bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender Differences in Emergency Department Patients with Chronic Obstructive Pulmonary Disease Exacerbation
Authors: Cydulka Rita K. , Rowe Brian H. , Clark Sunday , Emerman Charles L. , Rimm Alfred R. , Camargo Carlos A.
Published: November 2005

Objectives: Although more men are diagnosed as having chronic obstructive pulmonary disease (COPD), its prevalence is increasing among women. Little is known about gender differences in exacerbations of COPD. The objective of this study was to determine if acute presentation, management, and outcomes differ among men and women seeking care in the emergency department (ED) for exacerbation of COPD. Methods: This was a secondary analysis of a prospective cohort study of ED patients aged 55 years or older who presented with an exacerbation of COPD. Subjects underwent structured interviews in the ED and two weeks later. Results: The cohort consisted of 397 subjects with COPD, of whom 52% were women. Self‐report of COPD only tended to be more common among men (61% of men vs. 52% of women), while mixed COPD/asthma tended to be more common among women (39% vs. 48%; p = 0.10). Despite reporting similar chronic symptom severity, women were less likely than men to use anticholinergic agents before their ED visit (59% vs. 69%; p = 0.04). During the exacerbation, women initiated less home therapy and were less likely to seek emergency care within the first 24 hours of symptom onset (25% vs. 36%; p = 0.01). Although ED care and disposition were similar, post‐ED outcomes differed. At two‐week follow‐up, men were more likely to report an ongoing exacerbation (42% vs. 31%; p = 0.03). Conclusions: Men and women who present to the ED for treatment of an exacerbation of COPD have substantial differences in long‐term medication use, self‐treatment during exacerbation, delay in emergency care, and post‐ED outcomes. Further studies are warranted to confirm and explain these gender‐related differences.
Addressing the Systems‐based Practice Core Competency: A Simulation‐based Curriculum
Authors: Wang Ernest E. , Vozenilek John A.
Published: November 2005

Systems‐based practice is one of the six core competencies implemented by the Accreditation Council for Graduate Medical Education to direct residency educational outcome assessment and accreditation. Emergency medicine–specific systems‐based practice criteria have been described to define the expected knowledge and skill sets pertinent to emergency medicine practitioners. High‐fidelity patient simulation is increasingly used in graduate medical education to augment case‐based learning. The authors describe a simulation‐based curriculum to address the emergency medicine–specific systems‐based practice core competency.
Bench to Bedside: Pharmacogenomics, Adverse Drug Interactions, and the Cytochrome P450 System
Authors: Sikka Rishi , Magauran Brendan , Ulrich Andrew , Shannon Michael
Published: November 2005

As physicians attempt to improve the quality of health care, one area of particular concern has been preventable medical errors from adverse drug interactions. The cytochrome P450 family of enzymes has been implicated in a large number of these preventable, adverse drug interactions. This report reviews the basic biochemistry and pharmacogenomics underlying the reactions catalyzed by the cytochrome P450 family of enzymes. An emphasis is placed on the phenotypic variations within a population and the resulting clinical effects. In addition, six members of the cytochrome P450 superfamily that are responsible for the metabolism of the majority of pharmaceutical agents are profiled in detail. These enzymes, CYP3A4, CYP2D6, CYP2C9, CYP2C19, CYP2E1, and CYP1A2, are reviewed with regard to their phenotypic variation in the population and the resulting clinical and therapeutic implications.
Availability of Pediatric Emergency Visit Data from Existing Data Sources
Authors: Gorelick Marc H. , Alpern Elizabeth R. , Singh Tasmeen , Snowdon Donald , Holubkov Richard , Dean J. Michael , Kuppermann Nathan ,   for the Pediatric Emergency Care Applied Research Network (PECARN)
Published: November 2005

Objectives: To determine the availability and completeness of selected data elements from administrative and clinical sources for emergency department (ED) visits in a national pediatric research network. Methods: This was a retrospective study of 25 EDs in the Pediatric Emergency Care Applied Research Network. Data were obtained from two sources at each ED: 1) extant electronic administrative data for all visits during a 12‐month period in 2002 and 2) data abstracted from medical records by trained abstractors for visits during ten randomly selected days over a three‐month period in 2003. Epidemiologic data were obtained for all visits and additional clinical data for patients with two target conditions: asthma and fractures. Results: A total of 749,036 visits were analyzed from administrative sources and 12,756 medical records abstracted. Data availability varied by element, method of capture, and site. From administrative sources, data on insurance type were the most complete (1.3% overall missing; range, 0%–18.5% for individual sites), whereas mode of arrival (25.5% missing) and triage time (65.3%) were the least complete. Disposition was missing in only 1.2% of medical records overall (range, 0%–5%) and diagnosis was missing in 3% (range, 0%–16%); these were missing from 14.4% and 10.5%, respectively, of administrative sources. Among visits with injury diagnoses, E‐codes were missing in 27% of cases. For patients with asthma (n= 861), documentation of specific elements of the clinical examination by nurses and physicians was also variable. Conclusions: Data elements important in emergency medical care for children are frequently missing in existing administrative and medical record sources; completeness varies widely across EDs. Researchers must be aware of these limitations in the use of existing data when planning studies.
Reasons for Using the Emergency Department: Results of the EMPATH Study
Authors: Ragin Deborah Fish , Hwang Ula , Cydulka Rita K. , Holson Dave , Haley Leon L. , Richards Christopher F. , Becker Bruce M. , Richardson Lynne D. ,   The Emergency Medicine Patients' Access To Healthcare (EMPATH) Study Investigators
Published: November 2005

Objectives: Emergency Medicine Patients' Access To Healthcare (EMPATH) was a cross‐sectional, observational study conducted to identify the principal reasons why patients seek care in hospital emergency departments (EDs) in the United States. Methods: Twenty‐eight U.S. hospitals, stratified by geographic region and hospital characteristics, participated in this study. Demographic, clinical, and insurance data were collected for a 24‐hour period at each site, using chart reviews and a structured interview administered to all consenting adult patients seeking treatment during that period. Patients' reasons for presenting to the ED were assessed by their level of agreement (on a three‐point Likert scale) with 21 carefully worded statements designed to capture a range of possible reasons for seeking care in the ED. Factor analysis was used to consolidate highly correlated responses and to identify the principal factors explaining patients' reasons for coming to the ED. Results: A total of 1,579 patient interviews and 2,004 chart reviews were obtained from a diverse sample that was 55.4% female, 58.3% white, 28.3% African American, 7.0% Hispanic, and 6.0% other ethnic groups. This exploratory analysis yielded five factors characterizing patients' principal reasons for seeking ED care, with medical necessity the most frequent, followed by ED preference, convenience, affordability, and limitations of insurance. Conclusions: Use of the ED is, for most people, an affirmative choice over other providers rather than a last resort; it is often a choice driven by lack of access to or dissatisfaction with other sources of care.
The Effect of Ethanol on Uncontrolled Hemorrhage in a Rodent Model
Authors: Sinert Richard , Tillotson Roger D. , Adar Eric , Isaac Yanick , Nagdev Arun , Peng James , Carrer Alexandra , Shahidi Hosseinali , Zehtabchi Shahriar
Published: November 2005

Objectives: Ethanol intoxication has hemodynamic and metabolic effects after hemorrhage according to studies using fixed‐volume controlled blood loss models. The authors tested the null hypothesis that after uncontrolled hemorrhage there would be no difference in the hemodynamic responses between ethanol‐intoxicated (EtOH+) and nonintoxicated (EtOH−) rats. Methods: Forty Sprague–Dawley rats were anesthetized with althesin intraperitoneally. Twenty EtOH+ rats received a 3‐g/kg dose of 20% ethanol intraperitoneally 60 minutes before hemorrhage. The EtOH− rats received an equivalent volume of normal saline intraperitoneally. The femoral artery was cannulated by cutdown to monitor the mean arterial blood pressure (MAP) and to obtain blood samples for lactate (LAC). Twenty rats (ten EtOH+ and ten EtOH−) underwent uncontrolled hemorrhage by 75% tail amputation. Twenty rats (ten EtOH+ and ten EtOH−) served as nonhemorrhage controls. The MAP, LAC, and cumulative hemorrhage volume were measured prehemorrhage and then every 15 minutes posthemorrhage for 120 minutes. Data were reported as mean ± SEM. Group comparisons were analyzed by analysis of variance with repeated values and post hoc testing by Bonferroni (two tailed; α= 0.05). Results: Initially, EtOH+ and EtOH− rats were evenly matched for LAC and MAP. The mean (±SD) baseline ethanol level was 170 (±68) mg/dL in EtOH+ rats. Cumulative hemorrhage volume was similar (p = 0.23) for the EtOH− (2.36 ± 0.24 mL/100 g) and EtOH+ (1.87 ± 0.32 mL/100 g) rats. No significant difference was noted in posthemorrhage MAP between EtOH− (68.6 ± 6.8 mm Hg) and EtOH+ (69.3 ± 7.2 mm Hg) rats (p = 1.00). The EtOH− group had a significantly higher LAC (4.94 ± 1.07 mmol/L) than the EtOH+ group (2.27 ± 0.59 mmol/L) (p < 0.03). Conclusions: Ethanol intoxication does not deleteriously affect the hemodynamic response to uncontrolled hemorrhage.
Analysis of Unilateral Adrenal Hyperplasia with Primary Aldosteronism from the Aspect of Messenger Ribonucleic Acid Expression for Steroidogenic Enzymes: A Comparative Study with Adrenal Cortices Adhering to Aldosterone-Producing Adenoma
Authors: Shigematsu Kazuto , Kawai Kioko , Irie Junji , Sakai Hideki , Nakashima Osamu , Iguchi Atsushi , Shimamatsu Junichiro , Shimamatsu Kazuhide , Kusaba Yasuyuki , Takahara Osamu
Published: November 2005

Unilateral adrenal hyperplasia with primary aldosteronism is very rare and shows similar endocrine features to aldosterone-producing adenoma and bilateral adrenal hyperplasia. In this study, the mRNA expression of steroidogenic enzymes in unilateral adrenal hyperplasia was examined by in situ hybridization. We found subcapsular micronodules composed of spironolactone body-containing cells, which showed intense expression for 3β-hydroxysteroid dehydrogenase, 11β-hydroxylase, 18-hydroxylase, and 21-hydroxylase but not 17α-hydroxylase, indicating aldosterone production. This expression pattern was the same as that in unilateral multiple adrenocortical micronodules, reported recently. Additionally, it was noted that a nodule with active aldosterone production was closely adjacent to one showing intense 17α-hydroxylase expression. In the adrenal cortices adhering to aldosterone-producing adenoma, the majority of hyperplastic zona glomerulosa and hyperplastic nodules demonstrated a decreased steroidogenic activity. However, minute nodules indicative of active aldosterone production were found at high frequency. These results suggest that the subcapsular micronodules observed might be the root of aldosterone-producing adenoma. Furthermore, we emphasize the need for long-term follow-up after unilateral adrenalectomy or enucleation of the adenoma because of the possibility that buds with autonomous aldosterone production may still be present in the contralateral or remaining adrenal tissue.
Polychlorinated Biphenyls Exert Selective Effects on Cellular Composition of White Matter in a Manner Inconsistent with Thyroid Hormone Insufficiency
Authors: Sharlin David S. , Bansal Ruby , Zoeller R. Thomas
Published: November 2005

Developmental exposure to polychlorinated biphenyls (PCBs) is associated with a variety of cognitive deficits in humans, and recent evidence implicates white matter development as a potential target of PCBs. Because PCBs are suspected of interfering with thyroid hormone (TH) signaling in the developing brain, and because TH is important in oligodendrocyte development, we tested the hypothesis that PCB exposure affects the development of white matter tracts by disrupting TH signaling. Pregnant Sprague Dawley rats were exposed to the PCB mixture Aroclor 1254 (5 mg/kg), with or without cotreatment of goitrogens from gestational d 7 until postnatal d 15. Treatment effects on white matter development were determined by separately measuring the cellular density and proportion of myelin-associated glycoprotein (MAG)-positive, O4-positive, and glial fibrillary acidic protein (GFAP)-positive cells in the genu of the corpus callosum (CC) and in the anterior commissure (AC). Hypothyroidism decreased the total cell density of the CC and AC as measured by 4′,6-diamidino-2-phenylindole dihydrochloride (DAPI) staining and produced a disproportionate decrease in MAG-positive oligodendrocyte density with a simultaneous increase in GFAP-positive astrocyte density. These data indicate that hypothyroidism reduces cellular density of CC and AC and fosters astrocyte development at the expense of oligodendrocyte density. In contrast, PCB exposure significantly reduced total cell density but did not disproportionately alter MAG-positive oligodendrocyte density or change the ratio of MAG-positive oligodendrocytes to GFAP-positive astrocytes. Thus, PCB exposure mimicked some, but not all, of the effects of hypothyroidism on white matter composition.
Hypoxia-Inducible Factor-1α Expression in Human Endometrium and Its Regulation by Prostaglandin E-Series Prostanoid Receptor 2 (EP2)
Authors: Critchley Hilary O. D. , Osei Julia , Henderson Teresa A. , Boswell Lyndsey , Sales Kurt J. , Jabbour Henry N. , Hirani Nik
Published: November 2005

The menstrual cycle is a complex interaction of sex steroids, prostanoids, and cytokines that lead to coordinated tissue degradation, regeneration and repair. The transcription factor hypoxia-inducible factor (HIF-1) plays critical roles in cellular responses to hypoxia, the generation of an inflammatory response and vasculogenesis through transcriptional activation of angiogenic genes. We hypothesize that HIF-1 is expressed in human endometrium and that locally synthesized prostaglandins (PGE2 and PGF2α) regulate HIF-1 activity. Here we demonstrate that PGE2 up-regulates HIF-1α mRNA and protein via the E-series prostanoid receptor 2 (EP2), and this up-regulation is dependent on epidermal growth factor receptor kinase activity. We show the tight temporal-spatial confinement of HIF-1α protein expression in endometrium across the cycle. HIF-1α is expressed exclusively during the secretory and menstrual phases. Protein expression is maximal at progesterone withdrawal during the late secretory and menstrual phase. HIF-1α protein colocalizes with prostaglandin EP2 receptor in glandular cells. In contrast, HIF-1β/aryl receptor nuclear translocator 1 expression occurs throughout the cycle but is maximal in glandular cells during the proliferative phase. This provides evidence for a role for HIF-1 in the menstrual cycle and demonstrates that HIF-1 activation in human endometrium may occur via a PGE2-regulated pathway and provides a coordinated pathway from progesterone withdrawal through to angiogenic gene expression via HIF-1.
Activin A and Inhibin A Differentially Regulate Human Uterine Matrix Metalloproteinases: Potential Interactions during Decidualization and Trophoblast Invasion
Authors: Jones Rebecca L. , Findlay Jock K. , Farnworth Paul G. , Robertson David M. , Wallace Euan , Salamonsen Lois A.
Published: November 2005

Embryo implantation and trophoblast invasion are tightly regulated processes, involving sophisticated communication between maternal decidual and fetal trophoblast cells. Decidualization is a prerequisite for successful implantation and is promoted by a number of paracrine agents, including activin A. To understand the downstream mechanisms of activin-promoted decidualization, the effects of activin on matrix metalloproteinases (MMPs) (important mediators of decidualization) were investigated. Activin A stimulated endometrial production of proMMPs-2, -3, -7, -9, and active MMP-2. In contrast, inhibin A was a potent inhibitor of proMMP-2, and antagonized the effect of activin on MMPs. Activin is up-regulated with decidualization, and MMPs-2, -3, and -9 increase in parallel. Furthermore, proMMP-2 production is stimulated when decidualization is accelerated with activin, and suppressed when activin is neutralized, attenuating decidualization. These data support that activin A promotes decidualization through up-regulating MMPs. Previous in vitro evidence proposes further roles for activin and MMPs in promoting trophoblast invasion; therefore, we examined their interrelationships in early human implantation sites. MMPs-7 and -9 were produced by static cytotrophoblast subpopulations, whereas MMP-2 was strikingly up-regulated in invasive extravillous cytotrophoblasts (EVT). Maternal decidua is the primary source of activin, where a role in stimulating MMP-2 in iEVTs can be envisaged. Inhibin was absent from cytotrophoblast populations, except for a dramatic up-regulation in endovascular EVT plugs, coinciding with a down-regulation of MMP-2. This suggests that inhibin may have a role in the cessation of vascular invasion. These data support that activin, via effects on MMPs, is an important factor in the maternal-fetal dialog regulating implantation.
Repetitive Activation of Hypothalamic G Protein-Coupled Receptor 54 with Intravenous Pulses of Kisspeptin in the Juvenile Monkey (Macaca mulatta) Elicits a Sustained Train of Gonadotropin-Releasing Hormone Discharges
Authors: Plant Tony M. , Ramaswamy Suresh , DiPietro Meloni J.
Published: November 2005

The purpose of the present study was to further examine the hypothesis that activation of G protein-coupled receptor 54 (GPR54) signaling at the end of the juvenile phase of primate development is responsible for initiation of gonadarche and the onset of puberty. Accordingly, we determined whether repetitive iv administration of the GPR54 receptor agonist kisspeptin-10 (2 μg as a brief 1-min infusion once every hour for 48 h) to the juvenile male rhesus monkey would prematurely elicit sustained, pulsatile release of hypothalamic GnRH, the neuroendocrine trigger for gonadarche. GnRH release was monitored indirectly by measuring LH secretion from the in situ pituitary, the GnRH responsiveness of which had been heightened before the experiment with an intermittent iv infusion of synthetic GnRH. Agonadal animals (n = 4) were employed to eliminate any confounding and secondary effects of changing feedback signals from the testis. The first brief infusion of kisspeptin-10 evoked an LH discharge that mimicked those produced by GnRH priming, and this was followed by a train of similar LH discharges in response to hourly activation of GPR54 by repetitive kisspeptin-10 administration. Concomitant treatment with a GnRH receptor antagonist, acyline, abolished kisspeptin-10-induced LH release. Repetitive kisspeptin-10 administration also provided a GnRH-dependent signal to FSH secretion. These findings are consistent with the notion that, in primates, the transition from the juvenile (attenuated GnRH release) to pubertal (robust GnRH release) state is controlled by activation of GPR54 resulting from increased expression of hypothalamic KiSS-1 and release of kisspeptin in this region of the brain.
Stress Kinase Signaling Regulates Androgen Receptor Phosphorylation, Transcription, and Localization
Authors: Gioeli Daniel , Black Ben E. , Gordon Vicki , Spencer Adam , Kesler Cristina T. , Eblen Scott T. , Paschal Bryce M. , Weber Michael J.
Published: November 2005

Activation of signal transduction kinase cascades is known to alter androgen receptor (AR) activity, but the molecular mechanisms are still poorly defined. Here we show that stress kinase signaling regulates Ser 650 phosphorylation and AR nuclear export. In LNCaP prostate cancer cells, activation of either MAPK kinase (MKK) 4:c-Jun N-terminal kinase (JNK) or MKK6:p38 signaling pathways increased Ser 650 phosphorylation, whereas pharmacologic inhibition of JNK or p38 signaling led to a reduction of AR Ser 650 phosphorylation. Both p38α and JNK1 phosphorylated Ser 650 in vitro. Small interfering RNA-mediated knockdown of either MKK4 or MKK6 increased endogenous prostate-specific antigen (PSA) transcript levels, and this increase was blocked by either bicalutamide or AR small interfering RNA. Stress kinase inhibition of PSA transcription is, therefore, dependent on the AR. Similar experiments involving either activation or inhibition of MAPK/ERK kinase:ERK signaling had little effect on Ser 650 phosphorylation or PSA mRNA levels. Ser 650 is proximal to the DNA binding domain that contains a nuclear export signal. Mutation of Ser 650 to alanine reduced nuclear export of the AR, whereas mutation of Ser 650 to the phosphomimetic amino acid aspartate restored AR nuclear export. Pharmacologic inhibition of stress kinase signaling reduced wild-type AR nuclear export equivalent to the S650A mutant without affecting nuclear export of the S650D mutant. Our data suggest that stress kinase signaling and nuclear export regulate AR transcriptional activity.
Nausea and Dizziness after Vestibular Schwannoma Surgery: A Multivariate Analysis of Preoperative Symptoms
Authors: Stieglitz Lennart H. , Samii Amir , Kaminsky Jan , Gharabaghi Alireza , Samii Madjid , Lüdemann Wolf O.
Published: November 2005

OBJECTIVE:

Nausea and dizziness are very discomforting for patients after vestibular schwannoma surgery and they impair recovery.

METHODS:

To identify preoperative symptoms and conditions that increase the risk of development of nausea after vestibular schwannoma surgery, a multivariate analysis was performed. One hundred fifteen patients with vestibular schwannoma had a microsurgical tumor removal in a standardized procedure in 2001 and 2002. Eighteen patients were excluded from the study because of previous surgery (recurrent tumors, 7 patients) or bilateral tumor occurrence (neurofibromatosis, 11 patients). Analysis was performed regarding postoperative amount of antiemetic medication, vomiting, and subjective feeling of the patient. Tumor grading, body mass index, sex, previous complaints, examination at admission, and side of the tumor were taken in consideration.

RESULTS:

Women had significant longer postoperative complaints (mean, 3.0 d; standard error, 0.47) and needed longer antiemetic therapy (mean, 3.3 d; standard error, 0.49) than men (mean, 1.72 d; standard error, 0.21). Patients developing no significant postoperative complaints were all in the higher tumor grading group, Grades 3a, 4a, and 4b. There was a significant difference in the duration of antiemetic therapy between tumors graded 1 and tumors graded 3 or 4. Patients with a positive stepping test preoperatively had a tendency to demand less antiemetic medication. Women with small tumors are most likely to develop significant complaints after vestibular schwannoma surgery.

CONCLUSION:

It is possible to identify patients with a higher risk of postoperative nausea and dizziness after vestibular schwannoma surgery. This allows one to inform these patients preoperatively and to initiate an early postoperative drug therapy to ease their symptoms.
Presentation, Natural History, and Management of Carotid Cavernous Aneurysms
Authors: Stiebel-Kalish Hadas , Kalish Yuval , Bar-On Ruth Huna , Setton Avi , Niimi Yasu , Berenstein Alejandro , Kupersmith Mark J.
Published: November 2005

OBJECTIVE:

We present the largest reported cohort of carotid cavernous aneurysms (CCA), comparing the neuro-ophthalmic presentation, complications, and outcome with and without endovascular treatment.

METHODS:

Retrospective review of 185 patients with 206 CCAs examined between 1980 and 2001 at a tertiary neuro-ophthalmology and neurovascular service. Patients' symptoms and findings at presentation were recorded and compared with those at outcome. The effect of treatment on outcome and on complication rate was analyzed using the χ2 test, multivariate analysis of covariance, model-selection log-linear analysis, and multinomial logistic regression.

RESULTS:

Long-term follow-up was available for 189 of 206 CCAs. Seventy-four CCAs underwent treatment (endovascular, 67 [91%]; surgical treatment, 6 [9%]), and 115 were followed for an average of 4 years, two of which required later treatment. Treatment reduced the incidence and severity of pain, even after adjusting for the severity of initial pain (F(1,192 = 9.59, P = 0.002). Treatment did not significantly affect the patient's final diplopia after adjusting for their initial diplopia (F(1, 182 = 2.01, P = 0.158). Statistical examination revealed that the treated group had a higher proportion of neurological and visual complications than people who were not treated (2(2). = 25.26, P = 0.0003).

CONCLUSION:

Endovascular treatment of carotid cavernous aneurysms leads to a significantly higher rate of pain resolution compared with untreated patients, even after adjusting for initial pain severity. Diplopia may not resolve after treatment. The results of this study underscore our approach indicating treatment only in cases of debilitating pain, visual loss from compression, or diplopia in primary gaze or in patients with risk factors for major complications such as pre-existing coagulopathy or sphenoid sinus erosion.
Meningioma Resection in the Elderly: Nationwide Inpatient Sample, 1998–2002
Authors: Bateman Brian T. , Pile-Spellman John , Gutin Philip H. , Berman Mitchell F.
Published: November 2005

OBJECTIVE:

Morbidity and mortality rates reported for meningioma resection in the elderly vary widely. Thus, it is difficult for neurosurgeons to compare the risks and benefits of operating on elderly patients against opting for radiosurgery or watchful waiting. To address this issue, we studied the effect of advanced age on outcome after meningioma resection using the Nationwide Inpatient Sample.

METHODS:

We identified all patients over the age of 20 in the Nationwide Inpatient Sample database who underwent surgical resection of a meningioma between 1998 and 2002 and were admitted from home. Primary outcomes were in-hospital mortality, adverse outcome (defined as death or discharge to a facility other than home), and length of hospitalization. Multivariate models were constructed to assess the effect of elderly age on the primary outcomes, adjusting for patient demographics, comorbid medical conditions, and hospital surgical volume.

RESULTS:

There were 8861 patients in the Nationwide Inpatient Sample database who underwent resection of meningioma during the study period; 26.0% were age 70 or older. Each of the primary outcomes demonstrated a marked effect of advancing age. The in-hospital mortality rate was higher in the elderly than in the nonelderly (4.0% versus 1.1%, P < 0.001), as was the rate of discharge to a facility other than home (53.2% versus 16.6%, P < 0.001). Elderly patients also had a longer mean length of stay (7.2 versus 5.1 d P < 0.001).

CONCLUSION:

The association between elderly age and adverse outcome after meningioma resection suggests a note of caution before proceeding to surgery with these patients.
Intracranial Epidural Hematoma in Newborn Infants: Clinical Study of 15 Cases
Authors: Heyman Rachel , Heckly Anne , Magagi Joseph , Pladys Patrick , Hamlat Abderrahmane
Published: November 2005

OBJECTIVE:

Epidural hematoma (EDH) in newborn infants is rare. We have described the history of 15 newborns with EDH to provide a better understanding of this pathology.

METHODS:

This is a descriptive case series study using a retrospective review of the medical records of newborns who were admitted to the Pediatric Intensive Care Unit and Neurosurgery Department with the diagnosis of birth EDH over a 24-year period (1979–2002).

RESULTS:

There was no sex predominance, and most of the mothers were young, nulliparous women. The time latency from birth to the first signs varied from 0 to 24 hours. Clinical presentation was nonspecific: seizures and hypotonia were the main symptoms. The parietal area was the most frequent location. Surgical drainage was required in nine patients, and no deaths were reported.

CONCLUSION:

This report highlights the clinicoradiological characteristics of newborn EDH, which occurs more frequently in newborns that experienced difficult delivery from a nulliparous mother. Surgery is not a rule; some patients can be managed with conservative treatment. The outcome is generally good.
Incidence and Characteristics of Spinal Decompression Surgery after the Onset of Symptoms of Amyotrophic Lateral Sclerosis
Authors: Yoshor Daniel , Klugh Arnett , Appel Stanley H. , Haverkamp Lanny J.
Published: November 2005

OBJECTIVE:

The high incidence of spondylosis in patients at the mean age of onset (55.7 yr) of amyotrophic lateral sclerosis (ALS) can make recognition of ALS as a cause of weakness difficult.

METHODS:

To assess the impact of this diagnostic dilemma on neurosurgical practice, we performed a retrospective analysis of a database of more than 1500 patients with motor neuron disease.

RESULTS:

Of 1131 patients with typical, sporadic ALS, 47 (4.2%) underwent decompressive spinal surgery after the onset of retrospectively recognized symptoms of ALS. Among 55 operations in 47 ALS patients, 86% yielded no improvement, 9% produced minor improvement, and only 5% provided significant benefit. Cervical decompression was performed in 56%, lumbar in 42%, and thoracic in 2%. Foot drop was a symptom prompting surgery in 11 patients, and in 10, this finding was subsequently attributed solely to ALS. No differences between ALS patients who underwent spinal decompression and other ALS patients were noted regarding age at symptom onset, severity of impairment at time of diagnosis, or rate of disease progression. Not surprisingly, patients who had spinal surgery tended to have a longer interval between retrospectively recognized symptom onset and diagnosis of ALS.

CONCLUSION:

A small but significant number of patients with unrecognized ALS undergo spinal surgery that in retrospect may be inappropriate. The possibility of ALS must be considered in the evaluation of patients with weakness even in the presence of radiographic evidence of spondylosis and nerve root or spinal cord impingement.
Mutations in Apoptosis-related Gene, PDCD10, Cause Cerebral Cavernous Malformation 3
Authors: Guclu Bulent , Ozturk Ali K. , Pricola Katie L. , Bilguvar Kaya , Shin Dana , O'Roak Brian J. , Gunel Murat
Published: November 2005

OBJECTIVE:

To identify the CCM3 gene in a population of 61 families with a positive family history of cerebral cavernous malformations (CCM), 8 of which had suggestive linkage to the CCM3 locus.

METHODS:

We searched for mutations within the CCM3 interval using a high-throughput screening technique, temperature-gradient capillary electrophoresis. Mutations detected by this device were subsequently sequenced, and the results were analyzed.

RESULTS:

A recent study by Bergametti et al. established Programmed Cell Death 10 (PDCD10) as the gene responsible for CCM3. We hereby confirm PDCD10 as the CCM3 gene by reporting four novel mutations in 61 CCM families. Two of these mutations were identical and produced a stop codon in exon 7. Another two resulted in frameshift mutations in exon 6, although the mutations occurred at different points along the exon. The last mutation caused a frameshift in exon 9. Of note, mutations in these families completely cosegregated with the trait. Three of the five families had prior linkage data suggestive of the CCM3 locus, whereas the remaining two were identified in index patients with a positive family history but no linkage data.

CONCLUSION:

Our data establish PDCD10 as the gene responsible for CCM in families linking to the CCM3 locus. The discovery of the third gene involved in inherited forms of CCM, after KRIT1 and Malcavernin, is an important step toward dissecting the molecular pathophysiology of this disease.
Safety of Heparinization for Cerebral Aneurysm Coiling Soon after External Ventriculostomy Drain Placement
Authors: Hoh Brian L. , Nogueira Raul G. , Ledezma Carlos J. , Pryor Johnny C. , Ogilvy Christopher S.
Published: November 2005

OBJECTIVE:

Our practice has been to heparinize patients for cerebral aneurysm coiling even after recent external ventriculostomy drain (EVD) placement. The current medical literature cites a 12.5% symptomatic hemorrhage rate with heparinization after recent EVD placement. We reviewed our experience to determine our level of safety with this practice.

METHODS:

A search of our prospectively collected computerized aneurysm database revealed that from February 1998 to February 2004, 356 aneurysms were coiled, of which 119 patients had had recent EVD placement before coiling. During the same time period, 251 subarachnoid hemorrhage patients underwent EVD placement without coiling or heparinization. We reviewed the head computed tomographic scan reports and medical records to determine the incidence of EVD-related hemorrhage in heparinized patients compared with nonheparinized patients.

RESULTS:

There was only 1 patient in the heparinized group who had a symptomatic EVD-related hemorrhage attributable to heparinization (0.8%) and 11 patients with asymptomatic EVD-related hemorrhage (9.2%). Among the nonheparinized patients, there were 3 patients who had symptomatic EVD-related hemorrhages (1.2%) and 22 patients with asymptomatic EVD-related hemorrhages (8.8%) (P = not significant for both symptomatic and asymptomatic EVD-related hemorrhages). The time interval between EVD placement and heparinization in the heparinized patient with symptomatic EVD-related hemorrhage was 0.5 day; the mean time interval in the heparinized patients with asymptomatic EVD-related hemorrhage was 0.8 day; and in the heparinized patients with no hemorrhage, it was 0.8 day. The peak activated prothrombin time of the heparinized patient with symptomatic EVD-related hemorrhage was >150 seconds, the mean peak activated prothrombin time of the heparinized patients with asymptomatic EVD-related hemorrhage was 73.1 seconds, and that of the heparinized patients with no hemorrhage was 90.3 seconds.

CONCLUSION:

Heparinization for cerebral aneurysm coiling can be safely performed even after EVD placement within 24 hours, particularly if the activated prothrombin time is kept strictly controlled.
Rapid Administration of Antifibrinolytics and Strict Blood Pressure Control for Intracerebral Hemorrhage
Authors: Sorimachi Takatoshi , Fujii Yukihiko , Morita Kenichi , Tanaka Ryuichi
Published: November 2005

OBJECTIVE:

Hematoma growth is a major cause of poor outcome in patients with intracerebral hemorrhage. We evaluated the efficacy of a combination of rapid antifibrinolytic therapy and strict blood pressure control for prevention of hematoma growth in this retrospective study.

METHODS:

Systolic blood pressure was strictly controlled below 150 mm Hg by use of intravenously administered nicardipine (BPC). Prolonged infusion of antifibrinolytic therapy was given by intravenous administration of 1 g tranexamic acid over a period of 6 hours (PAF). Rapid administration of antifibrinolytic therapy was given by intravenous administration of 2 g tranexamic acid over a period of 10 minutes (RAF). Immediately after diagnosis of intracerebral hemorrhage on computed tomographic scan, 156 patients who were admitted within 24 hours of onset were treated with either a combination of PAF and BPC (PAF group) or a combination of RAF and BPC (RAF group). The incidence of hematoma growth determined by a second computed tomographic scan the day after admission was compared between the PAF and the RAF groups.

RESULTS:

Hematoma growth was observed in 11 (17.5%) of 63 patients in the PAF group and 4 (4.3%) of 93 patients in the RAF group using a 20% cutoff value for hematoma enlargement. The RAF group showed a significantly low incidence of hematoma growth compared with the PAF group (P < 0.05). Between the two groups, there was no significant difference in any of the other factors reported to affect hematoma growth.

CONCLUSION:

The combination of rapid administration of antifibrinolytics and strict blood pressure control may prevent hematoma growth in patients with intracerebral hemorrhage.
Simulation of electrosprays in model direct-injection spark-ignition engine in-cylinder flows
Authors: Nhumaio G C S , Watkins A P
Published: November 2005

The calculated effects on injected charged sprays of dielectric and conductive in-cylinder wall materials are presented for a half-cycle of an axisymmetric flow model direct-injection spark-ignition (DISI) engine. A plain orifice electrostatic atomizer, previously used in experiments for application in fuel burners, is embodied into the EPISO code and this is assumed to pump a charged spray while working at moderate pressures of 5 MPa and fuel deliveries of 5 cm3/s, the maximum rates currently reported in electrostatic atomization of hydrocarbons. The transition mode operation of DISI engines is selected for the study and this consists of multiple pulses of 5 mg each, occurring at 80, 150, and 300° crank angle with the engine running at 3000 r/min. In the case of the third pulse, which impinges on the piston surface, the wall impaction model of Park and Watkins is used particularly when an electric potential of 1 kV is applied on this surface for it helps to reduce excessive fuel film build-up. Particles impinging on the cylinder roof and liner are treated with the stick impaction model of Naber and Reitz. A simple axisymmetric engine geometry of flat piston and cylinder heads is considered and computations of an uncharged spray are taken as a reference case. It is found in the study, firstly, that charge improves mixture preparation when dielectric in-cylinder surfaces are used, secondly, that the need for charge drainage in metallic surfaces produces poor spray characteristics in comparison with an ideal charged spray with boundary electric fields (this is shown by the large impingement of drop parcels relative to an ordinary spray as well as to a charged spray with electric boundary fields) and, thirdly, that charge reduces the fuel film thickness on the piston surface during late injection.
Effects of CO2and dust on present‐day solar radiation and climate on Mars
Authors: Savijärvi Hannu , Crisp David , Harri Ari‐Matti
Published: November 2005

A comprehensive spectrum‐resolving radiative transfer model (SRM) was used to simulate the average, present‐day, solar radiation field on Mars. A CO2‐only 6 hPa Martian atmosphere absorbs about 1% of zenith solar radiation, producing a modest heating rate of 4–5 K day−1in the lowest 10 km. The trace gases have an insignificant effect but airborne dust reduces the downwelling solar flux effectively, and the reflected flux somewhat less. This produces an anti‐greenhouse trend (cooling at the surface, warming within the atmosphere, reflection at the top), which increases strongly with the dust load. For instance, with dust visible optical depth of unity and sun in zenith, the surface solar irradiation is attenuated by 26% and the solar heating rate increases to about 70 K day−1in the lowest 25 km. The numbers are however strongly dependent on the optical properties of the dust, which are not known very well.

Several fast two‐stream methods for dust were compared with the SRM results. Their common systematic errors were reduced by a simple, physically‐based correction. The global albedo of Mars was then studied as a function of dust load, dust optics and surface albedo. The crossover from added airborne dust tending to make the whole planet look whiter or darker occurred at surface albedo of about 35%, nearly independently of the dust load. We demonstrate, however, that this value is sensitive to the optical properties of the assumed dust. Copyright © 2005 Royal Meteorological Society
A general‐purpose extension of the Malkmus band‐model average equivalent width to the case of the Voigt line profile
Authors: Geleyn J.‐F. , Bénard P. , Fournier R.
Published: November 2005

Bypassing the definition of an approximate function with a primitive one for the convoluted Voigt line shape, one may get an accurate and economical analytical approximation of the average equivalent width for an absorption band having the Malkmus‐type statistical distribution of line intensities and a random positioning of those lines. The trick is to start from the well‐known analytical solution of the same problem for the Lorentzian line shape and to identify which term to add to the latter in order to keep the correct asymptotic behaviours. One can then numerically evaluate this unknown term for various values of its two relevant parameters, representative of atmospheric conditions, and make an analytical fit of the resulting table of values. The recombined function, albeit without any inferred line profile, can best be interpreted in terms of a modified amount of absorber, which may lead to the application of the advocated method in many other conditions than in pure band‐model computations. Additionally, one can adapt the classical Curtis–Godson approximation to the resulting new framework in a quite natural way. Copyright © 2005 Royal Meteorological Society.
A simple prediction model of hurricane intensity
Authors: Shen Weixing
Published: November 2005

A simple model to predict hurricane intensity based on energetics is described and tested. It is assumed that future hurricane intensity is solely determined by the large‐scale environmental conditions and the present state of the hurricane, implying that subscale processes, if important, are strongly conditioned by the environment. It is also assumed that the hurricane track and the large‐scale environmental conditions that are used as inputs to the intensity model can be reasonably predicted by comprehensive numerical models. A series of runs starting from different times are performed. The results by the model are fairly consistent with observations. The intensity sensitivity to various factors and parameters used in the model is also discussed. Copyright © 2005 Royal Meteorological Society
Mesoscale analysis and impact on simulation of IOP14 of the MAP experiment
Authors: Nuret M. , Lafore J. P. , Gouget V. , Ducrocq V.
Published: November 2005

This paper examines the benefit on quantitative precipitation forecasts of assimilating a mesoscale network of surface observations. The analysis is performed with an optimal interpolation system tuned for meso‐β scale (10 km resolution). The case‐study is chosen in the framework of the Mesoscale Alpine Program (MAP). It corresponds to a frontal system crossing France on 2 November 1999 followed by moderate to strong convective activity which developed over the Alps and Italy on 3 November (MAP Intensive Observation Period (IOP) 14).

Model sensitivity to the various initial conditions (European Centre for Medium‐Range Weather Forecasts analysis, mesoscale analyses with dense surface observations) and to the resolution (meso‐β versus meso‐γ (2.5 km scale)) is investigated. A comprehensive network of rain‐gauges is used for validation. Conventional objective scores (correlation and equitable threat) are produced for precipitation accumulated over short durations (6 and 1 h) for consistency with the target horizontal scales (meso‐β, meso‐γ). The positive contribution of the surface network to precipitation forecasts is confirmed by a novel and powerful validation method based on the comparison of METEOSAT synthetic radiances (infrared and water vapour channels) computed from the simulations to the corresponding satellite observations. Copyright © 2005 Royal Meteorological Society
Improvement of high‐resolution weather forecasts through humidity adjustment based on satellite data
Authors: Lagouvardos K. , Kotroni V.
Published: November 2005

Humidity is recognized as the least well analysed parameter in the current operational assimilation systems applied in operational weather forecasting. In this work a humidity adjustment technique is applied in order to modify the initial fields used by a limited‐area model. For the adjustment of humidity, near real‐time precipitation estimates distributed by the National Aeronautic and Space Administration Goddard Space Flight Center are used. Based on these data, the humidity field of the National Centers for Environmental Prediction/Global Forecasting System global model is adjusted and the modified initial conditions are used by the BOLAM limited‐area model. The method is evaluated for 16 cases with heavy and widespread precipitation over Greece. It is shown that the humidity adjustment technique provides improved precipitation forecasts mainly for medium and high precipitation amounts. Moreover, as this technique is simple to implement and it is not computer power demanding, it is a good candidate for application in regional weather forecasting centres. Copyright © 2005 Royal Meteorological Society.
The effects of wind shear on cirrus: A large‐eddy model and radar case‐study
Authors: Marsham J. H. , Dobbie S.
Published: November 2005

Wind shear is an almost ubiquitous feature of the troposphere at cirrus altitudes, but there have been few studies focused on investigating its effects on cirrus clouds. In this study we consider a case of strongly sheared frontal ice cloud, which was observed by the Chilbolton radar. This was simulated using the Met Office large‐eddy model (LEM), which included a fully integrated radiation code. It is well known that there can be significant variations between results from different cirrus models, which makes a comparison of the simulations with observations important. So, radar observations of ice water content (IWC) were simulated directly within the framework of the LEM, and true and simulated IWC observations were compared, as well as their Fourier transforms and probability density functions (p.d.f.s). This showed that the LEM was capturing reasonably well the horizontally averaged IWC profile, and also at upper levels the variability in the IWC field, at scales of less than approximately 14 km. At lower levels the IWC field was too homogeneous.

Varying the shear within the LEM simulations showed that shear had little effect on the mean IWC profile, but it increased the mixing and so the homogeneity of the IWC field. P.d.f.s of IWC derived from the simulated radar data compared well with observed p.d.f.s, except that the largest IWCs were not captured and there was too little variance at lower levels. Comparing p.d.f.s of IWC and total water for runs with and without shear clearly showed the effects of shear‐induced mixing. LEM results also showed that the variation of the correlation of IWC with vertical separation is shear dependent and initially linear, with or without shear. In this case, shear had little effect on the top‐of‐atmosphere and surface fluxes, or the within‐cloud heating rate profile, but this would be significantly different for a more patchy cloud.

A modified case‐study, which allowed Kelvin–Helmholtz wave breaking, showed that wave breaking can significantly affect the microphysical processes, by increasing nucleation, deposition and sublimation rates. Wave breaking can occur in thin layers of limited horizontal extent, which would not be resolved by a global model. These effects were most significant when there was no large‐scale uplift and the vertical velocities from the wave breaking formed a cirrus cloud which did not otherwise occur. Copyright © 2005 Royal Meteorological Society