bluuebunny/crossref_metadata_2025 huggingface dataset:
A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years
Authors: Berglundh Tord , Persson Leif , Klinge Björn
Published: May 2003

Objective:  To systematically review the incidence of biological and technical complications in implant therapy reported in prospective longitudinal studies of at least 5 years.

Methods:  A MEDLINE search was conducted for prospective longitudinal studies with follow‐up periods of at least 5 years. Screening and data abstraction were performed independently by multiple reviewers. The types of complications assessed were as follows: implant loss, sensory disturbance, soft tissue complications, peri‐implantitis, bone loss ≥2.5 mm, implant fracture and technical complications related to implant components and suprastructures.

Results:  The search provided 1310 titles and abstracts, out of which 159 were selected for full‐text analysis. Finally, 51 studies were included. Meta analysis of these studies indicated that implant loss prior to functional loading is to be expected to occur in about 2.5% of all implants placed in implant therapy including more than one implant and when routine procedures are used. Implant loss during function occurs in about 2–3% of implants supporting fixed reconstructions, while in overdenture therapy >5% of the implants can be expected to be lost during a 5‐year period. Few studies (41% of those included) reported data on the incidence of persisting sensory disturbance >1 year following implant surgery. Most of the studies that provided such data reported on the absence or a low incidence (1–2%) of this complication beyond this interval. A higher incidence of soft tissue complications was reported for patients treated with implants supporting overdentures. There is limited information regarding the occurrence of peri‐implantitis and implants exhibiting bone loss ≥2.5 mm. Implant fracture is a rare complication and occurs in <1% of all implants during a 5‐year period. The incidence of technical complications related to implant components and suprastructures was higher in overdentures than in fixed reconstructions.

Conclusion:  Implant loss was most frequently described (reported in about 100% of studies), while biological complications were considered in only 40–60% and technical complications in only 60–80% of the studies. This observation indicates that data on the incidence of biological and technical complications may be underestimated and should be interpreted with caution.
A systematic review on the clinical efficacy of subgingival debridement in the treatment of chronic periodontitis
Authors: Van der Weijden G. A. , Timmerman M. F.
Published: May 2003

Objective:  The purpose of this study was to perform a systematic review of the literature and to evaluate, in patients with chronic periodontitis, what the effect is of subgingival debridement (SGD), in terms of bleeding on probing, pocket depth and probing attachment level.

Material and methods:  An electronic search of the Cochrane Oral Health Group specialized register and MEDLINE were performed using specific search terms to identify studies assessing in patients with chronic periodontitis the effect of subgingival debridement with regard to clinical outcomes. This was performed on titles registered up to 2001. The only papers included were those which utilized data based on the patient as unit of observation.

Results:  The searches identified 702 abstracts. Titles and abstracts were independently screened by two reviewers (G.A.W. & M.F.T.) to identify publications that met specific inclusion criteria. The agreement between the two reviewers was assessed. The kappa score for agreement was 0.80. Review of these abstracts resulted in 114 publications for detailed review. Finally, 26 papers which met the criteria of eligibility were independently selected by the two reviewers. The kappa score for agreement on this decision was 0.92. Disagreement regarding inclusion of both abstracts and full papers was resolved by discussion between the reviewers. No randomized controlled trials (RCT) could be retrieved that were specifically designed to answer the question formulated at the outset of this systematic review. From the 10 controlled studies, four provide a definitive ‘yes’ that SGD is effective with regard to clinical outcomes. In the one study where subgingival debridement was not supported by oral hygiene instruction, the paper provided a definitive ‘no’. The weighted mean of attachment gain of SGD in pockets initially ≥5 mm was 0.64 mm as compared with 0.37 mm for supragingival plaque control only (SPC). The reduction of pocket depth was 0.59 mm and 1.18 mm for SPC and SGD, respectively. Of the 18 papers that provided only information on the effect of treatment as compared with the baseline values, eight showed SGD to be beneficial with regard to clinical attachment level change while the remaining 10 provided no such an analysis. The weighted mean of this effect was a 0.74‐mm gain of attachment as a result of treatment in pockets initially ≥ 4 mm.

Conclusions:  In patients with chronic periodontitis, subgingival debridement (in conjunction with supragingival plaque control) is an effective treatment in reducing probing pocket depth and improving the clinical attachment level. In fact it is more effective than supragingival plaque control alone.
A systematic review of graft materials and biological agents for periodontal intraosseous defects
Authors: Trombelli Leonardo , Heitz‐Mayfield Lisa J.A. , Needleman Ian , Moles David , Scabbia Alessandro
Published: May 2003

Objectives: To determine the adjunctive effect of grafting biomaterials/biological agents with open flap debridement (OFD) in the treatment of deep intraosseous defects.

Background: No systematic review of treatment outcomes in patients who received graft biomaterials or biological agents have been published.

Methods: A rigorous systematic review of randomized controlled trials of at least 6‐month duration was conducted comparing grafting biomaterials/biological agents (alone or in combination) + OFD (test group) to OFD alone or in combination with a placebo (control group).

Results: The difference in CAL change between test and control groups varied from −1.45 mm to 1.40 mm with respect to different biomaterials/biological agents. Meta‐analysis showed that CAL change significantly improved after treatment for coralline calcium carbonate (weighted mean difference 0.90 mm; 95% CI: 0.53–1.27), bioactive glass (weighted mean difference 1.04 mm; 95% CI: 0.31–1.76), hydroxyapatite (weighted mean difference 1.40 mm, 95% CI 0.64–2.16), and enamel matrix proteins (weighted mean difference 1.33 mm, 95% CI 0.78–1.88). However, heterogeneity in results between studies was highly statistically significant for most of biomaterials/biologicals and could not be fully explained.

Conclusions: Overall, the use of specific biomaterials/biologicals was more effective than OFD in improving attachment levels in intraosseous defects. Difference in CAL gain varied greatly with respect to different biomaterial/biological agent. Due to a significant heterogeneity in results between studies in most treatment groups, general conclusions about the expected clinical benefit of graft biomaterials/biologicals need to be interpreted with caution. Further research should focus on understanding this variability.
Zebra mussels (Dreissena polymorpha) in Ireland, AFLP‐fingerprinting and boat traffic both indicate an origin from Britain
Authors: Pollux Bart , Minchin Dan , Van Der Velde Gerard , Van Alen Theo , Moon‐Van Der Staay Seung YeO , Hackstein Johannes
Published: May 2003

1. The zebra mussel (Dreissena polymorpha) is an aquatic nuisance species that invaded Ireland around 1994. We studied the invasion of the zebra mussel combining field surveys and genetic studies, to determine the origin of invasion and the vector of introduction.

2. Field surveys showed that live zebra mussels, attached to the hulls of pleasure boats, were transported from Britain to Ireland. These boats were lifted from British waters onto trailers, transported to Ireland by ferry and lifted into Irish waters within a day. Length‐frequency distributions of dead and living mussels on one vessel imported 3 months earlier revealed a traumatic occurrence caused by the overland, air‐exposed transportation. Results show that a large number of individuals survived after re‐immersion in Irish waters and continued to grow.

3. Zebra mussels from populations in Ireland, Great Britain, the Netherlands, France and North America, were analysed using amplified fragment length polymorphisms (AFLP)‐fingerprinting to determine the origin of the Irish invasion. Phylogenetic analysis revealed that Irish and British mussels clustered closely together, suggesting an introduction from Britain.

4. Ireland remained un‐invaded by the zebra mussel for more than 150 year. The introduction of the zebra mussel to Ireland occurred following the abolition of value added tax in January 1993 on imported second‐hand boats from the European Union (UK and continental Europe). This, together with a favourable monetary exchange rate at that time, may have increased the risk of invasion of the zebra mussel.
Phytoplankton, light and nutrients along a gradient of mixing depth: a field test of producer‐resource theory
Authors: Kunz Thomas J. , Diehl Sebastian
Published: May 2003

1. Variation in depth of the mixed surface layer of temperate lakes should affect phytoplankton dynamics because, with increasing mixing depth, average light intensity in and specific sedimentation losses out of the mixed layer both decrease.

2. Our aim was to test a recent dynamic model which relates phytoplankton biomass and the availability of production‐limiting resources (light and dissolved mineral nutrients) to mixing depth and nutrient supply from external sources.

3. During summer stratification we sampled the mixed layers of 30 dimictic, phosphorus‐limited, oligo‐ to mesotrophic, mostly non‐humic lakes north of the Alps.

4. The results agree well qualitatively with model expectations. Algal concentration in the mixed layer was negatively related to mixing depth or its surrogate log‐transformed lake area. Light intensity at the bottom of the mixed layer decreased whereas the concentration of available, inorganic phosphorus increased with increasing mixing depth. Across all depths, higher total phosphorus content was accompanied by higher phytoplankton biomass, lower light availability, and higher inorganic phosphorus concentration.

5. Our data match the predicted shift with increasing mixing depth from predominantly nutrient limitation towards increased light limitation of algal biomass.
Reproduction of interspecific hybrids of Atlantic salmon and brown trout in a stream environment
Authors: Garcia‐Vazquez Eva , Ayllon Fernando , Martinez Jose Luis , Perez Juliana , Beall Edward
Published: May 2003

1. Reproduction between Atlantic salmon males and interspecific hybrid Salmo salar × Salmo trutta females was monitored in a controlled flow channel diverted from a south European river located at the edge of Atlantic salmon natural geographic distribution in Europe.

2. Post‐F1 hybrids were viable and survived in the wild, at least until dispersal from redds. After transfer to hatchery conditions, 67% survived into the second year.

3. The hybrids possessed 98 chromosomes: two sets of Atlantic salmon(2n = 58) and one set of brown trout (n = 40) chromosomes.

4. The existence of a low proportion of allotriploid individuals can be expected in rivers where Atlantic salmon and brown trout populations coexist.
Impacts of freshwater invaders at different levels of ecological organisation, with emphasis on salmonids and ecosystem consequences
Authors: Simon Kevin S. , Townsend Colin R.
Published: May 2003

1. Invaders can influence freshwater systems at the individual, population, community and ecosystem levels. Some of these impacts may be subtle or not easily predicted but they may be critical to understanding more obvious changes. Despite this, studies of impacts of freshwater invaders at several levels of ecological organisation are rare. Most commonly reported are changes in the distribution or abundance of populations after invasion, whereas documentation of impacts on ecosystem functioning, such as energy and nutrient flux, is rare.

2. Unlike most invaders, salmonids have been studied at multiple ecological levels. These fish can cause trophic cascades that result in increased algal biomass and production and are responsible for changes to energy and nutrient flux in both streams and lakes. The mechanisms behind these changes are different in the two systems and only become evident when information at the individual and population levels are considered. In streams, salmonids can alter invertebrate behaviour that suppresses grazing of periphyton. In lakes, salmonid feeding behaviour can stimulate phytoplankton by shunting nutrients from the littoral to the pelagic zone.

3. Simultaneous study at several ecological levels should yield a fuller understanding of the mechanisms underlying impacts of invading animals and plants, providing a sounder basis for predicting the impacts of freshwater invasive species. Species traits of the invaders that may be associated with particularly profound impacts include: a method of resource acquisition formerly lacking in the invaded system, a broad feeding niche that links previously unlinked ecosystem compartments, a feeding relationship with negative consequences for native strong interactors, physiological traits that enhance resource transformation and lead to high biomass, and behavioural or demographic traits that provide high resistance or resilience in the face of natural disturbances.
Distribution of an alien aquatic snail in relation to flow variability, human activities and water quality
Authors: Schreiber E. S. G. , Quinn G. P. , Lake P. S.
Published: May 2003

1. Disturbance and anthropogenic land use changes are usually considered to be key factors facilitating biological invasions. However, specific comparisons of invasion success between sites affected to different degrees by these factors are rare.

2. In this study we related the large‐scale distribution of the invading New Zealand mud snail (Potamopyrgus antipodarum) in southern Victorian streams, Australia, to anthropogenic land use, flow variability, water quality and distance from the site to the sea along the stream channel.

3. The presence of P. antipodarum was positively related to an index of flow‐driven disturbance, the coefficient of variability of mean daily flows for the year prior to the study.

4. Furthermore, we found that the invader was more likely to occur at sites with multiple land uses in the catchment, in the forms of grazing, forestry and anthropogenic developments (e.g. towns and dams), compared with sites with low‐impact activities in the catchment. However, this relationship was confounded by a higher likelihood of finding this snail in lowland sites close to the sea.

5. We conclude that P. antipodarum could potentially be found worldwide at sites with similar ecological characteristics. We hypothesise that its success as an invader may be related to an ability to quickly re‐colonise denuded areas and that population abundances may respond to increased food resources. Disturbances could facilitate this invader by creating spaces for colonisation (e.g. a possible consequence of floods) or changing resource levels (e.g. increased nutrient levels in streams with intense human land use in their catchments).
Effects of the exotic macrophyte, para grass (Urochloa mutica), on benthic and epiphytic macroinvertebrates of a tropical floodplain
Authors: Douglas Michael M. , O'Connor Ruth A.
Published: May 2003

1. We examined the effect of the exotic macrophyte, para grass (Urochloa mutica), on benthic and epiphytic macroinvertebrates of a tropical floodplain in northern Australia. Macroinvertebrates were sampled from four grass communities: (1) para grass, (2) hymenachne (Hymenachne acutigluma), a native perennial; (3) rice (Oryza meridionalis), a native annual, and (4) areas where para grass had been sprayed with herbicide.

2. Macroinvertebrate richness, abundance and community similarity showed very few differences among the grass communities, particularly in the epiphytic habitat. Benthic invertebrates showed some differences among grasses, with lower richness and abundance and different community structure associated with hymenachne. Herbicide control of para grass had no apparent effect on benthic invertebrates but reduced the abundance of epiphytic invertebrates in the short term.

3. The results of this study indicate that para grass has very little impact on macroinvertebrate communities, despite the changes to macrophyte communities. This is probably because para grass has similar physical structure to the native grasses and because none of these grasses contribute directly to aquatic food webs. Control of para grass using herbicide has little impact on aquatic invertebrates. This suggests that predicting the impact of weed invasion in wetlands requires an understanding of both the functional properties of macrophytes and the habitat preferences of the macroinvertebrates.
Estimation of the proportion of metabolically active mass in the amphipod Gammarus fossarum
Authors: Simčič Tatjana , Brancelj Anton
Published: May 2003

1. The proportion of metabolically active mass in the freshwater amphipod Gammarus fossarum was determined using different parameters [chemical oxygen demand (COD), total nitrogen (Ntot), total phosphorus (Ptot) and mass of chitinous cuticle].

2. The results of linear regressions between body mass and body length, and measured parameters (COD, Ntot, Ptot) show high correlation coefficients for both fresh and the dry animals. The proportion of chitinous mass increased with body size.

3. Chemical analysis of Ptot in individuals appears to be the most appropriate parameter for quantitating the metabolically active tissues in animals.

4. The dependence of the intensity of electron transport system (ETS) activity per protoplasm, calculated from the Ptot and dry mass of animals, shows that large animals have the same ETS activity per unit of protoplasm as smaller ones.

5. We conclude that the chitinous mass is not the only factor which contributes to negative allometry of metabolic activity in G. fossarum.
The HLA System: An Update and Relevance to Patient‐Donor Matching Strategies in Clinical Transplantation
Authors: Howell W. Martin , Navarrete Cristina
Published: May 2003

In recent years the development of recombinant DNA and sequencing techniques has led to a greatly increased understanding of the genetic complexity, structure and function of the human major histocompatibility complex. This system may be subdivided into the ‘classical' HLA (human leukocyte antigen) class I and II transplantation antigens and novel HLA and non‐HLA genes, involved in antigen processing and presentation to T cells. Parallel technological developments in HLA DNA typing in the clinical laboratory have resulted in a more precise awareness of the role of HLA matching for the classical HLA antigens in bone marrow and solid organ transplantation, while alternative strategies and techniques for donor selection are currently under evaluation. This review offers a current perspective on the genetics, structure and function of the HLA system, its relevance to clinical transplantation and future prospects for improvements in donor selection.
Use of the DAF Assay to Assess the Functional Properties of Polyclonal and Monoclonal Rh D Antibodies
Authors: Ducrot T. , Beliard R. , Glacet A. , Klein P. , Harbonnier S. , Benmostefa N. , Bourel D.
Published: May 2003

The mechanism whereby passive Rh (D) immunoglobulins suppress the feto‐maternal alloimmunization is still unclear. New in vitro tests are needed to better characterize the functional properties of polyclonal anti‐Ds. The DAF assay was developped to monitor the antibody‐dependent cell‐mediated cytotoxicity (ADCC) and the phagocytosis of anti‐Rh (D)‐sensitized RBCs by effector cells. The principle of this test is based on the oxydization of the 2,7‐diaminofluorene (DAF) by the pseudoperoxidase activity of free hemoglobin. The reaction is proportional to the hemoglobin concentration. This test was performed to determine and emphasize the efficacy of different polyclonal anti‐D immunoglobulin preparations to mediate lysis and phagocytosis of sensitized RBCs by human peripheral mononuclear cells. The functional properties of different human RhD monoclonal antibodies were also analyzed and compared. The test was found to be convenient to perform and allowed the avoidance of radioactive labelling of RBCs for ADCC studies. It is mainly useful for the direct quantitation of phagocytosis.
Comparison of Solid‐Phase Antibody Screening Tests with Pooled Red Cells in Blood Donors
Authors: Schrem A. , Flegel W.A.
Published: May 2003

Solid‐phase systems are very sensitive for detection of erythrocyte alloantibodies in serum and suitable for large scale donor screening. Serum samples of 10,008 blood donors were screened by three solid‐phase tests (Capture R Ready Screen, Solidscreen II, and Solidscreen II‐Donor) with pooled red cells derived from two donors. The prevalence of antierythrocyte IgG and IgM antibodies in donor sera was 0.56% (IgG antibodies: 0.42%). The test efficiency for IgG antibodies was 1.40 with Capture R Ready Screen (test sensitivity 97.6%, test specificity 99.39%), 1.78 with Solidscreen II (95.1, 99.88%), and 1.95 with Solidscreen II‐Donor (92.7, 99.98%). The IgG antibody titers differed significantly between all tests including a gel matrix test: Capture R > ID‐Gel > Solidscreen II > Solidscreen II‐Donor. Previously characterized antibodies that were not detected after long‐term follow‐up by any of the three solid‐phase tests had a prevalence of 0.10%. All three solid‐phase tests detected the alloantibodies, which were of higher titers and considered clinically relevant in blood components. The significant difference in antibody titers between the tests was not matched by a similar variance in the detection of donors with antibodies. Even with sensitive solid‐phase tests, many antibodies may not be detected after long‐term follow‐up.
Disappearance of Antibodies to Cromer Blood Group System Antigens during Mid Pregnancy
Authors: Reid Marion E. , Chandrasekaran Visalam , Sausais Laima , Pierre Jeannot , Bullock Rebecca
Published: May 2003

The Cromer blood group system consists of 7 high incidence and 3 low incidence antigens that are carried on the complement regulatory glycoprotein called decay‐accelerating factor (DAF; CD55). Despite laboratory results that would predict clinical significance, antibodies with specificities in the Cromer blood group system have not been reported to cause hemolytic disease of the newborn. It is possible that strong expression of DAF on the apical surface of antigen‐positive fetally derived placental trophoblasts may absorb maternal antibodies that are directed to antigens in the Cromer blood group system. We studied two cases where strongly reactive anti‐Cra and anti‐Dra became undetectable during second and third trimesters of pregnancies.
Transfusion‐Transmitted AIDS with Blood Negative for Anti‐HIV and HIV‐Antigen
Authors: Chuansumrit Ampaiwan , Varavithya Wandee , Isarangkura Parttraporn , Sirinavin Sayomporn , Chiewsilp Pimol , Tanprasert Sriwilai , Hathirat Phongjan
Published: May 2003

A four‐year‐old boy who was diagnosed with Glanzmann's thrombasthenia received supportive treatment and desmopressin for his bleeding episodes. He seldom received blood components, except for platelet concentrates, due to severe bleeding. He was exposed to 18 routine donors and 2 plateletpheresis donors who were negative for human immunodeficiency virus (HIV) antigen and anti‐HIV upon screening. At the age of 3 years and 9 months (4.5 months after the transfusion of platelet concentrate), he developed full‐blown AIDS and died from circulatory failure 3 months later. The source of HIV transmission was identified as 1 donor who developed anti‐HIV 3 months after the last donation. The rather short incubation time of AIDS in this case was attributed to a large inoculum of HIV virus in the ‘window perioD' of infectivity of the newly infected donor. This case illustrates transfusion‐transmitted HIV leading to AIDS, even though HIV antigen and anti‐HIV screening tests were negative.
Serial Dilutions on Synthetic Peptide‐Based Assays Can Resolve Dual Seroreactivity to HIV‐1 and HIV‐2
Authors: Soriano V. , Gutiérrez M. , Heredia A. , Bravo R. , Aguilera O. , Mas A. , Hewlett I. , Baquero M. , González‐Lahoz J.
Published: May 2003

Several authors have reported a high rate of dual seroreactivity to HIV‐1 and HIV‐2 in areas where both viruses are prevalent [1, 2]. For instance, Ghys et al. [2] pointed out that 38% of HIV‐seropositive female sex workers in Abidjan, Côte d'Ivoire, show dual seroreactivity to HIV‐1 and HIV‐2. Moreover, the authors make the point that in this area endemic for both viruses, dual seroreactivity using synthetic peptide‐based assays, such as Pepti‐LAV 1+2 (Diagnostics Pasteur, Paris, France), more likely reflects truly dual infections than cross‐reactivity in subjects with either HIV‐1 or HIV‐2 monotypic infections. Since a recent report from Senegal has claimed that HIV‐2 might protect against subsequent infection by HIV‐1 [3], a very high rate of true coinfections is likely to be in conflict with this hypothesis.
Procoagulant Effect of Incompatible Platelet Transfusions in Alloimmunized Refractory Patients
Authors: Mazzara R. , Escolar G. , Garrido M. , Sanz C. , Pereira A. , Castillo R. , Ordinas A.
Published: May 2003

The clinical effectiveness of platelet transfusion in refractory patients is still a subject of debate. We have evaluated the possible hemostatic effect of platelet transfusion in 16 alloimmunized thrombocytopenic patients whose platelet counts were less than 20,000/μl. Platelet concentrates were always obtained by apheresis procedures from incompatible donors. The posttransfusion platelet recovery was greater than 15% only in 3 cases. In the first 6 patients, measurements of bleeding time performed immediately before transfusion were in all cases longer than 30 min and did not change significantly 10 and 60 min after platelet transfusions. In all patients, ex vivo perfusion experiments with Baumgartner's platelet adhesion model, using native nonanticoagulated blood, were performed immediately before and 10 and 60 min after transfusion. No difference in platelet deposition onto the subendothelial surface was observed after platelet transfusion. Unexpectedly, the deposition of fibrin on the subendothelial surface was statistically augmented in the posttransfusion studies. Quantification of thrombin‐antithrombin complexes (TAT) in plasma showed statistically significant elevations (p < 0.01) in the posttransfusion samples (31.9±12.6 vs. baseline 5.8±1.7 ng/ml), not justified by TAT levels in the transfused material (2.3±0.17 ng/ml). Transfusion of incompatible platelets to refractory patients may activate coagulation mechanisms in the absence of an increase in peripheral platelet count.
Stability of Blood Coagulation Factors and Inhibitors in Blood Drawn into Half‐Strength Citrate Anticoagulant
Authors: Suontaka A. M. , Åkerblom O. , Blombäck M. , Eriksson L. , Högman C. F. , Payrat J. M.
Published: May 2003

Drawing of blood into a citrate‐phosphate‐dextrose (CPD) solution with a reduced citrate concentration has been shown to improve the maintenance of coagulation factor VIII (F VIII) in plasma and to give possibilities to improve erythrocyte preservation. We studied the quality of plasma obtained from whole blood drawn under continuous mixing into CPD in which the citrate concentration was reduced by 50% (0.5CPD). The blood was stored at room temperature for 8 h before component preparation. We confirmed improved stability of F VIII by 0.5CPD. We found no clinically significant changes in inhibitors to the coagulation and kallikrein systems, and no signs of activation of these systems, during the 8‐hour holding time. In control blood drawn into CPD, F VIII and coagulation factor IX decreased by 0.09 IU/ml (8%) and 0.07 U/ml (7%), respectively, otherwise we found no significant differences between 0.5CPD plasma and CPD plasma.
Maternal‐Fetal Hemorrhage: A Reappraisal
Authors: Brossard Y. , Pons J. C. , Jrad I. , van Nifterik J. , Gillot R. , Saure C. , Le Gaudion M. , Richard A. , Papiernik E.
Published: May 2003

Purpose:To determine the frequency of maternal‐fetal hemorrhage at or above 1 μl of maternal whole blood.

Methods:Seventy‐three mothers whose red blood cells bore an Rh antigen (Rh D, Rh c, Rh E) that was absent on red blood cells of their newborns were identified and a new cytological method, the Kleihauer‐immunogold‐silver‐staining technique, was applied on the blood of their neonates to detect and quantify maternal red blood cells. Stringent precautions were taken to avoid contaminations of neonatal blood samples by adult red blood cells.

Results:Maternal red blood cells were present in 3 newborns, a frequency of 4% (95% CI: 1–11%), and the estimated volumes of hemorrhage were 0.8, 1.5, and 101 μl of maternal whole blood. No obstetric factor was clearly associated in this limited study with the occurrence of maternal‐fetal hemorrhage.

Conclusions:Mother‐to‐fetus microtransfusion greater than 1 μl is infrequent at or near delivery, and it may be observed after an uncomplicated pregnancy and vaginal delivery.
Haemolytic Disease of the Newborn Due to Anti‐G
Authors: Hadley A. G. , Poole G. D. , Poole J. , Anderson N. A. , Robson M.
Published: May 2003

Mrs P. presented at 13 weeks of gestation with apparent anti‐C+D. At week 34, with antibody levels of 168 IU/ml, a D‐negative (r′r) baby was delivered with a strongly positive DAT and an Hb of 3.0 g/dl. Anti‐G in maternal serum was isolated by adsorption and elution from R2R2 cells and shown, using flow‐cytometric and chemiluminescence assays, to sensitize r′r cells at levels of cell‐bound IgG consistent with fetal haemolysis. In an analysis of 28 sera from alloimmunized women with over 5 IU/ml anti‐C+D, 2 sera were shown to contain levels of anti‐G consistent with moderate or severe haemolytic disease of the newborn (HDN). Thus HDN due to anti‐G may not be rare. An analysis of 187,037 blood donors in the south‐west of England showed the r′ gene frequency to be 0.005897 suggesting that approximately 2.9% of matings of rr women with D‐negative fathers can produce an r′r baby. These findings highlight the need for the continuous non‐invasive monitoring of D‐negative fetuses of women with apparent anti‐C+D.
Evidence for a New Type of O Allele at the ABO Locus, due to a Combination of the A2 Nucleotide Deletion and the Ael Nucleotide Insertion
Authors: Olsson Martin L. , Chester M. Alan
Published: May 2003

Using a recently introduced multiplex polymerase chain reaction and restriction fragment length polymorphism ABO genotype screening method we have found an anomalous ABO genotype (A2O1 variant) not correlating with the serological phenotype (blood group O). The blood group was confirmed by absorption/elution and detection of blood group substances in saliva. Sequencing of exons 6 and 7 in the ABO genes of the propositus indicated an A2 gene (C467T and C1060‐) apparently inactivated by the same single nucleotide insertion recently reported in individuals with the ABO subgroup Ael. Investigation of relatives confirmed the inheritance of this new inactive hybrid allele.
Rapid Typing for Human Platelet Antigen Systems ‐1, ‐2, ‐3 and ‐5 by PCR Amplification with Sequence‐Specific Primers
Authors: Klüter Harald , Fehlau Kirstin , Panzer Simon
Published: May 2003

Typing for human platelet antigens (HPA) is useful in a variety of clinical situations. We developed a method for genotyping for HPA‐1, ‐2, ‐3 and ‐5 by means of the PCR amplification with sequence‐specific primers (PCR‐SSP) technique. Primer sets were designed to allow PCR amplification for all systems using the same assay conditions. Specificity and sensitivity of the method were assessed in a blind quality control study (n = 112). In 111 cases, results obtained by PCR‐SSP were identical as compared with PCR‐restriction fragment length polymorphism technique. One discrepancy was found to be due to a typing error in the data sheet. The results of the PCR‐SSP technique were available within 3 h. We conclude that genotyping based on PCR‐SSP enables rapid typing for HPA systems, which makes this technique feasible in most clinical settings where urgent HPA typing is required.
Provision of Random‐Donor Platelets (HPA‐1a Positive) in Neonatal Alloimmune Thrombocytopenia Due to Anti HPA‐1a Alloantibodies
Authors: Win Nay
Published: May 2003

Most cases of neonatal alloimmune thrombocytopenia (NAIT) are diagnosed after birth and infants with severe NAIT remain at risk for intracranial haemorrhage [1]. In suspected severe NAIT cases, treatment must be instituted prior to confirmation of the diagnosis. HPA‐1a alloimmunisation is the most common cause of NAIT. The most effective forms of treatment are provision of compatible antigen‐negative platelets or provision of maternal platelets [2].
The struggle for methodological orthodoxy in nursing research: The case of mental health
Authors: White Edward
Published: May 2003

ABSTRACT: This paper is not intended as an exhaustive review of contemporary mental health nursing research. Rather, the intention is to explore some of the competing arguments for different methodological approaches in social research, using mental health nursing as a case example. The paper questions the extent to which the artificially dichotomized debate over quantitative versus qualitative research impacts upon the working lives of practitioners, managers and policy makers. In particular, the paper traces the development of survey method, during this its centennial anniversary year. It also traces its subsequent decline, in favour of what will be referred to as the new methodological orthodoxy in nursing research. It is also interwoven with occasional accounts of personal experience, drawn from an international perspective. The paper calls for a rapprochement between different wings of methodological opinion, in deference to a publicly unified position for nursing research in which the achievement of quality becomes the over‐arching concern.
The Tidal Model: Psychiatric colonization, recovery and the paradigm shift in mental health care
Authors: Barker Phil
Published: May 2003

ABSTRACT: Psychiatric research and practice involves the colonization of the personal experience of problems of human living. From a Western perspective, this process shares many similarities with the subjugation of women, people of colour and people embracing non‐Christian faiths and cultures. The Tidal Model® is a mental health recovery and reclamation model, developed to provide the framework for discrete alternatives to the colonizing approach of mainstream psychiatric practice. The Model asserts the intrinsic value of personal experience and the centrality of narrative in the development of contextually bound, personally appropriate, mental health care. This paper summarizes the features of the Model, which attempt to address the foci of the more significant critiques of psychiatric practice (and psychiatric nursing), against a background sketch of psychiatric colonization.
Nurse–patient relationship: A dichotomy of expectations
Authors: Moyle Wendy
Published: May 2003

ABSTRACT:The nurse–patient relationship has traditionally been viewed as the essence of nursing practice. This paper disputes that the ideals of such a relationship occur effortlessly in nursing practice. Findings from a phenomenological study of individuals hospitalized with a depressive illness found that a therapeutic relationship did not come instinctively to the mental health nurses, and that there was a dichotomy between the close relationship expected by patients and the distant relationship provided by nurses. It is unclear whether nurses’ distancing behaviour was as a result of the participant's depressive illness, a normal part of nursing practice, or whether other features such as nurses’ workloads were an influencing factor. Further research is required to explore this issue.
On the path to recovery: Patients’ experiences of treatment with long‐acting injections of antipsychotic medication
Authors: Svedberg Bodil , Backenroth‐Ohsako Gunnel , Lützén Kim
Published: May 2003

ABSTRACT: The aim of the present study was to explore how patients experience living with long‐acting depot antipsychotics given by injection. An interpretive perspective and a qualitative content analysis guided the research process and data analysis. Findings indicate that the participants understood dependency on depot treatment, as a ‘safety‐net’ protecting from relapses and re‐hospitalizations. More ‘normal lives’ became possible despite continuing distress from untoward effects. Participants also expressed favourable attitudes when they suffered from disabling side‐effects or when they were committed to psychiatric treatment. Adherence to treatment was understood as crucial for recovering. The recovery process, related to depot treatment, was described as mainly based on the participants’ experiential knowledge. This implies the need for exploring, in communication with patients, different kinds of support that might benefit their recovery.
Parents with mental illness: Lacking motivation to parent
Authors: Thomas Lyndall , Kalucy Ross
Published: May 2003

ABSTRACT: Parents with mental illness sometimes struggle to manage the demands of a family and the disabling symptoms of their illness. Limited interaction and poor relationships can negatively impact on children. Lack of motivation may inhibit these parents’ ability to interact with, and provide adequate care for their children. This is especially problematic following a hospital admission. Lack of motivation, in psychiatric illnesses, can be a symptom, due to medication, or perhaps associated with frontal lobe disorder. Assessment, rehabilitation and support that focuses on parents’ problems with motivation and planning and enhances their parenting would be beneficial in helping parents with mental illness provide the best possible care for their children.
The health effects of stimulant drinks
Authors: Finnegan Derek
Published: May 2003

Stimulant drinks belong to a class of food, known as functional foods and at present there is no legislation relating specifically to the consumption or labelling of stimulant drinks in Ireland or the UK. Following the death of a young male student in Ireland in November 1999, much controversy has surrounded stimulant drinks, prompting concern among the public about the safety of these drinks. At the request of the Minister of State at the Department of Health, safefood, the Food Safety Promotion Board, established a Stimulant Drinks Committee to commission independent scientific research into the health effects of stimulant drinks. This committee published a report in March 2002.

Stimulant drinks often contain ingredients such as caffeine, gaurana, taurine and glucuronolactone. Caffeine is a pharmacologically active substance and despite extensive research, its effects and health consequences are the subject of ongoing debate. Guarana has similar stimulatory effects to caffeine. Little is known about the health effects of taurine and glucuronolactone, other than levels in stimulant drinks are several times higher than that of the rest of the diet. The report from the Stimulant Drinks Committee recommends that stimulant drinks should be labelled with an indication that they are unsuitable for children (< 16 years), pregnant women and individuals sensitive to caffeine. Consumers should also be advised that caution be exercised in the consumption of stimulant drinks with alcohol or in association with sport and the products should carry a clear statement on the label to this effect.
Committee on Toxicity draft report on phyto‐oestrogens and health – review of proposed health effects of phyto‐oestrogen exposure and recommendations for future research
Authors: Cassidy Aedin
Published: May 2003

The public health implications of exposure to phyto‐oestrogens in the diet was recently reviewed by the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) for the Food Standards Agency and provided the agency with recommendations for future research. These recommendations suggest a broadening of interest to the other classes of phyto‐oestrogens, such as the lignans and prenylated compounds which to date have not been as thoroughly investigated as the isoflavones class. COT's draft report suggests that future research may focus on further understanding how these compounds work, defining the relative importance of metabolism, the hypothetical risk:benefit in subsections of the population who may be exposed to high levels through the diet or through supplement intake and the relative importance of phyto‐oestrogens in relation to chronic diseases such as osteoporosis and cancer. However, it will be important to integrate future programmes with ongoing European Union and international funded work to ensure effective use of resources to further our understanding of the relative risk:benefit of these compounds to human health.
Endotoxin Adsorption by Polymyxin B Immobilized Fiber Column in Patients with Systemic Inflammatory Response Syndrome: The Japanese Experience
Authors: Sato Takashi , Shoji Hisataka , Koga Nobuhiko
Published: May 2003

Abstract:  The polymyxin B immobilized fiber column (PMX) has been used to treat septic shock patients since 1994 under the Japanese health insurance system. In 1997, the results of the first multicenter clinical study enrolling 42 patients were published, showing a significant reduction in the plasma endotoxin level of the survivors, whilst there was no change with the non‐survivors, following treatment with PMX. Body temperature, blood pressure and hemodynamic abnormalities were significantly improved after PMX treatment. The second multicenter study enrolling 88 patients demonstrated that in the survivors, the plasma level of mediators such as TNF‐α, IL‐6, IL‐10 and plasminogen activator inhibitor‐1 (PAI‐1) was significantly decreased following treatment with PMX. Recent studies investigating the mechanisms of PMX treatment have indicated that various mediators other than endotoxin might be adsorbed by PMX. Possible mediators include endogenous cannabinoids, such as macrophage‐derived anandamide, and platelet‐derived 2‐arachidonyl glyceride (2‐AG) and tetrahydrobiopterin (BH4), an essential cofactor for inducible NO synthase. The interaction between PMX and activated monocytes may suggest an alternative mechanism for the improvement in patient condition following PMX treatment. Further studies are needed to clarify the mechanisms of PMX treatment and to strengthen the scientific basis of this treatment.
Clinical Analysis of Renoprotective Responding Patients Administrated with Oral Adsorbent in Chronic Renal Failure Secondary to Chronic Glomerulonephritis
Authors: Sanaka Tsutomu , Akizawa Tadao , Koide Keizo , Koshikawa Shozo
Published: May 2003

Abstract:  An oral adsorbent (AST‐120) that removes uremic toxin has attenuated the progression of renal dysfunction. Although there were decreased serum creatinine (Scr) levels observed during administration, it is expected that the action of an oral adsorbent is different according to the patient. In the present study, the difference in the background was clarified. Methods: A total of 842 patients whose Scr had increased from 3.8 to 4.8 mg/dL during the prior 5.2 months were investigated. Antihypertensive medications and dietary protein intake were unmodified during 6 months administration. The patients were divided into three efficacy groups based on the changes in Scr level; those who had a decrease in Scr were grouped as Group A (N = 290), while those with a <1.5‐fold increase were defined as Group B (N = 428) and those with a ≥1.5‐fold increase were defined as Group C (N = 124). Results: Before administration, these three groups were indistinguishable by the Scr level. No Group A patient went onto dialysis, whereas 12% and 40% of Group B and C patients, respectively, required dialysis. In Group A, the slopes of 1/Scr over time, serum urea nitrogen, uric acid, phosphate, total protein, and diastolic blood pressure were all improved. Group B improved moderately and Group C showed less improvement. Conclusions: In this study, a fairly large number of patients (29% of the population) were believed to be the first case to report the reversibility of severe chronic renal failure. Except in patients with hypoproteinemia, hypercholesterolemia, anemia or hypertension, AST‐120 either attenuates or arrests the progression in patients with severe chronic glomerulonephritis.
Therapeutic Plasma Exchange in Patients with Grade 2–3 Hematopoietic Stem Cell Transplantation‐associated Thrombotic Thrombocytopenic Purpura: A Ten‐year Experience
Authors: Christidou Fotini , Athanasiadou Athanasia , Kalogiannidis Panagiotis , Natse Taïsir , Bamichas Gerasimos , Salum Riant , Sakellari Ioanna , Anagnostopoulos Achileas , Fassas Athanasios , Sombolos Kostas
Published: May 2003

Abstract:  In the present retrospective study we report our 10‐year experience with therapeutic plasma exchange (TPE) in 18 patients with grade 2–3 hematopoietic stem cell transplantation (HSCT)‐associated thrombotic thrombocytopenic purpura (TTP). During TPE a mean total quantity of 26.5 ± 15.1 L of plasma was exchanged. Five patients (27.7%) had a complete response eight patients (44.4%) had a partial response while five patients (27.7%) died during TPE treatment. Among the survivors, relapse of TTP occured in three patients (23%) and although these patients were treated again with TPE, all died. First‐year survival rate was 41.2%. Our results indicate that TPE may be effective in the treatment of some patients with grade 2–3 HSCT‐associated TTP.
The Effect of Membrane Differential Filtration on the Colloid Osmotic Pressure in Patients with Age‐Related Macular Degeneration: Significance to Visual Function?
Authors: Lüke Christoph , Widder Randolf A , Walter Peter , Brunner Richard , Kirchhof Bernd , Borberg Helmut
Published: May 2003

Abstract:  To investigate the effect of membrane differential filtration (MDF) on plasma colloid osmotic pressure (COP) and visual functions in age‐related geographic macular degeneration (AMD). Ten consecutive patients with non‐exudative AMD underwent one MDF cycle. Primary endpoint was COP. Secondary endpoints were visual acuity and the mean defect of visual field. The COP was markedly reduced after one MDF cycle by 23.9% (P = 0.001). Compared with the baseline examination, visual acuity and the mean defect of visual field improved significantly after MDF. A significant positive correlation was found between the improvement in visual field and the decrease in COP (Pearson's coefficient = 0.65; P= 0.04). Membrane differential filtration lowers plasma colloid osmotic pressure in patients with non‐exudative AMD. Based on the observation that visual field and COP are correlated, one may hope for a means to improve decreased central retinal function in eyes with geographic AMD by modulation of COP plasma level.
Plasmapheresis in Immunologically Mediated Polyneuropathies
Authors: Kiprov Dobri D. , Hofmann Jan C.
Published: May 2003

Abstract:  One of the most common uses of therapeutic plasmapheresis is for the treatment of immunologically mediated polyneuropathies. This paper discusses the use of plasmapheresis in Guillain‐Barré syndrome, chronic inflammatory demyelinating polyneuropathy, polyneuropathies associated with paraproteins, lower motor neuron syndromes, and polyneuropathies associated with HIV. As the pathogenesis of immunologically mediated polyneuropathies becomes better understood, newer therapies for these syndromes will evolve; however, therapeutic plasmapheresis is likely to continue to play a central role in the treatment of many of these diseases.