bluuebunny/crossref_metadata_2025 huggingface dataset:
Complete Recovery From Intractable Complex Regional Pain Syndrome, CRPS‐Type I, Following Anesthetic Ketamine and Midazolam
Authors: Kiefer Ralph‐Thomas , Rohr Peter , Ploppa Annette , Altemeyer Karl‐Heinz , Schwartzman Robert Jay
Published: June 2007

Objective: To describe the treatment of an intractable complex regional pain syndrome I (CRPS‐I) patient with anesthetic doses of ketamine supplemented with midazolam.

Methods: A patient presented with a rapidly progressing contiguous spread of CRPS from a severe ligamentous wrist injury. Standard pharmacological and interventional therapy successively failed to halt the spread of CRPS from the wrist to the entire right arm. Her pain was unmanageable with all standard therapy. As a last treatment option, the patient was transferred to the intensive care unit and treated on a compassionate care basis with anesthetic doses of ketamine in gradually increasing (3–5 mg/kg/h) doses in conjunction with midazolam over a period of 5 days.

Results: On the second day of the ketamine and midazolam infusion, edema, and discoloration began to resolve and increased spontaneous movement was noted. On day 6, symptoms completely resolved and infusions were tapered. The patient emerged from anesthesia completely free of pain and associated CRPS signs and symptoms. The patient has maintained this complete remission from CRPS for 8 years now.

Conclusions: In a patient with severe spreading and refractory CRPS, a complete and long‐term remission from CRPS has been obtained utilizing ketamine and midazolam in anesthetic doses. This intensive care procedure has very serious risks but no severe complications occurred. The psychiatric side effects of ketamine were successfully managed with the concomitant use of midazolam and resolved within 1 month of treatment.

This case report illustrates the effectiveness and safety of high‐dose ketamine in a patient with generalized, refractory CRPS.
Investigation of an isolate of Staphylococcus lugdunensis implicated in a platelet fatality: a possible advantage of the use of an anaerobic bottle
Authors: Brecher Mark E. , Hay Shauna N.
Published: June 2007

BACKGROUND: Cases have been reported in which detection with an early culture failed to interdict the transfusion of a bacterially contaminated platelet. One fatal case involved Staphylococcus lugdunensis, missed with a 4‐mL aerobic (BPA) bottle (BacT/ALERT, bioMérieux). This report noted “deviation from culture methods that meet manufacturer's recommendations (e.g., decreased blood volume) can result in reduced sensitivity and produce false negatives.” The manufacturer's package insert “strongly” recommends that more than one type of culture bottle be utilized. The utility of an anaerobic (BPN) bottle compared to a BPA bottle was investigated for the detection of S. lugdunensis.

STUDY DESIGN AND METHODS: This isolate was subjected to a series of spiking experiments designed to assess the effect of sample volume and recovery of BPA and/or BPN bottles over a range of concentrations (0.1‐6 colony‐forming units/mL).

RESULTS: With low levels of contamination, larger volumes cultured were associated with higher recovery. With the lowest inoculation, such that only one to two organisms were present in a bottle, reactivity was accelerated in the BPN bottle compared to the BPA bottle. At higher concentrations, 10 mL in the BPA bottle yielded equivalent time to reactivity as 4 mL in the BPN bottles.

CONCLUSION: These data support the use of larger inocula; however, when only one to two organisms were present in a bottle, time to reactivity was accelerated in a BPN bottle compared to a BPA bottle. The accelerated growth was not observable with higher inoculum (e.g., more than six organisms per bottle). Quicker time to reactivity might make the difference between interdiction or transfusion of the product.
Assessment of cord blood hematopoietic cell parameters before and after cryopreservation
Authors: Kurtz James , Seetharaman Shalini , Greco Nicholas , Moroff Gary
Published: June 2007

BACKGROUND: The testing of cord blood (CB) progenitor and stem cell units for transplantation suitability involves enumeration of total nucleated cells before freezing. CD34+ cell counts may also be a means of determining suitability. Studies have been conducted to evaluate how specific storage conditions influence cell counts.

STUDY DESIGN AND METHODS: CB units were processed by hydroxyethyl starch volume reduction. Cryopreserved‐thawed samples were diluted 1:3 without washing. CD34+ cells were measured with three commercially available assay methods. In specific studies, apoptosis‐indicating reagents were included. CB units were analyzed for nucleated cells, aldehyde dehydrogenase–containing cells, and progenitor colonies.

RESULTS: CD34+ cell levels and nucleated cells were retained during storage in test tubes at 1 to 6°C for 3 days. Cryopreserved‐thawed samples showed a reduction in CD34+ cells relative to prefreeze levels with the largest decrease with the Stem‐Kit (Beckman Coulter) restricted gating procedure. Prefreeze samples contained minimal numbers of presumed apoptotic cells detected with 7‐aminoactinomycin D or SYTO16, but after cryopreservation‐thawing there was an increase. Nucleated cell levels determined with a hematology analyzer or flow cytometry were reduced after thawing. Cryopreservation‐thawing reduced the percentage of CD34+ cells positive for the presence of aldehyde dehydrogenase and the number of progenitor colonies. These differences were significant.

CONCLUSION: These studies indicate that CD34+ cell counts were maintained when CB samples were stored at 1 to 6°C in test tubes for 3 days. Cryopreservation‐thawing resulted in changes in a number of parameters including the percentage of CD34+ cells that were aldehyde dehydrogenase+ and the number of 7‐aminoactinomycin D+ cells and SYTO16low cells.
The donor health assessment questionnaire: potential for format change and computer‐assisted self‐interviews to improve donor attention
Authors: Goldman Mindy , Ram Shefali S. , Yi Qi‐Long , Mazerall John , O'Brien Sheila F.
Published: June 2007

BACKGROUND: The Canadian donor health assessment questionnaire (DHAQ) has developed gradually over many years. The purpose of this study was to determine whether the format and method of administration of the DHAQ influences donor attentiveness.

STUDY DESIGN AND METHODS: Between May 2004 and September 2005, a total of 1397 donors participated in the study by completing the DHAQ by one of three methods: the current Canadian Blood Services (CBS) format and method of administration, which is partly self‐administered and partly interviewer‐administered (Method 1); the DHAQ reformatted to the AABB Uniform Donor Health Questionnaire format and self‐administered (Method 2); and an audiovisual computer‐assisted self‐interview (CASI; Method 3). This was followed by a short, scripted interview assessing recall of 17 specific items queried on the DHAQ. Time to completion of the DHAQ and degree of familiarity with computer use were also assessed.

RESULTS: The percentages of donors identifying all 17 items correctly were 9.4, 20.9, and 34.8 percent and the mean percentages recall of items were 53.9, 56.0, and 69.8 percent with DHAQ administration Methods 1, 2, and 3, respectively (p  < 0.0001). This difference was largely attributable to the poor recall of items queried as part of a list in Method 1. Mean times to complete the DHAQ were 3.1, 3.8, and 8.1 minutes for Methods 1, 2, and 3, respectively. More than 95 percent of donors had used a personal computer in the past year.

CONCLUSION: The current format of the Canadian DHAQ is not optimal for donor attention to specific questions asked as part of a list. Attention was improved by use of AABB uniform donor history questionnaire format and was best with use of a CASI format.
Determinants of repeated blood donation among new and experienced blood donors
Authors: Godin Gaston , Conner Mark , Sheeran Paschal , Bélanger‐Gravel Ariane , Germain Marc
Published: June 2007

BACKGROUND: The maintenance of a safe level of blood supply is provided by a small number of volunteers, and their retention is difficult. The aim of this study was to identify factors predicting repeated blood donation among experienced and new donors.

STUDY DESIGN AND METHODS: A random sample of 2231 donors (2070 experienced and 161 new) completed a questionnaire assessing psychosocial factors as defined by the most prominent social cognitive theories. Six months later, an objective measure of frequency of registrations to give blood was obtained from the database of the local official agency for blood donation.

RESULTS: Logistic regression analysis indicated that for experienced donors, the predictors were intention, perceived control, anticipated regret, moral norm, age, and frequency of blood donation in the past. For new donors, intention and age were the only determinants of behavior. Important differences in the determinants of intention were also noted between experienced and new donors.

CONCLUSION: In summary, the results of this study support the idea that distinct promotion strategies should be adopted to increase repeated blood donation among experienced versus new donors.
Prokaryotic versus eukaryotic recombinant Lutheran blood group protein for antibody identification
Authors: Seltsam Axel , Grüger Daniela , Blasczyk Rainer
Published: June 2007

BACKGROUND: At present, identification of antibodies against high‐frequency antigens is limited to reference laboratories having panels of rare red blood cell (RBC) specimens in stock. Antibodies against Lub are among the most frequent clinically relevant antibody specificities directed against high‐frequency antigens.

STUDY DESIGN AND METHODS: Soluble recombinant Lub fusion proteins consisting of the first three N‐terminal immunoglobulin superfamily domains and a V5‐His tag were generated. Eukaryotic recombinant Lub proteins were isolated from cell culture supernatant of stably transfected HEK293 cells with anti‐V5 Sepharose. Prokaryotic Lub fusion proteins were expressed in Escherichia coli, purified by Ni‐NTA, and refolded by chromatographic procedures. Ten anti‐Lub serum samples, 6 anti‐Lua serum samples, 30 serum samples directed against other blood group antigens, 10 serum samples from patients with RBC autoantibodies, and 100 serum samples from randomly selected donors were used for antibody screening.

RESULTS: Eukaryotic and prokaryotic recombinant Lub proteins proved to be equally suited for identification of anti‐Lub. Recombinant Lub protein–based enzyme‐linked immunosorbent assay correctly identified samples containing anti‐Lub sera, and the titers were at least two times higher than those measured by the gel agglutination–based indirect antiglobulin test. In hemagglutination inhibition assays, recombinant Lub protein neutralized all anti‐Lub, but none of the other alloantibodies decreased in reactivity.

CONCLUSION: Antibody detection systems based on soluble eukaryotic or prokaryotic recombinant blood group proteins have the potential to replace current systems with rare RBCs for identification of alloantibodies against high‐ or low‐frequency antigens. This innovation could bring routine laboratories one step closer to specialized antibody diagnostics.
Comparison of High Power, Medium Power, and Irrigated‐Tip Ablation Strategies for Pulmonary Vein Isolation in a Canine Model
Authors: GERSTENFELD EDWARD P. , JACOBSON JASON , BAZAN VICTOR , LAZAR SORIN , TOMASZEWSKI JOHN E. , MARCHLINSKI FRANCIS E. , MICHELE JOHN
Published: June 2007

Background: We sought to compare the efficacy and collateral damage during pulmonary vein (PV) isolation in a canine model using three different ablation strategies.

Methods: Normal dogs (three each) were randomized to high power (70 W, 20 seconds, 60°C, Hi), medium power (50 W, 60 seconds, 50°C; Med), or irrigated‐tip (35 W, 60 seconds, 45°C; Cool) ablation. Two transseptal punctures were performed and right and left superior PV electrical isolation was performed using the assigned ablation strategy. Animals survived for 30 days.

Results: There was no difference in the number of lesions required to achieve PV isolation (Hi vs Med vs Cool; 43 vs 38 vs 44 lesions; P = NS). At sacrifice, Hi and Med lesions showed gross evidence of endocardial cratering and eschar formation. Corresponding histopathology showed transmural atrial necrosis with granulation tissue and fibrosis. Cool lesions demonstrated superficial endocardial white patches. The corresponding histopathology was subendocardial fibrosis with full and partial thickness necrosis of the atrial wall. One Hi animal had a large thrombus adherent to the left atrial wall above the left superior PV. PV stenosis was noted in one of three Hi and one of three Med, and none of three Cool. There were visible burns to the lung overlying the left atrial wall in one of three Hi, one of three Med, and none of three Cool. The esophagus demonstrated no evidence of serosal injury.

Conclusions: The Hi and Med power 8‐mm‐tip ablation strategies for achieving PV isolation appear to result in excessive tissue destruction. Irrigated‐tip lesions resulted in less endocardial eschar formation, PV stenosis, and damage to collateral structures.
Comparison of Two‐ and Three‐Dimensional Transthoracic Echocardiography in the Assessment of Trabeculations and Trabecular Mass in Left Ventricular Noncompaction
Authors: Rajdev Sanjay , Singh Anurag , Nanda Navin C. , Baysan Oben , Hsiung Ming Chon
Published: June 2007

Twenty‐one patients (mean age 47.5 years, 9 females) with left ventricular noncompaction (LVNC) diagnosed by both two‐dimensional transthoracic echocardiography (2DTTE) and live/real time three‐dimensional transthoracic echocardiography (3DTTE) were included in the study. Left ventricular (LV) mass was calculated with epicardial and endocardial border tracings first including the LV trabeculations and then excluding them. LV trabecular mass was then derived as the difference between the two measurements. This was done by 2DTTE using the modified biplane Simpson's method and by live/real time 3DTTE using the Tom Tec imaging system. The number of trabeculations arising from each segment of LV walls as well as the segmental distribution of trabeculations were also assessed by both 2DTTE and 3DTTE. The calculated LV trabecular mass by 3DTTE (mean 11.8 ± 5.5 g) was significantly greater than 2DTTE (mean 7.3 ± 4.3 g, P = 0.005). The total number of trabeculations assessed by 3DTTE (mean 11.2 ± 3.3) was also significantly greater than 2DTTE (mean 3.76 ± 1.2, P < 0.0001). The values for inter‐ and intraobserver variability were lower for 3DTTE than 2DTTE. In conclusion, both LV trabecular mass as well as the total number of trabeculations in patients with LVNC were significantly underestimated by 2DTTE as compared to 3DTTE.
Determinants of Augmentation of ECG QRS Complexes and R Waves in Patients after Hemodialysis
Authors: Drighil Abdenasser , Madias John E. , Mosalami Hanane El , Badaoui Nadia El , Bennis Ahmed , Mouine Bahija , Fadili Wafae , Ramdani Beenyouness
Published: June 2007

Background: Hemodialysis (HD) leads to an augmentation in the amplitude of QRS complexes (QRS‐c), and R waves (R‐w); some correlates of this phenomenon have been identified, but the exact mechanism for these ECG changes remains elusive. The objective of this study is to search for the underlying mechanism(s) of the post‐HD augmentation of QRS‐c and R‐w.

Methods: The sum of the amplitudes of ECG QRS‐c and R‐w, along with a host of other parameters (body weight, fluid volumes, echocardiographically‐derived left ventricular dimensions and volumes, serum potassium, hemoglobin, hematocrit, and others) was measured, before and after HD, in 17 patients with end‐stage renal failure.

Results: While there were many correlations noted between the changes in the QRS‐c and R‐w and some of the above variables in numerous univariate analyses carried out, multivariate analyses did not identify any of the examined variables as exerting an independent influence on the observed ECG changes after HD.

Conclusion: Augmentation of QRS‐c and R‐w following HD is engendered by an interplay of a decrease in the LVEDD/LVEDV, and K+, loss of fluid volume, and a rise in Hb and Ht, without any of the above being an independent variable; also other factor(s) (e.g., increase in the body electrical impedance) exerting an influence in this ECG phenomenon cannot be excluded.
Thin‐Film Proton BaZr0.85Y0.15O3 Conducting Electrolytes: Toward an Intermediate‐Temperature Solid Oxide Fuel Cell Alternative
Authors: Serra José M. , Meulenberg Wilhelm A.
Published: June 2007

A novel method for the preparation of a thin oxidic proton‐conducting electrolyte is presented. This kind of supported film was studied in detail as it is applicable for IT–SOFC, H2 membranes, and advanced catalytic converters. Thin‐film (∼5 μm) proton‐conducting membranes with the nominal composition BaZr0.85Y0.15O3−δ (BZY) were prepared over porous Ni–8YSZ/Ni–BZY substrates by the solid‐state reaction of a gastight 8YSZ layer and a coated BaCO3 layer. The resulting asymmetric membranes are of a homogeneous composition and are gastight. Indeed, XRD analysis showed a highly crystalline cubic perovskite. The solid‐state reaction promoted the formation of (i) an electrolyte with very fine (∼100 nm) grains and high packing density and (ii) an unexpected porous needle‐like top layer with a nominal composition similar to that of the protonic electrolyte, to which it is intimately attached. The layer morphology, phase distribution, and lattice composition were investigated by EDS–SEM, EDX as well as SIMS. Conduction properties of the protonic material were investigated by DC conductivity of pressed bars under different gas compositions and also by impedance spectroscopy of a supported thin film.
FTIR Spectra, Lattice Shrinkage, and Magnetic Properties of CoTi‐Substituted M‐Type Barium Hexaferrite Nanoparticles
Authors: Zhao Wen‐Yu , Wei Ping , Cheng Hai‐Bin , Tang Xin‐Feng , Zhang Qing‐Jie
Published: June 2007

Single‐phase BaCoTiFe10O19 (BaCoTi‐M) nanoparticles were prepared by a modified sol–gel process, using metallic chlorides as starting materials. The physical chemistry process of BaCoTi‐M formation, the interdependences between composition, technological conditions, microstructure, and magnetic properties were studied by X‐ray diffraction (XRD), Fourier transform‐infrared (FTIR), scanning electron microscope (SEM), transmission electron microscope (TEM), and vibrating sample magnetometer (VSM). XRD and FTIR results show that BaCoTi‐M nanoparticles formed directly from γ‐Fe2O3, spinel ferrite, and barium salts without the formation of α‐Fe2O3 and BaFe2O4. The lattice shrinkage of BaCoTi‐M nanoparticles that occurred on increasing the calcining temperature from 973 to 1173 K under holding for 2 h or on increasing the holding time in the range 0–2 h at 1173 K was discovered by analyzing the dependences of lattice parameters on the heat‐treatment conditions. The shrinkage led to a relatively higher concentration of magnetic Fe3+ cations in the unit cell, and resulted in an increase of specific saturation magnetization under the corresponding conditions. Microstructural characterization shows that the evolutions of coercivity, remnant magnetization, and squareness ratio depended on the crystal growth and the reduction of structural defect as well as a decrease of grain boundary.
Fabrication of Mullite Ceramics With Ultrahigh Porosity by Gel Freeze Drying
Authors: Ding Shuqiang , Zeng Yu‐Ping , Jiang Dongliang
Published: June 2007

Porous mullite (3Al2O3·2SiO2) ceramics with an open porosity up to 92.9% were fabricated by a gel freeze‐drying process. An alumina (Al2O3) gel mixed with ultrafine silica (SiO2) was frozen and sublimation of ice crystals was carried out by drying the frozen body under a low pressure. Porous mullite ceramics were prepared in air at 1400°–1600°C due to the mullitization between Al2O3 and SiO2. A complex and porous microstructure was formed, where large dentritic pores with a pore size of ∼100 μm contained small cellular pores of 1–10 μm on their internal walls. Owing to the complete mullitization, a relatively high‐compressive strength of 1.52 MPa was obtained at an open porosity of 88.6%.
Estimation of Elastic Properties of Porous Ceramic Using Ultrasonic Longitudinal Wave Velocity Only
Authors: Phani Kalyan Kumar
Published: June 2007

A method for estimation of the elastic moduli of porous ceramics solely based on ultrasonic longitudinal wave velocities is proposed. The method is based on a polynomial correlation between ultrasonic shear wave and longitudinal wave velocities of a given porous material. It is also shown that variations of Poisson's ratios for porous material with longitudinal wave velocities agree with the predictions of Mori‐Tanaka mean field approach. The method provides a simplified route to quantitative non‐destructive evaluation of the elastic moduli of porous material.
Effect of BaO Addition on Crystallization, Microstructure, and Properties of Diopside–Ca‐Tschermak Clinopyroxene‐Based Glass–Ceramics
Authors: Goel Ashutosh , Tulyaganov Dilshat U. , Kharton Vladislav V. , Yaremchenko Aleksey A. , Agathopoulos Simeon , Ferreira José M. F.
Published: June 2007

This work presents the processing and the characterization of diopside–Ca‐Tschermak clinopyroxene‐based glass–ceramics (GCs), where partial (i.e., 5%, 10%, and 20%) substitution of Ba for Ca was attempted in the composition of CaMg0.8Al0.4Si1.8O6. Sintering, crystallization, microstructure, and properties of the new materials were investigated under different heat‐treatment conditions concerning heating rates (5–40 K/min), temperatures (850°–1000°C), and times (1–300 h). The good matching of thermal expansion coefficients and the strong, but not reactive, adhesion to yttria‐stabilized cubic zirconia, in conjunction with the low level of electrical conductivity and oxygen permeability, indicate that the investigated GCs are suitable for further experimentation as candidates for solid oxide fuel cells sealants.
Thermodynamic and Electrical Effects of Residual Carbon in Glass–Barium Titanate Composites for MLCC Applications
Authors: Janosik William , Randall Clive A. , Lanagan Michael
Published: June 2007

The thermodynamic and electrical effects of residual carbon in glass–barium titanate composites were investigated. Thermodynamic arguments are made suggesting that new phases form through carbothermal reactions between carbon and titanate‐based dielectrics. Experimentally, it was shown that the reduced dielectric separated by insulating glass in the grain boundaries gave rise to a dielectric relaxation at room temperature consistent with the Maxwell–Wagner model. The conductivity of the dielectric was calculated based on the relaxation frequencies, allowing an estimate of the local oxygen activity due to the presence of carbon. This activity was consistent with the equilibrium oxygen activity for carbon oxidation at the processing temperature, and eight orders of magnitude different from the oxygen activity in the furnace atmosphere.
Forensic DNA Analysis on Microfluidic Devices: A Review
Authors: Horsman Katie M. , Bienvenue Joan M. , Blasier Kiev R. , Landers James P.
Published: June 2007

Abstract:  The advent of microfluidic technology for genetic analysis has begun to impact forensic science. Recent advances in microfluidic separation of short‐tandem‐repeat (STR) fragments has provided unprecedented potential for improving speed and efficiency of DNA typing. In addition, the analytical processes associated with sample preparation––which include cell sorting, DNA extraction, DNA quantitation, and DNA amplification––can all be integrated with the STR separation in a seamless manner. The current state of these microfluidic methods as well as their advantages and potential shortcomings are detailed. Recent advances in microfluidic device technology, as they pertain to forensic DNA typing, are discussed with a focus on the forensic community.
Validation of LAB Color Mode as a Nondestructive Method to Differentiate Black Ballpoint Pen Inks*
Authors: Hammond Derek L.
Published: June 2007

Abstract:  Nondestructive digital processing methods such as lab color mode (available in Adobe® Photoshop®) are emerging as alternative methods for forensic document examiners to use when attempting to differentiate writing instrument inks. Although these techniques appear to be viable, little data currently exists regarding the known or potential error rates associated with these techniques. Without adequate data, the validity and reliability of these techniques, including lab color, can not be established. In an attempt to begin to address these issues, 44 black ballpoint ink pens were obtained and used to create 990 pen‐pair samples for analysis using established lab color mode techniques. No erroneous findings of “different” were reported following the examination of the known pen‐pair combinations in which the same pen was used to create the samples (n = 44). Of the remaining 946 samples, 737 pen‐pair samples were differentiated using the lab color mode method, while 209 samples were unable to be differentiated and were recorded as either being “similar” (n = 153) or “unsure” (n = 56). Comparison of the lab color mode results with the results obtained through additional testing using traditional infrared reflectance and infrared luminescence test methods showed that lab color differentiated 102 pen‐pair samples (11%; 102/946) that were not differentiated using a VSC‐4C.
Virtual Autopsy and Forensic Identification—Practical Application: A Report of One Case
Authors: Dedouit Fabrice , Telmon Norbert , Guilbeau‐Frugier Céline , Gainza David , Otal Philippe , Joffre Francis , Rougé Daniel
Published: June 2007

Abstract: The body of an unidentified elderly woman was found trapped in a floodgate. Prior to autopsy, full‐body multislice computed tomography (MSCT) was performed for study of bone lesions and cause of death. Age was estimated by analysis of the sternal end of the fourth rib and of the pubic symphyseal medial articular surfaces. The results were then compared with the autopsy findings. MSCT was superior to autopsy in diagnosis of traumatic bone lesions and also revealed dental anomalies and signs of drowning. Age estimation gave a similar result for both methods. This case report illustrates the potential value of MSCT for medico‐legal investigations of death: diagnosis of injuries, possibility of determining the cause of death, and anthropological study in order to estimate age or to visualize features likely to enable identification of a corpse.
Four New Illicit Cocaine Impurities from the Oxidation of Crude Cocaine Base: Formation and Characterization of the Diastereomeric 2,3‐Dihydroxy‐3‐Phenylpropionylecgonine Methyl Esters from cis‐ and trans‐Cinnamoylcocaine
Authors: Casale John F. , Hays Patrick A. , Toske Steven G. , Berrier Arthur L.
Published: June 2007

Abstract:  Four new impurities have recently been detected in the gas chromatographic signature profiles of many illicit cocaine hydrochloride exhibits. These impurities are only seen in exhibits that have been oxidized and are most prominent in samples that have been highly oxidized. Exhibits containing these compounds were subjected to gas and liquid chromatographic–mass spectrometric analyses to determine the identity of the impurities. These impurities were subsequently synthesized to verify their structures. Four diastereomeric diols formed from the oxidation of cis‐ and trans‐cinnamoylcocaine were characterized by nuclear magnetic resonance spectrometry, mass spectrometry, and synthesis. Oxidation of cis‐cinnamoylcocaine in neutral conditions yielded (2R,3R)‐dihydroxy‐3‐phenylpropionylecgonine methyl ester and (2S,3S)‐dihydroxy‐3‐phenylpropionylecgonine methyl ester, while trans‐cinnamoylcocaine produced (2R,3S)‐dihydroxy‐3‐phenylpropionylecgonine methyl ester and (2S,3R)‐dihydroxy‐3‐phenylpropionylecgonine methyl ester. The recent appearance of these new impurities suggests that some illicit cocaine processors have modified their oxidation procedures of crude cocaine base for transformation into illicit refined cocaine hydrochloride.
Characterization of the Triacylglycerol Crystal Formation in Adipose Tissue During a Vehicle Collision
Authors: Stuart Barbara H. , Notter Stephanie J. , Langlois Neil , Maynard Philip , Ray Abhi , Berkahn Mark
Published: June 2007

Abstract:  The unusual appearance of crystalline fat structures was observed during the postmortem examination of a motor vehicle accident victim. The crystal structures were characterized using Fourier transform infrared spectroscopy and x‐ray diffractometry. The structures were found to be made of triacylglycerols, a dominant lipid structure found in human adipose tissue, capable of forming various polymorphic structures. The morphology of the crystalline material was found using both techniques to be predominantly the β′ form of triacylglycerols. The accelerated growth of such triacylglycerol morphology has been observed as a result of shear stresses in other studies involving edible fats. As a result of the findings of this study, it is proposed that increased shear forces may be responsible for the formation of the unusual fat structure found in the victim. An understanding of the effect of forces on the structure of body fat in high‐impact collisions can potentially assist in verifying a high‐velocity impact.
Acute Fatal Acetaminophen Overdose Without Liver Necrosis
Authors: Singer Peter P. , Jones Graham R. , Bannach Bernard G. , Denmark Lloyd
Published: June 2007

Abstract:  Two unusual cases of suicidal overdose of acetaminophen (paracetamol) without the usual extensive centrilobular necrosis of the liver are reported. Both cases were subjected to comprehensive drug screening by immunoassay, and a combination of gas chromatography with mass spectrometry, nitrogen detection, and electron capture detection. Acetaminophen was detected in both cases. No other drugs were detected in case #1, and only a small amount of olanzapine (<0.1 mg/L) was detected in case #2. No anatomical cause of death was identified in either case. If untreated, the normal outcome of a large acetaminophen overdose would be massive hepatic necrosis with delayed death and low blood and tissue acetaminophen concentrations. In contrast, particularly high postmortem acetaminophen concentrations were measured in both our cases with little hepatic tissue damage. For case #1, femoral blood acetaminophen 1280 mg/L, vitreous 878 mg/L, and liver 729 mg/kg; in case #2, cardiac blood 1220 mg/L, vitreous 779 mg/L, liver 3260 mg/kg, and gastric 11,500 mg/500 g. Acetaminophen was measured using high performance liquid chromatography with UV detection (254 nm) using 3‐hydroxyacetanilide as the internal standard. The very high concentrations of acetaminophen is these cases but relatively little hepatic damage suggests an alternative, possibly cardiac, mechanism of death.
Schizophrenia and Suicide: A 10‐Year Review of Kentucky Medical Examiner Cases
Authors: Shields Lisa B.E. , Hunsaker Donna M. , Hunsaker John C.
Published: June 2007

Abstract:  The risk of suicide is significantly increased in schizophrenics; it is estimated that 10–13% of individuals suffering from schizophrenia commit suicide. Schizophrenia is marked by psychotic exacerbations and remissions, with persistent deterioration in baseline functioning with each relapse. We present a 10‐year (1993–2002) retrospective review of Medical Examiners’ cases of suicide of schizophrenic victims. Twenty‐nine cases were between the ages of 20 and 75 (mean age of 41.6 years). The majority of victims were male (62.1%) and Caucasian (86.2%). The leading method of suicide for both males and females was firearm injury (48.3%) mostly of the head, followed by overdose (20.7%), and hanging (13.8%). A comprehensive investigation of the biopsychosocial factors is warranted in cases of schizophrenics who commit suicide. This study offers an insightful analysis pertaining to the determination of intent in formulating the manner of death in this unique population.
Expression of the focal adhesion protein PINCH in normal and alkali‐injured corneas and the role of PMNs
Authors: Bourghardt Peebo Beatrice , Gan Lisha , Sun Xiao Feng , Knutsen Annica , Rearden Ann , Fagerholm Per
Published: June 2007

Purpose:  To evaluate the role of particularly interesting new cysteine‐histidine‐rich protein (PINCH) in corneal wound healing and early neovascularization and to assess the influence of granulocytes.

Methods:  A standardized corneal alkali wound was inflicted under general anaesthesia to the right eye of 14 New Zealand White rabbits. Seven of the rabbits received i.v. 5 mg/kg fucoidin every 2 hours to prevent granulocytes from entering the wound area. After 36 hours, the rabbits were killed, the corneas excised, fixed in 4% formaldehyde and embedded in paraffin. The sections were double‐stained with antibodies against PINCH and with haematoxylin.

Results:  In the normal cornea and limbus, PINCH was weakly expressed in the corneal epithelium and in a wedge of the conjunctival stroma. In the wounded corneas, PINCH expression was seen in the frontline of repopulating endothelial and epithelial cells, and in active keratocytes. The vascular endothelium and the granulocytes expressed PINCH, as did the conjunctival epithelium. In the fucoidin‐treated rabbits, PINCH expression was markedly reduced. The vascular endothelial cells and the few granulocytes did not express PINCH in these rabbits.

Conclusions:  PINCH is only slightly expressed in the normal cornea. A corneal wound induces PINCH expression in the repopulating cells, in the vascular endothelial cells of the limbus, in the limbal epithelium and in the granulocytes. Exclusion of granulocytes reduces expression of PINCH and there is no expression at all in the vascular endothelium.
The dynamics of symptomatic and non‐symptomatic coping with psychotic symptoms in the flow of daily life
Authors: Lardinois M. , Myin‐Germeys I. , Bak M. , Mengelers R. , Van Os J. , Delespaul P. A. E. G.
Published: June 2007

Objective:  Previous research has suggested that going along with psychotic symptoms (symptomatic coping) is less effective than other coping strategies with psychotic symptoms. This pilot study aims to validate such findings using a momentary assessment strategy of coping with stress in daily life.

Method:  Patients with psychosis (n = 35) were studied with the Experience Sampling Method (ESM; a structured diary technique) to assess coping with stress in daily life. This was analysed in relation to coping with psychotic symptoms using a previously validated interview (Maastricht Assessment of Coping Strategies).

Results:  Symptomatic and non‐symptomatic coping were negatively associated with each other. Symptomatic coping was negatively associated with the level of coping in daily life, whereas a positive association was apparent for non‐symptomatic coping. Non‐symptomatic coping, but not symptomatic coping, predicted appraisals of distress associated with psychotic symptoms.

Conclusion:  Effective coping may be associated with the tendency to develop conscious appraisals of distress associated with psychotic symptoms.
Effect of constant strain rate, composed of varying amplitude and frequency, of early loading on peri‐implant bone (re)modelling
Authors: De Smet E. , Jaecques S. V. N. , Jansen J. J. , Walboomers F. , Vander Sloten J. , Naert I. E.
Published: June 2007

Aim: Examine the effect of varying components of strain rate – amplitude versus frequency – while maintaining a constant strain rate of early controlled mechanical loading on implant stability, peri‐implant bone mass and bone‐to‐implant contact.

Material and Methods: Three groups of guinea‐pigs received TiO2‐blasted implants in both tibiae. One week after installation test implants were loaded 5 days/week during 4 weeks. The contra‐lateral implants were the unloaded controls. Strain rate was kept constant (1600 μɛ/s), while amplitude and frequency were varied per group. Implant stability was followed by resonance frequency analysis. Animals were sacrificed, and ground sections were prepared to rate bone‐to‐implant contact and bone mass.

Results: All implants (n=78) integrated uneventfully. A significant positive effect (p=0.03) of early loading on bone mass was observed in the distal medullar cavity. A significant difference in bone mass between test and control implants was evidenced between the groups (p=0.03 and 0.04). A significant increase in implant stability and bone‐to‐implant contact could not be shown.

Conclusions: Early controlled stimulation of peri‐implant bone is related to amplitude/frequency and not to strain rate as such, considering a constant stimulation time. An increase of bone mass around early‐loaded implants was shown. This cortical bone model is most sensitive to low‐frequency/high‐amplitude stimulation.
Eccrine syringofibroadenoma with co‐existent squamous cell carcinoma
Authors: Schadt Courtney R , Boyd Alan S
Published: June 2007

Eccrine syringofibroadenoma (ESFA) is a rare, benign adnexal tumor arising most often on the extremities of elderly individuals. It is typically a slow‐growing, flesh‐ to reddish‐colored nodule or plaque. Histologically, the tumor consists of anastomosing cords of cuboidal epithelial cells surrounded by a fibrovascular stroma containing plasma cells. The cords contain scattered ductal structures lined with cuboidal cells resembling eccrine ducts. The co‐existence of ESFA with squamous cell carcinoma has been described, eliciting the term eccrine syringofibroadenoma. The differential diagnosis includes poroma, porocarcinoma, fibroepithelioma of Pinkus and clear cell acanthoma. ESFA stain positively with epithelial membrane antigen and carcinoembryonic antigen. Cytokeratin studies have been inconsistent.
Immunohistochemical detection of phosphorylated Akt, PI3K, and PTEN in ameloblastic tumors
Authors: Kumamoto Hiroyuki , Ooya Kiyoshi
Published: June 2007

Objective:  To evaluate roles of the Akt signaling pathway in oncogenesis and cytodifferentiation of odontogenic tumors, expression of phosphorylated Akt (pAkt), PI3K, and PTEN was analyzed in ameloblastic tumors as well as in tooth germs.

Methods:  11 tooth germs, 40 ameloblastomas, and 5 malignant ameloblastic tumors were examined immunohistochemically with antibodies against pAkt, PI3K, and PTEN.

Results:  Immunoreactivity for pAkt, PI3K, and PTEN was detected predominantly in odontogenic epithelial cells near the basement membrane in tooth germs and ameloblastic tumors. The levels of immunoreactivity for pAkt and PI3K were slightly higher in ameloblastic tumors than in tooth germs. Plexiform ameloblastomas showed significantly higher expression of PI3K than follicular ameloblastomas, and PI3K immunoreactivity in ameloblastomas without cellular variation was significantly higher than that in acanthomatous ameloblastomas. The level of PTEN immunoreactivity was significantly lower in ameloblastomas than in tooth germs.

Conclusion:  Expression of pAkt, PI3K, and PTEN in tooth germs and ameloblastic tumors suggests that these signaling molecules regulate cell survival and growth in normal and neoplastic odontogenic tissues by mediating growth factor signals. Increased expression of pAkt and PI3K and decreased expression of PTEN in ameloblastic tumors may participate in oncogenesis of odontogenic epithelium by activating the Akt signaling pathway.
Low‐frequency noise effects on the parotid gland of the Wistar rat
Authors: Oliveira PMA , Pereira da Mata ADS , Martins dos Santos JAM , Da Silva Marques DN , Branco NC , Silveira JML , Correia da Fonseca JCD
Published: June 2007

Background:  Long‐term low‐frequency noise (LFN) (≤500 Hz) exposure is known to cause extracellular matrix proliferation by fibrosis in the absence of inflammatory signs.

Aim:  We have examined the morphofunctional alterations of the parotid glands of Wistar rats exposed to LFN. The hypothesis is that the parotid glands are a target for LFN‐induced lesions.

Materials and methods:  Ten rats were exposed to LFN for 2184 consecutive hours while 10 rats were kept under similar conditions but in silence for control purposes. The parotid glands were surgically removed. One gland was sectioned and stained with hematoxylin–eosin and periodic acid Schiff for light microscopy observation. The other was used for functional amylase secretion measurements, basal and nerve‐mediated [with electrical field stimulation (EFS)] and secretagogue‐evoked secretion [acetylcholine (ACh) 10‐‐5 m] with established fluorimetric techniques.

Results:  All the rats exposed to LFN showed marked morphological lesions including vacuolar degeneration, hyalinization, cell death and blood vessels wall focal thickening. No morphological changes were detected in the control group. The functional results presented significantly diminished basal, EFS and ACh‐evoked amylase secretion when compared with the control group.

Conclusion:  These results suggest that the parotid gland is a target for LFN‐induced lesions with an impairment of its function.
FGF signaling in mandibular skeletogenesis
Authors: Mina M , Havens B
Published: June 2007

Structured Abstract

Authors –  Mina M, Havens B

Objective –  To examine the functions of FGF/FGFR signaling during mandibular skeletogenesis in ovo.

Design –  We examined the effects of inhibition of FGF signaling during mandibular skeletogenesis by overexpressing replication‐competent RCAS virus encoding a truncated form of FGFR3 in the chicken mandibular process between stages 17 and 26.

Results –  Injection of RCAS‐dnFGFR3 into the developing mandible resulted in abnormalities in a stage‐ and region‐dependent manner. Injection at early stages of development resulted in the truncation of Meckel's cartilage, severely reduced outgrowth of the mandibular process and absence of five of the mandibular bones. Injection at later stages did not affect the outgrowth of the mandibular process and Meckel's cartilage but resulted in abnormalities in mandibular osteogenesis in a region‐specific manner. The bones in the more caudal region were frequently truncated whereas bones in the more rostral regions such as dentary and splenial bones were frequently absent.

Conclusion –  Together these experiments have revealed essential roles for FGF/FGFR signaling in the elongation of Meckel's cartilage, development of osteogenic condensations and appositional growth of mandibular bones.
Subclinical features in non‐syndromic cleft lip with or without cleft palate (CL/P): review of the evidence that subepithelial orbicularis oris muscle defects are part of an expanded phenotype for CL/P*
Authors: Marazita ML
Published: June 2007

Structured Abstract

Author – Marazita ML

Objectives – Non‐syndromic cleft lip with or without cleft palate (CL/P) is a common, complex birth defect with a wide phenotypic spectrum. This review summarizes the evidence that subepithelial (occult) defects of the superiororbicularis oris(OO) muscle represent the mildest form of the lip portion of CL/P.

Experimental Design – The rate of OO defects was assessed via ultrasound in non‐CL/P relatives of individuals with CL/P and compared with controls. Descriptive histology of OO muscles from cadavers was carried out. BMP4 was sequenced in non‐CL/P individuals with OO defects vs. controls.

Results – 1) Non‐CL/P relatives of individuals with overt CL/P have a significantly increased frequency of OO defects compared with controls with no family history of CL/P; 2) Preliminary histological studies of cadaver OO muscles show a pattern of disorganized muscle fibers in an individual with OO discontinuities as seen on ultrasound compared with another individual with no OO defect. That is, the defects seen on ultrasound appear to have an anatomical basis; 3) Sequencing BMP4 found a significant increase in potentially damaging mutations in individuals with OO defects vs. controls.

Conclusions – Taken together, these data provide significant support for the hypothesis that subepithelial OO muscle defects are a mild manifestation of the lip portion of the CL/P phenotype. Given that subepithelial OO muscle defects are relatively straightforward to identify via ultrasound, such defects show great promise for providing more accurate recurrence risk estimates to relatives in cleft families. Furthermore, inclusion of OO defects in the CL/P phenotypic spectrum should improve the power of genetic studies.
Potential role of PC‐1 expression and pyrophosphate elaboration in the molecular etiology of the FGFR‐associated craniosynostosis syndromes
Authors: Hatch NE
Published: June 2007

Structured Abstract

Author –  Hatch NE

Background –  Fibroblast growth factor/fibroblast growth factor receptor (FGF/FGFR) signaling is associated with the aberrant mineralization phenotype of the craniosynostosis syndromes. One critical aspect of mineralization involves the elaboration and transport of pyrophosphate into the extracellular matrix with subsequent enzymatic hydrolysis into phosphate. We have previously shown that FGF2 up‐regulates expression of the pyrophosphate generating enzyme, PC‐1, and the pyrophosphate channel, ANK, while down‐regulating expression of the pyrophosphate hydrolyzing enzyme, tissue non‐specific alkaline phosphatase in pre‐osteoblastic, MC3T3E1(C4) cells. These results suggest that FGF/FGFR signaling may affect mineralization via changes in the elaboration and metabolism of pyrophosphate.

Objectives –  We are currently conducting experiments towards a more systematic analysis of PC‐1 expression in osteoblastic cells, in order to more clearly elucidate the significance of pyrophosphate elaboration in the process of normal bone mineralization and in the molecular etiology of the FGFR‐associated craniosynostosis syndromes.

Design –  Towards this goal we have constructed a PC‐1 gene promoter/firefly luciferase reporter construct, in order to more directly investigate the regulation of PC‐1 by FGF/FGFR signaling in osteoblastic and non‐osteoblastic cells.

Results and Conclusions –  Preliminary results confirm that FGF/FGFR signaling, either via treatment with FGF2 or via expression of a Crouzon syndrome‐associated mutant FGFR2, induces PC‐1 promoter activity in osteoblastic cells in culture. This appears to be a cell type specific phenomenon. These results suggest that the expression of PC‐1 downstream of FGF signaling is an integral aspect of osteoblastic function, and that pyrophosphate elaboration may play a significant role in the pathology of craniosynostosis.
Greening of the Tooth–Amalgam Interface during Extended 10% Carbamide Peroxide Bleaching of Tetracycline‐Stained Teeth: A Case Report
Authors: HAYWOOD VAN B.
Published: June 2007

At‐home bleaching with 10% carbamide peroxide in a custom‐fitted tray has been shown to have some minor effects on certain brands of amalgam, pertaining to mercury release, but generally, effects on amalgam are not considered clinically significant. However, in this case report, a greening of the tooth structure in certain areas immediately adjacent to amalgam restorations in the maxillary and mandibular first molars occurred during tooth whitening. Other amalgam restorations in mandibular and maxillary second molars in the same mouth did not demonstrate any green discoloration of the teeth. Upon removal of the affected amalgam restorations, recurrent decay was present in the areas of tooth greening but not in other areas adjacent to the restoration. The teeth were restored with posterior composite restorations. Whether the green discoloration was a result of some loss of material from a particular brand of amalgam, indicating leakage, or indicative of original or recurrent tooth decay is unclear in this single‐patient situation. Other patients in the same study did not demonstrate this occurrence. Dentists should be ready to replace amalgam restorations should this green discoloration in adjacent tooth structure occur during bleaching, in case decay is present.

CLINICAL SIGNIFICANCE

The unusual discoloration cited suggests that amalgam restorations in potentially esthetic areas, including the lingual of anterior teeth, should be replaced prior to bleaching, to avoid the problem of difficult stain removal or translucency allowing restoration visibility following bleaching.