bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional simulation of long‐term organic carbon stock changes in cropland soils using the DNDC model: 2. Scenario analysis of management options
Authors: Sleutel S. , De Neve S. , Beheydt D. , Li C. , Hofman G.
Published: August 2010

The development of successful agricultural policies in response to the Kyoto Protocol is aided by the identification of regions where the effects of soil organic carbon (SOC) sequestration measures can be maximized. We describe a modelling approach which incorporates a spatial analysis of the results from regional simulation under different management alternatives. SOC stock changes in Flemish cropland soils, simulated with the DNDC model, were previously fitted to a large data set of SOC measurements for the period 1990–2000. Using the results of this study, simulations with DNDC of SOC stock changes during the period 2006–2012 including the Kyoto commitment period were carried out at the community level for a business‐as‐usual (BAU) scenario and seven alternative agricultural management options for SOC sequestration. The baseline SOC stock decreased during that period by 0.15 t OC ha−1 year−1 compared with 0.48 t OC ha−1 year−1 in the 1990s. All alternative scenarios resulted in net SOC storage compared with the BAU scenario, but none of the individual scenarios were able to increase the average absolute SOC stock. Overall, spatial variability in SOC storage for the selected management options was strongly dependent on the current distribution of crops and associated management. The modelling approach used in this study provides a case study in regional scale modelling of SOC sequestration and is applicable to other regions in Europe with comparable intensive agriculture.
Identifying potential management zones in a layered soil using several sources of ancillary information
Authors: Vitharana U. W. A. , Van Meirvenne M. , Cockx L. , Bourgeois J.
Published: August 2010

Variation in soil texture has a profound effect on soil management, especially in texturally complex soils such as the polder soils of Belgium. The conventional point sampling approach requires high sampling intensity to take into account such spatial variation. In this study we investigated the use of two ancillary variables for the detailed mapping of soil texture and subsequent delineation of potential management zones for site‐specific management. In an 11.5 ha arable field in the polder area, the apparent electrical conductivity (ECa) was measured with an EM38DD electromagnetic induction instrument. The geometric mean values of the ECameasured in both vertical and horizontal orientations strongly correlated with the more heterogeneous subsoil clay content (r = 0.83), but the correlation was weaker with the homogenous topsoil clay content (r = 0.40). The gravimetric water content at wilting point (θg(−1.5 MPa)) correlated very well (r = 0.96) with the topsoil clay content. Thus maps of topsoil and subsoil clay contents were obtained from 63 clay analyses supplemented with 117θg(−1.5 MPa)and 4048ECameasurements, respectively, using standardized ordinary cokriging. Three potential management zones were identified based on the spatial variation of both top and subsoil clay contents. The influence of subsoil textural variation on crop behaviour was illustrated by an aerial image, confirming the reliability of the results from the small number of primary samples.
Involvement of p38 mitogen‐activated protein kinase pathway in honokiol‐induced apoptosis in a human hepatoma cell line (hepG2)
Authors: Deng Junfang , Qian Yigang , Geng Lei , Chen Jie , Wang Xiaohui , Xie Haiyang , Yan Sheng , Jiang Guoping , Zhou Lin , Zheng Shusen
Published: August 2010

Background: Honokiol has been known to have antitumour activity. This study was conducted to evaluate the antiproliferative potential of honokiol against the hepG2 heptocellular cell line and its mechanism of action.

Methods: hepG2 cells were treated with honokiol of 0–40 μg/ml concentration. The cytotoxic effect of honokiol was determined by a 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide (MTT) assay. The apoptosis was evaluated by flow cytometry. Western blots were used to analyse the expression of various proteins (procaspase‐9, procaspase‐3, cleaved caspase‐3, cytochrome c, Bcl‐2, Bax, Bad, Bcl‐XL and p38).

Results: Honokiol induced apoptosis with a decreased expression of procaspase‐3 and ‐9 and an increased expression of active caspase‐3. Exposure of hepG2 cells to honokiol resulted in the downregulation of Bcl‐XL and Bcl‐2 expression and the release of mitochondrial cytochrome c to the cytosol. In addition, honokiol activated the p38 mitogen‐activated protein kinase (MAPK) pathway, and the inhibition of this pathway by SB203580 reduced honokiol‐induced apoptosis and activation of caspase‐3.

Conclusion: Honokiol induces apoptosis of hepG2 human hepatocellular carcinoma cells through activation of the p38 MAPK pathway, and, in turn, activation of caspase‐3.
Women’s health in early pregnancy: Findings from an Australian nulliparous cohort study
Authors: GARTLAND Deirdre , BROWN Stephanie , DONATH Susan , PERLEN Susan
Published: August 2010

Background:  Much is known about severe maternal morbidity during pregnancy, but there has been little attention paid to the impact of pregnancy itself on women’s general health and well‐being.

Aim:  To investigate women’s general health and well‐being in early pregnancy and examine the relationship between maternal age and women’s physical and mental health.

Method:  Cross‐sectional analysis of baseline data from a multicentre, prospective nulliparous pregnancy cohort study. The baseline questionnaire included the SF‐36 health status measure and individual items assessing a range of common maternal health issues.

Results:  A total of 1507 eligible women returned baseline questionnaires in early pregnancy (mean gestation 15 weeks, range 6–24 weeks) ranging from 18 to 49 years of age (mean age 30.1 years). Study participants reported significantly poorer health compared with age and gender‐standardised population means on all SF‐36 scales except general health. Two‐thirds of women (68%) reported three or more health issues, the most common being exhaustion (87%), nausea (64%), back pain (46%), constipation (44%) and severe headaches/migraines (30%). Younger women (18–24 years) had significantly lower SF‐36 scores (poorer self perceived health) compared with women ≥35 (P ≤ 0.03). After adjusting for socio‐demographic factors, maternal age remained significantly positively associated with women’s mental and physical component scores. Younger women reported significantly more health issues than women ≥35 (4.39 and 3.27, mean difference = 1.12, 95% CI 0.75–1.79, P < 0.001).

Conclusions:  Common pregnancy symptoms have a marked impact on women’s physical and mental health in early pregnancy, with the greatest impact apparent for younger women.
The attitudes of Australian gynaecologists to HPV vaccination: An ASCCP survey
Authors: TAN Jeffrey , FARRELL Louise , ALLEN David G.
Published: August 2010

Background:  With human papilloma virus (HPV) vaccines now approved for women up to 45 years of age, gynaecologists in Australia will be approached increasingly for advice on whether to have the HPV vaccine.

Aim:  We seek to establish the attitudes of gynaecologists to HPV vaccination when advising women in various age groups.

Methods:  Fellows, members and trainees of Royal Australian and New Zealand College of Obstetricians and Gynaecologists were approached in early 2009 to complete an Australian Society for Colposcopy and Cervical Pathology survey, which they could return by post or internet on‐line. There were 836 (49.0%) responses, with 35.6% of responders using ‘Tuna’ on‐line.

Results:  836 RANZCOG fellows, members and trainees responded to the survey. The gender of responders are 261 (43%) females and 470 (56%) males. Of the responders, 391 (46.8%) usually initiated discussion regarding the role of HPV vaccination with their patients. More than 93% encourage when recommending the HPV vaccines for female responders aged 12–26 years. This proportion decreased to 66% for women aged 27–45 years, with 15% strongly encouraging vaccination for this age group. The attitudes to HPV vaccination for the different age groups of females were similar for trainees, fellows and members, as well as for gender and age groups of the responders. However, those with lower level of knowledge are less likely to encourage HPV vaccination in all vaccination age groups and the association is statistically significant after adjusting for role, gender and age.

Conclusions:  The results show a strong support from gynaecologists in Australia for HPV vaccination.
Management of pre‐labour rupture of membranes at term – A survey of current practice in Australia
Authors: WEEKES Christopher R. , MAHOMED Kassam
Published: August 2010

Background:  Women with pre‐labour rupture of membranes at term (Term‐PROM) commonly choose to have early induction of labour with the use of oxytocin. Although there is evidence of efficacy and safety of induction by the use of prostaglandin, it is used infrequently in Australia.

Aims:  To identify current practice and views of obstetricians in Australia, on Term‐PROM

Methods:  A postal survey among all obstetricians in Australia in April 2009. Fellows no longer practising obstetrics or who were non‐practising were asked to return the survey without completing it.

Results:  Of the 1319 surveys posted, 720 (54.6%) were returned, 23.8% of whom were practising only gynaecology or non‐practising, leaving 548 respondents practising obstetrics (41.5%). The most common management of Term‐PROM is induction of labour (IOL) within 24 h at the next convenient opportunity (75%). More than 96% would use intravenous oxytocin at some stage as their method of induction. Prostaglandin gel (PGE2) was utilised by 15% of respondents regularly, mainly for ripening of an unfavourable cervix in a primigravida, but nearly 40% would consider the use of PGE2 indicating that it would produce a more ‘natural’ labour, that women could ambulate more and that there would be reduced impact on midwifery staff. For those who would not consider PGE2, the most common reasons were concerns of hyperstimulation, increased infection rate and precautions of use based on product information.

Conclusions:  Oxytocin is the most widely used induction agent for women with term‐PROM. PGE2 is an important alternative method of induction and nearly 40% would consider using it. Clarification from RANZCOG and further studies on whether PGE2 offers a safe and effective option are now required.
The effect of cultural and linguistic diversity on pregnancy outcome
Authors: THOMAS Penelope E. , BECKMANN Michael , GIBBONS Kristen
Published: August 2010

Background:  Cultural and linguistic diversity in Australia is increasing rapidly. Culturally and linguistically diverse (CALD) women include those born outside Australia/New Zealand, non‐English speaking, non‐Caucasian and refugees. Individually, each of these factors has the potential to influence health and pregnancy outcomes.

Aims:  The aim of this study was to determine whether CALD parameters, including country of birth, race, primary language spoken, need for an interpreter and refugee status are independent predictors of obstetric or neonatal outcomes.

Methods:  A retrospective analysis of 4751 women (including 461 women using an interpreter; 1046 non‐Caucasian and 117 women identifying as refugees) was performed.

Results:  Generalized ordered logistic modelling found no significant relationship between adverse outcomes and refugee status (P = 0.863). Use of interpreter services (P = 0.015) and country of birth (P < 0.001 when at least one adverse outcome has occurred) were significant indicating that using an interpreter and/or being born outside Australia/New Zealand reduced the likelihood of an adverse outcome.

Conclusions:  These findings are relevant to planning appropriate models of care and guiding effective use of resources.
What’s shaking in the ICU? The differential diagnosis of seizures in the intensive care setting
Authors: Benbadis Selim R. , Chen Shirley , Melo Maria
Published: August 2010

To analyze what conditions mimic seizures in the intensive care unit (ICU) setting, we reviewed all bedside electroencephalography (EEG)–videos obtained in the adult ICU setting over an 18‐month period. Only those studies performed for “possible seizures” due to motor phenomena and whose clinical events were captured on video were analyzed. A total of 52 studies were performed. Fourteen patients (27%) had epileptic seizures. Thirty‐eight (73%) had nonepileptic events. These consisted of 12 (23%) with tremor‐like movements, 7 (13.5%) with multifocal myoclonic jerks without electrographic changes, 7 (13.5%) with slow semipurposeful movements, and 10 with other movements. Therefore, seizure mimics in the ICU setting were diverse and distinct from the usual differential diagnosis of seizures seen in ambulatory patients.
Comparative pharmacodynamic and pharmacokinetic analysis of two anticonvulsant halo derivatives of 2,2,3,3‐tetramethylcyclopropanecarboxamide, an amide of a cyclic analog of valproic acid
Authors: Pessah Neta , Kaufmann Dan , Yagen Boris , Hen Naama , Wlodarczyk Bogdan , Finnell Richard H. , Bialer Meir
Published: August 2010

Purpose:  α‐Fluoro‐2,2,3,3‐tetramethylcyclopropanecarboxamide (α‐F‐TMCD) and α‐Cl‐TMCD, are α‐halo derivatives of TMCD, the corresponding amide of a cyclopropane analog of valproic acid (VPA). This study aimed to comparatively evaluate the pharmacodynamics and pharmacokinetics of α‐F‐TMCD and α‐Cl‐TMCD in rodent models of epilepsy and for antiepileptic drug (AED)–induced teratogenicity. The potential of α‐F‐TMCD as an antiallodynic and antinociceptive compound was also evaluated.

Methods:  α‐F‐TMCD and α‐Cl‐TMCD were synthesized. α‐Cl‐TMCD anticonvulsant activity was evaluated in comparison to VPA in the mouse maximal‐electroshock‐seizure (MES), Metrazol (scMet), and 6‐Hz psychomotor‐seizure tests. Neurotoxicity was assessed by the Rotorod‐ataxia test. Induction of neural tube defects (NTDs) by α‐Cl‐TMCD and α‐F‐TMCD was evaluated after intraperitoneal administration to a mouse strain highly susceptible to VPA‐induced teratogenicity. The ability of α‐F‐TMCD to reduce pain was evaluated in the rat spinal nerve ligation (SNL) model for neuropathic pain and in the formalin test. α‐F‐TMCD and α‐Cl‐TMCD pharmacokinetics was evaluated following intraperitoneal (40 mg/kg) and oral (60 mg/kg) administration to rats.

Results:  α‐F‐TMCD and α‐Cl‐TMCD had similar potencies in the 6‐Hz test and were more potent than VPA in this model and in the scMet test. Neither induced NTDs, and both exhibited wide safety margins. α‐F‐TMCD was active in the two pain models, and was found to be equipotent to gabapentin in the SNL model (ED50 = 37 and 32 mg/kg, respectively). Comparative pharmacokinetic analysis showed that α‐Cl‐TMCD is less susceptible to liver first‐pass effect than α‐F‐TMCD because of lower total (metabolic) clearance and liver extraction ratio.

Conclusions:  Based on their potent anticonvulsant activity and lack of teratogenicity, α‐F‐TMCD and α‐Cl‐TMCD have the potential for development as new antiepileptics and central nervous system (CNS) drugs.
Semiologic aspects of epileptic seizures in 31 patients with hypothalamic hamartoma
Authors: Oehl Bernhard , Brandt Armin , Fauser Susanne , Bast Thomas , Trippel Michael , Schulze‐Bonhage Andreas
Published: August 2010

Purpose: Characterization of seizure semiology in patients with hypothalamic hamartoma (HH) based on video–electroencephalography (EEG) monitoring (VEM).

Methods: We retrospectively analyzed seizure semiology of 31 patients (20 male, mean age 23.5 years) who underwent VEM at the University Hospitals Freiburg or Heidelberg, Germany. Inclusion criteria were magnetic resonance evidence of an HH, no prior surgical or radiosurgical treatment, and at least two video‐documented seizures. A total of 263 seizures were included (mean number of seizures/patient 8.5, range 2–10). To analyze age‐dependent changes in seizure semiology, patients were grouped into “children” (3–11 years, n = 5), “adolescents” (12–17 years, n = 4), and “adults” (≥18 years, n = 22).

Results: According to patient history, gelastic seizures had occurred in all patients, in 74% as the initial seizure type at epilepsy onset. In VEM, epileptic laughter varied from facial grinning to intense contractions of the diaphragm and body shaking. Unilateral motor signs were seen ipsi‐ and contralaterally to the HH. Tonic seizures were frequent and did not depend on the state of vigilance. Children, in contrast to adults and adolescents, did not show secondarily generalized tonic–clonic seizures, the gelastic component was the dominating and initial semiologic element, and seizures were significantly shorter.

Conclusion: Seizure semiology is highly variable and age dependent. This may reflect network modulations with different propagation of ictal activity and/or secondary epileptogenesis. Detailed knowledge about such changes may contribute to both earlier recognition of seizures during childhood and better assignment of seizure types to a hypothalamic origin.
Generalized convulsive status epilepticus management in adults: A cohort study with evaluation of professional practice
Authors: Aranda Alexandre , Foucart Guillaume , Ducassé Jean Louis , Grolleau Sabrina , McGonigal Aileen , Valton Luc
Published: August 2010

Purpose: Generalized convulsive status epilepticus (GCSE) needs immediate management. Despite guidelines, adherence to management protocols is often poor, this contributing to poor outcome. We aimed to evaluate the usefulness of a management protocol in GCSE.

Methods: This is a prospective population‐based study of consecutive adults with GCSE in Haute‐Garonne district, France. Demographics and treatment procedures were documented. Factors associated with seizure termination and refractoriness were analyzed using logistic regression.

Results: One hundred eighteen episodes in 111 adults (mean age 55 years) between October 2006 and February 2008 were included. SE was convulsive in 101 episodes. Incidence was 6.6 per 100,000 and case fatality was 9%. Adequate initial treatment according to protocol was observed in 38%; 64% were treated out‐of‐hospital, and SE was refractory in 27% [no response after two antiepileptic drugs (AED)]. Patients who received adequate first‐line treatment were 6.8 times [95% confidence interval (CI) 2.8–16.9] more likely to have seizure termination, with 74% versus 29% efficacy rate (p < 0.0001). Inadequate initial management was 4.7 times (1.9–11.1) more likely to need several benzodiazepine doses (p = 0.0004) and 9.1 times (3.7–20) more likely to require a long‐acting AED as next treatment (p < 0.0001). Seizure termination after initial treatment was associated with decreased intensive care unit stay [1 (1–2) versus 2 (1–5.5) days, p < 0.0001] and hospital stay [3 (2–11) versus 7 (3–18) days, p = 0.009].

Discussion: GCSE termination and outcome seem clearly associated with adherence to treatment protocol. Results add to the debate on appropriate allocation of resources for out‐of‐hospital treatment, licensed drugs, and achievement of guideline implementation to improve SE outcome.
A case of SUDEP in a patient with Dravet syndrome with SCN1A mutation
Authors: Le Gal François , Korff Christian M. , Monso‐Hinard Christine , Mund Michael T. , Morris Michael , Malafosse Alain , Schmitt‐Mechelke Thomas
Published: August 2010

A boy with a clinical history of pharmacologically resistant Dravet syndrome died suddenly after falling asleep. The autopsy concluded that the cause of death was sudden unexpected death in epilepsy (SUDEP). Postmortem molecular analysis of the SCN1A gene by multiplex ligation‐dependent probe amplification (MLPA), high‐resolution melting curve analysis (HRMCA), and sequencing revealed a frameshift duplication of adenosine at position 504. The incidence of this mutation is discussed as a potential cause of SUDEP.
Novel mutations in EPM2A and NHLRC1 widen the spectrum of Lafora disease
Authors: Lesca Gaetan , Boutry‐Kryza Nadia , De Toffol Bertrand , Milh Mathieu , Steschenko Dominique , Lemesle‐Martin Martine , Maillard Louis , Foletti Giovanni , Rudolf Gabrielle , Nielsen Jørgen Erik , á Rogvi‐Hansen Bjarke , Erdal Jesper , Mancini Josette , Thauvin‐Robinet Christel , M’Rrabet Amel , Ville Dorothée , Szepetowski Pierre , Raffo Emmanuel , Hirsch Edouard , Ryvlin Philippe , Calender Alain , Genton Pierre
Published: August 2010

Purpose:  Lafora disease (LD) is an autosomal recessive form of progressive myoclonus epilepsy with onset in childhood or adolescence and with fatal outcome caused by mutations in two genes: EPM2A and NHLRC1. The aim of this study was to characterize the mutation spectrum in a cohort of unrelated patients with presumed LD.

Methods:  Sequencing of the two genes and search for large rearrangements was performed in 46 unrelated patients with suspected LD, 33 originating from France and the others from different countries. Patients were classified into two groups according to the clinical presentation.

Results:  Mutations of various types were found in EPM2A in 10 patients and in NHLRC1 in 4 patients. Mutations were found in 14 (93%) of 15 patients with classical clinical and electroencephalography (EEG) presentation of LD and in no patients with an atypical presentation. Ten mutations were novel, including the first substitution reported in a donor splice site of EPM2A, leading to the deletion of exon 2 at the RNA level. Four large deletions, including two deletions of exon 2 with different sizes and breakpoints, were found in EPM2A, corresponding to 20% of the alleles of this gene.

Discussion:  We described several novel mutations of EPM2A and NHLRC1 and brought additional data to the genetic epidemiology of LD. This study emphasized the high mutation rate in patients with classical LD as well as the high negativity rate of skin biopsy.
The Quality of Over‐ and Undercollected Blood for Transfusion
Authors: Button L. N. , Orlina A. R. , Kevy S. V. , Josephson A. M.
Published: August 2010

Whole blood was collected in increments varying from 100 g to 600 g into plastic containers intended for 450 ml collections. In order to determine the clinical usefulness of over and undercollected bloods, red blood cell survival studies were performed after 21 and 28 days of storage and in vitro measurements were performed weekly throughout the storage period. The red blood cell survival of 21‐day‐old CPD bloods was acceptable if as little as 300 g of blood were collected whereas a minimum of 400 g of blood was necessary to provide normal survival after 21 days storage in ACD solution. If as much as 600 g of whole blood were collected into a standard ACD or CPD blood pack, the red blood cell survival was within normal limits after 21 days of storage. These data demonstrate the limits to which over‐ and undercollected units can be utilized in transfusion therapy.
Plasmapheresis‐Induced Hemodilution and Its Effects on Serum Constituents
Authors: Friedman B. A. , Schork M. A. , Alm S. K. , Jones A. S. , Oberman H. A.
Published: August 2010

Samples were obtained from 23 plasmapheresis donors before, during, and after double plasmapheresis. Seventeen chemical analyses were performed on these specimens and the results were subjected to statistical analysis. Representative samples can be obtained from plasmapheresis donors before the procedure has begun, immediately after the first unit of whole blood has been removed, or 15 minutes after the completion of the entire procedure. The sample obtained after the first unit of whole blood has been removed will show dilutional lowering of the uric acid concentration, and the 15‐minute equilibration sample will show dilutional lowering of the inorganic phosphorus concentration. Short‐term donors and long‐term donors manifest a somewhat different hemodilutional response to plasmapheresis.
Book Review
Authors: Vyas Girish N.
Published: August 2010

Hepatitis B. Edited by Robert J. Gerety.
Multicenter performance evaluation of a transcription‐mediated amplification assay for screening of human immunodeficiency virus‐1 RNA, hepatitis C virus RNA, and hepatitis B virus DNA in blood donations
Authors: Koppelman Marco H.G.M. , Assal Azzedine , Chudy Michael , Torres Pilar , De Villaescusa R. Garcia , Reesink Henk W. , Lelie P. Nico , Cuypers H. Theo M.
Published: August 2010

BACKGROUND: The performance of the recently launched Procleix Ultrio (Chiron/Gen‐Probe) human immunodeficiency virus‐1 (HIV‐1), hepatitis C virus (HCV), and hepatitis B virus (HBV) blood screening assay was evaluated in a European multicenter study.

STUDY DESIGN AND METHODS: Serial dilutions of reference materials were tested to determine the detection limits. Robustness and specificity were assessed by testing alternating high‐load HCV RNA–positive and –negative samples, and 2912 test pools of eight donations. The added value of minipool and single‐donation HBV nucleic acid testing protocols was compared to the currently used Prism (Abbott GmbH & Co. KG) hepatitis B surface antigen (HBsAg) and Auszyme (Abbott GmbH & Co. KG) dynamic HBsAg tests in 15 HBV seroconversion panels.

RESULTS: The 95 percent detection limits (and 95% confidence interval [CI]) on the WHO International Standards was 26 (16‐58) IU per mL for HIV‐1 RNA, 4.6 (3.7‐6.5) IU per mL for HCV RNA, and 11 (7.3‐22) IU per mL for HBV DNA. No cross‐contamination was observed. Testing 2912 pools of eight donations revealed 16 initial reactive samples; 11 were confirmed. The specificity after initial testing and percentage of invalid results were 99.83 and 0.48 percent, respectively. The HBV window‐period (WP) reductions relative to HBsAg seroconversion in Prism and Auszyme dynamic HBsAg were, respectively, 6 days (95% CI, 3‐8) and 9 days (95% CI, 7‐12) in 1:8 minipool (MP) testing.

CONCLUSION: The performance characteristics of Procleix Ultrio assay and the Procleix HIV‐1 and HCV assay are comparable. The sensitivity for HIV‐1 and HCV met the directives of the Paul‐Ehrlich Institute and the FDA. The assay can reduce the WP for HBV by 6 days to 2 weeks when used in small MP (<1:8) or single‐donation screening protocols.
Efficacy of apheresis platelets treated with riboflavin and ultraviolet light for pathogen reduction
Authors: AuBuchon James P. , Herschel Louise , Roger Jill , Taylor Harry , Whitley Pamela , Li Junzhi , Edrich Rick , Goodrich Raymond P.
Published: August 2010

BACKGROUND:Pathogen reduction technologies for platelet (PLT) components offer a means to address continued viral transmission risks and imperfect bacterial detection systems. The efficacy of apheresis PLTs treated with riboflavin (vitamin B2) plus ultraviolet (UV) light (Mirasol, Navigant Biotechnologies) was investigated in a single‐blind, crossover study in comparison to untreated PLTs.

STUDY DESIGN AND METHODS:Normal subjects (n = 24) donated PLTs by apheresis on two occasions at least 2 weeks apart. Units were randomized to control or test arms, the latter receiving the addition of 28 mL of 500 µmol per L B2 and exposure to 6.2 J per mL UV light. PLTs were stored for 5 days with biochemical and hematologic analyses performed before and after illumination on Day 0 and at the end of storage. An aliquot of each unit was radiolabeled and returned to determine recovery and survival.

RESULTS:The PLT content of treated units was maintained from Day 0 (4.1 × 1011 ± 0.4 × 1011) to Day 5 (4.0 × 1011 ± 0.4 × 1011). Treatment with B2 plus UV light was associated with an increase in lactate production with concomitant increases in glucose consumption. pH (control, 7.38 ± 0.07; test, 7.02 ± 0.10) was well maintained throughout storage. Recovery of treated PLTs (50.0 ± 18.9%) was reduced from that of control PLTs (66.5 ± 13.4%); survival was similarly shortened (104 ± 26 hr vs. 142 ± 26 h; p < 0.001).

CONCLUSIONS:PLTs treated with B2 plus UV light demonstrate some alterations in in vitro measures but retain in vitro and in vivo capabilities similar to pathogen‐reduced and licensed PLT components that have been shown to have useful clinical applicability. The recovery, survival, and metabolic properties of Mirasol PLTs should provide sufficient hemostatic support in thrombocytopenia to justify patient clinical trials.
Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta‐analysis of randomized controlled trials
Authors: Cid Joan , Lozano Miguel
Published: August 2010

BACKGROUND: The delayed bleeding associated with total knee arthroplasty (TKA) may be a result of a tourniquet‐induced imbalance of the procoagulant and fibrinolytic systems. There are conflicting results in the literature about tranexamic acid (TA) infusion in reducing postoperative blood loss and the number of transfused red cells (RBC) units. A meta‐analysis was performed to summarize the results of different research studies.

STUDY DESIGN AND METHODS: Randomized controlled trials reported through October 2004 were retrieved, and nine studies met the criteria for meta‐analysis. Summary odds ratio (OR) of allogeneic transfusion and a weighted mean difference (WMD) of transfusions per patient in TA‐treated group versus placebo group were calculated across studies.

RESULTS: The use of TA significantly reduced the proportion of patients requiring blood transfusion (summary OR, 0.10; 95% CI, 0.06‐0.18; p < 0.00001) and the number of RBC transfusions per patient (WMD, −1.72; 95% CI, −2.11 to −1.33; p < 0.00001) when compared with patients who received placebo.

CONCLUSION: Our meta‐analysis shows that the use of TA for patients undergoing TKA is effective in reducing the requirements of allogeneic blood transfusion.
Sequestration of anti‐Cra in the placenta: serologic demonstration by placental elution
Authors: Weber Shanasey L. , Bryant Barbara J. , Indrikovs Alexander J.
Published: August 2010

BACKGROUND: Few cases of antibodies to the Cromer (a) antigen have been described during pregnancy. Interestingly, the anti‐Cra titers decreased during pregnancy, and although the newborns were Cra+, the direct antiglobulin tests (DATs) were negative and hemolytic disease of the newborn (HDN) was not observed. Cromer antigens reside on the decay‐accelerating factor (DAF), which is expressed on the fetal derived syncytiotrophoblast layer of the placenta. It has been postulated that Cromer antibodies are not transported to the fetus, but are bound to placental DAF, thereby protecting the fetus from HDN and causing the disappearance of Cromer antibody in maternal plasma. This report is the first to demonstrate Cromer antibody sequestration by the placenta.

CASE REPORT: A G4P1 woman with an anti‐Cra presented for prenatal care during her fourth pregnancy. The anti‐Cra titer decreased from 64 at 7 weeks gestation to undetectable after 25 weeks. At delivery, the infant had no evidence of HDN. The infant's DAT was negative, and the maternal plasma, cord plasma, and the cord blood eluate were negative with screening cells, the infant's cord cells, and the mother's cells. Placental eluates revealed anti‐Cra.

CONCLUSIONS: This is the fourth case report of a Cromer (a–) woman producing anti‐Cra during pregnancy, and the first demonstrating anti‐Cra sequestration in the placenta. The presence of anti‐Cra in the placental eluate, but not in the cord plasma, maternal plasma, or cord blood eluate, strongly supports the hypothesis that DAF at the fetomaternal interface absorbs anti‐Cra from the maternal circulation blocking its passage to the fetus.
The influence of blood group differences in allogeneic hematopoietic peripheral blood progenitor cell transplantation
Authors: Erker Christian G. , Steins Martin B. , Fischer Rudolf‐Josef , Kienast Joachim , Berdel Wolfgang E. , Sibrowski Walter , Cassens Uwe
Published: August 2010

BACKGROUND: Severe immunohematologic complications after ABO‐mismatched allogeneic blood peripheral blood progenitor cell (PBPC) transplantation (PBPCT), including pure red cell aplasia and immune hemolysis, have been described. Although several studies have addressed this issue, the clinical influence of blood group differences on transfusion requirements and survival is still discussed controversially, especially in the case of PBPCT.

STUDY DESIGN AND METHODS: This single‐center study is based on 143 patients receiving PBPCT after standard or reduced‐intensity conditioning. The influence of blood group differences in the ABO, Rh, and Kell systems on red blood cell, platelet, and plasma transfusion requirements; length of hospitalization in transplantation unit; survival; and occurrence of graft‐versus‐host disease was investigated. Additionally, the influence of the conditioning regimen and irregular antibodies on the measures mentioned above was analyzed.

RESULTS: Multivariate analysis demonstrated that minor and bidirectional ABO mismatch (p = 0.028) and Rh difference (p = 0.020) independently led to poorer survival. The Kell difference did not show significant influences on the measures mentioned above. A clinically relevant influence of blood group differences on transfusion requirements could not be demonstrated. Irregular antibodies also did not show significant influences.

CONCLUSION: These findings indicate an influence of blood group differences in PBPCT on survival and must be studied in further detail.
Effect of cessation of tobacco use on the incidence of oral mucosal lesions in a 10–yr follow‐up study of 12 212 users
Authors: Gupta PC , Murti PR , Bhonsle RB , Mehta FS , Pindborg JJ
Published: August 2010

OBJECTIVE: To study the effect of cessation of tobacco use on the incidence of lichen planus, leukoplakia and other oral mucosal lesions.

DESIGN: A 10–yr cohort study in a rural population of Ernakulam district, Kerala, India.

MATERIAL AND METHODS: Some 12 212 tobacco users were interviewed and examined in a basetine survey and re‐examined annually for 10 years. At each examination they were exposed to health educational programs to encourage them to quit their tobacco use. The incidence rates were calculated using person‐years method among those who stopped their tobacco use and all others.

RESULTS: A total of 77 681 person‐years of observation accrued among men and 32 544 among women. Among men 6.5% of these and among women 14.4% were in the stopped category. The incidence of oral lichen planus did not show any consistent association with cessation of tobacco habits (incidence ratio I.35) but for leukoplakia there was a substantial drop in the incidence after cessation (incidence ratio 0.3I). Several other tobacco‐associated oral mucosal lesions such as oral lichen planus‐like lesion, smoker's palate, preteukoplakia, central papillary atrophy of the tongue and leukoedema showed either zero, or very small incidence, after cessation. CONCLUSION: The reported association between tobacco use and lichen planus appears to be indirect but for all other lesions it is direct. The cessation of tobacco use led to a substantial fall in the incidence of leukoplakia and other lesions implying a reduced risk for oral cancer after cessation of tobacco use.
Cytokine profiles of Porphyromonas gingivalis‐reactive T lymphocyte lines and clones derived from P. gingivalis‐infected subjects
Authors: Gemmell E , Kjeldsen M , Yamazaki K , Nakajima T , Aldred MJ , Seymour GJ
Published: August 2010

Porphyromonos gingivolis is generally recognized as a major periodontopathogen such that a study of T cell responses to this organism may help to elucidate immune regulation in periodontal disease.

OBJECTIVE The aim of this study was to examine interleukin (IL)‐4, interferon (IFN)‐gamma and IL‐10 production by p‐gingivolis‐responsive T cell lines and clones derived from the peripheral blood of two P. gingivolis‐infected subjects with different disease expression and from the gingival tissues of one of the P. gingivolis‐infected subjects.

MATERIALS AND METHODS: FACS analysis was used to determine the percentage of T cells staining positive for cytoplasmic IL‐4, IFN‐gamma and IL‐10 and reverse transcriptase polymerase chain reaction (RT‐PCR) was performed to determine the presence of mRNA for IL‐4 and IFN‐gamma in the T cell lines and clones.

RESULTS FACS analysis showed that virtually all the T cell lines and clones contained IL‐4– and IFN‐gamma‐pro‐ducing T cells. The RT‐PCR results generally supported this trend. However, a higher percentage of cells in the clones derived from one subject produced IL‐4 while a lower percentage produced IFN‐gamma compared with the clones derived from the other subject. FACS analysis also demonstrated that the lines and clones derived from the two subjects showed differences in IL‐10 production. CONCLUSION: This study has demonstrated that there may be differences in IL‐4 and 11–10 production by the P. gingivolis responsive lines and clones derived from P. gingivalis‐infected subjects with different disease expression. Any relationship to disease however, remains to be determined.
Correlation between gingival crevicular fluid dipeptidyl peptidase II and IV activity and periodontal attachment loss. A 2–year longitudinal study in chronic periodontitis patients
Authors: Eley BM , Cox SW
Published: August 2010

OBJECTIVE: The aim of this study is to determine whether gingival crevicular fluid (GCF) dipeptidyl peptidase (DPP) II or IV levels, total activity (TA) and concentration (EC), predict progressive attachment loss (AL). SUBJECTS AND METHODS: Seventy five patients with moderate periodontitis were recruited. GCF was first collected from 16 molar and premolar mesiobuccal sites and then probing attachment level (PAL) and probing pocket depth (PPD) were measured with an electronic probe. Finally, gingival index, gingival bleeding and plaque indices were scored. Patients were given basic periodontal treatment prior to baseline after which the above procedures were repeated. Patients were seen 3 monthly for 2 years and the procedures were repeated. Carefully localised radiographs were taken of the test teeth annually.

RESULTS: One hundred and twenty AL sites, 88 rapid AL (RAL) and 32 gradual AL (GrAL), in 48 patients were detected. DPP It and IV levels (TA and EC) at RAL sites were significantly higher (P ≤ 0.0001) than paired control sites at the attachment loss time (ALT) and prediction time (PT). Mean levels over the study period of both proteases (TA and EC) at GrAL sites were significantly higher (P≤ 0.0001) than paired control sites. The GCF levels of DPP IV were always slightly higher than those of DPP II. Critical values (CV) of 5 μU per 30 s (TA) and 25 μU μPI‐1 (EC) for both proteases showed high sensitivity and specificity values for TA and EC and these were the same at both ALT and PT. The positive predictive values were slightly higher for DPP II. Mean site DPP II and IV levels (TA and EC) in intra‐patient comparisons were significantly higher (P ≤ 0.0001) at RAL and GrAL sites than non‐attachment loss (NAL) sites in AL patients and mean patient levels were significantly higher (P ≤ 0.0001) in AL patients than NAL patients in inter‐patient comparisons.

CONCLUSIONS: These results indicate that both GCF

DPP II and IV may be predictors of periodontal attachment loss.
Collagenases and tissue inhibitors of metalloproteinases: a functional balance in tissue degradation
Authors: Reynolds JJ
Published: August 2010

BACKGROUND: Members of the family of matrix metalloproteinases (MMPs; also called collagenases or matrixins) are key enzymes in matrix degradation. They function at neutral pH and can digest synergistically all the matrix macromolecules. Biochemical and clonal studies indicate that there are three major groups: the specific collagenases cleave interstitial collagens; the gelatinases degrade types IV, V, VII and XI collagens and act synergistically with collagenases by degrading denatured collagens (gelatins): and the stromelysins have broader specificity and can degrade basement membrane collagens as well as proteoglycans and matrix gly‐coproteins. Others not in these groups are matrilysin, metalloelastase and a recently cloned membrane‐bound metalloproteinase. MMPs are Zn2+‐ and Ca2+‐requiring endopeptidases and are secreted in a latent proform: activation involves the loss of a propeptide.

Naturally occurring inhibitors, TlMPs (Tissue Inhibitors of MetalloProteinases), are important controlling factors in the actions of MMPs, and tissue destruction in disease processes often correlates with an imbalance of MMPs over TIMPs. The major inhibitor is TIMP‐I (or TIMP), a 30‐kDa glycoprotein that is synthesised by most cells. A second unglycosylated inhibitor, TIMP‐2, which is less abundant, has the interesting property of binding to the proform of gelatinase A and is involved in controlling its activation.

BIOLOGICAL AND PSYCHOLOGICAL IMPLICATIONS: The expression of MMPs and TlMPs by cells is regulated by many cytokines (particularly interleukin‐I, IL‐I), growth factors and hormones, some of which are specific to cell type and others that are ubiquitous (eg transforming growth factor β, TGF‐β). Many of these factors are products of monocytes/macrophages and their production in inflammatory situations is therefore part of the chain of events leading to tissue degradation. From many recent studies it seems that tissue destruction, both physiological and pathological, is correlated with an imbalance of inhibitors over proteinases. We proposed that one way in which pathogenic organisms might mediate tissue degradation in periodontal diseases is through the ability of cell wall antigens to stimulate cytokine production by circulating mononuclear cells. These would then induce MMP synthesis by resident gingival cells (or by the mononuclear cells themselves), thereby initiating degradative events. We have identified MMPs in human gingival biopsy specimens by using specific poly‐clonal antibodies and indirect immunofluorescence. Their distributions are extremely variable, both in the connective tissue and the epithelium, but the results indicate that host cell production of MMPs may contribute to tissue degradation in periodontal disease. TIMP could also be found in some situations and could be a limiting factor.
Peroxidases, Iactoferrin and lysozyme in peripheral blood neutrophils, gingival crevicular fluid and whole saliva of patients with localized juvenile periodontitis
Authors: Suomalainen K , Saxén L , Vilja P , Tenovuo J
Published: August 2010

OBJECTIVE: The aim of this study was to examine the longitudinal association of selected non‐immune antimicrobial host factors (peroxidases, lysozyme and lactoferrin) to the localized juvenile periodontitis (LJP) disease status.

MATERIALS AND METHODS: Peroxidases, lysozyme and lactoferrin were quantitated from seven patients with LJP before and after periodontal therapy. Analyses were performed from simultaneously collected samples of peripheral blood polymorphonuclear leukocytes (PMNs), gingival crevicular fluid (GCF from diseased sites) and paraffin‐stimulated whole saliva. Similar assays were done also from seven periodontally healthy controls.

RESULTS During untreated phase of LIP myeloperoxid‐ase, lysozyme and lactoferrin concentrations were remarkably elevated in peripheral blood PMNs, also reflected in their high concentrations in GCF. All these values normalised with respect to healthy controls during the periodontal therapy. No similar longitudinal changes were seen in whole saliva but during therapy salivary per‐oxidase concentrations declined below the control values, in accordance with our previous observations in parotid saliva samples of LJP patients.

CONCLUSIONS: In LJP the concentrations of lysozyme, lactoferrin and myeloperoxidase are significantly elevated in peripheral blood PMNs, also reflected in GCF. During periodontal therapy these values decline and approach those observed in healthy controls. No similar changes are seen in stimulated whole saliva.
Apoptosis‐associated proteins in oral hairy leukoplakia
Authors: Chrysomali E , Greenspan JS , Dekker N , Greenspan D , Regezi JA
Published: August 2010

OBJECTIVE To test the hypothesis that the anti‐apop totic ability of Epstein‐Barr virus (EBV) may result in altered expression of apoptosis‐associated proteins in oral hairy leukoplakia (HL), we evaluated HL tissue and normal epithelium for these proteins by immunohistochemistry.

MATERIALS AND METHODS Twenty formalin‐fixed, paraffin‐embedded specimens of HL lesions and six spedmens of normal control mucosa were selected from archived tissue specimens. Bcl‐2. Bcl‐x, Bax and p53 apoptoris‐associated proteins were evaluated in immu‐nohistochemically stained tissue sections according to staining intensity and pattern. The percentage of p53‐positive burl cells was estimated in sequential fields.

RESULTS: Generalty, there were only slight differences in the expression of Bcl‐2 and Bcl‐x proteins in the epithelium of HL and control tissue. The staining for Bcl‐2 was weaker in keratinocytes than in putative melano‐cytes and Langerhans cells. Equivocal diffuse cytoplasmic staining of prickle cells was also noted. Keratinocytes throughout the epithelium stained positively for Bcl‐x protein, although upper layers were more weakly stained. The ‘balloon’ keratinocytes in HL were infrequently positive for Bcl‐x. Bax staining in HL differed from that in control tissue in being more heterogeneous. The staining reaction in HL was weak to negative in upper epithelial levels where ‘balloon’ keratinocytes were located. Weak to moderate nuclear p53 protein staining was detected in a mean of 25.3% of basal keratinocytes in all but one of the HL specimens; weak staining was seen in only two control specimens.

CONCLUSIONS: We found only slight immunohistochemid evidence that expression of the apoptosis‐associated proteins is altered in HL. p53 appears to be over‐expressed in HL; we speculate that this may be related to upregulation or stabilization of wild‐type p53 protein related to EBV infedon.
Angioedema and swellings of the orofacial region
Authors: Rees SR , Gibson J.
Published: August 2010

OBJECTIVE: Patients may have various forms of angioedema and require dental treatment which can cause or contribute to the onset of an episode of angioedema. This paper seeks to highlight the causes and the management of this serious condition.

DESIGN: An outline of the different types of angioedema is given here, along with three case reports which illustrate treatment and management.

SUBJECTS AND METHODS: Three patients who presented to an Oral Medicine clinic with angioedema are presented to illustrate various types of angioedema and the different contributing factors that precipitated episodes of the condition.

MAIN OUTCOME MEASURES: The three patients were all investigated for biochemical and allergic factors which may have caused their disease.

RESULTS: Both drugs and dental materials were shown to be involved in the pathogenesis of angioedema in this short series of patients.

CONCLUSIONS: Dental treatment or the use of some materials may promote or contribute to the disorder. Referral to hospital for specialist care is indicated for certain groups of patients who require invasive dental treatment. The multi‐disciplinary team approach in the investigation and management of patients with angioedema is emphasised.