bluuebunny/crossref_metadata_2025 huggingface dataset:
Empiric Antimicrobial Therapy for Pediatric Skin and Soft-Tissue Infections in the Era of Methicillin-Resistant Staphylococcus aureus
Authors: Elliott Daniel J. , Zaoutis Theoklis E. , Troxel Andrea B. , Loh Andrew , Keren Ron
Published: May 2009

OBJECTIVE. The goal was to compare the clinical effectiveness of monotherapy with β-lactams, clindamycin, or trimethoprim-sulfamethoxazole in the outpatient management of nondrained noncultured skin and soft-tissue infections (SSTIs), in a methicillin-resistant Staphylococcus aureus (MRSA)-endemic region.

METHODS. A retrospective, nested, case-control trial was conducted with a cohort of patients from 5 urban pediatric practices in a community-acquired MRSA-endemic region. All subjects were treated as outpatients with oral monotherapy for nondrained noncultured SSTIs between January 2004 and March 2007. The primary outcome was treatment failure, defined as a drainage procedure, hospitalization, change in antibiotic, or second antibiotic prescription within 28 days.

RESULTS. Of 2096 children with nondrained noncultured SSTIs, 104 (5.0%) were identified as experiencing treatment failure and were matched to 480 control subjects. Compared with β-lactam therapy, clindamycin was equally effective but trimethoprim-sulfamethoxazole was associated with an increased risk of failure. Other factors independently associated with failure included initial treatment in the emergency department, presence or history of fever, and presence of either induration or a small abscess.

CONCLUSIONS. Compared with β-lactams, clindamycin monotherapy conferred no benefit, whereas trimethoprim-sulfamethoxazole was associated with an increased risk of treatment failure in a cohort of children with nondrained noncultured SSTIs who were treated as outpatients. Even in regions with endemic community-acquired MRSA, β-lactams may still be appropriate, first-line, empiric therapy for children presenting with these infections.
Growth-Attenuation Therapy: Principles for Practice
Authors: Allen David B. , Kappy Michael , Diekema Douglas , Fost Norman
Published: May 2009

Publication of an account of growth attenuation with high-dose estrogen in a child with profound physical and cognitive disability brought widespread attention to a common and complex issue faced by families caring for similarly affected children, namely, the potentially negative effect of the increasing size of a child on the ability of his or her family to provide independent care, which in turn makes it more difficult for parents to keep the child in the home and involved in family activities. In this article we explore the scientific rationale for, effectiveness and safety of, and ethical considerations bearing on growth-attenuation treatment of children with profound and permanent cognitive disability. Informed responses to key clinically relevant questions are proposed. Our analysis suggests that growth attenuation is an innovative and sufficiently safe therapy that offers the possibility of an improved quality of life for nonambulatory children with profound cognitive disability and their families. Pediatricians and other care providers should include discussion of these options as part of anticipatory guidance around the age of 3 years so that, if elected, potential clinically meaningful benefits of growth-attenuation therapy can be realized. Because of the publicity and debate surrounding the first reported case, ethics consultation is recommended.
Weight for Gestational Age Affects the Mortality of Late Preterm Infants
Authors: Pulver Laurie S. , Guest-Warnick Ginger , Stoddard Gregory J. , Byington Carrie L. , Young Paul C.
Published: May 2009

BACKGROUND. Late preterm infant mortality is higher than that for term newborns. The association between weight for gestational age (WGA) category and late preterm mortality has not been well described.

OBJECTIVES. Our objectives for this research were as follows: (1) to compare neonatal and infant mortality rates of SGA, AGA, and LGA late preterm, early term, and term newborns; (2) to determine the relative risk of neonatal and infant death for each WGA category; and (3) to examine causes of neonatal and infant death.

METHODS. We reviewed linked birth and death certificate data for all infants from Utah born between 1999 and 2005 with a GA ≥34 weeks. We calculated neonatal and infant mortality rates for each GA/birth weight stratum and estimated mortality rate ratios using AGA term infants as the reference. International Classification of Diseases, Ninth Revision, codes were used to classify cause of death.

RESULTS. There were 343322 newborns with GA ≥34 weeks from 1999 to 2005. Late preterm SGA infants were ∼44 times more likely than term AGA newborns to die in their first month and 22 times more likely to die in their first year. When infants dying from congenital conditions were excluded, the differences in mortality rate ratios persisted for SGA infants, especially those born in the late preterm period.

CONCLUSIONS. Being SGA substantially increases the already higher mortality of late preterm and early term newborns. This increased risk cannot be fully explained by an increased prevalence of lethal congenital conditions among SGA late preterm newborns. Clinicians caring for late preterm and early term newborns should be cognizant of their WGA category.
Efficacy of Pneumococcal Vaccination in Children Younger Than 24 Months: A Meta-Analysis
Authors: Pavia Maria , Bianco Aida , Nobile Carmelo G. A. , Marinelli Paolo , Angelillo Italo F.
Published: May 2009

CONTEXT. Pneumococcal conjugate bacterial vaccines that are able to prevent invasive disease and mucosal infections have been developed.

OBJECTIVE. A meta-analysis of published data from trials on pneumococcal conjugate vaccine was performed to determine the efficacy in reducing the incidence of invasive disease caused by Streptococcus pneumoniae, pneumonia, and acute otitis media in healthy infants younger than 24 months.

METHODS. A systematic search of the literature was conducted. Controlled clinical trials had to compare the protective efficacy of the pneumococcal conjugate vaccine in reducing the incidence of invasive disease caused by S pneumoniae, pneumonia, and acute otitis media in healthy infants with placebo or control vaccines. Information was extracted by using a standardized protocol.

RESULTS. The efficacy of pneumococcal conjugate vaccine in the reduction of invasive pneumococcal disease was 89% involving vaccine serotypes in both the intention-to-treat and per-protocol analyses and ranged from 63% to 74% for all serotypes. The efficacy to prevent acute otitis media sustained by vaccine serotypes was 55% in the intention-to-treat and 57% in the per-protocol analyses, whereas it was 29% to prevent otitis involving all serotypes in the per-protocol analysis. Finally, in the intention-to-treat and per-protocol analyses, the efficacy to prevent clinical pneumonia was 6% and 7%, respectively, whereas for the prevention of radiograph-confirmed pneumonia it was 29% and 32%, respectively.

CONCLUSIONS. The pneumococcal conjugate vaccine produces a significant effect regarding prevention of invasive pneumococcal disease. Results on prevention of otitis or pneumonia have been less striking, but considering the high burden of these diseases in infants, even a low efficacy has potential for tremendous impact on the health of infants in developing and industrialized countries.
Microstructures induced by femtosecond laser pulses inside glasses
Authors: Su Dong , Jiang Nan , Qiu Jianrong , Spence John C.H.
Published: May 2009

In this article, the chemical and structural changes inside soda-lime glasses induced by femtosecond (fs) laser pulsing have been reported, based on transmission electron microscopy and electron energy loss spectroscopy studies. Under fs-laser interaction, Na-rich phases are formed, and Na nanoparticles are also precipitated around the Na-rich phases. These findings demonstrate how powerful and efficient the fs-laser pulsing and interaction can be in making novel microstructures in soda-lime silicate glass, and they bridge the gap between the macroscale property changes and nanometer-scale structures.
Ultrafine-grained Ti66Nb13Cu8Ni6.8Al6.2 composites fabricated by spark plasma sintering and crystallization of amorphous phase
Authors: Li Y.Y. , Yang C. , Chen W.P. , Li X.Q. , Qu S.G.
Published: May 2009

We report on the formation of ultrafine-grained Ti66Nb13Cu8Ni6.8Al6.2 composites with in situ precipitated micrometer-sized β-Ti(Nb) phase by spark plasma sintering with crystallization. Microstructure analysis indicated that all alloys consisted of soft (Cu, Ni)Ti2 regions surrounded by hard β-Ti(Nb) regions but displayed different microstructures. The alloys exhibited high fracture strength of more than 2200 MPa and remarkable plasticity of ∼25%. The results provided a promising method for fabricating large-sized bulk composites with excellent mechanical properties by powder metallurgy.
Synthesis and room-temperature ferromagnetism of cobalt-doped SnO2 nanowires
Authors: Wu Jin , Yu Ke , Zhang Yongsheng , Li Lijun , Zhu Ziqiang
Published: May 2009

We have observed ferromagnetism in dilute cobalt-doped SnO2 nanowires at room temperatures. The Co-doped SnO2 nanowires with an average diameter of ∼50 nm were synthesized by the thermal chemical vapor transport method. High-resolution transmission electron microscopy and energy-dispersive x-ray spectroscopy analyses demonstrate that the nanowires are single-crystal structures and Co is homogeneously doped into the SnO2 lattice. The ferromagnetic hysteresis curves and temperature-dependent magnetization measurement provide evidence for ferromagnetic properties with a Curie temperature above room temperature. Oxygen annealing has been performed to study the roles played by the oxygen vacancies in determining the ferromagnetic properties of the nanowires.
Ball milling-induced pyrochlore-to-tungsten bronze phase transition in RbNbWO6
Authors: Zorzi Janete E. , de Amorim Cintia L.G. , Milani Raquel , Figueroa Carlos A. , da Jornada J.A.H. , Perottoni Claudio A.
Published: May 2009

A set of Bragg peaks consistent with a hexagonal Bravais lattice was observed in the x-ray powder diffraction pattern of cubic pyrochlore rubidium tungstoniobate (RbNbWO6) subjected to high-energy ball milling. The calculated lattice parameters for this hexagonal phase are similar to those of compounds with tungsten bronze structure. In fact, the powder pattern of the hexagonal phase could be refined with a structural model based on the tungsten bronze structure. The hexagonal phase produced by high-energy ball milling of RbNbWO6 transforms back to the pyrochlore structure upon heating to 773 K in air. A similar phase was obtained by ball milling the mixture RbNbWO6 + WO3, but, in this case, the stoichiometric hexagonal tungsten bronze compound thus obtained remained stable up to 1273 K.
Microstructure and properties of high-conductivity, super-high-strength Cu–8.0Ni–1.8Si–0.6Sn–0.15Mg alloy
Authors: Li Z. , Pan Z.Y. , Zhao Y.Y. , Xiao Z. , Wang M.P.
Published: May 2009

A high-conductivity and super-high-strength alloy, Cu-8.0Ni-1.8Si-0.6Sn-0.15Mg, has been developed. The processing conditions of the alloy have been investigated. The evolution of microstructure of the alloy on aging has been examined by transmission electron microscopy. The processing condition giving the highest hardness and good electrical conductivity is as follows: solution treatment at 970 °C for 4 h, cold rolling to 60% reduction, and aging at 500 °C for 30 min. The processed alloy has an average tensile strength of 1180 MPa, 0.2% proof strength of 795 MPa, elongation of 2.75%, and average electrical conductivity of 26.5% IACS. Orthorhombic Ni2Si precipitates are responsible for the age-hardening effect. The orientation relationship between the precipitates and the matrix is (110)m(211)p and. DO22 ordering together with spinodal decomposition also contributed to the hardening.
Glucose transporter GLUT1 expression is an stage-independent predictor of clinical outcome in adrenocortical carcinoma
Authors: Fenske Wiebke , Völker Hans-Ullrich , Adam Patrick , Hahner Stefanie , Johanssen Sarah , Wortmann Sebastian , Schmidt Melanie , Morcos Michael , Müller-Hermelink Hans-Konrad , Allolio Bruno , Fassnacht Martin
Published: May 2009

Owing to the rarity of adrenocortical carcinoma (ACC) no prognostic markers have been established beyond stage and resection status. Accelerated glycolysis is a characteristic feature of cancer cells and in a variety of tumour entities key factors in glucose metabolism like glucose transporter 1 and 3 (GLUT1 and -3), transketolase like-1 enzyme (TKTL1) and pyruvate kinase type M2 (M2-PK) are overexpressed and of prognostic value. Therefore, we investigated the role of these factors in ACC. Immunohistochemical analysis was performed on tissue microarrays of paraffin-embedded tissue samples from 167 ACCs, 15 adrenal adenomas and 4 normal adrenal glands. Expression was correlated with baseline parameters and clinical outcome. GLUT1 and -3 were expressed in 33 and 17% of ACC samples respectively, but in none of the benign tumours or normal adrenals glands. By contrast, TKTL1 and M2-PK were detectable in all benign tissues and the vast majority of ACCs. GLUT1 expression was strongly associated with prognosis in univariate and multivariate analysis (P<0.01), whereas GLUT3, TKTL1 and M2-PK did not correlate with clinical outcome. Patients with strong GLUT1 staining showed a considerably higher overall mortality (hazard ratio (HR) 6.34 (95% confidence interval 3.10–12.90) compared with patients with no GLUT1 staining. When analysing patients in their early stages and advanced disease separately, similar results were obtained. HR for survival was 5.31 (1.80–15.62) in patients with metatastic ACC and in patients after radical resection the HR for disease-free survival was 6.10 (2.16–16.94). In conclusion, GLUT1 is a highly promising stage-independent, prognostic marker in ACC.
A Translational Research Orientation to Family Violence
Authors: Heyman Richard E. , Smith Slep Amy M.
Published: May 2009

We discuss translational research and its application in family violence research by (a) discussing what translational research is, (b) describing a six-stage model of the translational research cycle, (c) pondering the implication of each stage for family maltreatment research, and (d) providing examples of areas ready for translational research relevant to family violence.
Immunolocalization of Androgen Receptors, Estrogen α Receptors, and Estrogen β Receptors in Experimentally Induced Canine Prostatic Hyperplasia
Authors: Gallardo Fanny , Lloreta Josep , García Felix , Moll Xavier , Baró Teresa , González Luciano A. , Morote Joan , Reventos Jaume , Mogas Teresa
Published: May 2009

ABSTRACT: Benign prostatic hyperplasia (BPH) is an age‐dependent prostatic disease affecting male humans and dogs. In dogs, the combined administration of estrogens and androgens synergistically increases prostate weight, and continued treatment leads to the development of glandular hyperplasia. The aim of the present study was to examine the immunohistochemical expression of androgen receptor (AR), estrogen receptor α (ERα), and estrogen receptor β (ERβ) in the different cell types of the prostate gland in an experimental model. Five male beagle dogs were castrated and treated with 25 mg of 5α‐androstane‐3α and 17β‐diol and 0.25 mg 17β‐estradiol for 30 weeks. Prostate specimens were surgically obtained every 45 days (experimental stages M0 to M6: 0, 12, 18, 24, 30, and 36 weeks from the beginning of the hormonal treatment). The control group consisted of 3 noncastrated dogs treated with a vehicle, from which specimens were only taken at the time points M0, M1, M4, and M6. Immunohistochemical data revealed high AR and ERα expression in the epithelial and stromal cell nuclei of all the experimental and control specimens. Weak staining of the cytoplasm was observed only in epithelial cells. The suspension of hormone treatment led to a significant reduction in the expression of both receptors. On the contrary, ERβ was expressed only in epithelial cell nuclei, with no significant differences in the percentages of stained nuclei between control and hormonally treated or atrophic prostates. Results indicate that AR, ERα, and ERβ are differently expressed in canine prostate tissue and that they show specific expression patterns in response to the hormonal induction of BPH.
Hydrogen Sulfide Removal in Biofilter: Evaluation of a New filter Material by Immobilization of Thiobacillus sp.
Authors: Potumarthi Ravichandra , Anupoju Gangagni Rao , Mugeraya Gopal , Jetty Annapurna
Published: May 2009

Different agricultural residue was evaluated as a biofilter material for the removal of Hydrogen sulfide (H2S) using Thiobacillus sp. A Combination of four different agricultural residues, viz., sugarcane bagasse, coconut coir pith, rice husk and saw dust were evaluated as biofilter material. From results, it was observed that filter material having composition of 2:4:2:2, 4:4:2:2 and 4:2:2:4 has resulted in retaining 70% moisture content at the end of 10 days. The biofilter was operated for 128 days in three phases by varying inlet H2S concentration from 321 to 2020 ppmv. Biofilter exhibited 100% removal efficiency (RE) at an inlet concentration of 570 ppmv, 99% RE at an inlet concentration of 1416 ppmv and 66% RE at a maximum inlet concentration of 2020 ppmv. The filter performance in terms of RE, dropped to 48% when the air was not humidified before sending to the filter, which has direct relation with the MC of the filter material. The RE recovered to 66% with recovery of moisture content (MC) to 57% upon subsequent re-introduction of the humidifier in to the circuit. The pH has dropped from 7.8 to 4.8 during the course of operation of the filter. H2S was effectively removed under different operating conditions using mixed agricultural residue as filter material. However humidification was most essential to maintain the required moisture content in the biofilter. SEM analysis has shown the good growth of Thiobacillus sp. in the filter bed and hence the new material proved to be good support for the immobilization of Thiobacillus sp.
On the solid hull of the Hardy-Lorentz space
Authors: Jevtic Miroljub , Pavlovic Miroslav
Published: May 2009

The solid hulls of the Hardy-Lorentz spaces Hp,q,0 < p < 1, 0 < q ? ? and Hp,? 0, 0 < p < 1, as well as of the mixed norm space H p,?,? 0,0 < p ? 1, 0 < ? < ?, are determined.
Spacelike and timelike normal curves in Minkowski space-time
Authors: İlarslan Kazim , Nesovic Emilija
Published: May 2009

We define normal curves in Minkowski space-time E41. In particular, we characterize the spacelike normal curves in E41 whose Frenet frame contains only non-null vector fields, as well as the timelike normal curves in E41 , in terms of their curvature functions. Moreover, we obtain an explicit equation of such normal curves with constant curvatures.
Study on high temperature sintering processes of selective laser sintered Al2O3/ZrO2/TiC ceramics
Authors: Bai P. , Li Y.
Published: May 2009

High temperature sintering processes of selective laser sintered Al2O3/ZrO2/TiC ceramics were studied. The effects of the sintering temperature and the sintering time on the relative density, strength and fracture toughness of Al2O3/ZrO2/TiC ceramics were investigated. The results showed that the sintering temperature and sintering time had a great effect on the relative density and the mechanical properties of Al2O3/ZrO2/TiC ceramics. The mechanical strength increased from 120MPa to 360MPa and KIC increased from 3.7 J/m2 to 6.9 J/m2 when the sintering temperature increased from 1400?C to 1600?C, however, the mechanical strength decreased rapidly from 370MPa to 330MPa and KIC decreased from 6.9 J/m2 to 6.1 J/m2 when the sintering time increased from 30min to 90min. Furthermore, the addition of TiC and ZrO2 in the Al2O3 matrix significantly improved mechanical strength and fracture toughness of the Al2O3 matrix ceramics.
Collisions between discrete spatiotemporal dissipative Ginzburg-Landau solitons in two-dimensional photonic lattices
Authors: Mihalache Dumitru , Mazilu Dumitru , Lederer Falk
Published: May 2009

Systematic results of collisions between discrete spatiotemporal dissipative Ginzburg-Landau solitons in two-dimensional photonic lattices are reported. The generic outcomes are identified for (i) the collision of two identical solitons located in the corner, at the edge, and in the center of the photonic lattice, and for (ii) the collision of two non-identical corner and edge solitons located at different distances from the boundaries of the photonic lattice. Depending on the values of the kick (collision momentum) and of the nonlinear (cubic) gain, the collision scenarios include soliton merging, creation of an extra soliton, soliton bouncing, soliton spreading, and quasi-elastic (symmetric) interactions.
Germanium segregation in CVD grown SiGe layers
Authors: Novikau Andrei , Gaiduk Peter
Published: May 2009

A 2D layer of spherical, crystalline Ge nanodots embedded in a SiO2 layer was formed by low pressure chemical vapour deposition combined with furnace oxidation and rapid thermal annealing. The samples were characterized structurally by using transmission electron microscopy and Rutherford back scattering spectrometry, as well as electrically by measuring C-V and I-V characteristics. It was found that formation of a high density Ge dots took place due to oxidation induced Ge segregation. The dots were situated in the SiO2 at the average distance 5–6 nm from the substrate. Strong evidence of charge storage effect in the crystalline Ge-nanodot layer was demonstrated by the hysteresis behavior of the high-frequency C-V curves.
Antimicrobial therapy for multidrug resistant pathogens
Authors: Weese J. S.
Published: May 2009

Multidrug resistant bacteria are tremendous causes of morbidity and mortality in human medicine, and emerging pathogens in equine medicine. A variety of organisms, such as methicillin‐resistantStaphylococcus aureus(MRSA), vancomycin resistantEnterococcusspp. (VRE) and multidrug resistantAcinetobacterspp.,Pseudomonasspp. and Enterobacteriaceae are of concern in equine medicine. Veterinary practitioners need to be aware of key diagnostic, clinical, therapeutic, epidemiological and infection control aspects to limit the impact of these organisms on the equine, and perhaps human, population.
Policy Level Improvement in Hydropower Development
Authors: Thapa Bikash Thapa
Published: May 2009

Mother Nature has given Nepal a vast opportunity for hydro energy production, but still the country is reeling under painful load shedding due to an electric power production deficit of 70MW. The main challenge for the country now is to harness the hydropower potentiality, which contributes for its economic development. In Nepal, policy deficiencies and the slow decision making process in electricity sector has resulted in the increased project costs and has reduced the involvement of private sectors and the entrepreneurs. Thus, restructuring and improvements at all policy level is required to overcome various hurdles, and then only will hydropower develop in Nepal.

Hydro Nepal: Journal of Water, Energy and Environment Vol. 1, No. 2(2008) pp. 17-18
Water Quality Profile of Yamuna River, India
Authors: Sharma M. P. , Singal S. K. , Patra S.
Published: May 2009

The water quality profile of a river represents the extent of its pollution in terms of health of a river with respect to its longitudinal direction. This paper deals with the water quality profile of north India’s Yamuna river using physico-chemical and bacteriological parameters that converge into a single value NSF WQI. The water quality map of the river has been prepared showing that the Delhi stretch is highly polluted due to dumping of waste and discharge of untreated sewage and industrial effluents. The water quality map is a useful tool for policy makers, decision makers and environmentalists to suggest and implement appropriate conservation measures to improve the health of the water body.Key words: Water quality; pollution; river profile; indices; mapping; Indiadoi: 10.3126/hn.v3i0.1914Hydro Nepal Journal of Water, Energy and Environment Issue No. 3, July 2008. Page: 19-24
Irrigation Management Transfer: A New Methodology to Improve thePerformance of Agency Managed Irrigation Systems (AMISs)
Authors: Singh Achyut Man
Published: May 2009

This paper presents a new concept on the management of Agency Managed Irrigation Systems with the joint participation of the agency and the users, with their defined roles and responsibilities. The message of the system governance and operation methodology are disseminated to the grass root level of the users. Resource management and water charge collection are anticipated to be firmly applied in the system. The users and Water User's Association and also Department of Irrigation field staff will be well trained in the Irrigation Management Transfer process with capacity building. For sustainability, monitoring and evaluation with independent auditing are part of the process. The general Irrigation Management Transfer procedures adopted by Department of Irrigation are redefined to this new concept in the World Bank assisted Irrigation and Water Resources Management Project. Key words: Irrigation management transfer, water users, AMIS, World Bank, Nepal  doi: 10.3126/hn.v3i0.1916 Hydro Nepal Journal of Water, Energy and Environment Issue No. 3, July 2008. Page: 29-34
Accelerated Transmission Development For Accelerated Power Development
Authors: Bhat Sher Singh
Published: May 2009

Due to our lack of vision, planning and other mistakes, Nepal is in a very serious situation of load shedding. The nation is about 200 MW deficit of power supply. Hydropower development is an endeavor related with several sectors. It cannot be taken as only a commercial sector considering that businessmen will make all necessary things when there is a demand. In the past, the transmission sector has not been given due importance. Because of the complex nature of Transmission, there should only be one transmission operator in the country. Based on the periodic basin-wise generation plan of the nation, we should prepare an accelerated Development Plan. The Basin Plan should indicate how and where local level, regional level and national level hydro plants will be connected to the grid, and the sequence of developing the basin transmission network.Hydro Nepal: Journal of Water, Energy and Environment Issue No. 4, January, 2009 Page 8-10
Using critical pedagogies from adult education to inspire and challenge higher education students
Authors: Kadi-Hanifi Karima
Published: May 2009

This interdisciplinary paper is about applying Adult Education methods of learning and teaching to higher education. I argue that higher education students need to be stimulated via interactive methods that improve their motivation and lead them to question the value system/s that exist around them. A Freirean approach as used in the teaching of Adult Literacy and English for Speakers of Other Languages (ESOL) was applied to a group of 'elite' students at the University of Birmingham who were taking a language foundation course. As a sociolinguist and ESOL practitioner from a black perspective, I argue that the understanding of concepts of language and racism, imperialism and social class can best be facilitated using such an approach. Taking groups of students through this learning journey is challenging for higher education practitioners and the results add a relatively new dimension to the collective reflection on learning and teaching in higher education today.
Continuous monitoring of jugular venous oxygen saturation in head-injured patients
Authors: Sheinberg Michael , Kanter Malcolm J. , Robertson Claudia S. , Contant Charles F. , Narayan Raj K. , Grossman Robert G.
Published: May 2009

✓ The continuous measurement of jugular venous oxygen saturation (SjvO2) with a fiberoptic catheter is evaluated as a method of detecting cerebral ischemia after head injury. Forty-five patients admitted to the hospital in coma after severe head injury had continuous and simultaneous monitoring of SjvO2, intracranial pressure, arterial oxygen saturation, and end-tidal CO2. Cerebral blood flow, cerebral metabolic rates of oxygen and lactate, arterial and jugular venous blood gas levels, and hemoglobin concentration were measured every 8 hours for 1 to 11 days. Whenever SjvO2 dropped to less than 50%, a standardized protocol was followed to confirm the validity of the desaturation and to establish its cause. Correlation of SjvO2 values obtained by catheter and with direct measurement of O2 saturation by a co-oximeter on venous blood withdrawn through the catheter was excellent after in vivo calibration when there was adequate light intensity at the catheter tip (176 measurements: r = 0.87, p < 0.01). A total of 60 episodes of jugular venous oxygen desaturation occurred in 45 patients. In 20 patients the desaturation value was confirmed by the co-oximeter. There were 33 episodes of desaturation in these 20 patients, due to the following causes: intracranial hypertension in 12 episodes, hypocarbia in 10, arterial hypoxia in six, combinations of the above in three, systemic hypotension in one, and cerebral vasospasm in one. The incidence of jugular venous oxygen desaturations found in this study suggests that continuous monitoring of SjvO2 may be of clinical value in patients with head injury.
Evoked potentials from direct cerebellar stimulation for monitoring of the rodent spinal cord
Authors: Hurlbert R. John , Tator Charles H. , Fehlings Michael G. , Niznik Greg , Linden R. Dean
Published: May 2009

✓ Although the assessment of spinal cord function by electrophysiological techniques has become important in both clinical and research environments, current monitoring methods do not completely evaluate all tracts in the spinal cord. Somatosensory and motor evoked potentials primarily reflect dorsal column and pyramidal tract integrity, respectively, but do not directly assess the status of the ventral funiculus. The present study was undertaken to evaluate the use of evoked potentials, elicited by direct cerebellar stimulation, in monitoring the ventral component of the rodent spinal cord. Twenty-nine rats underwent epidural anodal stimulation directly over the cerebellar cortex, with recording of evoked responses from the lower thoracic spinal cord, both sciatic nerves, and/or both gastrocnemius muscles. Stimulation parameters were varied to establish normative characteristics. The pathways conducting these “posterior fossa evoked potentials” were determined after creation of various lesions of the cervical spinal cord.

The evoked potential recorded from the thoracic spinal cord consisted of five positive (P1 to P5) and five negative (N1 to N5) peaks. The average conduction velocity (± standard deviation) of the earliest wave (P1) was 53 ± 4 m/sec, with a latency of 1.24 ± 0.10 msec. The other components followed within 4 msec from stimulus onset. Unilateral cerebellar stimulation resulted in bilateral sciatic nerve and gastrocnemius muscle responses; there were no significant differences (p > 0.05) in the thresholds, amplitudes, or latencies of these responses elicited by right- versus left-sided stimulation. Recordings performed following creation of selective lesions of the cervical cord indicated that the thoracic response was carried primarily in the ventral funiculus while the sciatic and gastrocnemius responses were mediated through the dorsal half of the spinal cord. It is concluded that the posterior fossa evoked potential has research value as a method of monitoring pathways within the ventral spinal cord of the rat, and should be useful in the study of spinal cord injury.
Multilevel anterior cervical fusion using skull bone grafts
Authors: Tanaka Tokutaro , Ninchoji Toshiaki , Uemura Kenichi , Ryu Hiroshi , Sugiura Masashi , Ohishi Haruyuki , Tomita Mamoru , Takehara Seiya , Yamamoto Takamichi
Published: May 2009

✓ The successful use of autogenous skull bone grafts for a C3–7 anterior cervical fusion is reported and compared with results using other bone grafts. A 51-year-old man with C4–7 anterior cord compression due to spurs and ossified posterior longitudinal ligaments developed progressive tetraparesis following a minor head injury. He underwent anterior decompression and fusion. On two occasions an iliac graft had failed; however, a graft of autogenous skull bone was successful. The skull bone was found superior to bone from other sites, such as the iliac crest, rib, tibia, and fibula, showing sufficient strength and less morbidity. The skull may be a better source of graft material for multilevel anterior cervical fusion, which requires long and strong grafts.
Long-term results after lateral canthal advancement for unilateral coronal synostosis
Authors: Machado Helio R. , Hoffman Harold J.
Published: May 2009

✓ The procedure of lateral canthal advancement was carried out to correct unilateral coronal synostosis in 39 consecutive patients at The Hospital for Sick Children during a 20-year period. Thirty-seven children were available for follow-up study, and results were considered to be good or excellent in 81% of them. Liberation of the supraorbital margin and release of stenotic skull base sutures are crucial for a successful result. The severity of the process and the age of the patient were not restrictive factors in regard to indication for this procedure. Some patients showed a continuous improvement with time. Morbidity was minimal. It is suggested that lateral canthal advancement is the procedure of choice for unilateral coronal synostosis.
Surgical stabilization of cervical spinal fractures using methyl methacrylate
Authors: Duff Thomas A. , Khan Agha , Corbett Joseph E.
Published: May 2009

✓ This study analyzes the long-term outcome of 52 consecutively treated patients with acute cervical spinal fracture/dislocation who underwent posterior surgical stabilization using methyl methacrylate in the absence of bone grafting. The patients ranged in age from 15 to 93 years. In 40 patients the injury was located in the lower cervical spine; for these a previously described surgical format was employed. In 12 patients the fracture involved C-1 or C-2, and the modification used for these injuries is presented. The postoperative period of evaluation ranged from 6 months to 12 years. There was one case of infection, which eventually required removal of the acrylic, but there were no instances of new neurological injury or of operative mortality. Failure of stabilization occurred in two previously reported patients treated early in the series. Comparison of the patient outcome in this study with that of certain other reports suggests that at least four technical factors are important for the success of methyl methacrylate stabilization: 1) the acrylic inlay must be provided with an anchor to bone; 2) the anchor must be of a type that does not easily erode through bone; 3) the inclusion of wire must be done in a manner that allows each strand to be completely encased in the acrylic; and 4) the cross-sectional area of the inlay is critical.
Aneurysms arising from the proximal (A1) segment of the anterior cerebral artery
Authors: Suzuki Michiyasu , Onuma Takehide , Sakurai Yoshiharu , Mizoi Kazuo , Ogawa Akira , Yoshimoto Takashi
Published: May 2009

✓ This study reviews aneurysms of the proximal segment (A1) of the anterior cerebral artery in 38 patients (23 men and 15 women) and their surgical, angiographic, and clinical management. Thirty-seven aneurysms were saccular and one was fusiform. The incidence of A1 aneurysms among a total of 4295 aneurysm cases treated was 0.88%. Multiple aneurysms occurred in 17 patients (44.7%) of the 38 cases; in 10 (58.8%), there was bleeding from the A1 aneurysm. The aneurysms were classified into five categories according to the mode of origin of the aneurysm in relation to the A1 segment: in 21 cases, aneurysms originated from the junction of the A1 segment and a perforating artery; in eight, from the A1 segment directly; in six, from the proximal end of the A1 fenestration; and in two, from the junction of the A1 segment and the cortical branch. One patient had a fusiform aneurysm. Computerized tomography (CT) of these aneurysms revealed bleeding extending to the septum pellucidum similar to that of anterior communicating artery aneurysms. When performing radical surgery it is very important to recognize the characteristics of A1 aneurysms, including multiplicity, a high incidence of vascular anomalies (especially A1 fenestration), and their similarity to anterior communicating artery aneurysms on CT.
Ligamentum flavum hematoma
Authors: Sweasey Thomas A. , Coester Hans C. , Rawal Harish , Blaivas Mila , McGillicuddy John E.
Published: May 2009

✓ Two patients presenting with signs and symptoms suggestive of nerve root compression secondary to extradural masses were found to have ligamentum flavum hematomas. Both patients had neurological deficits preoperatively and regained normal function postoperatively. There was no significant antecedent injury in either case. The symptom course was longer than that for spontaneous epidural hematoma. In one case, there was remodeling of bone, initially suggesting either infection or tumor.
End-to-side anastomosis of small vessels using an Nd:YAG laser with a hemispherical contact probe
Authors: Tulleken Cornelis A. F. , van Dieren Andries , Verdaasdonk Ruud M. , Berendsen Wim
Published: May 2009

✓ A new technique is described which enables the surgeon to perform an end-to-side anastomosis between arteries with little (< 2 minutes) or no occlusion of the recipient artery. The technique was developed in rabbits, but has recently been successfully used in a patient in whom an anastomosis between the superficial temporal artery and a proximal branch of the middle cerebral artery was created.
Effect of AT877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage
Authors: Shibuya Masato , Suzuki Yoshio , Sugita Kenichiro , Saito Isamu , Sasaki Tomio , Takakura Kintomo , Nagata Izumi , Kikuchi Haruhiko , Takemae Toshiki , Hidaka Hiroyoshi , Nakashima Mitsuyoshi
Published: May 2009

✓ With the cooperation of 60 neurosurgical centers in Japan, a prospective randomized placebo-controlled double-blind trial of a new calcium antagonist AT877 (hexahydro-1-(5-isoquinolinesulfonyl)-1H-1,4-diazepine hydrochloride, or fasudil hydrochloride) was undertaken to determine the drug's effect on delayed cerebral vasospasm in patients with a ruptured cerebral aneurysm. A total of 276 patients, who underwent surgery within 3 days after subarachnoid hemorrhage (SAH) of Hunt and Hess Grades I to IV, were entered into the study. Nine patients were excluded because of protocol violation. The remaining 267 patients received either 30 mg AT877 or a placebo (saline) by intravenous injection over 30 minutes, three times a day for 14 days following surgery. Demographic and clinical data were well matched between the two groups.

It was found that AT877 reduced angiographically demonstrable vasospasm by 38% (from 61% in the placebo group to 38% in the AT877 group, p = 0.0023), low-density regions on computerized tomography associated with vasospasm by 58% (from 38% to 16%, p = 0.0013), and symptomatic vasospasm by 30% (from 50% to 35%, p = 0.0247). Furthermore, AT877 reduced the number of patients with a poor clinical outcome associated with vasospasm (moderate disability or worse on the Glasgow Outcome Scale at 1 month after SAH) by 54% (from 26% to 12%, p = 0.0152). There were no serious adverse events reported in the AT877 group. This is the first report of a placebo-controlled double-blind trial that has demonstrated a significant reduction in angiographically revealed vasospasm by intravenous drug therapy.
Malignant lymphoma of the central nervous system presenting with central neurogenic hyperventilation
Authors: Shibata Yasushi , Meguro Kotoo , Narushima Kiyoshi , Shibuya Fumiho , Doi Mikio , Kikuchi Yoichi
Published: May 2009

✓ The case is described of a 72-year-old woman who presented with a progressive right hemiparesis and central neurogenic hyperventilation. Pathological and radiological studies revealed diffuse infiltration of a malignant lymphoma into the entire central nervous system and the upper spinal cord. The authors review 12 cases of tumor-induced central neurogenic hyperventilation and discuss the pathophysiology of this condition.
A randomized comparison of intra-arterial versus intravenous with or without intravenous 5-fluorouracil, for newly diagnosed patients with malignant glioma
Authors: Shapiro William R. , Green Sylvan B. , Burger Peter C. , Selker Robert G. , VanGilder John C. , Robertson James T. , Mealey John , Ransohoff Joseph , Mahaley M. Stephen
Published: May 2009

✓ This Phase III trial tested the efficacy and safety of intra-arterial 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) for the treatment of newly resected malignant glioma, comparing intra-arterial BCNU and intravenous BCNU (200 mg/sq m every weeks), each regimen without or with intravenous 5-fluorouracil gm/sq m three times daily given 2 weeks after BCNU). All patients also received radiation therapy. A total of 505 patients were randomly assigned within the study. Fifty-seven patients were excluded, primarily because of neuropathology error, and the remaining 448 patients constituted the Valid Study Group. Of the total 505 patients, 190 patients could not receive intra-arterial BCNU and 315 patients were randomly assigned to receive intra-arterial (167 patients) and intravenous (148 patients) BCNU. Actuarial analysis (log-rank) demonstrated reduced survival for the intra-arterial group (p = 0.03). Serious toxicity was observed in the intra-arterial group; 16 patients (9.5%) developed irreversible encephalopathy with computerized tomography evidence of cerebral edema, and 26 patients (15.5%) developed visual loss ipsilateral to the infused carotid artery. Administration of 5-fluorouracil did not influence survival. The survival rate between the intravenous and the intra-arterial BCNU patients with glioblastoma multiforme did not differ, but was worse for intra-arterial BCNU patients with anaplastic astrocytoma than for those receiving intravenous BCNU (p = 0.002). Neuropathologically, intra-arterial BCNU produced white matter necrosis. It is concluded that intra-arterial BCNU is neither safe nor effective in prolonging survival when administered by the methods used in this study of newly diagnosed patients with malignant glioma.
Effect of the expression of transforming growth factor-β2 in primary human glioblastomas on immunosuppression and loss of immune surveillance
Authors: Maxwell Marius , Galanopoulos Theofanis , Neville-Golden Janine , Antoniades Harry N.
Published: May 2009

✓ Glioblastomas are malignant brain tumors that are attended by an immunosuppressed state. The authors have studied the expression of transforming growth factor-β2, which is known to have potent immunosuppressive and angiogenic properties. Transforming growth factor-β2 messenger ribonucleic acid and its protein product are both found to be greatly overexpressed in these tumors and are absent from normal brain tissue. The overexpression of this growth factor may contribute to the escape of neoplastic astrocytes from immune surveillance and, furthermore, to the immunosuppressed state that is characteristic of many of these patients.
Reduced cerebral blood flow, oxygen delivery, and electroencephalographic activity after traumatic brain injury and mild hemorrhage in cats
Authors: DeWitt Douglas S. , Prough Donald S. , Taylor Carol L. , Whitley John M.
Published: May 2009

✓ The authors investigated the effects of transient, mild hemorrhagic hypotension after fluid-percussion traumatic brain injury on intracranial pressure, cerebral blood flow (CBF), cerebral oxygen delivery (CBF × arterial O2 content), and electroencephalographic (EEG) activity. Adult mongrel cats were anesthetized with 1.6% isoflurane in N2O:O2 (70:30) and prepared for trauma and for radioactive microsphere CBF measurement. Isoflurane concentration was decreased to 0.8%, and the cats were randomly assigned to one of four control groups or to an experimental group. Animals in the four control groups underwent either mild hemorrhage (18 ml · kg−1) immediately followed by resuscitation with equal volumes of 10% Hetastarch (eight cats), mild hemorrhage followed by replacement of shed blood (six cats), isovolemic hemodilution with 18 ml · kg−1 of Hetastarch (six cats), or moderate (2.2 atm) trauma alone (eight cats). The experimental group received a combination of trauma and mild hemorrhage followed by resuscitation with Hetastarch (eight cats). Mild hemorrhage produced no significant changes in CBF, renal blood flow, or cardiac output. Following resuscitation from mild hemorrhage, mean arterial blood pressure, cardiac output, renal blood flow, and CBF were not significantly different from baseline; cardiac output and renal blood flow did not differ significantly from baseline 2 hours after Hetastarch resuscitation. Neither hemorrhage nor trauma alone produced significant decreases in CBF or in EEG activity, but trauma followed by hemorrhage and resuscitation produced significant (p < 0.01) decreases in CBF, cerebral oxygen delivery, and EEG score. These data demonstrate that, following traumatic brain injury, even mild hemorrhagic hypotension is associated with significant deficits in cerebral oxygen availability and neurological function.
Suppression of anchorage-independent growth of human glioblastoma cell by major histocompatibility complex class I gene-transfection
Authors: Momozaki Nobuaki , Oh-Uchida Mamoru , Tabuchi Kazuo , Ikezaki Kiyonobu , Hori Katsuji
Published: May 2009

✓ The host's immune system discriminates tumor cells from normal cells by recognizing the major histocompatibility complex (MHC) class I antigen expressed on the tumor cell membrane. However, the role of MHC class I antigen in tumor cells has not yet been clarified. In this study, the influence of MHC class I antigen expression on the tumorigenicity of a human glioblastoma cell line (KMG4) is examined. Barely detectable levels of MHC class I messenger ribonucleic acid were found to express in KMG4 cells by Northern blot analysis using mouse MHC class I (H-2Ld) and human leukocyte antigen (HLA)-B7 genes as probes. The H-2Ld gene connected at the downstream end of murine mammary tumor virus (MMTV)-promoter was cotransfected with the neomycine-resistant gene pSV2-neo into KMG4 cells, and the drug-resistant cells were selected. The KMG4 cells (KMG4-MMTV-Ld), which acquired the MHC class I gene were detected by Northern blot analysis with H-2Ld as the probe, and by immunohistochemistry using the H-2Ld-specific monoclonal antibody. Tumorigenicity, as determined by colony-forming ability in soft agar, was then compared between MHC class I-expressing KMG4-MMTV-Ld and nonexpressing control cells. The MHC class I-expressing cells were found to be deprived of colony-forming ability, indicating that MHC class I antigen could negatively influence the anchorage-independent cell growth of the human glioblastoma cell line KMG4.
Secondary malignant lymphoma of the central nervous system with delayed high uptake on 123I-IMP single-photon emission computerized tomography
Authors: Kitanaka Chifumi , Eguchi Tsuneyoshi , Kokubo Takeshi
Published: May 2009

✓ A case of secondary central nervous system (CNS) lymphoma with high uptake in the delayed image of N-isopropyl-[123I]-p-iodoamphetamine (123I-IMP) single-photon emission computerized tomography (SPECT) is presented. Previous to this report, only six cases of brain tumor with high uptake on the delayed 123I-IMP SPECT scan have been reported, two of which were CNS malignant lymphomas. Of 19 brain tumors examined with 123I-IMP SPECT at Kameda General Hospital, this case was the only one that showed high uptake in the delayed image. These data imply that 123I-IMP SPECT, which has now become rather obsolete as a tumor-imaging method, can be useful in diagnosing CNS malignant lymphoma.