arthroscopy was labral pathology in 11 (61%) and subacromial impingement in five shoulders (28%). Operative procedures included debridement in 11 swimmers, partial release of the coraco‐acromial ligament in four, and bursectomy in four.

Sixteen (89%) responded to the follow‐up evaluation. Nine swimmers (56%) were able to compete at preinjury level after 4 (2–9) months.

Findings at arthroscopy suggest that the term “Swimmer's shoulder” covers a variety of pathologies including labral wearing and subacromial impingement. Arthroscopic debridement of labral tears or bursectomy in swimmers with shoulder pain has a low success rate with regard to return to sport. Further understanding and investigation of this syndromes complex pathophysiology is needed.
Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older
Authors: Larson E. B. , Wang L. , Bowen J. D. , McCormick W. C. , Teri L. , Crane P. , Kukull W.
Published: June 2006

BACKGROUND: Alzheimer disease and other dementing disorders are major sources of morbidity and mortality in aging societies. Proven strategies to delay onset or reduce risk for dementing disorders would be greatly beneficial.

OBJECTIVE: To determine whether regular exercise is associated with a reduced risk for dementia and Alzheimer disease.

DESIGN: Prospective cohort study.

SETTING: Group Health Cooperative, Seattle, Washington.

PARTICIPANTS: One thousand seven hundred and forty persons older than age 65 years without cognitive impairment who scored above the 25th percentile on the Cognitive Ability Screening Instrument in the Adult Changes in Thought study and who were followed biennially to identify incident dementia.

MEASUREMENTS: Baseline measurements, including exercise frequency, cognitive function, physical function, depression, health conditions, lifestyle characteristics, and other potential risk factors for dementia (e.g., apolipoprotein E epsilon4); biennial assessment for dementia.

RESULTS: During a mean follow‐up of 6.2 years (SD, 2.0), 158 participants developed dementia (107 developed Alzheimer disease). The incidence rate of dementia was 13.0 per 1000 person‐years for participants who exercised three or more times per week compared with 19.7 per 1000 person‐years for those who exercised fewer than three times per week. The age‐ and sex‐adjusted hazard ratio of dementia was 0.62 [95% confidence interval (CI), 0.44–0.86; P=0.004]. The interaction between exercise and performance‐based physical function was statistically significant (P=0.013). The risk reduction associated with exercise was greater in those with lower performance levels. Similar results were observed in analyses restricted to participants with incident Alzheimer disease.

LIMITATIONS: Exercise was measured by self‐reported frequency. The study population had a relatively high proportion of regular exercisers at baseline.

CONCLUSION: These results suggest that regular exercise is associated with a delay in onset of dementia and Alzheimer disease, further supporting its value for elderly persons.
Moderate exercise in hypoxia induces a greater arterial desaturation in trained than untrained men
Authors: Woorons X. , Mollard P. , Pichon A. , Lamberto C. , Duvallet A. , Richalet J.‐P.
Published: June 2006

During moderate exercise breathing a low inspired O2 fraction (FIO2), arterial O2 desaturation may depend on the fitness level. Seven trained (TM) and seven untrained men (UTM) cycled in normoxia and in hypoxia (FIO2=0.187, 0.173, 0.154, 0.13 and 0.117). We compared TM and UTM at submaximal intensities below the ventilatory threshold. Ventilatory variables were monitored and arterial oxygen saturation was measured by pulse oximetry. O2 saturation was not different between groups at sea level. In hypoxia, O2 saturation was lower in TM than in UTM at FIO2=0.154 (87.3 ± 2.9% vs 90.4 ± 1.5% at 90 W) and below. Both the ventilatory‐equivalent and the end‐tidal O2 pressure were lower in TM at sea level and at every FIO2, with the differences between TM and UTM becoming apparent at lower exercise intensity and increasing in magnitude as the severity of hypoxia increased. O2 saturation was correlated with the ventilatory parameters at every FIO2 and the correlations were stronger in severe hypoxia. These results demonstrate that a moderate exercise carried out in hypoxia, contrary to normoxic conditions, can lead to a greater arterial desaturation in TM compared with UTM. This phenomenon could be partly attributed to a relative hypoventilation in trained subjects.
Anatomy of the anterior cruciate ligament double bundle structure: a macroscopic evaluation
Authors: Steckel H. , Starman J. S. , Baums M. H. , Klinger H. M. , Schultz W. , Fu F. H.
Published: June 2006

Introduction:
Traditional anterior cruciate ligament (ACL) surgery has demonstrated good results, but there is still a subset of unsatisfactory outcomes. Trends in reconstruction technique have changed from bone–patella–tendon–bone to hamstring refixation, and the next step appears to be the double bundle concept.

Methods:
We examined six fresh‐frozen cadaver knees to evaluate the double bundle structure, dynamic motion characteristics and the relationship of knee flexion and relative position of the femoral insertion sites of the ACL.

Results:
In all knees, we identified an anteromedial (AM) and posterolateral (PL) bundle. The motion pattern demonstrated that the AM and PL bundles are oriented near parallel with the knee extended, and twist around each other as the knee is flexed. The visualization of the femoral footprint anatomy differs with knee flexion.

Discussion:
The double bundle model facilitates restoration of the original footprint anatomy and biomechanics more easily than the concept of the ACL as a one‐bundle structure and the use of the o'clock position. It is essential to be aware of the degree of knee flexion when drilling the femoral tunnels.

Perspective:
Anatomic ACL reconstruction is a concept, not a technique, and allows a more refined surgical approach to ACL reconstruction including revision cases and partial ACL tears.
Evaluation of the Efficacy of the Acellular Dermal Matrix Allograft with Partial Thickness Flap in the Elimination of Gingival Melanin Pigmentation. A Comparative Clinical Study with 12 Months of Follow‐Up
Authors: Pontes Ana E. f. , Pontes Carla C. , Souza Sérgio l. s. , Novaes Arthur B. , Grisi Márcio f. m. , Taba Mário
Published: June 2006

Acellular dermal matrix (ADM) has been used as a substitute for gingival allografts. The aim of this study was to evaluate the effectiveness of ADM with partial thickness flap in the elimination of gingival melanic pigmentations. Fifteen patients presenting bilateral gingival melanin pigmentation were selected for this study. Each side of the pigmentation was randomly assigned to be part of a group. The sites of the experimental group had a partial thickness flap raised, excised, followed by adaptation and suture of the ADM. On the opposite side (ie, sites from the control group), the oral epithelium was removed with a diamond bur. The healing process was evaluated at 1 and 2 weeks, and 1, 3, 6, 9, and 12 months postoperatively. Images of the patient’s follow‐up were digitalized, and occurrence and quantification of clinical repigmentation were evaluated. After 12 months, minimal repigmentation (mean 3.14 ± 7.45%) was noted in 8 of 15 sites from the ADM group, while significant repigmentation (mean 55.84 ± 27.25%) was seen in 15 of 15 abrasion sites. According to our results, it can be concluded that ADM may be successfully used in the elimination or greater reduction of gingival melanic pigmentations, and is more efficient than epithelium abrasion after 12 months (p < 0.0001).

CLINICAL SIGNIFICANCE

Gingival pigmentation is a common finding in several ethnic groups. Although physiologic melanin pigmentation is not a medical problem, cosmetic demands may turn it into a problem of social acceptance in different cultures. In this way, different treatment modalities have been used with the aim of removing pigmentations for esthetic reasons. In the present study, the use of ADM with partial thickness flap resulted in more effective elimination of gingival melanin pigmentation, as repigmentation occurred later and was much weaker when compared to the outcomes of epithelial abrasion.
Use of Hydrogen Peroxide‐Based Tooth Whitening Products and its Relationship to Oral Cancer
Authors: Munro Ian C. , Williams Gary M. , Heymann Harald O. , Kroes Robert
Published: June 2006

Tooth whitening products containing hydrogen peroxide or carbamide peroxide were evaluated in this review for potential oral cancer risk from their use. Hydrogen peroxide is genotoxic in vitro, but not in vivo. Hydrogen peroxide was not considered to pose a genotoxic risk to humans. The animal toxicology data relevant to the assessment of the carcinogenicity of hydrogen peroxide do not indicate that it has significant carcinogenic activity at any site, including the oral cavity. Hydrogen peroxide was found to enhance the carcinogenic effects of potent DNA reactive carcinogens in experimental animals. However, these experimental conditions are artificial as they are related to high exposures and are of no relevance to potential human exposures to low quantities of hydrogen peroxide from the use of tooth whitening products. Clinical data on hydrogen peroxide‐containing tooth whitening products show no evidence for the development of preneoplastic or neoplastic oral lesions. Exposures to hydrogen peroxide received by the oral cavity are exceedingly low, of short duration (30–60 minutes), and could not plausibly enhance any carcinogenic risk associated with exposure of the oral cavity to chemicals in cigarette smoke or to alcohol, both known risk factors for the development of oral cancer.

CLINICAL SIGNIFICANCE

Based on a comprehensive review of the available literature and research, the use of tooth whitening products containing hydrogen peroxide or carbamide peroxide does not appear to pose an increased risk of oral cancer in the general population, including those persons who are alcohol abusers and/or heavy cigarette smokers.
QUARTZ‐TUNGSTEN‐HALOGEN AND LIGHT‐EMITTING DIODE CURING LIGHTS
Authors: Vandewalle Kraig S. , Roberts Howard W. , Miniotis Nicholas , Swift Edward J.
Published: June 2006

Curing lights are an integral part of the daily practice of restorative dentistry. Quartz‐tungsten‐halogen (QTH), plasma‐arc (PAC), argon laser, and light‐emitting diode (LED) curing lights are currently commercially available. The QTH curing light has a long, established history as a workhorse for composite resin polymerization in dental practices and remains the most common type of light in use today. Its relatively broad emission spectrum allows the QTH curing light to predictably initiate polymerization of all known photo‐activated resin‐based dental materials. However, the principal output from these lamps is infrared energy, with the generation of high heat. Filters are used to reduce the emitted heat energy and provide further restriction of visible light to correlate better with the narrower absorbance spectrum of photo‐initiators. The relatively inefficient emission typically requires corded handpieces with noisy fans. PAC lights generate a high voltage pulse that creates hot plasma between two electrodes in a xenon‐filled bulb. The irradiance of PAC lights is much higher than the typical QTH curing light, but PAC lights are more expensive and generate very high heat with an inefficient emission spectrum similar to that of QTH bulbs. Light emitted from an argon laser is very different from that emitted from the halogen or PAC lights. The photons produced are coherent and do not diverge; therefore, lasers concentrate more photons of specific frequency into a tiny area. With very little infrared output, unwanted heat is minimized. However, argon lasers are very expensive and inefficient due to a small curing tip. LED curing lights have been introduced to the market with the promise of more efficient polymerization, consistent output over time without degradation, and less heat emission in a quiet, compact, portable device. This review evaluates some of the published research on LED and QTH curing lights.
Integration of Composite and Ceramic Restorations in Tetracycline‐Bleached Teeth: A Case Report
Authors: Deliperi Simone , Congiu M. Debora , Bardwell David N.
Published: June 2006

The success of an esthetic rehabilitation depends on the understanding of the patient’s need and expectation. The management of patients with moderate to severe tetracycline‐stained teeth is very challenging. Tooth whitening may be a valid alternative to more aggressive treatments; however, patients should be aware of the limitations of tooth whitening therapy.

Clinicians may select differing treatment plans; tooth whitening can improve intrinsic discoloration in a way so that no further treatment is required. Once tooth whitening is completed, direct or indirect restorative procedures may be afforded to match the existing restoration with the bleached tooth structure.

This article describes a conservative clinical approach to rehabilitate the smile of a patient with moderate to severe tetracycline‐stained teeth using a combination of tooth whitening and direct composite and indirect porcelain restorations in the maxillary anterior segment.

CLINICAL SIGNIFICANCE

The combination of tooth whitening and adhesive restorations allows clinicians a significantly more conservative approach to intrinsically stained teeth; tooth preparation for porcelain veneers and porcelain‐fused‐to‐metal and full‐ceramic crowns can be restricted to conditions in which persistent tooth discoloration or significant loss of both dentin and enamel exists.
Saying Things: Collecting Conflicts in Eighteenth‐Century Object Literatures
Authors: Benedict Barbara M.
Published: June 2006

The British literature of the long eighteenth century, from 1660 to 1820, represents objects as sites of complex meanings. In recording the changing culture of collecting, the various, “factual” literatures of collection – collecting catalogs, museum guides, and advertisements – present things paradoxically both as physically real objects, and as transcendent representations of identity and idea. They negotiate this paradox by descriptive and organizational modes that translate material culture into a literary theme, structure, and technique. These narratives thus embrace divergent registers of meaning: history, myth, science, religion, and personal and social valuation. This narrative practice of juxtaposing or collapsing contrary meanings informs the self‐consciously “literary” devices of antithesis and of authentication by means of provenance in eighteenth‐century literature.
Surveying Ann Radcliffe’s Gothic Landscapes
Authors: Brabon Benjamin A.
Published: June 2006

This article examines the use of space in Ann Radcliffe’s Gothic romances, considering how issues of female propriety, property and identity are explored through contradictions within her landscapes. In so doing, it analyses the connections between being and place, studying Radcliffe’s representations of the sublime and the picturesque in relationship to the ‘female Gothic’.1 It contends that Radcliffe brings together the opposing forces of cartography and poetry in her panoramic surveys of space. In conclusion, it introduces the critical concept of ‘Gothic cartography’ in order to define these conflicting approaches within Radcliffe’s literary geographies.2
The Contemporary Study of Eighteenth‐Century Poetry
Authors: Rounce Adam
Published: June 2006

This article is a descriptive summary of critical views of eighteenth‐century poetry, from the 1950s to the present. It looks at general surveys of poetry of the period from 1700 to 1790, as well as the most influential criticism of specific poets. It is not intended to be exhaustive, but rather an introduction to major trends and approaches, and to offer some descriptions of criticism of all significant poets. After an initial introduction, it is organised according to the following categories: Pope and the Scriblerians, the long poem, the mid‐century and poetry near the close of the century.
Pain and quality of life for patients with venous leg ulcers: proof of concept of the efficacy of Biatain®‐Ibu, a new pain reducing wound dressing
Authors: Jørgensen Bo , Friis Gitte Juel , Gottrup Finn
Published: June 2006

Wound pain is a serious problem for elderly patients suffering from chronic leg ulcers, and it may lead to reduced wound healing rates and reduced quality of life. Biatain®‐Ibu Non‐adhesive (Coloplast A/S), a new pain‐reducing moist wound healing dressing containing ibuprofen was tested for pain reduction, safety, and efficacy on 10+2 patients in a single‐blinded crossover study against Biatain Non‐adhesive (Coloplast A/S). Pain was measured with a Numeric Box Scale before, during, and after dressing change. Quality of life was measured using the World Health Organization‐5 Well‐Being Index. Dressing moist wound healing properties such as absorption capacity and leakage were tested together with assessment of wound exudate and blood plasma content of ibuprofen. Use of the Biatain®‐Ibu foam dressing correlated with a decrease in pain intensity scores from 7 in the run‐in period to approximately 2.5 in the Biatain®‐Ibu treatment phase. Quality of life measures were improved which together with the reduced pain could contribute to faster wound healing. The moist wound healing properties of Biatain®‐Ibu were similar to that of the Biatain Non‐adhesive and ulcer size was reduced by 24% during the treatment period. Neither side effects nor systemic plasma concentrations of ibuprofen were observed. These data indicate that Biatain®‐Ibu could reduce persistent and temporary wound pain, increase Quality of life, was found safe to use, and had excellent moist wound healing properties.
The effect of amelogenins (Xelma™) on hard‐to‐heal venous leg ulcers
Authors: Vowden Peter , Romanelli Marco , Peter Ralf , Boström Åsa , Josefsson Anna , Stege Helger
Published: June 2006

With an aging population venous ulceration is likely to become an increasing problem. Despite improvements in care and the widespread introduction of compression bandaging, the mainstay of current management, a significant proportion of venous leg ulcers remain hard to heal. Therefore, a single‐blinded, randomized multicenter study was performed to compare wound size reduction using amelogenin proteins (Xelma™) formulated into a solution which forms a temporary extracellular matrix on contact with the wound bed. Propylene glycol alginate 7% served as a control. Patients were randomized to receive either amelogenin protein or control treatment. The investigational products were applied weekly under soft silicone secondary dressings for up to a maximum of 12 weeks. Compression therapy was maintained throughout the investigation. Wound size reduction was measured by tracing and all wounds were photographed. In total 123 patients were recruited, 62 patients in the amelogenin group, and 61 in the control group, respectively. Subgroup analyses were performed for ulcers with a size >10 cm2 at baseline and for ulcers of duration of >12 months. The wound size reduction was greatest in the group treated with amelogenin (33.8 vs. 25.6%, n= 117), this difference being greatest for larger ulcers (25 vs. 7.9% for ulcers>10 cm2, n= 61) and those of long duration (29.3 vs. 10.9% for ulcers >12‐month duration, n= 61).We conclude that this product may be clinically useful in the treatment of these venous leg ulcers.
Hyaluronan in human acute and chronic dermal wounds
Authors: Dechert Tracey A. , Ducale Ashley E. , Ward Susan I. , Yager Dorne R.
Published: June 2006

There is growing interest in the relationship of hyaluronan and inflammation in a number of physiologic processes including wound healing. The objective of this study was to make a quantitative comparison of inflammation and hyaluronan expression in human normal healing open wounds and in pressure ulcers. Using an open dermal wound model, myeloperoxidase activity was found to peak at day 3. Hyaluronan levels showed a bimodal distribution with transient peaks occurring on days 1 and 7. Mean levels of myeloperoxidase activity in pressure ulcers were significantly higher than at any time in the acute wounds, whereas hyaluronan levels were significantly lower than at any time in the acute wounds. Levels of hyaluronidase activity increased slightly in the postwound period. Hyaluronidase activity in pressure ulcers was significantly elevated compared with the acute wounds. These results suggest a role for increased enzymatic degradation of hyaluronan as a function of inflammation during wound repair. This is the first reported quantitative examination of hyaluronan expression in human acute dermal wounds and in chronic pressure ulcers.
Scarless skin repair in immunodeficient mice
Authors: Gawronska‐Kozak Barbara , Bogacki Marek , Rim Jong‐Seop , Monroe W. Todd , Manuel Jessica A.
Published: June 2006

Scarring, the end result of the wound healing process in adult mammals, is a problem of significant clinical importance. We observed that athymic nude‐nu mice, similar to mammalian fetuses, are able to restore the structure and integrity of injured skin through a process resembling regeneration, where scar formation is absent. Among the postinjured skin tissues collected from athymic nude‐nu, wild‐type controls (C57BL/6J), severe‐combined immunodeficient, Rag (lack of B and T cells), athymic (thymectomized neonates and adult C57BL/6J), and mice treated with an immunosuppressant (cyclosporin A), only athymic nude‐nu mice showed: a lack of scar by histological examination (hematoxylin & eosin and Masson's trichrome staining), low levels of collagen (as determined by hydroxyproline content), high levels of hyaluronic acid, a statistically significant increase in elastic modulus for injured samples over unwounded (biomechanical testing) and low levels of the pro‐scarring cytokines platelet‐derived growth factor‐B and transforming growth factor β1. Additionally, immunohistochemical and Western blot analyses of postinjured tissues as well as flow cytometry analysis of blood samples showed the presence of CD8‐positive cells in all studied animals except nude‐nu mice. We conclude that scarless skin healing in athymic nude‐nu mice provides a new model to study the influence of the immune system on tissue regeneration.
Lactate stimulates endothelial cell migration
Authors: Beckert Stefan , Farrahi Farshid , Aslam Rummana S. , Scheuenstuhl Heinz , Königsrainer Alfred , Hussain M. Zamirul , Hunt Thomas K.
Published: June 2006

The significance of the high lactate levels that characterize healing wounds is not fully understood. Lactate has been shown to enhance collagen synthesis by fibroblasts and vascular endothelial growth factor (VEGF) production by macrophages and endothelial cells. VEGF has been shown to induce endothelial cell migration. However, it has not been shown whether accumulated lactate correlates with the biological activity of VEGF. Therefore, we investigated the effect of lactate on migration of endothelial cells. Human umbilical vein endothelial cells and human microvascular endothelial cells were cultured to subconfluent monolayers in standard six‐well tissue culture plates. Following a 24‐hour serum starvation, cells were treated with the indicated concentrations of l‐lactate. Cell migration was assessed using a modified Boyden chamber. VEGF protein in the cell culture supernatant was measured by enzyme‐linked immunoassay. Lactate‐enhanced VEGF protein synthesis in a time‐ and dose‐dependent manner. Lactate added into the bottom well did not stimulate cellular migration from the upper well. However, lactate when added together with endothelial cells to the bottom well of the Boyden chamber increased cellular migration in a dose‐dependent manner. This effect was blocked by anti‐VEGF and by cycloheximide. Lactate enhances VEGF production in endothelial cells, although lactate, itself, is not a chemoattractant. We conclude that the lactate‐mediated increase in cellular migration is regulated by VEGF.
Enhanced wound‐healing quality with bone marrow mesenchymal stem cells autografting after skin injury
Authors: Fu Xiaobing , Fang Lijun , Li Xiaokun , Cheng Biao , Sheng Zhiyong
Published: June 2006

Adult stem cells exist in various tissues and organs and have the potential to differentiate into different cell lineages, including bone, cartilage, fat, tendon, muscle, and epithelial cells of the gastrointestinal tract. Here, we report that the in vitro expanded and purified bone marrow mesenchymal stem cells (MSCs) might take on phenotypes with characteristics of vascular endothelial cells (7% on day 3 and 15% on day 1) or epidermal cells (3% on day 3 and 13% on day 1) after being cultured under different lineage‐specific culture conditions. Also, in vivo grafting experiments showed that 5‐bromodeoxyuridine‐labeled MSCs could convert into the phenotypes of vascular endothelial cells (3.43, 3.46, and 2.94% on days 7, 14, and 28, respectively) in granulation tissues, sebaceous duct cells, and epidermal cells (0–1.49%) in regenerated skin, implying that these grafted MSCs might have transdifferentiated into the above three cell types. Animal autografting experiments with MSCs further confirmed that indices pertaining to wound healing quality, such as the speed of reepithelialization, the number of epidermal ridges and thickness of the regenerated epidermis, the morphology and the number and arrangement of microvasculature, fibroblasts and collagen, were much enhanced. Our results indicate that locally delivered bone marrow MSCs can enhance wound healing quality, and may generate de novo intact skin, resulting in perfect skin regeneration after full‐thickness injury.