bluuebunny/crossref_metadata_2025 huggingface dataset:
Smoothing Techniques for Computing Nash Equilibria of Sequential Games
Authors: Hoda Samid , Gilpin Andrew , Peña Javier , Sandholm Tuomas
Published: May 2010

We develop first-order smoothing techniques for saddle-point problems that arise in finding a Nash equilibrium of sequential games. The crux of our work is a construction of suitable prox-functions for a certain class of polytopes that encode the sequential nature of the game. We also introduce heuristics that significantly speed up the algorithm, and decomposed game representations that reduce the memory requirements, enabling the application of the techniques to drastically larger games. An implementation based on our smoothing techniques computes approximate Nash equilibria for games that are more than four orders of magnitude larger than what prior approaches can handle. Finally, we show near-linear further speedups from parallelization.
Tribological performance of various CoCr microstructures in metal-on-metal bearings
Authors: Kamali A. , Hussain A. , Li C. , Pamu J. , Daniel J. , Ziaee H. , Daniel J. , McMinn D. J. W.
Published: April 2010

Hip simulators have been used for ten years to determine the tribological performance of large-head metal-on-metal devices using traditional test conditions. However, the hip simulator protocols were originally developed to test metal-on-polyethylene devices. We have used patient activity data to develop a more physiologically relevant test protocol for metal-on-metal devices. This includes stop/start motion, a more appropriate walking frequency, and alternating kinetic and kinematic profiles.

There has been considerable discussion about the effect of heat treatments on the wear of metal-on-metal cobalt chromium molybdenum (CoCrMo) devices. Clinical studies have shown a higher rate of wear, levels of metal ions and rates of failure for the heat-treated metal compared to the as-cast metal CoCrMo devices. However, hip simulator studies in vitro under traditional testing conditions have thus far not been able to demonstrate a difference between the wear performance of these implants.

Using a physiologically relevant test protocol, we have shown that heat treatment of metal-on-metal CoCrMo devices adversely affects their wear performance and generates significantly higher wear rates and levels of metal ions than in as-cast metal implants.
Is peri-articular multimodal drug infiltration in knee arthroplasty safe when used in conjunction with autologous retransfusion drains?
Authors: Gill I , Gallagher K , Busch CA
Published: April 2010

INTRODUCTION

Adequate peri-operative analgesia following total knee arthroplasty (TKA) promotes earlier rehabilitation but remains problematic because of the drug side-effects. Peri-articular multimodal drug infiltration (PMDI) has been developed as an alternative strategy to avoid such complications. Autologous retransfusion drains reduce the need for peri-operative allogenic blood transfusions and the consequent risk. There is a theoretical risk of local anaesthesia toxicity when these systems are used concurrently. We performed a review of current practice to quantify this risk.

PATIENTS AND METHODS

A series of 10 patients undergoing TKA by the senior author (CAB) had drain fluid analysed for the concentration of ropivacaine. At the same time, the patients completed a questionnaire to establish the presence of ropiva-caine-induced side-effects.

RESULTS

The ropivacaine level in the retransfusion blood was less than 10 mg in all patients. This concentration was a factor of 6 below the published safe level. Three patients had minor neurological disturbances which recovered spontaneously and quickly. There were no cases of significant cardiovascular compromise.

CONCLUSIONS

The theoretical risk of local anaesthesia toxicity when these systems are used together is negligible and we conclude that peri-articular multimodal drug infiltration is safe in conjunction with the use of autotransfusion drains.
Radiation risk from fluoroscopically-assisted anterior cruciate ligament reconstruction
Authors: Chitnavis JP , Karthikesaligam A , Macdonald A , Brown C
Published: April 2010

INTRODUCTION

Precise tunnel positioning is crucial for success in anterior cruciate ligament (ACL) reconstruction. The use of intra-operative fluoroscopy has been shown to improve the accuracy of tunnel placement. Although radiation exposure is a concern, we lack information on the radiation risk to patients undergoing fluoroscopically-assisted ACL reconstruction with a standard C-arm. The aim of our study was to determine the mean radiation doses received by our patients.

PATIENTS AND METHODS

Radiation doses were recorded for 18 months between 1 April 2007 and 30 September 2008 for 58 consecutive patients undergoing ACL reconstruction assisted by intra-operative fluoroscopy. Dose area product (DAP) values were used to calculate the entrance skin dose (ESD), an indicator of potential skin damage and the effective dose (ED), an indicator of long-term cancer risk, for each patient.

RESULTS

The median age of 58 patients included in data analysis was 28 years (range, 14–52 years), of whom 44 were male (76%). The mean ESD during intra-operative fluoroscopy was 0.0015 ± 0.0029 Gy. The mean ED was 0.001 ± 0.002 mSv. No results exceeded the threshold of 2 Gy for skin damage, and the life-time risk of developing new cancer due to intra-operative fluoroscopy is less than 0.0001%.

CONCLUSIONS

Radiation doses administered during fluoroscopically-assisted ACL reconstruction were safe and do not represent a contra-indication to the procedure.
Haemostasis in head and neck surgical procedures: Valsalva manoeuvre versus Trendelenburg tilt
Authors: Moumoulidis I , Del Pero Martinez M , Brennan L , Jani P
Published: April 2010

INTRODUCTION

The aim of the study was to identify whether Trendelenburg position helps detect any further bleeding points following Valsalva manoeuvre in order to achieve adequate haemostasis in head and neck surgery.

PATIENTS AND METHODS

Fifty consecutive patients undergoing major head and neck surgical procedures were included. The protocol consisted in performing Valsalva manoeuvre to check haemostasis and treated any bleeding points identified. The operating table was tilted 30° and haemostasis was checked again and treated accordingly. The number of vessels identified and the treatment was recorded.

RESULTS

Twelve male and 38 female patients were included. The median age was 53 years and 74% had an ASA of 1. Twelve patients had complicating features such as retrosternal extensions or raised T4 levels pre-operatively. Thyroid resections were the most common operations performed. The total number of bleeding vessels identified in Trendelenburg tilt was significantly greater than when using Valsalva manoeuvre (P < 0.0001). All bleeding points found on Valsalva manoeuvre were minor (< 2 mm) and dealt with using diathermy. In Trendelenburg position, 11% of bleeding vessels required ties or stitching. The time taken during Valsalva manoeuvre was 60 s on average and 360 s in Trendelenburg position.

CONCLUSIONS

The results show that the Trendelenburg position is vastly superior to the Valsalva manoeuvre in identifying bleeding vessels at haemostasis. It has become our practice to put patients in Trendelenburg tilt routinely (we have discontinued the Valsalva manoeuvre), to check its adequacy before closing the wound. We have not noticed any intracranial complications using a tilt angle of 30°.
The use of the Flexi-Seal® Faecal Management System in laparostomy wounds involving enterocutaneous fistula
Authors: Hardwicke Joseph , Wright Thomas C , Hargest Rachel , Dickson William
Published: April 2010

We present an innovative application of the Flexi-Seal® Faecal Management System (FMS) for the diversion of upper and lower gastrointestinal secretions from enterocutaneous fistulae associated with complex wounds. Fistula is a common complication after the formation of a laparostomy, secondary to cases of severe intra-abdominal sepsis, acute mesenteric ischaemia, necrotising infection of the abdominal wall, or intra-abdominal hypertension. A significant mortality rate is associated with such fistula. With the successful continent diversion of gastrointestinal secretions by the Flexi-Seal® FMS, abdominal wounds can be successfully skin-grafted, and wound healing expedited.
Laparoscopic drainage of retroperitoneal abscess secondary to pyogenic sacroiliitis
Authors: Chan David SY , Saklani Avanish , Shah Parin R , Haray Puthucode N
Published: April 2010

Retroperitoneal abscesses are rare complications of pyogenic sacroiliitis. Diagnosis is often delayed due to the initial non-specific symptoms and signs and also a low awareness of the clinical presentation and diagnostic procedures among clinicians. We describe a case of an 18-year-old man who was diagnosed with septic arthritis of his left sacro-iliac joint which was complicated by a retroperitoneal abscess. After discussion with the radiologist and orthopaedic surgeons, the abscess was successfully drained via minimally invasive surgery transperitoneally.
Spontaneous omental haematoma – clinical image
Authors: Reid TD , Sheridan WG
Published: April 2010

A case report of spontaneous omental bleeding attributed to a combination of vigorous abdominal exercise and antiplatelet agents. This case serves to high-light the bleeding risks associated with antiplatelet therapy.
An Assessment of Cumulative Axial and Torsional Fatigue in a Cobalt-Base Superalloy
Authors: Kalluri Sreeramesh , Bonacuse Peter J.
Published: April 2010

Cumulative fatigue under axial and torsional loading conditions can include both load-order (high/low and low/high) as well as load-type sequence (axial/torsional and torsional/axial) effects. Previously reported experimental studies on a cobalt-base superalloy, Haynes 188 at 538°C, addressed these effects. These studies characterized the cumulative axial and torsional fatigue behavior under high amplitude followed by low amplitude (Kalluri, S. and Bonacuse, P. J., “Cumulative Axial and Torsional Fatigue: An Investigation of Load-Type Sequence Effects,” in Multiaxial Fatigue and Deformation: Testing and Prediction, ASTM STP 1387, S. Kalluri, and P. J. Bonacuse, Eds., American Society for Testing and Materials, West Conshohocken, PA, 2000, pp. 281–301) and low amplitude followed by high amplitude (Bonacuse, P. and Kalluri, S. “Sequenced Axial and Torsional Cumulative Fatigue: Low Amplitude Followed by High Amplitude Loading,” Biaxial/Multiaxial Fatigue and Fracture, ESIS Publication 31, A. Carpinteri, M. De Freitas, and A. Spagnoli, Eds., Elsevier, New York, 2003, pp. 165–182) conditions. In both studies, experiments with the following four load-type sequences were performed: (a) axial/axial, (b) torsional/torsional, (c) axial/torsional, and (d) torsional/axial. In this paper, the cumulative axial and torsional fatigue data generated in the two previous studies are combined to generate a comprehensive cumulative fatigue database on both the load-order and load-type sequence effects. This comprehensive database is used to examine applicability of the Palmgren–Langer–Miner linear damage rule and a nonlinear damage curve approach for Haynes 188 subjected to the load-order and load-type sequencing described above. Summations of life fractions from the experiments are compared to the predictions from both the linear and nonlinear cumulative fatigue damage approaches. The significance of load-order versus load-type sequence effects for axial and torsional loading conditions is discussed. Possible reasons for the observed differences between the computed and observed summations of cycle fractions are rationalized in terms of the observed evolutions of cyclic axial and shear stress ranges in the cumulative fatigue tests.
Pheochromocytomas detected by biochemical screening in predisposed subjects are associated with lower prevalence of clinical and biochemical manifestations and smaller tumors than pheochromocytomas detected by signs and symptoms
Authors: van Duinen N , Steenvoorden D , Bonsing B A , Vuyk J , Vriends A H J T , Jansen J C , Romijn J A , Corssmit E P M
Published: May 2010

Context

Sporadic pheochromocytomas are detected by clinical signs and symptoms, whereas pheochromocytomas in patients with a known hereditary predisposition for these tumors are detected by repetitive screening for catecholamine excess.

Objective

To document the clinical, biochemical, and pathological differences between patients with sporadic pheochromocytomas, detected by signs and symptoms and patients with pheochromocytomas, detected by biochemical screening in established hereditary syndromes.

Design

Retrospective follow-up study.

Patients and methods

We included 60 consecutive patients diagnosed with pheochromocytoma (pheochromocytomas detected by signs and symptoms: n=28 and pheochromocytomas detected by screening: n=32) in our center.

Results

Patients with pheochromocytomas detected by screening presented with less complaints of diaphoresis (P<0.01), palpitations (P=0.01), paleness (P=0.01), nausea (P<0.01), and vomiting (P=0.01) compared with patients with symptomatic pheochromocytomas. Patients with pheochromocytomas detected by screening tended to be younger at the time of diagnosis (41±2 vs 47±3 years, P=0.07). In addition, patients with pheochromocytomas detected by screening had significantly lower rates of 24-h urinary catecholamine excretion, and considerably smaller tumors (3.7±0.5 vs 7.3±0.7 cm, P<0.01).

Conclusions

Pheochromocytomas detected by screening of patients with a hereditary predisposition have a much lower prevalence of signs and symptoms, lower catecholamine excess, and smaller tumors, compared with sporadic pheochromocytomas, detected by signs and symptoms. These data support the benefits of screening for pheochromocytomas in patients with hereditary syndromes predisposing for these tumors.
Hydronephrosis in the Fetus and Neonate: Causes, Management, and Outcome
Authors: Ringer Steven Alan
Published: April 2010

Hydronephrosis is one of the most commonly identified prenatal anomalies, and the severity may vary from mild to severe, depending on the underlying cause, many of which stem from disruptions in the formation of the renal collecting system. Permanent renal damage may occur if the condition progresses before birth, and in some cases, oligohydramnios may result in lung hypoplasia, a potentially fatal condition. Many cases resolve spontaneously before birth, but for those that do not, the additional prenatal evaluation can identify cases sufficiently severe to require fetal intervention to preserve renal function. The benefits of these interventions are not completely clear and must be balanced against the significant risks of the procedures and their sequelae as well as the questions that remain about long-term efficacy. For other cases, a process of further evaluation before and after birth is warranted, and factors such as cause, severity, and whether the condition is uni- or bilateral are used to formulate decisions about additional assessment and potential intervention. The long-term outcome of the common causes of hydronephrosis and the impact of each of these factors and medical and surgical intervention on this outcome are reviewed.
The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States
Authors: Parks John S. , Lin Michelle , Grosse Scott D. , Hinton Cynthia F. , Drummond-Borg Margaret , Borgfeld Lynette , Sullivan Kevin M.
Published: April 2010

The reported incidence rate of primary congenital hypothyroidism (CH) has been increasing in the United States over the past 2 decades. We have considered the possibility that the inclusion of cases of transient hypothyroidism has inflated the reported incidence rate of CH. Assessing the effects of cases of transient hypothyroidism on the incidence rate is problematic, because the definitions, diagnostic criteria, and differentiation from transient hyperthyrotropinemia vary widely among state newborn screening programs. Among the 4 etiologies for transient hypothyroidism (maternal thyrotropin receptor–blocking antibodies, exposure to maternal antithyroid medications, iodine deficiency, and iodine excess), there is little evidence of increases in the incidence rate from thyrotropin receptor–blocking antibodies. Exposure to antithyroid drugs could contribute significantly to the incidence rate of transient CH, given the high estimated incidence of active maternal hyperthyroidism. Iodine deficiency or excess in the United States seems unlikely to have contributed significantly to the incidence rate of CH, because the secular trend toward lower iodine intake among women of reproductive age in the 1980s and 1990s seems to have plateaued, and perinatal iodine exposure has presumably declined as a result of recommendations to discontinue using iodine-containing disinfectants. Although the female-to-male sex ratio among newborns with thyroid agenesis or dysgenesis (the most common causes of CH) is typically 2:1, analysis of the sex ratio of newborns diagnosed with presumed CH in the United States suggests that a substantial proportion might have transient hypothyroidism or hyperthyrotropinemia, because the sex ratio has been well below the expected 2:1 ratio. Combined ultrasonography and 123I scintigraphy of the thyroid gland are effective tools for identifying cases of thyroid agenesis and dysgenesis and can help to differentiate cases of transient hypothyroidism from true CH. Imaging is also a vital component in evaluating children who, at 3 years of age, undergo a trial of discontinuation of levothyroxine treatment to test for persistence of hypothyroidism. Ultimately, thyroid gland imaging, in conjunction with long-term follow-up studies that appropriately assess and report whether there was permanence of hypothyroidism, will be necessary to address the true incidence rate of CH and any contribution to the observed rate by transient cases of hypothyroidism or hyperthyrotropinemia.
The Scenic Road to Nowhere: Reflections on the History of National Health Insurance in the United States
Authors: Berkowitz Edward D
Published: May 2010

This historical essay looks at the changing meaning of health insurance over time and explains how broad economic and political forces have created that meaning at any one time but that these forces interact with the contingencies of the moment to produce a particular outcome. That outcome in turn influences the subsequent development of health insurance.
Review of Presidential Party Building: Dwight D. Eisenhower to George W. Bush
Authors: Rhodes Jesse H
Published: May 2010

This article reviews Daniel Galvin's Presidential Party Building (Princeton University Press, 2010).
Why the "Death Panel" Myth Wouldn't Die: Misinformation in the Health Care Reform Debate
Authors: Nyhan Brendan
Published: May 2010

Both Bill Clinton and Barack Obama struggled to overcome widespread and persistent myths about their proposals to reform the American health care system. Their difficulties highlight the influence of factual misinformation in national politics and the extent to which it correlates with citizens' political views. In this essay, I explain how greater elite polarization and the growth in media choice have reinforced the partisan divide in factual beliefs. To illustrate these points, I analyze debates over health care reform in 19931994 and 20092010, tracing the spread of false claims about reform proposals from Bill Clinton and Barack Obama and analyzing the prevalence of misinformation in public opinion. Since false beliefs are extremely difficult to correct, I conclude by arguing that increasing the reputational costs for dishonest elites might be a more effective approach to improving democratic discourse.
Stem Cells, Cloning, and Political Liberalism
Authors: Stabile Bonnie B.
Published: May 2010

This paper examines the political and policy making challenges posed by human embryonic stem cell research and somatic cell nuclear transfer, known colloquially as cloning, by applying two facets of John Rawls' construct of political liberalism—the burdens of judgment and overlapping consensus—to consider how such seemingly intractable controversies are resolved in a constitutional democracy. The analysis underscores the importance of both civic and scientific education to promoting the capacity of citizens to achieve what Rawls calls an overlapping consensus of reasonable comprehensive doctrines.
Behavioral Features of Men Who Have Sex with Men (MSM) in Harbin, China
Authors: Tang Houlin , Zhang Weidong , Lv Fan
Published: May 2010

Background: Incidence of homosexuality has been underestimated in China. This study was intended to investigate behavioral features of men having sex with men (MSM) practicing different sexual orientations, and to explore their contribution to the transmission of HIV/AIDS for the effective prevention and intervention measures. Methods: A standardized questionnaire was used to interview 673 MSM in the Harbin city, Heilongjiang province, from June to July in 2006. The information was used to characterize the sexual orientation and behavioral of the MSM. Results: The prevalence of homosexual and bisexual men among MSM were 78.9% and 16.7%, respectively. The rate of receptive anal intercourse was higher among homosexual men (?2 = 18.5, p<0.001), while the rate of inserting anal intercourse was higher among bisexual men (?2 = 18.4, p<0.001). A total of 59.7% of MSM searched for sexual partners on the internet; 1.7% of MSM reported having experience with drug use; and 13.1% of them reported having received an HIV antibody test. Conclusion: The incidence of MSM who also engage in sex with female partners is very high. MSM, including both with homosexual and bisexual orientations, may serve as a contributing factor to transmit HIV from the high risk population to lower risk populations in the presence of unprotected sex.
Addressing the Inadequacies of the Current Healthcare Model with a Universal Healthcare System in the United States
Authors: All Angelo Homayoun
Published: May 2010

Despite the immense amount of resources available in the United States, more than 46 million U.S. citizens remain uninsured. The United States has the means and the resources to provide universal health care. However, before initiating remedial steps, problems associated with the current healthcare system must be analyzed. The healthcare dilemma can be resolved by changing patient behavior, provider performance, reducing unnecessary costs, and better allocation of resources. These changes will necessitate deviations from the current model and, to be successful, should be made step by step and gradually.
Transportation and Health: the Good and the Bad
Authors: Button Kenneth J
Published: May 2010

Transportation has contributed in many ways to improve human life and well‐being. From humanitarian assistance to rapid sharing, food and pharmaceutical transportation does benefit mankind in ways that are not always appreciated. Unfortunately, transportation can negatively impact human health in two broad ways: accidents and environmental pollution. It can also facilitate the spread of infectious diseases. Safe and responsible use of transportation technology is of concern to all users, operators, and technologists, including healthcare providers. Medical professionals should participate in safety and educational campaigns, bioengineering and human factors research, and advocacy of the timely introduction of health and safety policies for a more responsible operation of transportation and new technology insertion.
In the News
Authors: Jacobs William , Nicogossian Arnauld
Published: May 2010

The Editors of the Journal are pleased to provide the readership with the most recent medical and health news. In the Editors' opinion, the materials summarized in this section have the potential for the development of health policies, standards or for use in the daily practice and counseling of patients in preventative care. For additional information readers might wish to visit internet‐based medical news websites, some free of charge, such as MedScape, Stone Heart, American College of Physicians and the World Medical Association.
HIV: The Hidden Face of Human Trafficking
Authors: Stein Richard A.
Published: May 2010

Human trafficking emerges as one of the most significant social, legal, medical, and public health crises of our time. A relatively under‐explored facet of human trafficking is the victim' risk to become infected with HIV and other sexually transmitted pathogens. Several studies reported that significant percentages of trafficking victims are HIV‐positive. In addition, some of the HIV‐positive victims are co‐infected with hepatitis B, tuberculosis, or syphilis. The large numbers of clients, together with the unprotected sexual relationships that many trafficking victims are forced to have, greatly heighten their risk to become infected. Furthermore, just like trafficking, HIV represents a taboo topic in many societies worldwide, and the marginalization of rescued trafficking victims by families and society significantly compounds their suffering and increases their susceptibility for further abuse. The interface between human trafficking and HIV represents an important area that needs to be explored in future studies, and should receive increased attention from public health officials.
Ash dust concentration in the vicinity of ash disposal site, depending on the size of pond (“Water mirror”)
Authors: Grsic Zoran , Milutinovic Predrag , Rajkovic Borivoj , Dramlic Dragan , Velikic Zoran , Dramlic Stefan
Published: April 2010

Thermal power plants Nikola Tesla ?A? and ?B? are large sources of ash from their ashes/slag deposit sites. Total sizes of ashes/slag depots are 600ha and 382ha, with active cassettes having dimensions ~200ha and ~130ha. Active cassettes of the disposal sites are covered by rather large waste ponds, which sizes varies depending on working condition of sluice system and on meteorological conditions. Modeling of ash lifting was attempted using results from dust lifting research. Relation between sizes of ponds and air dust concentration in the vicinity of ash disposal sites was analyzed. As expected, greater sizes of dried disposal site surfaces in combination with stronger winds give greater dust emission and greater air dust concentration.
The Use of Peripherally Inserted Central Catheters in Cancer Patients
Authors: Lin Su-Chen , Wen Kuei-Yen , Liu Chin-Yen , Wei Chih-Hsin
Published: May 2010

From 2002 to 2006, 524 cancer patients who underwent PICC insertion by nursing staff were studied. 568 PICCs were in place for a total of 32068 days (mean duration: 56 days; range: 1 to 487 days). The complication rates were phlebitis – 24.07%, broken/leaking catheter – 12.33%, accidental removal – 7.44%, occlusion – 14.68%, and infection – 1.77%. Group A patients who underwent PICC insertion for the major purpose of receiving repeated chemotherapy had higher incidences of phlebitis, broken/leakage catheter and infection. Group B patients who underwent PICC insertion for the major purpose of hospice care had a higher incidence of accidental removal.
Establishing a Nurse-Led Central Venous Catheter Insertion Service
Authors: Alexandrou Evan , Spencer Tim , Frost Steven A. , Parr Michael , Davidson Patricia M. , Hillman Ken M.
Published: May 2010

Background: Health care systems promote care models that deliver both safety and quality. Nurse-led vascular access teams show promise as a model to achieve hospital efficiencies and improve patient outcomes.

Objectives: The aim of this paper is to discuss the process of establishing a nurse-led central venous catheter (CVC) insertion service in a university affiliated hospital using a process evaluation method.

Method: Archival information, including reports, communications and minutes of departmental meetings were reviewed. Key stakeholders involved in establishing this nurse-led service at the time were interviewed.

Results: A nurse-led CVC insertion service was first established in 1996 and has increased in service provision over 13 years. Initially there was scepticism from some medical practitioners about the feasibility of a nurse performing a traditional medical procedure. The service currently provides central venous access across the hospital including critical care areas. The service places up to 500 catheters per annum.

Conclusions: Establishing a nurse-led CVC insertion service has increased organizational efficiencies and provided an infrastructure for support of best practice. The support of senior management and medical practitioners was crucial to the successful implementation of this model of care.
Prevalence and Predictors of Overweight and Insulin Resistance in Offspring of Mothers With Gestational Diabetes Mellitus
Authors: Boerschmann Heike , Pflüger Maren , Henneberger Lydia , Ziegler Anette-G. , Hummel Sandra
Published: May 2010

OBJECTIVE

Gestational diabetes mellitus (GDM) is associated with high birth weight in the offspring. This may lead to overweight and insulin resistance during childhood. The aim of the study was to assess the impact of GDM on overweight risk and insulin resistance in offspring.

RESEARCH DESIGN AND METHODS

BMI measurements were collected at age 2, 8, and 11 years from 232 offspring of mothers with GDM (OGDM) and compared with those from 757 offspring of mothers with type 1 diabetes (OT1D) and 431 offspring of nondiabetic mothers (ONDM) born between 1989 and 2000. Insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR]) was determined at age 8 and 11 years in 751 children (74 OGDM). Overweight was defined as BMI percentile ≥90; insulin resistance was defined by HOMA-IR.

RESULTS

Overweight prevalence was increased in OGDM compared with OT1D and to ONDM throughout childhood (age 11 years 31.1, 15.8, and 15.5%; P = 0.005). Maternal obesity was an important predictor of overweight risk in children (age 11 years odds ratio 7.0 [95% CI 1.8–27.7]; P = 0.006); birth size and maternal smoking during pregnancy were inconsistently associated with and treatment of GDM during pregnancy did not affect overweight risk. HOMA-IR was increased in OGDM compared with offspring of ONDM mothers (P = 0.01, adjusted for sex and age) and was associated with the child's BMI (P = 0.004).

CONCLUSIONS

Overweight and insulin resistance in children is increased in OGDM compared with OT1D or ONDM. The finding that overweight risk is associated mainly with maternal obesity suggests that familial predisposition contributes to childhood growth in these offspring.
Prevalence and Clinical Outcome of Hyperglycemia in the Perioperative Period in Noncardiac Surgery
Authors: Frisch Anna , Chandra Prakash , Smiley Dawn , Peng Limin , Rizzo Monica , Gatcliffe Chelsea , Hudson Megan , Mendoza Jose , Johnson Rachel , Lin Erica , Umpierrez Guillermo E.
Published: May 2010

OBJECTIVE

Hospital hyperglycemia, in individuals with and without diabetes, has been identified as a marker of poor clinical outcome in cardiac surgery patients. However, the impact of perioperative hyperglycemia on clinical outcome in general and noncardiac surgery patients is not known.

RESEARCH DESIGN AND METHODS

This was an observational study with the aim of determining the relationship between pre- and postsurgery blood glucose levels and hospital length of stay (LOS), complications, and mortality in 3,184 noncardiac surgery patients consecutively admitted to Emory University Hospital (Atlanta, GA) between 1 January 2007 and 30 June 2007.

RESULTS

The overall 30-day mortality was 2.3%, with nonsurvivors having significantly higher blood glucose levels before and after surgery (both P < 0.01) than survivors. Perioperative hyperglycemia was associated with increased hospital and intensive care unit LOS (P < 0.001) as well as higher numbers of postoperative cases of pneumonia (P < 0.001), systemic blood infection (P < 0.001), urinary tract infection (P < 0.001), acute renal failure (P = 0.005), and acute myocardial infarction (P = 0.005). In multivariate analysis (adjusted for age, sex, race, and surgery severity), the risk of death increased in proportion to perioperative glucose levels; however, this association was significant only for patients without a history of diabetes (P = 0.008) compared with patients with known diabetes (P = 0.748).

CONCLUSIONS

Perioperative hyperglycemia is associated with increased LOS, hospital complications, and mortality after noncardiac general surgery. Randomized controlled trials are needed to determine whether perioperative diabetes management improves clinical outcome in noncardiac surgery patients.
Fluid balance, glomerular filtration rate, and urine output in dogs anesthetized for an orthopedic surgical procedure
Authors: Boscan Pedro , Pypendop Bruno H. , Siao Kristine T. , Francey Thierry , Dowers Kristy , Cowgill Larry , Ilkiw Jan E.
Published: May 2010

Objective—To determine fluid retention, glomerular filtration rate, and urine output in dogs anesthetized for a surgical orthopedic procedure.

Animals—23 dogs treated with a tibial plateau leveling osteotomy.

Procedures—12 dogs were used as a control group. Cardiac output was measured in 5 dogs, and 6 dogs received carprofen for at least 14 days. Dogs received oxymorphone, atropine, propofol, and isoflurane for anesthesia (duration, 4 hours). Urine and blood samples were obtained for analysis every 30 minutes. Lactated Ringer's solution was administered at 10 mL/kg/h. Urine output was measured and glomerular filtration rate was estimated. Fluid retention was measured by use of body weight, fluid balance, and bioimpedance spectroscopy.

Results—No difference was found among control, cardiac output, or carprofen groups, so data were combined. Median urine output and glomerular filtration rate were 0.46 mL/kg/h and 1.84 mL/kg/min. Dogs retained a large amount of fluids during anesthesia, as indicated by increased body weight, positive fluid balance, increased total body water volume, and increased extracellular fluid volume. The PCV, total protein concentration, and esophageal temperature decreased in a linear manner.

Conclusions and Clinical Relevance—Dogs anesthetized for a tibial plateau leveling osteotomy retained a large amount of fluids, had low urinary output, and had decreased PCV, total protein concentration, and esophageal temperature. Evaluation of urine output alone in anesthetized dogs may not be an adequate indicator of fluid balance.
Identification of variants of the SPINK1 gene and their association with pancreatitis in Miniature Schnauzers
Authors: Bishop Micah A. , Xenoulis Panagiotis G. , Levinski Melinda D. , Suchodolski Jan S. , Steiner Jörg M.
Published: May 2010

Objective—To evaluate the serine protease inhibitor, Kazal type 1 (SPINK1) gene for variants and to determine their possible association with pancreatitis in Miniature Schnauzers.

Animals—39 Miniature Schnauzers with pancreatitis, 25 healthy Miniature Schnauzers, and 23 healthy dogs of other breeds.

Procedures—The entire canine SPINK1 gene with its intron-exon boundaries was initially sequenced in 22 Miniature Schnauzers. Then, 2 regions of the gene were sequenced in 65 additional canine DNA samples at the locations of variants identified in the initial sequencing of the entire SPINK1 gene.

Results—Analysis of the SPINK1 gene in Miniature Schnauzers revealed 3 closely associated variants in healthy Miniature Schnauzers and Miniature Schnauzers with pancreatitis. These variants consisted of 2 missense mutations in the second exon (N20K and N25T) and a poly T insertion in the third intron that was near the boundary of exon 3 (IVS3+26–27ins(T)33–39,15_61dup11). Pancreatitis was significantly associated with homozygous alleles for these 3 variants in Miniature Schnauzers. In healthy dogs of other breeds, only the 2 exon variants were identified.

Conclusions and Clinical Relevance—Variants of the SPINK1 gene may be associated with the development of pancreatitis in Miniature Schnauzers.
Evaluation of the effect of phosphodiesterase on equine platelet activation and the effect of antigen challenge on platelet phosphodiesterase activity in horses with recurrent airway obstruction
Authors: Dunkel Bettina , Rickards Karen J. , Werling Dirk , Page Clive P. , Cunningham Fiona M.
Published: May 2010

Objective—To determine whether expression of equine platelet activation–dependent surface markers is influenced by phospodiesterase (PDE) isoenzyme activity and whether antigen challenge alters platelet PDE activity in horses with recurrent airway obstruction (RAO).

Animals—16 horses.

Procedures—7 healthy horses were used for in vitro experiments, 6 horses with RAO were used for antigen challenge, and 6 healthy horses were used as control animals. Three of the healthy horses had also been used in the in vitro experiments. Effects of PDE inhibition and activation of adenylyl cyclase on CD41/61 and CD62P expression on platelets and platelet-neutrophil aggregate formation in vitro were investigated via flow cytometry. Platelet PDE activity and sensitivity to inhibition of PDE3 and PDE5 isoenzymes were examined in horses with RAO and control horses before and after antigen challenge.

Results—Inhibition of PDE or activation of adenylyl cyclase significantly inhibited stimulus-induced expression of CD41/61 and CD62P (by approx 94% and 40%, respectively) and percentage of CD62P positive cells (by approx 30%). Only the PDE3 inhibitor, trequinsin, caused a significant (53%) reduction in platelet-neutrophil aggregate formation. Platelet PDE activity decreased following antigen challenge in RAO-affected horses and control horses. In horses with RAO, a significant increase in sensitivity of platelet PDE to inhibition by the PDE5 inhibitor zaprinast was observed after 5 hours.

Conclusions and Clinical Relevance—Results provided further evidence that PDE3 is an important regulator of equine platelet activation and suggested that changes in regulation of platelet PDE5 may contribute to antigen-induced response in horses with RAO.
Evaluation of the function of polymorphonuclear neutrophilic leukocytes in healthy dogs given a high dose of methylprednisolone sodium succinate
Authors: Shimamura Shunsuke , Kanayama Kozue , Shimada Takuya , Maeda Kenichi , Nakao Ruriko , Kobayashi Saori , Sato Reeko , Okano Shozo
Published: May 2010

Objective—To evaluate effects of a high dose of methylprednisolone sodium succinate (MPSS) on function of polymorphonuclear neutrophilic leukocytes (PMNs) in dogs.

Animals—7 healthy male Beagles (body weight, 10.5 to 15 kg; age, 2 to 4 years).

Procedures—All dogs were treated by IV administration of a high dose of MPSS (30 mg/kg). Additional doses of MPSS (15 mg/kg) were administered IV at 2 and 6 hours and then at 6-hour intervals until 48 hours after the initial dose. Blood samples were collected before and 1, 2, 4, 7, and 14 days after completion of the MPSS administrations and used for evaluation of PMN functions. Isolated PMNs were used for assessment of functions, such as adhesion, migration, phagocytosis, and oxidative burst.

Results—On days 1, 2, and 4 after completion of MPSS administration, there was a decrease in PMN expression of adhesion markers such as CD11b and CD18. There was a decrease in the phagocytotic ability of PMNs on days 1, 2, and 7 after completion of MPSS administration, with a reduction in the oxidative burst of PMNs detected on day 7. No significant changes were identified for migration. All functional changes returned to their pretreatment values by 14 days after completion of MPSS treatment.

Conclusions and Clinical Relevance—Treatment with a high dose of MPSS suppressed PMN functions in dogs. Analysis of these results suggested that treatment with a high dose of MPSS can suppress some of the major functions of PMNs for at least 7 days.
Effects of lithium carbonate on carboplatin-induced thrombocytopenia in dogs
Authors: Leclerc Amélie , Abrams-Ogg Anthony C. G. , Kruth Stephen A. , Bienzle Dorothee
Published: May 2010

Objective—To describe the effects of lithium carbonate on thrombopoiesis in clinically normal dogs and in dogs treated with carboplatin.

Animals—18 young adult sexually intact female Beagles.

Procedures—Dogs were assigned to each of 3 treatment groups (6 dogs/group). Group 1 received 150 mg of lithium carbonate (14 to 16 mg/kg), PO, every 12 hours on days 1 through 21. Group 2 received carboplatin (300 mg/m2, IV) on day 0 and cephalexin (30 mg/kg, PO, q 12 h) on days 14 through 21. Group 3 received lithium, carboplatin, and cephalexin at the aforementioned doses and schedules. Plasma lithium and blood platelet concentrations were measured on days 0, 2, 4, 7, 9, 11, 14, 16, 18, and 21. Number of megakaryocytes in bone marrow specimens and the percentage of large unstained cells and CD34+ mononuclear cells in bone marrow aspirates were determined on days 0, 7, 14, and 21 by manual enumeration, automated hematologic analysis, and flow cytometric immunophenotyping, respectively.

Results—Plasma lithium concentrations ranged from 0.12 to 2.41 mmol/L. All dogs given lithium achieved a concentration within the target interval of 0.5 to 1.5 mmol/L by days 4 to 7. Thrombopoiesis was increased in dogs receiving lithium alone. All dogs given carboplatin developed mild thrombocytopenia. There were no differences between group 2 and group 3 throughout the study.

Conclusions and Clinical Relevance—Lithium stimulated thrombopoiesis in clinically normal dogs. Lithium administration at the doses and schedules used, with concurrent administration of cephalexin, did not prevent thrombocytopenia induced by carboplatin.
Evaluation of the effects of transendoscopic diode laser palatoplasty on clinical, histologic, magnetic resonance imaging, and biomechanical findings in horses
Authors: Alkabes Kira C. , Hawkins Jan F. , Miller Margaret A. , Nauman Eric , Widmer William , Dunco Doug , Kras Jeffery , Couetil Laurent , Lescun Timothy , Gautam Raju
Published: May 2010

Objective—To determine the effects of diode laser palatoplasty on the soft palate in horses.

Animals—6 clinically normal horses and 6 euthanized horses from another study.

Procedures—6 horses underwent diode laser palatoplasty (treated horses); 3 received low-dose laser treatment (1,209 to 1,224 J), and 3 received high-dose treatment (2,302 to 2,420 J). Six other horses received no treatment (control horses). The upper respiratory tracts of all treated horses were evaluated immediately following surgery (day 0) and on days 2, 7, 14, 21, 30, and 45. Horses were euthanized on day 45, and magnetic resonance imaging (MRI) of the head was performed. The soft palate was removed from treated and control horses, evaluated grossly, and scored for edema, inflammation, and scarring. Soft palates from all horses were sectioned for histologic and biomechanical evaluations.

Results—Endoscopic examination revealed a significant increase in soft palate scarring and decrease in edema and inflammation in treated horses by day 7. Gross postmortem findings corresponded with MRI findings. Gross and histologic examination revealed a significant increase in scarring, edema, and inflammation at day 45. Histologic evaluation of palatal tissue from high-dose–treated horses revealed full-thickness injury of skeletal muscle, with atrophy of muscle fibers; findings in low-dose–treated horses indicated superficial injury to skeletal muscle. After surgery, treated horses had a significant decrease in soft palate elastic modulus, compared with control horses.

Conclusions and Clinical Relevance—Laser palatoplasty resulted in soft palate fibrosis and skeletal muscle loss; however, the fibrosis did not result in an increase in soft palate elastic modulus.
Response to experimentally induced infection with bovine respiratory syncytial virus following intranasal vaccination of seropositive and seronegative calves
Authors: Ellis John A. , Gow Sheryl P. , Goji Noriko
Published: May 2010

Objective—To determine whether a combination modified-live bovine respiratory syncytial virus (BRSV) vaccine can stimulate protective immunity in young BRSV-seropositive calves following intranasal (IN) administration.

Design—Controlled challenge study.

Animals—66 Holstein bull calves, 3 to 8 days old.

Procedures—In experiment 1, BRSV-seropositive and -seronegative calves were vaccinated IN with a commercially available combination modified-live virus vaccine formulated for SC administration; calves underwent BRSV challenge 4.5 months later. In experiment 2, BRSV-seronegative calves were vaccinated IN or SC (to examine the effect of route of administration) with the same combination vaccine that instead had a 1/100 dose of BRSV (to examine the effect of dose); calves underwent BRSV challenge 21 days later.

Results—In experiment 1, BRSV challenge resulted in severe respiratory tract disease with low arterial partial pressures of oxygen and lung lesions in most calves from all groups. Maximum change in rectal temperature was significantly greater in seropositive IN vaccinated calves, compared with seronegative IN vaccinated and seropositive control calves. Number of days of BRSV shedding was significantly lower in seronegative IN vaccinated calves than in seropositive IN vaccinated and seropositive control calves. In experiment 2, maximum change in rectal temperature was significantly greater in seronegative control calves, compared with seronegative IN and SC vaccinated calves. Shedding of BRSV was significantly reduced in seronegative IN and SC vaccinated calves, compared with control calves; also, lung lesions were reduced in seronegative IN and SC vaccinated calves.

Conclusions and Clinical Relevance—Maternal antibodies may inhibit priming of protective responses by IN delivered BRSV vaccines.
Asymptomatic Spondylolisthesis and Pregnancy
Authors: Elliott James , Fleming Helen , Tucker Kylie
Published: April 2010

The patient was a 32-year-old woman diagnosed with grade III spondylolisthesis at the age of 18. While the patient had not experienced back pain in recent years, she anticipated a recurrence of symptoms during her final trimester of pregnancy. Lumbar magnetic resonance imaging was used to confirm the presence of grade IV spondylolisthesis. J Orthop Sports Phys Ther 2010;40(5):324. doi:10.2519/jospt.2010.0407
Instrumental Analysis of Volatiles in Air-and Nitrogen-Packed Peanut Butter
Authors: Fore S. P. , Fisher G. S. , Legendre M. G. , Wadsworth J. I.
Published: April 2010

Air- and nitrogen-packed samples from the same production lot of peanut butter, stored in the dark at 25°C for 1 yr, were analyzed periodically by direct gas chromatography. The ratio of methylbutanal to hexanal was consistently higher in nitrogen-packed than in equivalent air-packed samples and decreased throughout the storage period for both types of samples. Correlation coefficients, significant at 0.1%, were 0.99 for nitrogen-packed and 0.96 for air-packed samples. A total of 35 volatile components of peanut butter were identified by combined direct gas chromatography—mass spectrometry, and another 6 were tentatively identified.
Evaluation of the Peanut Administrative Committee Testing Program for Aflatoxin in Shelled Peanuts1
Authors: Whitaker T. B. , Dickens J. W.
Published: April 2010

Under provisions of a USDA Marketing Agreement, an aflatoxin control program for peanuts produced in the United States is administered by the Peanut Administrative Committee (PAC) composed of peanut growers and shellers. The PAC requires aflatoxin tests on all commercial lots of shelled peanuts.

The present PAC testing program initiated in 1975 was evaluated for Crop A which averaged 9.5 parts-per-billion (ppb) aflatoxin and for Crop B which averaged 5.2 ppb aflatoxin. For Crop A and Crop B, respectively, 7.3% and 2.0% of the lots were rejected. The accepted lots contained an average of 7.5 ppb for Crop A and 4.7 ppb for Crop B. A correct decision (accept a lot with le; 25 ppb aflatoxin and reject a lot with > 25 ppb aflatoxin) was made 95% of the time for Crop A and 98% of the time for Crop B.