bluuebunny/crossref_metadata_2025 huggingface dataset:
Primers for amplifying the hypervariable, male‐transmitted COII‐COI junction region in amblemine freshwater mussels (Bivalvia: Unionoidea: Ambleminae)
Authors: WALKER JENNIFER M. , BOGAN ARTHUR E. , BONFIGLIO ELSIE A. , CAMPBELL DAVID C. , CHRISTIAN ALAN D. , CUROLE JASON P. , HARRIS JOHN L. , WOJTECKI RUDY J. , HOEH WALTER R.
Published: November 2006

Freshwater bivalves in the superfamily Unionoidea possess distinct male (M)‐ and female (F)‐transmitted mitochondrial DNA (mtDNA). The former evolves independently of and at a significantly faster rate than the latter. Thus, population genetic and phylogenetic analyses of M sequences facilitate the generation of independent estimates of genetic variation and evolutionary relationships which are often more robust than those provided by analyses of F sequences alone. However, M mtDNA's rapid substitution rate often renders polymerase chain reaction (PCR) amplification difficult with ‘universal’ primers. Herein, we report on three pairs of PCR primers that consistently amplify the hypervariable M COII‐COI gene junction region in 25 bivalve genera (Unionoidea: Ambleminae).
Eleven microsatellite loci in the sociobiologically enigmatic antLasius austriacus(Hymenoptera: Formicidae)
Authors: STEINER F. M. , ARTHOFER W. , SCHLICK‐STEINER B. C. , CROZIER R. H. , STAUFFER C.
Published: November 2006

We describe the isolation and characterization of 11 microsatellite loci in the sociobiologically enigmatic antLasius austriacus. The polymerase chain reaction primers were tested on a population in East Austria. The number of alleles ranged from four to 19 and the observed heterozygosity from 0.200 to 0.900. Cross‐species amplification tests were performed, with some loci polymorphic in all species tested, for the closely related invasive speciesLasius neglectus, three furtherLasiusspecies, another formicine,Formica polyctena, and the invasive myrmicine speciesTetramorium tsushimae.
‘Science’, representation and resistance: the Bt cotton debate in Andhra Pradesh, India
Authors: PEARSON MARK
Published: November 2006

Transgenic cotton is promoted in India on the basis that it will improve rural livelihoods, but such claims are contested on the basis that they are ‘unscientific’. In this study, discourse analysis is utilized to deconstruct the environmental and scientific narratives employed by two key actors (Monsanto‐Mahyco and the Deccan Development Society) in the debate in India. Whilst strong differences in the ideology of the two actors are found to account for their approaches to managing the environment, significant similarities in their approach to science and their recourse to Foucauldian governmentality are also evident. The conclusion considers how the use of discourse analysis could empower the rural poor to take part in the debate in India.
Good, bad or ‘necessary evil’? Reinterpreting the colonial burning experiments in the savanna landscapes of West Africa
Authors: LARIS PAUL , WARDELL DAVID ANDREW
Published: November 2006

A simple ecological model underlies contemporary fire policy in many West African countries. The model holds that the timing (or seasonality) of annual savanna fires is a principal determinant of vegetation cover. The model's origin can be traced to the ideas held by influential colonial scientists who viewed anthropogenic fire as a prime force of regional environmental degradation. The main evidence in support of the model derives from the results of a series of long‐term burning experiments carried out during last century. The experimental results have been repeatedly mapped onto fire policy often taking the form of a three‐tiered model in which fire exclusion is considered the ultimate management objective, late dry‐season fire is discouraged and early dry‐season fire is allowed but only under specific, often state‐controlled circumstances. This paper provides a critique of contemporary fire policy in the region and the fire ecology model on which it is based. Through an analysis of burn scars for the 2002–3 fire season generated from ETM+ imagery, the study documents the spatiotemporal pattern of burning for an area in southern Mali. It argues that current policy, which is informed by an a‐spatial model, cannot adequately account for the critical pattern of burning that is characteristic of the region. A reinterpretation of the burning experiments is presented in light of four factors: empirical data; recent developments in patch‐mosaic theory; historical evidence on the effects of fire suppression; and data on indigenous burning strategies, all of which suggest a need to reconsider current fire policy.
Perceptions of water in a changing hydrological and ecological context: the case of the Logone flood plains in Cameroon
Authors: MOLENAAR JAN WILLEM , VAN SANTEN JOSÉ C M
Published: November 2006

We look at the beliefs of the population in North Cameroon concerning water, fish and water spirits in the context of the construction of a dam (1979) and of a flood embankment for a rice irrigation scheme financed by the World Bank. These operations caused a drought that had severe effects on the environment and the inhabitants’ economic activities. Acknowledging the new approaches within development and ecological development thinking, we emphasize that local people are part of their environment, and that the environment and people's use of the ecosystem ought to be regarded as a functional unit. Our main argument is that the success of environmental strategies requires that the unequal power relations between the different actors and agencies and the perceptions of policymakers and NGOs be analysed and examined regularly in the course of a project to test their aims and integrity. In addition, the positions of beings and cosmological entities, which in the eyes of the population are ‘actors of power to be reckoned with’, like the water spirit, should also be included. The hidden agendas of all actors can be as difficult as the water spirit (Maama Waata) itself, by which we mean that hidden agendas are equally a part of reality as is the water spirit, even if they are not visible at first.
Partnerships for protected area conservation in Rwanda
Authors: RUTAGARAMA EUGENE , MARTIN ADRIAN
Published: November 2006

This paper seeks to contribute to Rwanda's ongoing restructuring of protected area management. The early part of the paper draws on experiences elsewhere in Africa, as well as key contexts in Rwanda, to assert that conservation of national parks may best be served by flexible and inclusive partnerships that seek to integrate conservation activities across different agents and scales. This assertion is then explored more critically through empirical research that investigates the views of potential conservation partners. The findings suggest that attempts to develop partnerships that are built around national parks will face difficulties. Whilst there is a general willingness to be further involved in park management, this is complicated by cleavages in beliefs about how wider participation might be implemented. In particular, it is only international conservation NGOs that currently seem to be comfortable with the national park approach to conservation management: only they see themselves as having the expertise to be decision‐making partners and only they would want their role in a partnership to be formalized.
Population mobility and the survival of small farming in the Rio Grande Valley, Jamaica
Authors: ISHEMO AMANI , SEMPLE HUGH , THOMAS‐HOPE ELIZABETH
Published: November 2006

The relationship between population mobility and farming is complex and has been the focus of numerous studies. Despite differing perspectives on the subject, there is an increasing realization that migration sustains farming in many rural communities, but with contradictory effects. Notwithstanding this conclusion, there is a paucity of village level studies that explain the precise ways in which migration in its various forms affects the survival of small farms. This paper reports on the results of a village level study of migration and small farming in the Rio Grande Valley of Jamaica. Apart from highlighting the various ways in which migration affects small farming at the local level, the study confirms the contradictory impact of migration on small farming in this remote agricultural community. It is noted, however, that the net effect is positive and the capital and labour resources, which are made available as a result of migration, play pivotal roles in the survival of small‐scale farming as an economic activity in the area.
Variations in the transient prograde geothermal gradient from chloritoid‐staurolite equilibria: a case study from the Barrovian and Buchan‐type domains in the Bohemian Massif
Authors: KOŠULIČOVÁ M. , ŠTÍPSKÁ P.
Published: November 2006

Thermodynamic modelling of metamorphic rocks increases the possibilities of deciphering prograde paths that provide important insights into early orogenic evolution. It is shown that the chloritoid–staurolite transition is not only an indicator of temperature on prograde P–T paths, but also a useful indicator of pressure. The approach is applied to the Moravo‐Silesian eastern external belt of the Bohemian Massif, where metamorphic zones range from biotite to staurolite‐sillimanite. In the staurolite zone, inclusions of chloritoid occur in garnet cores, while staurolite is included at garnet rims and is widespread in the matrix. Chloritoid XFe = 0.91 indicates transition to staurolite at 5 kbar and 550 °C and consequently, an early transient prograde geothermal gradient of 29 °C km−1. The overall elevated thermal evolution is then reflected in the prograde transition of staurolite to sillimanite and in the achievement of peak temperature of 660 °C at a relatively low pressure of 6.5 kbar. To the south and to the west of the studied area, high‐grade metamorphic zones record a prograde path evolution from staurolite to kyanite and development of sillimanite on decompression. Transition of chloritoid to staurolite was reported in two places, with chloritoid XFe = 0.75–0.80, occurring at 8–10 kbar and 560–580 °C, and indicating a transient prograde geothermal gradient of 16–18 °C km−1. These data show variable barric evolutions along strike and across the Moravo‐Silesian domain. Elevated prograde geothermal gradient coincides with areas of Devonian sedimentation and volcanism, and syn‐ to late Carboniferous intrusions. Therefore, we interpret it as a result of heat inherited from Devonian rifting, further fuelled by syntectonic Carboniferous intrusions.
Evolution of Prevalence of Depressive Symptoms and Antidepressant Use Between 1988 and 1999 in a Large Sample of Older French People: Results from the Personnes Agées Quid Study
Authors: Montagnier Delphine , Barberger‐Gateau Pascale , Jacqmin‐Gadda Hélène , Dartigues Jean‐François , Rainfray Muriel , Pérès Karine , Lechevallier‐Michel Nathalie , Fourrier‐Réglat Annie
Published: November 2006

OBJECTIVES: To describe the evolution of prevalence of depressive symptoms and antidepressant use between 1988 and 1999 in a large representative sample of older community‐dwelling French people.

DESIGN: Prospective cohort designed in 1988/89 to study cerebral and functional aging.

SETTING: Urban and rural communities in southwestern France.

PARTICIPANTS: Three thousand six hundred thirty‐seven adults aged 65 and older living in noninstitutional settings at baseline.

MEASUREMENTS: Participants were interviewed 3, 5, 8, and 10 years after the initial data collection. Depressive symptomatology was evaluated using a French version of the Center for Epidemiological Studies Depression Scale. Longitudinal analysis of the prevalence of depressive symptomatology was performed using a logistic mixed model adjusted for antidepressant use, sex, age, education level, living conditions, psychiatric antecedents, drug consumption, and diagnosis of dementia.

RESULTS: Over the 10 years of follow‐up, the prevalence of depressive symptomatology decreased from 13.8% to 8.3%. This decrease was statistically significant even after adjustment (odds ratio=0.88 per increased year, 95% confidence interval=0.85–0.90) and was more pronounced in subjects having reported previous depression at baseline. During the same period, antidepressant use rose from 5.2% to 11.9%, mainly due to increased use of selective serotonin reuptake inhibitors. Furthermore, the proportion of subjects who had depressive symptoms and did not use antidepressants decreased from 11.8% to 6.2%.

CONCLUSION: This study suggests better management of late‐life depression in the last decade and illustrates the heterogeneity of depression disorder in late life.
Longitudinal Change in Positive Affect in Community‐Dwelling Older Persons
Authors: Kurland Brenda F. , Gill Thomas M. , Patrick Donald L. , Larson Eric B. , Phelan Elizabeth A.
Published: November 2006

OBJECTIVES: To determine whether positive affect, defined as emotional contentment and happiness, remains stable in late life and to identify predictors of longitudinal change in positive affect.

DESIGN: Longitudinal observational study.

SETTING: Community.

PARTICIPANTS: Six hundred sixty‐three individuals aged 70 and older without disability at baseline and free of chronically depressed mood.

MEASUREMENTS: Positive affect, social network, social activity, chronic health conditions, activities of daily living, instrumental activities of daily living (IADLs), cognitive functioning, and negative affect measured over 54 months, at 18‐month intervals, up to four times.

RESULTS: Positive affect remained relatively stable over 4.5 years of follow‐up. Higher average levels of social activity and lower levels of negative affect were associated with higher positive affect. An increase of 1 point in negative affect (on a 7‐point scale) was associated with a 0.23‐point concurrent decrease in positive affect (on a 5‐point scale). Needing help in an additional IADL was associated with a decrease in positive affect of 0.04 points. A greater number of chronic conditions at enrollment was associated with lower positive affect.

CONCLUSION: Positive affect is directly correlated with social involvement and inversely correlated with negative affect, IADL functioning, and comorbidity. Positive affect was mostly related to factors that do not change over time, although it showed some sensitivity to short‐ and long‐term changes in physical health and functioning.
Dynamic Balance and Stepping Versus Tai Chi Training to Improve Balance and Stepping in At‐Risk Older Adults
Authors: Nnodim Joseph O. , Strasburg Debra , Nabozny Martina , Nyquist Linda , Galecki Andrzej , Chen Shu , Alexander Neil B.
Published: November 2006

OBJECTIVES: To compare the effect of two 10‐week balance training programs, Combined Balance and Step Training (CBST) versus tai chi (TC), on balance and stepping measures.

DESIGN: Prospective intervention trial.

SETTING: Local senior centers and congregate housing facilities.

PARTICIPANTS: Aged 65 and older with at least mild impairment in the ability to perform unipedal stance and tandem walk.

INTERVENTION: Participants were allocated to TC (n= 107, mean age 78) or CBST, an intervention focused on improving dynamic balance and stepping (n=106, mean age 78).

MEASUREMENTS: At baseline and 10 weeks, participants were tested in their static balance (Unipedal Stance and Tandem Stance (TS)), stepping (Maximum Step Length, Rapid Step Test), and Timed Up and Go (TUG).

RESULTS: Performance improved more with CBST than TC, ranging from 5% to 10% for the stepping tests (Maximum Step Length and Rapid Step Test) and 9% for TUG. The improvement in TUG represented an improvement of more than 1 second. Greater improvements were also seen in static balance ability (in TS) with CBST than TC.

CONCLUSION: Of the two training programs, in which variants of each program have been proven to reduce falls, CBST results in modest improvements in balance, stepping, and functional mobility versus TC over a 10‐week period. Future research should include a prospective comparison of fall rates in response to these two balance training programs.
Methicillin‐Resistant Staphylococcus aureus Colonization Is Associated with Higher Mortality in Nursing Home Residents with Impaired Cognitive Status
Authors: Suetens Carl , Niclaes Luc , Jans Béatrice , Verhaegen Jan , Schuermans Annette , Van Eldere Johan , Buntinx Frank
Published: November 2006

OBJECTIVES: To assess the effect of methicillin‐resistant Staphylococcus aureus (MRSA) colonization on morbidity and mortality of nursing home residents.

DESIGN: Three‐year cohort study from 2000 to 2003.

SETTING: Twenty‐three nursing homes of all types and regions in the northern part of Belgium (Flanders).

PARTICIPANTS: Two thousand eight hundred fourteen nursing home residents.

MEASUREMENTS: The consequences of MRSA colonization on mortality and hospitalization were studied, adjusting for potential confounders. Dates and cause of death and hospitalization were collected every 6 months during 3 years of follow‐up.

RESULTS: After adjustment for age, sex, and Charlson comorbidity index, the risk for 36‐month mortality remained significantly higher in MRSA carriers (hazard ratio (HR)= 1.4, 95% confidence interval (CI) = 1.1–1.8) than in noncarriers. The effect of MRSA on mortality was dependent on the degree of cognitive impairment, with the highest effect in patients with severe cognitive impairment (adjusted HR =1.8, 95% CI =1.1–2.8) and absence of effect in residents with good mental status (adjusted HR =0.8, 95% CI =0.43–1.62). Deaths were more frequently reported to be infection‐related in MRSA carriers. No association was found between MRSA colonization and hospitalization for any reason, but during follow‐up, MRSA carriers were twice as frequently hospitalized for respiratory tract infections.

CONCLUSION: Colonization of MRSA in Belgian nursing home residents was associated with higher mortality. This excess mortality was restricted to residents with impaired cognitive function, probably reflecting differences in therapeutic approaches, in delay of diagnosis of pneumonia and other acute disorders in these patients, or in both.
Cooperative Dementia Care Clinics: A New Model for Managing Cognitively Impaired Patients
Authors: Lessig Mary , Farrell Jeanette , Madhavan Ernest , Famy Christopher , Vath Brian , Holder Teresa , Borson Soo
Published: November 2006

Cooperative health care clinics (CHCCs), or shared medical appointments, are a healthcare innovation that can improve access and expand physicians' capacity to manage common geriatric conditions. This report describes a pilot program and working model for extending CHCCs to patients with dementia. Three cooperative dementia care clinics (CDCCs) met monthly for up to 1 year, drawing participants from a dementia clinic roster of patients and caregivers who had required continued specialty care for at least 3 months. Twenty‐six of 33 eligible patient–caregiver dyads expressed interest, and 21 enrolled; five whose clinical status changed during the year withdrew and were replaced with new members. Brief introductory socialization, individualized clinical management, and an educational focus selected from problems of patients and caregivers were common to all sessions. Most participants required several types of clinical intervention and educational support. One group ended after reaching a natural termination point, and two others are ongoing at the request of participants. CDCCs can be a viable approach to increasing dementia care capacity in health systems. Formal service intervention trials to evaluate the generalizability and comparative effectiveness and economic viability of this model versus usual care are an appropriate next step.
Prognostic Significance of Micturition Disturbances After Acute Stroke
Authors: Pettersen Renate , Wyller Torgeir Bruun
Published: November 2006

OBJECTIVES: To investigate the prevalence, incidence, clinical types, and prognostic effect of micturition disturbances in acute stroke.

DESIGN: Prospective observational study.

SETTING: Geriatric department (stroke and rehabilitation unit) in a community hospital (acute phase); outpatient clinic, patients' own homes, or nursing homes (3 months follow‐up).

PARTICIPANTS: Three hundred fifteen patients (mean age 77) with acute first‐ever or recurrent stroke consecutively admitted to the hospital stroke unit.

MEASUREMENTS: Premorbid basic and instrumental activities of daily living (ADLs) and mental functioning; comorbidity; previous and actual micturition symptoms; stroke syndromes; medication use; and poststroke mobility, ADLs, and cognition.

RESULTS: One hundred forty‐seven patients (46%) had preexisting micturition disturbances (urinary incontinence (UI), n=98; urgency/frequency, n=37; voiding difficulties, n=12). Seventy‐eight developed new symptoms (UI, n=65; urgency/frequency, n=4; sustained retention, n=9). There were two UI types: urge UI (n=27) and UI with impaired awareness of bladder needs (IA UI, n=38). In regression analyses, IA UI was the only micturition disturbance predicting mortality and need for nursing home care at 3 months (odds ratio (OR)=27.5, 95% confidence interval (CI)=7.0–108.2), together with poor mobility (OR=8.2, 95% CI=2.6–26.2), and partial or total anterior circulation stroke type (OR=3.6, 95% CI=1.4–9.0).

CONCLUSION: New‐onset poststroke UI with impaired awareness of bladder needs is a strong and independent risk factor for poor outcome at 3 months. This probably reflects more serious brain damage, affecting sustained attention and information processing. Valid clinical tools to detect such dysfunction in stroke victims are needed. Clinical classification of poststroke UI is likely to improve management.
A sealed and unbreached system for purification, stimulation, and expansion of cytomegalovirus‐specific human CD4 and CD8 T lymphocytes
Authors: Li Pira Giuseppina , Bottone Laura , Ivaldi Federico , Pelizzoli Roberta , Risso Marco , Tripodi Gino , Manca Fabrizio
Published: November 2006

BACKGROUND: Recent clinical trials have demonstrated the efficacy of adoptive cellular therapy with virus‐specific lymphocytes in patients with defective cellular immune responses. Immunoreconstitution has become a challenge for cellular immunology and for transfusion medicine. In fact, both expertises are required to provide effective and safe cellular products. Because of in vitro manipulation, T‐lymphocyte cultures are at risk of contamination even under good manufacturing procedure (GMP) conditions.

STUDY DESIGN AND METHODS: To further improve the quality of these GMP cellular products, a procedure was designed for purification, stimulation, and expansion of antigen‐specific CD4 and CD8 T‐lymphocytes in a sealed, unbreached system. Leukopacks from the blood bank that fulfill the requirements of a GMP product were the starting material. Gradient separation and washing were performed in bags with sterile connecting devices on the bench‐top, as well as addition of ingredients (antigen, interleukin‐2) or transfer to larger bags.

RESULTS: The method is described in detail, and it is shown that increase in number of cytomegalovirus‐specific CD4 or CD8 T‐lymphocytes was similar to procedures based on open culture systems. Cell expansion after 4 weeks ranged from 800‐ to 2400‐fold for CD4 lymphocytes and 300‐ to 900‐fold for CD8 lymphocytes. Antigen specificity and loss of alloreactivity were demonstrated on the expanded cells with proliferation, intracytoplasmic interferon gamma‐γ staining, cytolytic activity, and pentamer binding.

CONCLUSION: This procedure can be applied to improve sterility under GMP conditions when T‐cell lines are generated for adoptive immunotherapy and may increase biosafety for the staff when cell lines are generated from subjects infected with dangerous pathogens.
Role of glycoprotein Ibα in phagocytosis of platelets by macrophages
Authors: Badlou Bahram A. , Spierenburg Gerrit , Ulrichts Hans , Deckmyn Hans , Smid W. Martin , Akkerman Jan‐Willem N.
Published: November 2006

BACKGROUND: Platelet (PLT) storage at 0 to 4°C suppresses bacterial multiplication, but induces clusters of glycoprotein (GP) Ibα that trigger their phagocytosis by macrophages and reduce their survival after transfusion. A method was sought that detects cold‐induced changes in GPIbα involved in phagocytosis.

STUDY DESIGN AND METHODS: Human PLTs were isolated and stored for up to 48 hours at 0°C. Binding of a phycoerythrin (PE)‐labeled antibody directed against amino acids (AA) 1‐35 on GPIbα (AN51‐PE) was compared with phagocytosis of PLTs by matured monocytic THP‐1 cells, analyzed by fluorescence‐activated cell sorting.

RESULTS: Freshly isolated PLTs were detected as a single population of AN51‐PE–positive particles and showed less than 5 percent phagocytosis. Cold storage led to a decrease in AN51‐PE binding and an increase in phagocytosis. N‐Acetylglucosamine, known to interfere with macrophage recognition of GPIbα clusters, restored normal AN51‐PE binding to cold‐stored PLTs and suppressed phagocytosis.

CONCLUSIONS: It is concluded that binding of an antibody against AA 1‐35 on GPIbα reflects changes in GPIbα that make PLTs targets for phagocytosis by macrophages.
Sterility testing of cell therapy products: parallel comparison of automated methods with a CFR‐compliant method
Authors: Khuu Hanh M. , Patel Nayana , Carter Charles S. , Murray Patrick R. , Read Elizabeth J.
Published: November 2006

BACKGROUND: Automated blood culture systems are not FDA‐approved for sterility testing of human cells, tissues, or cellular‐ or tissue‐based products. It was previously demonstrated that BacT/ALERT (bioMérieux) and Bactec (Becton Dickinson) were superior to the manual CFR method described in the general biologics regulations, in rates of detection and time to detection of organisms seeded into mock mononuclear cell products with a variety of background media and antibiotics. In this study, the two automated systems were compared to the CFR method for sterility testing of actual cell therapy products manufactured in our facility.

STUDY DESIGN AND METHODS: Over a 36‐month period, in‐process and final product samples from all cell therapy products manufactured in our facility were tested for sterility both by the CFR method and by either BacT/ALERT or Bactec. Products were categorized according to collection and processing variables for analysis of results.

RESULTS: For 1617 samples of a broad range of cell therapy products, rates of true‐positive tests were comparable for the automated and CFR methods (2.3% vs. 2.1%), but the CFR method had higher rates of false‐positive results (7.3% vs. 0.2%). For automated systems, time to detection of organisms was equivalent to, or faster than, the CFR method.

CONCLUSION: Compared to the CFR method, both BacT/ALERT and Bactec are more sensitive, faster in time to detection, less prone to false‐positive results, and less labor‐intensive. Both of these automated systems are suitable for sterility testing of cell therapy products after site‐specific validation has been performed.
An easy RHD genotyping strategy for D– East Asian persons applied to Korean blood donors
Authors: Luettringhaus Timo A. , Cho Duck , Ryang Dong Wook , Flegel Willy A.
Published: November 2006

BACKGROUND: In East Asian populations RHD alleles are known to occur frequently among D– donors, requiring suitable genotyping strategies. The molecular basis of the “RHDel” allele previously reported in Taiwan to harbor a genomic 1013‐bp deletion was questioned by several authors.

STUDY DESIGN AND METHODS: The presence of the RHD gene was investigated in 126 random serologic D– blood donors from Gwangju, southwest Korea. Four donors who typed weakly positive for the D antigen were also analyzed. RH alleles were determined by polymerase chain reaction (PCR) with sequence‐specific priming (PCR‐SSP) or nucleotide sequencing.

RESULTS: Seventy‐five percent of the serologically D– samples lacked the RHD gene, 10 percent carried the hybrid RHD‐CE(2‐9)‐D2 or RHD‐CE(2‐7)‐D2 alleles, 13 percent represented the RHD(K409K), and 2 percent were weak D type 15 and type 17. Among the four donors typing weak D, two carried weak D type 15, one RHD(K409K), and one the novel weak D type 43. Critical molecular characteristics of RHD(K409K) and its population frequencies were indistinguishable to those reported for the RHDel allele.

CONCLUSION: Korean RHD allele frequencies are comparable to Chinese and Japanese frequencies. It is concluded that the RHDel allele may actually not exist but is identical to RHD(K409K). A practical RHD genotyping strategy applicable to D– donors in all East Asian populations was devised. The strategy requires four PCR‐SSP procedures only for RHD intron 4 and exon 7 as well as RHD(K409K) and non‐RHD(K409K).
New mutation in the platelet β3‐integrin gene: implication for the diagnosis of fetomaternal alloimmunization
Authors: Bertrand Gerald , Bianchi Frederic , Chenet Christophe , Martageix Corinne , Blanchet Patricia , Bäumler Marcel , Kaplan Cecile
Published: November 2006

BACKGROUND: Fetal ventriculomegaly is a relatively common finding and fetomaternal alloimmune thrombocytopenia may be one of the causes.

STUDY DESIGN AND METHODS: Such a case discovered at 21 weeks of gestation leading to platelet (PLT) immunologic testing is reported here. PLT genotyping was performed by polymerase chain reaction (PCR)–sequence‐specific primers (SSPs) method and PCR–restriction fragment length polymorphism (RFLP) analysis. Serologic investigation was done with the monoclonal antibody–specific immobilization of PLT antigens technique.

RESULTS: The mother was found to be HPA‐1b homozygous and the father HPA‐1a homozygous with PCR‐SSP, but the mother was found to be HPA‐1 heterozygous by phenotyping. This result was confirmed by PCR‐RFLP. Sequencing of the glycoprotein IIIa exon 3 revealed a heterozygous mutation 262T>C, which does not induce an amino acid change. It is localized in the sequence of the antisense primer of the HPA‐1 PCR‐SSP, inducing the sole amplification of the DNA copy bearing the HPA‐1b allele.

CONCLUSION: Even if such mutations are a rare event, PLT phenotyping is still of interest to avoid rare false PLT typing assignation, the unknown polymorphism being only discovered by such a combination of techniques.
Evaluation of prenatalRHDtyping strategies on cell‐free fetal DNA from maternal plasma
Authors: Grootkerk‐Tax Martine G.H.M. , Soussan Aicha Ait , De Haas Masja , Maaskant‐van Wijk Petra A. , Van Der Schoot C. Ellen
Published: November 2006

BACKGROUND:The discovery of cell‐free fetal DNA in maternal plasma led to the development of assays to predict the fetal D status withRHD‐specific sequences. Few assays are designed in such a way that the fetus can be typed inRHDψmothers and thatRHDψfetuses are correctly typed. Owing to the limited knowledge about the mechanism responsible for the presence of fetal DNA in maternal plasma, precautions in developing prenatal genotyping strategies must be made.

STUDY DESIGN AND METHODS:Real‐time quantitative (RQ)‐polymerase chain reaction (PCR) assays were developed for prenatal diagnostic use with cell‐free fetal DNA from maternal plasma. An RQ‐PCR assay onRHDexon 5 (amplicon 361 bp), negative onRHDψ, was developed with genomic DNA and evaluated with cell‐free fetal DNA. A previously publishedRHDexon 5 RQ‐PCR (amplicon 82 bp) was duplexed with an in‐house developedRHDexon 7 RQ‐PCR and evaluated with cell‐free fetal DNA from pregnant D–RHDψ+ women.

RESULTS:TheRHDexon 5 361 bp assay showed on cell‐free plasma DNA from D– women carrying a D+ fetus, low amplification levels, resulting in high Ct values and false‐negative results. Owing to fragmentation of cell‐free plasma DNA, too few DNA stretches of sufficient length (>360 bp) are present. TheRHDexon 5 82 bp and exon 7 RQ‐PCR duplex was evaluated withRHDψ+ cell‐free plasma DNA and showed complete specificity and maximal sensitivity.

CONCLUSION:Assays designed for prenatal genotyping should be developed and evaluated on cell‐free plasma DNA. PrenatalRHDtyping is accurate with theRHDexon 5 82 bp and exon 7 duplex strategy.
In‐frame triplet deletions inRHDalter the D antigen phenotype
Authors: Flegel Willy A. , Eicher Nicole I. , Doescher Andrea , Hustinx Hein , Gowland Peter , Mansouri Taleghani Behrouz , Petershofen Eduard K. , Bauerfeind Ursula , Ernst Manfred , Von Zabern Ingeborg , Schrezenmeier Hubert , Wagner Franz F.
Published: November 2006

BACKGROUND:The deletion of three adjacent nucleotides in an exon may cause the lack of a single amino acid, while the protein sequence remains otherwise unchanged. Only one such in‐frame deletion is known in the twoRHgenes, represented by theRHCEalleleceBPexpressing a “very weak e antigen.”

STUDY DESIGN AND METHODS:Blood donor samples were recognized because of discrepant results of D phenotyping. Six samples came from Switzerland and one from Northern Germany. The molecular structures were determined by genomic DNA nucleotide sequencing ofRHD.

RESULTS:Two different variant D antigens were explained byRHDalleles harboring one in‐frame triplet deletion each. Both single‐amino‐acid deletions led to partial D phenotypes with weak D antigen expression. Because of their D category V‐like phenotypes, theRHD(Arg229del) allele was dubbedDVL‐1and theRHD(Lys235del) alleleDVL‐2. These in‐frame triplet deletions are located in GAGAA or GAAGA repeats of theRHDexon 5.

CONCLUSION:Partial D may be caused by a single‐amino‐acid deletion in RhD. The altered RhD protein segments in DVL types are adjacent to the extracellular loop 4, which constitutes one of the most immunogenic parts of the D antigen. These RhD protein segments are also altered in all DV, which may explain the similarity in phenotype. At the nucleotide level, the triplet deletions may have resulted from replication slippage. A total of nine amino acid positions in an Rhesus protein may be affected by this mechanism.
The restricted use of IGHV3 superspecies genes in anti‐Rh is not limited to hyperimmunized anti‐D donors
Authors: Dohmen Serge E. , Verhagen Onno J.H.M. , Muit Jessica , Ligthart Peter C. , Van Der Schoot C. Ellen
Published: November 2006

BACKGROUND:Antibodies produced against the D antigen make use ofIGHVgenes restricted to theIGHV3superfamily. These findings are based on theIGHVgene analysis in anti‐D–producing B cells from hyperimmunized donors, however, and therefore the restriction might be due to the hyperimmunization. In this study theIGHVgene usage of anti‐Rh–producing B cells in a woman who was immunized in the last trimester of her pregnancy was analyzed.

STUDY DESIGN AND METHODS:Serologic analysis was performed by absorption and elution. Antibody‐dependent cellular cytotoxicity (ADCC) of the different anti‐Rh was determined. A phage display library was constructed from 2.2 × 106isolated B cells and pannings were performed with red cells of the r′r, R1R1, and R2R2 phenotype.

RESULTS:A plasma sample of the immunized person showed high levels of both anti‐D and anti‐G and low levels of anti‐C. Anti‐D and anti‐G contributed equally strong to the ADCC whereas anti‐C did not. Eighteen anti‐D–, 5 anti‐G–, and 1 anti‐C–specific phage clones were found, of which 16, 2, and 1 used theIGHV3sgenes, respectively.

CONCLUSION:For the first time a restriction to theIGHV3sgenes in anti‐D in a naturally immunized pregnant woman is shown. Moreover, the use ofIGHV3sgenes appears to be present in anti‐C and anti‐G as well. Therefore, it is concluded that restrictedIGHV3sgene usage in anti‐D is not due to hyperimmunization but due to characteristics of the Rh antigens and the intrinsic binding capacities ofIGHV3sgenes, supporting the common Rh footprint hypothesis.
The Canadian donor health assessment questionnaire: can it be improved?
Authors: Goldman Mindy , Ram Shefali S. , Yi Qi‐Long , O’Brien Sheila F.
Published: November 2006

BACKGROUND: The donor health assessment questionnaire (DHAQ) plays an important role in ensuring blood safety. The Canadian DHAQ has been developed over many years on an ad hoc basis and has never been evaluated in light of cognitive science principles. In addition, donor attitudes about its mode of administration have not been assessed.

STUDY DESIGN AND METHODS: Between May and August 2005, a total of 456 donors participated in the study by completing the DHAQ, followed by a short, scripted interview assessing recall (as an indicator of attention to the questions) of 17 specific items queried on the DHAQ and attitudes toward interviewer or self‐administration of the DHAQ.

RESULTS: Overall, 7.5 percent of donors were able to correctly identify all 17 items. Recall was best for questions asked as individual items (87%‐99%) and decreased substantially for items that are part of a list (55%‐91%). Position effects were demonstrated, with items at the end of a list being the most frequently forgotten. Twenty percent of repeat donors favored the current practice of interviewer administration of high‐risk questions, whereas 80 percent were neutral or favored self‐administration.

CONCLUSION: The current format of the Canadian DHAQ is not optimal for donor attention to specific questions asked as part of a list. The majority of repeat donors are ready for a change in the method of administration of the DHAQ. Studies on donor recall may help guide evidence‐based changes to the DHAQ.
Hematomas in multicomponent apheresis: searching for related factors
Authors: Bueno José Luis , Castro Emma , García Fernando , Barea Luisa , González Rocío
Published: November 2006

BACKGROUND: The objective of this study was to identify donation variables that could be related to the development of hematoma during multicomponent apheresis collections (MACs).

STUDY DESIGN AND METHODS: This is an observational retrospective study where 1375 donors donated 5177 MACs during a 2‐year period with two different machines (Amicus Crescendo [AC], Baxter Healthcare Corp.; and Trima Accel [TA], Gambro BCT). Variable data were recorded prospectively. In the multiple logistic regression analysis, generalized estimating equations were used with an exchangeable correlation matrix to take into account the nonindependence of several measurements from the same donor.

RESULTS: During the study period, 170 procedures failed due to hematoma (3.3%). Several variables were related to hematoma development in the adjusted model: operator experience (less than 500 procedures supervised vs. more; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.19‐2.31), previous apheresis donations (first time vs. more than 16 donations; OR, 2.87; 95% CI, 1.52‐5.45), vein canalized (basilic vs. intermediate antebrachial or cephalic; OR, 1.42; 95% CI, 1.04‐1.94), diastolic blood pressure (units divided by 10 mmHg; OR, 0.79; 95% CI, 0.66‐0.94), and type of machine used (TA high return limit configuration [RLC] setting configuration vs. AC; OR, 1.94; 95% CI, 1.27‐2.96; TA low RLC setting configuration vs. AC; OR, 1.24; 95% CI, 0.83‐1.84).

CONCLUSIONS: Our study suggests that hematoma in MAC is not a random event. Appropriate machine configuration in the TA could reduce the hematoma rate to a level comparable with that of the AC. Operator training and donor blood pressure are also interesting variables for study because these could be modified to reduce the hematoma rate.
Triplane Tissue Doppler Imaging to Evaluate Mechanical Dyssynchrony Before and After Cardiac Resynchronization in a Patient with Congenitally Corrected Transposition of the Great Arteries
Authors: VAN DE VEIRE NICO R. , BLOM NICO A. , HOLMAN EDUARD R. , SCHALIJ MARTIN J. , BAX JEROEN J.
Published: November 2006

We report the case of a 13‐year‐old girl with congenitally corrected transposition of the great arteries. Since the implantation of a conventional pacemaker for acquired complete atrioventricular block, the patient experienced increased heart failure symptoms. Using triplane tissue Doppler imaging, significant intraventricular dyssynchrony induced by unilateral pacing and associated with diminished exercise capacity was demonstrated. A biventricular pacemaker was successfully implanted transvenously, leading to synchronous activation of the systemic ventricle and improved exercise capacity.
Ionic Basis of Pharmacological Therapy in Brugada Syndrome
Authors: MÁRQUEZ MANLIO F. , SALICA GABRIEL , HERMOSILLO ANTONIO G. , PASTELÍN GUSTAVO , GÓMEZ‐FLORES JORGE , NAVA SANTIAGO , CÁRDENAS MANUEL
Published: November 2006

An implantable cardioverter‐defibrillator is considered the only effective therapy to terminate ventricular arrhythmias in symptomatic patients with Brugada syndrome. However, it does not prevent future arrhythmic episodes. Only antiarrhythmic drug therapy can prevent them. There have been several reports of a beneficial effect of oral quinidine in both asymptomatic and symptomatic patients. Other possible beneficial oral agents could be Ito blockers. Intravenous isoproterenol has been reported to be especially useful in abolishing arrhythmic storms in emergency situations. Also, isolated case reports on the usefulness of cilostazol, sotalol, and mexiletine have been described. The present article reviews the mechanisms by which these drugs may act and their possible role in the pharmacotherapy of this disease.
High‐Density Mapping of Spontaneous Pulmonary Vein Activity Initiating Atrial Fibrillation in Humans
Authors: ARENTZ THOMAS , HAEGELI LAURENT , SANDERS PRASHANTHAN , WEBER REINHOLD , NEUMANN FRANZ JOSEF , KALUSCHE DIETRICH , HAÏSSAGUERRE MICHEL
Published: November 2006

Introduction: High‐density three‐dimensional (3D) mapping of the pulmonary vein (PV)‐left atrial (LA) junction was performed to characterize spontaneous PV activity in humans.

Methods and Results: The activation patterns of ectopic beats and of the initial 2 seconds of atrial fibrillation (AF) from the PVs were analyzed using a 64‐poles basket catheter. A focal mechanism was defined as a discrete site of early and centrifugal activation. Continuous activity was considered as an activation covering ≥80% of the tachycardia beat‐to‐beat cycle length within the mapping field. In 35 patients, 123 spontaneous focal ectopic beats that did not induce AF and 95 that did induce AF were mapped. The mean coupling interval of ectopic discharges not inducing AF was 281 ± 70 msec versus 236 ± 90 msec for ectopies initiating AF (P ≤ 0.01). The first ectopic activity of all 218 arrhythmogenic events showed exclusively a focal mechanism. During the 95 episodes of AF initiation, one or two ectopic beats from the PVs initiated AF in the LA in 39%, a stable focal tachycardia was recorded in 14%, continuous activity with important changes in cycle length (35 ± 15 msec) suggestive of decremental or fibrillatory conduction was found in 18%, and in 29% the activation pattern could not be classified. No stable and sustained reentrant circuit could be identified by our mapping tool in the PV‐LA junction.

Conclusions: Arrhythmogenic activity from PVs in humans is predominantly due to discrete focal activity.
Commotio Cordis—Sudden Cardiac Death with Chest Wall Impact
Authors: MADIAS CHRISTOPHER , MARON BARRY J. , WEINSTOCK JONATHAN , ESTES N. A. MARK , LINK MARK S.
Published: November 2006

Commotio cordis (CC), sudden death as a result of a blunt, often innocent‐appearing chest wall blow, is being reported with increasing frequency. The clinical spectrum is diverse; however, a substantial number of cases occur in youth athletics. In events that occur during sport, victims are struck by projectiles regarded as standard implements of the game. Sudden death is instantaneous and victims are most often found in ventricular fibrillation (VF). Overall survival is poor; however, successful resuscitation can be achieved with early defibrillation. Autopsy is notable for the absence of any significant cardiac or thoracic injury. Development of an experimental model has allowed for substantial insights into the underlying mechanisms of sudden death. In anesthetized juvenile swine, induction of VF is instantaneous following chest wall blows occurring during a vulnerable window before the T wave peak. Crucial variables including the velocity of impact, impact location, and hardness of the impact object have been identified. Rapid left ventricular (LV) pressure rise following chest impact likely results in activation of ion channels via mechano‐electric coupling. The generation of inward current via mechano‐sensitive ion channels likely results in augmentation of repolarization and nonuniform myocardial activation, and is the cause of premature ventricular depolarizations that are triggers of VF in CC. While softer‐than‐standard safety baseballs reduce the risk of CC, commercially available chest protectors are ineffective in preventing CC. The development of more effective chest protectors and more widespread use of automated external defibrillators at youth sporting events are needed.
Transvenous Cardioverter‐Defibrillator Implantation in a Patient with Tricuspid Mechanical Prosthesis
Authors: BIFFI MAURO , BERTINI MATTEO , ZIACCHI MATTEO , BORIANI GIUSEPPE
Published: November 2006

Background. A 64‐year‐old woman was referred to our center because of poorly tolerated ventricular tachycardia (VT) at 210 bpm due to an old myocardial infarction. The patient had been operated on at age of 20 for mitral valve commissurolysis, at age of 49 for ductal carcinoma, at age of 56 for mitral valve replacement, and at age of 61 for tricuspid valve replacement. Left ventricular EF was 31%. The patient was in permanent atrial fibrillation (AF) since the age of 53. She had undergone three cardiac surgery procedures, ending with two prosthetic mechanical valves. The cardiac surgery team advised against an epicardial ICD implantation.

Results. We achieved a fully transvenous implant, with a screw‐in defibrillation coil in the low right atrium and a bipolar pacing/sensing lead in a posterolateral branch of the coronary sinus. Pacing/sensing parameters were reliable, and effective defibrillation occurred at 20 J by a stepdown protocol. During 16‐month follow‐up, three VT episodes at 210 bpm were terminated by antitachycardia pacing (ATP) therapy. Left ventricular pacing/sensing was stable at long term.

Conclusion. Thanks to technologic improvements, transvenous ICD implantation is feasible and safe in patients with a tricuspid mechanical prosthesis.
Reliability of Echocardiographic Indices of Dyssynchrony
Authors: Gabriel Ruvin S. , Bakshi Tapash K. , Scott Anthony G. , Christiansen Jonathan P. , Patel Hitesh , Wong Selwyn P. , Armstrong Guy P.
Published: November 2006

Background: Echocardiographic indices of dyssynchrony are increasingly used to select candidates for cardiac resynchronization therapy. For widespread screening of heart failure patients, such variables need to be comparable when evaluated by different operators using different equipment. Objective and Methods: To evaluate the reproducibility and obtainability of echocardiographic indices of mechanical dyssynchrony, we studied 40 subjects stratified according to QRS morphology and systolic function. Two echocardiograms were performed on each patient by different sonographers on different machines and each study was analyzed by two observers.
Results: All blood‐pool and tissue Doppler indices of dyssynchrony were obtainable in over 97% of cases. Blood‐pool Doppler measures were the most reproducible indices of intraventricular dyssynchrony (aortic ejection delay) and interventricular dyssynchrony (aortopulmonary difference in ejection delay). For annular tissue Doppler delays, the time to peak velocity was consistently more reproducible than the time to velocity onset. Conclusion: Differences in the reliability of echocardiographic indices may affect their suitability as screening tests for dyssynchrony.
Patchy Myocardial Fibrosis 20 Years after Radiation Therapy
Authors: Wyman Rachael A. , Rahko Peter S.
Published: November 2006

We describe a case of a young woman diagnosed with Ewings sarcoma at age 8 and treated with adriamycin and radiation therapy. Twenty years later the patient has a cardiomyopathy and a focal area of patchy infiltration of fibrotic tissue along the left ventricle and atrium. Although fibrosis due to radiation exposure has been demonstrated on biopsy and autopsy studies, we are not aware of previous reports of echocardiographic demonstration of this finding. The most likely explanation for the fibrosis location is the left posterolateral direction of the radiation beam.