bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of an Autologous Blood Recovery System during Emergency Pericardiocentesis in the Electrophysiology Laboratory
Authors: VENKATACHALAM K. L. , FANNING LISA J. , WILLIS ELAINE A. , BEINBORN DOUGLAS S. , BRADLEY DAVID J. , CHA YONG‐MEI , SHEN WIN‐KUANG , ASIRVATHAM SAMUEL J. , SINAK LAWRENCE J. , PACKER DOUGLAS L. , MUNGER THOMAS M. , SANTRACH PAULA J. , FRIEDMAN PAUL A.
Published: October 2008

Autotransfusion during Pericardiocentesis. Introduction: Emergency pericardiocentesis during electrophysiology procedures is often associated with significant aspiration of pericardial blood, requiring transfusion. We sought to assess the feasibility of urgent use of an autologous blood recovery system in the electrophysiology laboratory to autotransfuse blood aspirated from the pericardium.

Methods and Results:
We retrospectively analyzed Mayo Clinic electrophysiology records for patients who had ablation procedure‐related pericardial effusions requiring emergency pericardial drainage during an 8‐month period. An autologous blood recovery system was used during pericardiocentesis to separate and clean packed red blood cells from the pericardial aspirate. These cells were returned acutely to the patient intravenously. The procedural safety, aspirated and autotransfused volumes, and efficacy of this approach were evaluated. During the study period, nine patients underwent pericardial drainage with autotransfusion using a cell‐salvage instrument during electrophysiology procedures. The mean aspirated volume was 1,078 mL, with a mean autotransfused volume of 390 mL. For four patients, all with aspirated volumes of 1,100 mL or less, autotransfusion alone was sufficient to maintain hemodynamic stability and avoid allogeneic transfusion. One patient required surgical intervention because of ongoing pericardial bleeding. The ablation procedure was completed after aspiration in two patients. No procedural complications related to the use of the cell‐salvage system occurred. 

Conclusion:
Autologous blood recovery during pericardiocentesis is safe, convenient, and feasible. With early use it may decrease or eliminate the need for allogeneic blood transfusion and, in selected cases, may permit completion of the ablation procedure. (J Cardiovasc Electrophysiol, Vol. 20, pp. 280‐283, March 2009)
Autonomic Elements within the Ligament of Marshall and Inferior Left Ganglionated Plexus Mediate Functions of the Atrial Neural Network
Authors: LIN JIAXIONG , SCHERLAG BENJAMIN J. , NIU GUODONG , LU ZHIBING , PATTERSON EUGENE , LIU SHAOWEN , LAZZARA RALPH , JACKMAN WARREN M. , PO SUNNY S.
Published: October 2008

Ligament of Marshall and Atrial Neural Network. Objectives: We sought to systematically investigate the role of the ligament of Marshall (LOM) and inferior left ganglionated plexi (ILGP) in modulating electrophysiological functions.

Methods:

The following structures were exposed in 36 dogs: (1) LOM, (2) superior left GP (SLGP) near the junction of left superior pulmonary vein (LSPV) and left atrium, (3) ILGP near the left inferior pulmonary vein‐atrial junction, (4) anterior right GP (ARGP) near the sino‐atrial node, and (5) inferior right GP (IRGP) at the junction of inferior vena cava and atria. High frequency stimulation (HFS; 0.6‐8.0 V, 20 Hz, 0.1 msec in duration) was applied to the LOM, SLGP, ILGP, ARGP, IRGP, or vagosympathetic trunk. Ventricular rate (VR) during atrial fibrillation (AF) was compared before and after ablation of GP in different sequences.

Results:

ARGP + ILGP ablation but not ARGP ablation alone eliminated the VR slowing response induced by LOM stimulation, suggesting that all the autonomic innervation from the LOM to AV node passes the ILGP. LOM ablation attenuated the VR slowing response caused by SLGP or left vagosympathetic stimulation, suggesting that LOM modulates the autonomic innervation between the AV node and the left vagosympathetic trunk or SLGP. ARGP attenuated while ARGP + ILGP ablation eliminated the VR slowing response induced by left vagosympathetic stimulation, suggesting that both ARGP and ILGP modulate the AV nodal innervation of the extrinsic and intrinsic cardiac autonomic nervous system (ANS).

Conclusion:

The LOM and ILGP function as the “integration centers” that modulate the autonomic interactions between extrinsic and intrinsic cardiac ANS on AV nodal function.
(J Cardiovasc Electrophysiol, Vol. 20, pp. 318‐324, March 2009)
Pulmonary Vein Stenting for the Treatment of Acquired Severe Pulmonary Vein Stenosis after Pulmonary Vein Isolation: Clinical Implications after Long‐Term Follow‐Up of 4 Years
Authors: NEUMANN THOMAS , KUNISS MALTE , CONRADI GUIDO , SPERZEL JOHANNES , BERKOWITSCH ALEXANDER , ZALTSBERG SERGEY , WOJCIK MACIEJ , ERKAPIC DAMIR , DILL THORSTEN , HAMM CHRISTIAN W. , PITSCHNER HEINZ‐F.
Published: October 2008

Pulmonary Vein Stenting. Introduction: Severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF) is a well‐recognized complication with a further reported incidence of 1.3%. The preferred therapy for symptomatic PVS is pulmonary vein (PV) angioplasty, but this treatment modality is followed by restenosis in 44–70%. Whether there is additional long‐term benefit from PVS stenting is uncertain. The aim of this study was the evaluation of the long‐term success after PV stenting of severe stenosis.

Methods and Results:
Ten patients (pts) with 13 PVS were prospectively evaluated. PV stenting was performed with Palmaz Genesis stents. Magnetic resonance imaging (MRI), lung perfusion scans, and CT‐scans were performed before, directly after, and every 12 months thereafter. Primary endpoint of the study was the occurrence of restenosis after PV stenting. After a median follow‐up of 47.7 (IQRs 25/75 47.2–48.5) months, the primary endpoint was achieved in 3 out of 13 PVs (23% of the treated PVs). We observed two in‐stent restenosis 2 and 4 years after PV stenting. These pts experienced onset of dyspnea some weeks before. After an additional balloon angioplasty, the in‐stent restenosis was resolved. In one asymptomatic patient, we observed an occlusion of the PV stent 13 months poststenting. Normalization of lung perfusion was noted 4 years after PV stenting versus directly poststenting in all pts without in‐stent restenosis (n = 7).

Conclusion:
PVS stenting with stent sizes ≥10 mm seems to be an adequate therapy modality for treatment of severe acquired PVS. Late in‐stent restenosis after PVS stenting can occur. The normalization of the initially disturbed lung perfusion scan is possible and remains stable, even 4 years after PVS stenting. (J Cardiovasc Electrophysiol, Vol. 20, pp. 251‐257, March 2009)
Basic mechanisms governing solute and fluid transport in hemodialysis
Authors: MISRA Madhukar
Published: October 2008

Hemodialysis (HD) is primarily a diffusion‐based transfer of small solutes. Diffusion is dependent on Fick's law. Convective removal, used mainly for removal of excess plasma water by ultrafiltration, also removes larger molecular‐weight solutes by the process of solvent drag. A number of physicochemical factors operative on the blood and the dialysate side impact solute and water removal during HD. A comprehensive yet brief discussion of these 2 basic processes operative in HD is presented in this article.
The role of dialyzer membrane flux in bio‐incompatibility
Authors: DAVENPORT Andrew
Published: October 2008

Dialyzer membrane flux is currently defined according to β2‐microglobulin (a middle molecule) clearance. Traditionally, high flux membranes were synthetic, and caused less inflammatory reaction in the extracorporeal circuit, compared with standard low‐flux cuprophan bio‐incompatible dialyzers. Initial reports suggested improved patient outcomes in acute renal failure when noncuprophan dialyzer membranes were used. However, over time these positive observations have not been substantiated. As the price differential between these dialyzer membrane types has become marginal, more high‐flux dialyzers are now used in routine clinical practice. Two multicenter trials have recently reported a survival advantage for high‐flux dialyzers. Whether this is directly consequent upon the choice of dialyzer membrane, or related to improvements in dialysate water quality, or changes in other clinical practices remains to be determined.
Type I (sporadic) porphyria cutanea tarda in a hemodialysis patient: A case report
Authors: TARWATER Kurt , MISRA Shamita , MISRA Madhukar
Published: October 2008

A hemodialysis patient with hepatitis C virus infection developed painful blisters on her hands that burst spontaneously. She was found to have serum porphyrin levels >2000 nmol/L. A punch biopsy revealed subepidermal blistering with festooning of dermal papillae associated with a mixed inflammatory infiltrate. Based on the clinical, biochemical, and histologic findings, a diagnosis of porphyria cutanea tarda was made. Treatment was started with twice‐weekly phlebotomy and oral hydroxychloroquine and significant clinical improvement resulted.
Extreme hyperglycemia with ketoacidosis and hyperkalemia in a patient on chronic hemodialysis
Authors: GUPTA Arvin , ROHRSCHEIB Mark , TZAMALOUKAS Antonios H.
Published: October 2008

A patient on hemodialysis for end‐stage renal disease secondary to diabetic nephropathy was admitted in a coma with Kussmaul breathing and hypertension (232/124 mmHg). She had extreme hyperglycemia (1884 mg/dL), acidosis (total CO2 4 mmol/L), hyperkalemia (7.2 mmol/L) with electrocardiographic abnormalities, and hypertonicity (330.7 mOsm/kg). Initial treatment with insulin drip resulted in a decrease in serum potassium to 5.3 mmol/L, but no significant change in mental status or other laboratory parameters. Hemodialysis of 1.75 hours resulted in rapid decline in serum glucose and tonicity and rapid improvement of the acidosis, but no change in mental status, which began to improve slowly after the hemodialysis was stopped, but with ongoing treatment with continuous insulin infusion. The rate of decline in tonicity during hemodialysis (14.5 mOsm/kg/h) was high, raising concerns about neurological complications. In this case, extreme hyperglycemia with ketoacidosis, hyperkalemia, and coma developing in a hemodialysis patient responded to insulin infusion. Monitoring of the clinical status and the pertinent laboratory values is required to assess the need for other therapeutic measures including volume and potassium replacement and emergency dialysis. The indications for and risks of emergency dialysis in this setting are not clearly defined.
Coded Talk, Scripted Omissions
Authors: Wood Kate , Lambert Helen
Published: October 2008

In this ethnographic article, we explore the character of local discourse about AIDS in an affected township community in South Africa, describing the “indirection” that characterized communication about suspected cases of AIDS. Through a case study of one affected family, the article first explores the diverse ways in which people came to “know” that specific cases of illness were AIDS related, and how this “knowledge” was communicated. We consider why communication was indirect and coded, arguing that this reflected not a “denial” of its presence in this community but, rather, a complex group of overlapping concerns far from unique to AIDS: first, a normative injunction on naming potentially fatal conditions; second, an interest in pursuing different therapeutic options and the need to maintain hope of recovery; and third, a wish to avoid the “disrespect” entailed in referring directly to the nature of the problem in a context where, discursively, stigma was still present. The coded and indirect character of HIV/AIDS‐related talk underlines the importance of ethnographic inquiry in understanding community responses to this epidemic, demonstrating that the subtleties entailed by verbal silence and elision should not be interpreted naively as collective “denial” but rather be grounded within existing patterns of responses to dangerous sickness.
Making Scenes
Authors: Park Melissa
Published: October 2008

A tension in medical anthropology, as an interdisciplinary field, exists between those polar territories of the logic—and therefore grammars—of a positivist–scientific stance of biomedicine and a literary–philosophical one used to represent experience. Taking up literary‐philosophical and existential perspectives from anthropology proper, I draw on an ethnographic study of a sensory‐integration–based clinic to propose that imaginative practices are one arena where such tension can be worked out. Enacted narratives, as a method, reveal how imaginative practices foreground the ways in which desire and hope are integral to healing.

Kenneth Burke's (1969[1945])

theory of dramatism, particularly his scene: act ratio, provides an analytic lens to examine the imaginary play of a singular session between a child with autism and an occupational therapist. Further, an interpretive frame that tacks between the positivist–biomedical and literary–philosophical discourses excavates how making scenes is integral to a healing of belonging and its embodiment.
Being Anorexic
Authors: Gooldin Sigal
Published: October 2008

This article explores the embodied process of being anorexic and the moral repertoires within which this process is entangled. The point of departure for this discussion is that, while critical feminist epistemology plays an important role in politicizing anorexia as a symbolic cluster of meanings, it has provided us with limited analytical tools for an in‐depth understanding of an anorexic's lived experiences and of the embodied realities involved in being anorexic. At the same time, autobiographical accounts of anorexia provide insightful emic perspectives on being anorexic but are not engaged with symbolic and theoretical etic perspectives on anorexia. This article attempts to bridge this gap through an anthropological exploration of anorexia from within; that is, as a situated embodied knowledge of anorexic women anchored in concrete lived experiences. Findings from an ethnographic study of young women who were diagnosed with anorexia and admitted to an outpatient hospital unit in Israel suggest that anorexic women actively construct a “heroic moral subjectivity,” in which the experience of hunger plays a crucial role, and in which everyday (mundane) practices gain “out‐of‐the‐ordinary” meanings. While these findings partially accord with feminist philosophical explorations of anorexia, I argue that it is only via a detailed ethnographic account that we can follow the ongoing phenomenological and semiotic process through which such heroic subjectivity actually develops. Using an anthropological perspective to bear on the phenomenology of anorexia as an embodied experience contributes toward extending our understanding of the concrete ways in which “culture” becomes present in anorexia. The concluding section discusses gaps between feminist and anorexic narratives of anorexia in terms of therapeutic encounters.
Comb Polymer Architecture, Ionic Strength, and Particle Size Effects on the BaTiO3 Suspension Stability
Authors: Yoshikawa Jun , Lewis Jennifer A. , Chun Byong‐Wa
Published: October 2008

We investigate the stability of aqueous barium titanate suspensions as a function of dispersant architecture, ionic strength, counterion valency, and particle size. Both pure polyelectrolytes, poly(acrylic acid) and poly(methacrylic acid) (PMAA), and comb polymer dispersants composed of a PMAA backbone with methoxy‐poly(ethylene oxide) (mPEO) teeth of varying molecular weights are studied. While each dispersant imparts stability to barium titanate suspensions at low ionic strength (<∼0.01M), only the PMAA–mPEO comb polymer with the longest teeth provides stability at higher ionic strengths independent of particle size and counterion valency. Our findings provide new insight into the design of comb polymer dispersants for stabilizing aqueous ceramic suspensions over a broad range of processing conditions.
Sol–Gel Synthesis of High‐k HfO2 Thin Films
Authors: Suzuki Kazuyuki , Kato Kazumi
Published: October 2008

HfO2 films were prepared using alkoxy‐derived precursor solutions. The effects of the chemical composition of precursor solutions on the microstructure development were investigated for HfO2 films on Si substrates. The microstructure distinguished developed in the HfO2 films prepared using the precursor solutions with and without diethanolamine. This result is considered to be due to the difference in the progress of organic decomposition and the behavior of nucleation and grain growth. The flatness and refractive index of the HfO2 films were improved using diethanolamine‐added solution. The refractive index and the dielectric constant of the HfO2 film prepared at 400°C using a diethanolamine‐added solution were about 1.85 and 17, respectively. A similar microstructure developed in the HfO2 films on polyimide films. Much flat and uniform HfO2 films are expected for application to integrated optical devices.
Advanced Medical Simulation Applications for Emergency Medicine Microsystems Evaluation and Training
Authors: Kobayashi Leo , Overly Frank L. , Fairbanks Rollin J. , Patterson Mary , Kaji Amy H. , Bruno Eric C. , Kirchhoff Michael A. , Strother Christopher G. , Sucov Andrew , Wears Robert L.
Published: October 2008

Participants in the 2008 Academic Emergency Medicine Consensus Conference “The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise” morning workshop session on developing systems expertise were tasked with evaluating best applications of simulation techniques and technologies to small‐scale systems in emergency medicine (EM). We collaborated to achieve several objectives: 1) describe relevant theories and terminology for discussion of health care systems and medical simulation, 2) review prior and ongoing efforts employing systems thinking and simulation programs in general medical sectors and acute care medicine, 3) develop a framework for discussion of systems thinking for EM, and 4) explore the rational application of advanced medical simulation methods to a defined framework of EM microsystems (EMMs) to promote a “quality‐by‐design” approach. This article details the materials compiled and questions raised during the consensus process, and the resulting simulation application framework, with proposed solutions as well as their limitations for EM systems education and improvement.
Toward a Definition of Teamwork in Emergency Medicine
Authors: Fernandez Rosemarie , Kozlowski Steve W. J. , Shapiro Marc J. , Salas Eduardo
Published: October 2008

The patient safety literature from the past decade emphasizes the importance of teamwork skills and human factors in preventing medical errors. Simulation has been used within aviation, the military, and now health care domains to effectively teach and assess teamwork skills. However, attempts to expand and generalize research and training principles have been limited due to a lack of a well‐defined, well‐researched taxonomy. As part of the 2008 Academic Emergency Medicine Consensus Conference on “The Science of Simulation in Healthcare,” a subset of the group expertise and group assessment breakout sections identified evidence‐based recommendations for an emergency medicine (EM) team taxonomy and performance model. This material was disseminated within the morning session and was discussed both during breakout sessions and via online messaging. Below we present a well‐defined, well‐described taxonomy that will help guide design, implementation, and assessment of simulation‐based team training programs.
Does Team Training Work? Principles for Health Care
Authors: Salas Eduardo , DiazGranados Deborah , Weaver Sallie J. , King Heidi
Published: October 2008

Teamwork is integral to a working environment conducive to patient safety and care. Team training is one methodology designed to equip team members with the competencies necessary for optimizing teamwork. There is evidence of team training’s effectiveness in highly complex and dynamic work environments, such as aviation and health care. However, most quantitative evaluations of training do not offer any insight into the actual reasons why, how, and when team training is effective. To address this gap in understanding, and to provide guidance for members of the health care community interested in implementing team training programs, this article presents both quantitative results and a specific qualitative review and content analysis of team training implemented in health care. Based on this review, we offer eight evidence‐based principles for effective planning, implementation, and evaluation of team training programs specific to health care.
Advanced Waterborne Maintenance and Salvage Operations for the Royal Navy
Authors: BLAIR IAN , RICHARDS DAVID
Published: October 2008

The Salvage and Marine Operations Integrated Project Team (S&MO IPT) is the principal authority in the UK Ministry of Defence (MoD) charged with providing Salvage, Blue Water Towing, Specialist Moorings, and Heavy Lift Expertise to the UK Armed Forces. It has recently become the MoD center of expertise for In Water Maintenance & Repair (IWMAR). UMC International Plc is a commercial enterprise specializing in the development and execution of waterborne maintenance both on commercial and military vessels worldwide. UMC is part of the V. Holdings Group, the world's largest marine service provider, offering comprehensive through life support to a fleet of almost 1,000 vessels. A unique partnering of industry and the UK MoD has led to the expansion of waterborne and underwater maintenance, providing the Royal Navy (RN) with significant opportunities for cost reduction, increased periods between dockings and enhanced platform availability. This paper discusses the various technologies developed for both waterborne maintenance of the RN fleet and specific tasks undertaken by the S&MO IPT.
Carrier Team One: Making Decisions “Mindful that a Carrier Must Last 50 Years”
Authors: BLANTON GERALD B.
Published: October 2008

For more than 10 years, Carrier Team One has effectively coordinated cross‐organizational process reviews to improve the execution of carrier maintenance availabilities. As noted in the Team One charter, these improvement efforts are “mindful that a carrier must last 50 years.” In recognizing the challenges of a 50‐year service life, Team One has adopted principles intended to ensure that an as yet unborn chief engineer on USS George H.W. Bush (CVN 77) can maintain high levels of ship material readiness in 2050. This paper reviews the “50‐year” principles that influence Carrier Team One efforts, focusing on three such principles. This paper does not suggest that the submarine and surface communities do not observe similar principles; undoubtedly, they do. And admittedly, these principles are interrelated, but are reviewed separately to emphasize each principle's contribution to improving carrier availabilities. The three principles are:

Core values—how a 50‐year service life influences decision making.

Process focus—how a 50‐year service life influences long‐term improvement methodologies.

Technical focus—how a 50‐year service life influences technical improvement decisions.

In examining these principles, the paper will consider their long‐term contributions to carrier readiness and their influences on Team One's efforts to improve carrier maintenance.
Shipboard Maintenance: What Do Surface Warfare Officers Need to Know—and When Do They Need to Know It?
Authors: SYDOW KENNETH R.
Published: October 2008

As the Navy has moved into the 21st century and the War on Terror has unfolded, the challenges to ship maintenance management have never been greater. These challenges include: a continuing high operating tempo compounded by less predictable schedules and coupled with fewer, shorter scheduled opportunities to conduct maintenance; a fleet of fewer albeit more capable—and therefore more complex—ships; a trend toward smaller, perhaps less stable crews to operate and maintain the ships; and continuing competition for the available budget dollars between operations and maintenance, as well as between current and future readiness concerns. In an era of “operations focused maintenance,” what is the role of the Surface Warfare Officer (SWO) in managing their shipboard maintenance? What do they need to know, and when do they need to know it? This paper addresses these questions and related issues and offers, where applicable, some near‐term and long‐term recommendations for improvement.
Use of the Rotational Path Removable Partial Denture Concept in a Kennedy Class II Patient: A Case Report
Authors: DONOVAN TERRY
Published: October 2008

This case report describes the treatment of a patient with Sjogren's syndrome who was missing all of the posterior teeth in the maxillary left arch. Implants were contraindicated for this patient because of a chronic sinus infection. Various removable prosthodontic options were considered, and the patient was ultimately treated very conservatively with a rotational path removable partial denture (RPD). This approach required no tooth preparation other than bonding a resin composite cingulum rest on the maxillary left canine. The use of the rotational path RPD eliminated any unsightly clasp assembly display and provided a satisfactory esthetic result.

CLINICAL SIGNIFICANCE

The rotational path removable partial denture is an underutilized option for the esthetic replacement of missing teeth. It should be considered as an option in both tooth‐borne and Kennedy Class II situations.
Multiple Cuspal‐Coverage Direct Composite Restorations: Functional and Esthetic Guidelines
Authors: DELIPERI SIMONE , BARDWELL DAVID N.
Published: October 2008

Many factors contribute to the achievement of clinical success with direct posterior composite restorations: (1) analysis of the occlusion and opposing dentition, (2) complete excavation of dental caries, (3) analysis of residual tooth structure, (4) control of polymerization stresses by using appropriate layering and curing techniques, (5) occlusal force equilibration, and (6) patient compliance to maintain good oral health. The goal of this paper was to provide a clinical protocol for the direct restoration of severely damaged posterior teeth, analyzing the benefit and limits of a similar procedure.

CLINICAL SIGNIFICANCE

This paper is intended to introduce specific esthetic and functional guidelines for the placement of cusp‐capping restorations using resin‐bonded composite.
Changes in Patient Evaluation of Completed Orthodontic Esthetics after Dental Bleaching
Authors: KRUG ARI Y. , GREEN CYNTHIA
Published: October 2008

As dental professionals, we tend to assess separately different treatment modalities; our patients, however, may only be aware of the total outcome, not discerning the contribution from each treatment. Orthodontists focus on dentoskeletal positioning, usually leaving other areas of esthetics such as tooth shade to other dental colleagues. Laypeople may not see the same differentiation. We suggested that patients would be more pleased with their orthodontic outcomes when cosmetic bleaching was done afterwards, not discriminating between the benefits derived from orthodontics alone and those derived from bleaching. Seventy‐five orthodontic patients were selected for the study. Two experimental groups underwent different bleaching protocols, while the third control group received no bleaching. A visual analog scale questionnaire evaluating different aspects of their orthodontic outcome was given to each participant 2 days after treatment and again 1 month later. The first survey was filled out prior to the bleaching procedure, while the second survey was post bleaching. None of the participants were informed that the questionnaire was related to the bleaching. A calibrated photospectrometer was used to measure the dental shade prior to bleaching and again at 1‐month follow‐up. The two bleached groups had significant shade improvement and a significant overall increase in their orthodontic evaluation, while the patients in the control group displayed a decrease in their assessment of their orthodontic treatment. Altering smile esthetics through bleaching does not change any of the parameters that orthodontists strive to correct, yet it has a positive effect on the patients’ perception of previous orthodontic treatment.

CLINICAL SIGNIFICANCE

Patients are more satisfied with previous orthodontic treatment when it is coupled with cosmetic bleaching. When providing multidisciplinary treatment, we dental professionals may tend to assess the outcome of each segment separately. To patients, however, there is an additive effect, and their opinion is based on the overall composition of the outcome.
Quantitative modeling of triacylglycerol homeostasis in yeast – metabolic requirement for lipolysis to promote membrane lipid synthesis and cellular growth
Authors: Zanghellini Jürgen , Natter Klaus , Jungreuthmayer Christian , Thalhammer Armin , Kurat Christoph F. , Gogg‐Fassolter Gabriela , Kohlwein Sepp D. , von Grünberg Hans‐Hennig
Published: October 2008

Triacylglycerol metabolism in Saccharomyces cerevisiae was analyzed quantitatively using a systems biological approach. Cellular growth, glucose uptake and ethanol secretion were measured as a function of time and used as input for a dynamic flux‐balance model. By combining dynamic mass balances for key metabolites with a detailed steady‐state analysis, we trained a model network and simulated the time‐dependent degradation of cellular triacylglycerol and its interaction with fatty acid and membrane lipid synthesis. This approach described precisely, both qualitatively and quantitatively, the time evolution of various key metabolites in a consistent and self‐contained manner, and the predictions were found to be in excellent agreement with experimental data. We showed that, during pre‐logarithmic growth, lipolysis of triacylglycerol allows for the rapid synthesis of membrane lipids, whereas de novo fatty acid synthesis plays only a minor role during this growth phase. Progress in triacylglycerol hydrolysis directly correlates with an increase in cell size, demonstrating the importance of lipolysis for supporting efficient growth initiation.
Correlation between Braden Scale and Palliative Performance Scale in advanced illness
Authors: Maida Vincent , Lau Francis , Downing Michael , Yang Ju
Published: October 2008

This study describes the significant correlation between the Braden Scale (BS) and the Palliative Performance Scale (PPS) in patients with advanced illness that has not been previously reported. The analysis was based on a prospective sequential case series of 664 patients suffering from advanced illness who were referred to a regional palliative medicine programme in Toronto, Canada. Baseline BS and PPS scores assessed within 24 hours of referral were considered for analysis. After controlling for age, gender, consult site and diagnosis (cancer versus non cancer), we observed a significant positive correlation between baseline PPS and BS scores (r = 0·885, P < 0·001). These findings suggest that for patients with advanced illness where BS is not routinely used, PPS could be considered as a proxy for pressure ulcer risk assessment.
Chitin membrane for wound dressing application – preparation, characterisation and toxicological evaluation
Authors: Singh Rita , Chacharkar Madhukar Parashuram , Mathur Adesh Kumar
Published: October 2008

Chitin, a unique biopolymer based on the N‐acetyl‐glucosamine monomer is envisioned to promote rapid dermal regeneration and accelerate wound healing. It has many useful and advantageous biological properties for its application as a wound dressing. Chitin membranes were prepared using lithium chloride/dimethylacetamide solvent system and evaluated for use as a wound dressing. Swelling behaviour, moisture vapour transmission rate, microbial impermeability and antimicrobial efficacy of the dressings was evaluated. The chitin dressing provided an effective barrier to microbial penetration and exerted a broad bacteriostatic action against Gram‐positive and Gram‐negative organisms. Gamma irradiation at 25 kGy was found suitable for sterilisation of the dressings. The thermal decomposition of unirradiated and irradiated chitin membranes was investigated. No significant change in the thermal behaviour because of irradiation at 25 kGy was observed. In vitro biodegradation of unirradiated and irradiated chitin membranes showed the susceptibility of the chitin dressing to lysozyme. Irritant effect of the chitin membrane dressings on skin was tested. Subcutaneous and scarification test in guinea pigs showed no signs of inflammation. This was further supported by the Finkelstein’s test performed in rabbits. The chitin membranes were found to have optimal performance characteristics of a wound dressing and showed no toxicity or possible adverse reactions. The study shows the chitin dressings as useful adjunct in wound care.
Tubercular infection in the sacrococcygeal pilonidal sinus – a case report
Authors: Gupta Pravin Jaiprakash
Published: October 2008

We report a case of multiple pus discharging sinuses in the sacrococcygeal region in a 22‐year‐old man, who had a history of episodes of pain and pus discharge since 8 months. The patient underwent radiofrequency sinotomy using a Ellman radiofrequency device and was treated with antitubercular treatment, which resulted in complete resolution, and healing of the wound.
The effects of education and training on clinical practice in wound healing
Authors: Seeley Michael A , Harding Keith G
Published: October 2008

This article considers the effects of two different types of educational programme on community nurse clinical practice in venous ulceration. One group of nurses (the experimental group) attended an educational programme designed to take account of training needs and learning styles. A second group of nurses (the control group) attended a standardised educational programme. A multiple‐choice question examination and Objective Structured Clinical Examination were used to measure knowledge and skills. Kolb’s Learning Styles Inventory was used to measure learning styles. Findings were that experimental nurses failed to show improved post‐intervention clinical practice compared with the control group.
A comparative study of the in vitro permeation characteristic of sulphadiazine across synthetic membranes and eschar tissue
Authors: Zadeh Behzad Sharif Makhmal , Moghimi Hamidreza , Santos Paulo , Hadgraft Jonathan , Lane Majella E
Published: October 2008

Infections of burn wounds are the source of significant problems in burn patients. Early excision of eschar tissue is an ideal solution to avoid sepsis. When early excision is not feasible, the application of topical antimicrobial formulations may be used to control burn wound sepsis. An understanding of the barrier properties of eschar tissue is essential for optimal design of topical antimicrobial formulations. To date, little research has been conducted on the permeability of eschar. Silver sulphadiazine (SSD) is the most frequently used topical agent in burn management. In this study, the permeation of sulphadiazine from aqueous saturated solutions of SSD through human full‐thickness burn eschar tissue was studied and compared with permeability through silicone and Carbosil as model membranes. The permeation of sulphadiazine through eschar tissue was significantly higher than that through silicone and Carbosil membranes (P < 0·05). Deconvolution of the data showed that the apparent sulphadiazine diffusion coefficient was much higher in eschar tissue and was comparable to transport through an aqueous protein gel. Further studies on a greater number of compounds are suggested to elucidate the utility of such membranes as predictive models of drug permeability through eschar tissue.
Extracorporeal shock wave therapy suppresses the early proinflammatory immune response to a severe cutaneous burn injury*
Authors: Davis Thomas A , Stojadinovic Alexander , Anam Khairul , Amare Mihret , Naik Shruti , Peoples George E , Tadaki Douglas , Elster Eric A
Published: October 2008

Following severe burn injury, persistent inflammation perpetuated by surface eschar, bacterial colonisation and neutrophil proteolytic activity can impede normal healing and result in further tissue damage. Extracorporeal shock wave treatment (ESWT) has been shown in the clinical setting to promote the healing of burn and difficult‐to‐heal wounds; however, the mechanism is unclear. We investigated the role of ESWT on the early proinflammatory response using a severe, full‐thickness and highly inflammatory cutaneous burn wound in a murine model. Various wound‐healing parameters were measured and leukocyte infiltration quantitated. A panel of 188 candidate genes known to be involved in acute inflammation and wound healing was screened. We show that ESWT of burn wounds 1 hour postwounding significantly blunts polymorphonuclear neutrophil and macrophage infiltration into the wound. ESWT treatment potently attenuates both CC‐ and CXC‐chemokine expression, acute proinflammatory cytokine expression and extracellular matrix proteolytic activity at the wound margin. Given these findings and the clinical success of ESWT, we speculate that ESWT may be a potential therapeutic modality to treat severe wounds wherein excessive inflammatory responses involving increased levels of inflammatory cells, proinflammatory cytokines and proteases may become self‐resolving allowing wound healing to progresses by way of normal physiological repair processes.
Six‐month mortality risks in long‐term care residents with chronic ulcers
Authors: Takahashi Paul Y , Cha Stephen S , Kiemele Lester J
Published: October 2008

Chronic ulcers are a common problem in long‐term care. Residents with ongoing ulcers are often frail and at risk for mortality. This study evaluated the relationship between wound characteristics and other health predictors with 6‐month mortality in nursing home residents. The subjects included were nursing home residents seen by the wound consult service from 1998 to 2007 with an ongoing chronic ulcer. This was a retrospective cohort study. Data were manually and electronically abstracted for each resident. Six‐month mortality was collected as the primary outcome. Statistical comparisons were made using logistic regression with a final multivariant model. Four hundred and forty residents were seen with 411 records reviewed. Ulcer area was not associated with mortality; however, chronic ulcer number was associated with 6‐month mortality with an odds ratio of 1·32 (95% CI 1·07–1·63). Other significant risk factors included heart failure, dementia, cancer, depression and blindness with all factors having an odds ratio greater than 1·75. Higher haemoglobin and venous insufficiency were protective of 6‐month mortality. Ulcer number is an important predictor for 6‐month mortality. The presence of multiple ulcers and comorbid health concerns may influence discussion of prognosis for healing and for potential end of life discussions.
Pattern of Coombs’ test reactivity has diagnostic significance in dogs with immune‐mediated haemolytic anaemia
Authors: Warman S. M. , Murray J. K. , Ridyard A. , Eastwood J. , Silva S. , Day M. J.
Published: October 2008

Objectives:To investigate the clinical significance of the pattern of Coombs’ test reactivity in dogs with immune‐mediated haemolytic anaemia.

Methods:Sixty‐five anaemic dogs with a positive Coombs’ test were included. Coombs’ testing was performed at 4 and 37°C with polyvalent canine Coombs’ reagent and antisera specific for each of canine immunoglobulin G, immunoglobulin M and complement factor C3. The impact of performing testing with only polyvalent antiserum at 37°C was assessed. Chi‐squared tests were used to compare Coombs’ test reactivity in dogs with primary immune‐mediated haemolytic anaemia (group A) and in dogs with concurrent/underlying disease (group B). Following Bonferroni correction, significance was set at P≤0·003.

Results:Eleven dogs would have been regarded as Coombs’ negative had they been tested with polyvalent antiserum at 37°C alone. Group A dogs were significantly more likely to be positive with polyvalent antiserum and/or anti‐dog immunoglobulin G at 4 and/or 37°C (P≤0·001) and tended to be less likely to be positive with anti‐dog immunoglobulin M at 4°C (P=0·040).

ClinicalSignificance:Testing of anaemic dogs with polyvalent Coombs’ reagent at 37°C was less sensitive than testing with monovalent reagents at 4 and 37°C. The pattern of Coombs’ test reactivity differed significantly between dogs with primary immune‐mediated haemolytic anaemia and those with concurrent/underlying disease.
CDKN2A mutations and MC1R variants in Italian patients with single or multiple primary melanoma
Authors: Pastorino L. , Bonelli L. , Ghiorzo P. , Queirolo P. , Battistuzzi L. , Balleari E. , Nasti S. , Gargiulo S. , Gliori S. , Savoia P. , Abate Osella S. , Bernengo M. G. , Bianchi Scarrà G.
Published: October 2008

We evaluated the contribution of germline CDKN2A mutations and MC1R variants to the development of melanoma in a hospital‐based study of single (SPM, n = 398) and multiple primary melanoma (MPM, n = 95). The overall frequency of CDKN2A mutations was 15.2%, and four‐fold higher in MPM than in SPM cases (OR = 4.27; 95% CI 2.43–7.53). The likelihood of identifying a CDKN2A mutation increased with family history of melanoma and younger age at diagnosis in MPM cases. Compared to SPM patients, the risk of harboring a CDKN2A mutation rose as the number of primary melanomas increased and was not influenced by family history. The G101W and E27X founder mutations were the most common. Several other mutations (W15X, Q50X, R58X, A68L, A127P and H142R) were detected for the first time in Italian patients. One novel mutation, T77A, was identified. Several non‐coding variants with unknown functional significance were also found (5′UTR −25C > T, −21C > T, −67G > C, IVS1 +37G > C); the novel 5′UTR −21C > T variant was not detected in controls. The CDKN2A A148T polymorphism was more frequent in MPM patients than in the control population (15.7% versus 6.6%). Compared to the SPM patients, MPM cases had a 2‐fold increased probability of being MC1R variant carriers and a higher probability of carrying two or more variants. No specific association was observed between the type of variant and the number of melanomas, suggesting that the number rather than the type of MC1R variant increases the risk of MPM. We observed no interaction between CDKN2A status and the presence of MC1R variants. The high frequency of CDKN2A mutations in our MPM cases, independent of their family history, is of relevance to genetic counseling and testing in our population.
Specific expression of Gsta4 in mouse cochlear melanocytes: a novel role for hearing and melanocyte differentiation
Authors: Uehara Shigeyuki , Izumi Yoshiko , Kubo Yuko , Wang Chi Chiu , Mineta Katsuhiko , Ikeo Kazuho , Gojobori Takashi , Tachibana Masayoshi , Kikuchi Toshihiko , Kobayashi Toshimitsu , Shibahara Shigeki , Taya Choji , Yonekawa Hiromichi , Shiroishi Toshihiko , Yamamoto Hiroaki
Published: October 2008

Mammalian pigment cells produce melanin as the main pigment. Melanocytes, one of the two types of mammalian pigment cells, differentiate from the neural crest and migrate to a variety of organs during development. Melanocytes exist not only in the skin but also in other sites such as the cochlea where they are essential for hearing. Mitfmi‐bw is one of the known recessive alleles of the mouse microphthalmia‐associated transcription factor (Mitf) locus, which is essential for the development of pigment cells. Homozygous Mitfmi‐bw/Mitfmi‐bw mice have a completely white coat with black eyes and are deaf due to the lack of melanocytes. By comparing gene expression profiles in cochleae of wild‐type and Mitfmi‐bw/Mitfmi‐bw mice, we now demonstrate the specific expression of glutathione S‐transferase alpha 4 (Gsta4) in the stria vascularis. Gsta4 encodes one of the cytosolic glutathione S‐transferases (GSTs) which participate in detoxification processes of many tissues. This gene is specifically expressed in intermediate cells of the stria vascularis, suggesting a novel function for cochlear melanocytes. Moreover, among mammalian pigment cells, expression of Gsta4 was restricted to cochlear melanocytes, suggesting that melanocytes in various tissues differentiate from one another depending on their location.
Evaluation of a Commercial Immunoblot, Helicoblot 2.1, for Diagnosis of
Helicobacter pylori
Infection
Authors: Veijola Lea , Oksanen Aino , Sipponen Pentti , Rautelin Hilpi
Published: October 2008

The best method to diagnose
Helicobacter pylori
infection in different clinical situations is controversial. The aim of the study was to assess the performance of a commercial immunoblot, Helicoblot 2.1. The study comprised 215 patients, who were grouped according to the presence of
H. pylori
infection (assessed by two gastroscopies including histology with a median interval of 7.1 years, enzyme immunoassay [EIA]-based serology, and history of previous
H. pylori
infections and eradication therapies) into four categories: no
H. pylori
infection ever, previous infection, ongoing infection, and EIA seropositivity as the only marker of a possible previous infection. The sensitivity of Helicoblot 2.1 to show an ongoing or previous
H. pylori
infection was 100% and 92%, respectively. Helicoblot 2.1 was negative in only 80% of individuals with no evidence of present or previous infection but in 96% of patients 50 years of age or younger. The current infection marker of the immunoblot was positive in 49% of patients with successful
H. pylori
eradication therapy. After successful eradication therapy, Helicoblot 2.1 sustained positive results in 87% of patients, and CagA positivity was detected in 87% of patients with follow-up samples for more than 10 years after therapy. Helicoblot 2.1 is a sensitive and, among patients of ages 50 years or younger, a specific test in the primary diagnosis of
H. pylori
infection. However, it does not discriminate between past and current infections. It can be used in epidemiological studies assessing the role of
H. pylori
in different late sequelae.
Recombinant Multiepitope Protein for Diagnosis of Leptospirosis
Authors: Lin Xu'ai , Chen Yin , Yan Jie
Published: October 2008

Leptospirosis is an emerging infectious disease and is considered to be the most widespread zoonotic disease in the world. It can be misdiagnosed because manifestations of this febrile disease vary from mild flu-like symptoms to severe illness involving vital organs such as the liver and lungs. Therefore, accurate diagnosis for differentiation of leptospirosis from other pyrogenic infections prevailing in the same locality is imperative for proper treatment. Here, we report a customized recombinant leptospirosis multiepitope protein (r-LMP) that can specifically detect the immunoglobulin class of anti-leptospirosis antibodies in patient sera. Immunodominant epitopes from leptospire outer membrane proteins OmpL1, LipL21, and LipL32 were predicted and confirmed using phage display and immunity reaction. On the basis of the sequences of the identified epitopes, five major immunodominant epitopes were selected to construct a synthetic gene, recombinant
lmp
. The recombinant
lmp
gene was doubled and expressed in
Escherichia coli.
The recombinant protein was purified and used as an antigen to develop an enzyme-linked immunosorbent assay for detection of special immunoglobulin M (IgM) or IgG in sera from patients with leptospirosis or other febrile illnesses and healthy subjects. The results showed that the r-LMP protein recognized IgG and IgM in all the sera that were microscope agglutination test positive, and there were no cross-reactions with other patient sera. This approach of creating customized antigens coupled to overexpression and simple purification offers a promising alternative option for leptospirosis diagnosis, with the potential to circumvent the drawbacks of whole-leptospirosis-antigen-based assays.