bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute dystonia caused by tetrabenazine—what does it tell us about pathophysiology?
Authors: Dietrichs E. , Magnusson A. , Opjordsmoen S.
Published: January 2011

A 21‐year‐old woman with Gilles de la Tourette syndrome developed acute dystonia 24 h after ingesting 750 mg of tetrabenazine in a suicide attempt The symptoms were rapidly resolved on diazepam and orphenadrine administration. Acute dystonia caused by tetrabenazine is extremely rare, but may help us understand the pathophysiology of drug‐induced dystonic reactions. We suggest that acute dystonia in this patient was caused by catecholamine depletion and a subsequently reduced dopaminergic neurotransmission rather than by dopamine receptor blockade.
Decrease in neuronal density in the cerebral cortex in multiple system atrophy
Authors: Spargo E. , Papp M.I. , Lantos P.L.
Published: January 2011

The presence of argyrophilic oligodendroglial cytoplasmic inclusions (GCIs) is a pathognomonic feature of multiple system atrophy (MSA), which has established MSA as a nosological entity, and serves as a diagnostic criterion. As a neurodegenerative disease, MSA exhibits neuronal degeneration and loss from several regions of the central nervous system. Recent mapping studies of the distribution of GCIs have shown their presence in regions of the brain previously thought not to be affected in MSA, for example the cerebral cortex. This study has used stereological techniques to establish whether neuronal loss is related to the presence of GCIs in three regions of the cerebral cortex. In the prefrontal cortex, in which GCIs are sparse, there is no significant difference in either neuronal or glial cell numerical density in MSA cases compared to controls. However in two cortical regions which are both GCI rich, the anterior central gyrus and the supplementary motor cortex, there is a marked reduction in neuronal density of 18.7% and 21.4% respectively, which is statistically significant only in the supplementary motor cortex. In both of these regions there is a concomitant increase in glial cell numerical density which results in a significant change in the ratio of neurons to glial cells. These results indicate that there is a regional reduction in the neuronal density in the cortex in multiple system atrophy which is associated with the presence of GCIs.
Efficacy and safety of stereotaxic surgical treatment of tremor disorders
Authors: Koller W. , Hristova A.
Published: January 2011

Limitations of current pharmacologic therapies and advances in surgical techniques have led to renewed interest in the stereotaxic treatment of tremor disorders. Thalamotomy is an effective treatment for parkinsonian tremor. Long‐term efficacy is established. Persistent morbidity with unilateral operations is rare, consisting of dysarthria, dysphagia and paresis. Bilateral thalamotomies are associated with a high prevalence of speech impairment Thalamotomies are also effective for essential and post‐traumatic tremors. Thalamotomies have a limited role in the cerebellar tremors of multiple sclerosis as functional disabilities cannot be reversed. Pallidotomy and pallidal stimulation may have a role in the treatment of Parkinson's disease; however, its effect on tremor has not been defined. Thalamic stimulation is effective for parkinsonism and essential tremor. We favour this procedure because of its reversibility and adaptability.
Pain and disability in migraine or other recurrent headaches as reported by children
Authors: Hämäläinen M. L. , Hoppu K. , Santavuori P.
Published: January 2011

To evaluate the pain intensity and physical disability during migraine attacks, 340 children suffering from headache were studied in an outpatient setting. A validated self‐reporting five‐faces scale was used. Intensity of headache was more severe and attacks longer but less frequent in 253 children with migraine than in 87 children with other types of headache. On a pain scale, 69% of the children with migraine expressed maximal pain vs 32% of those with other types of headache. Bed rest for migraine attacks was required by 96% of the children. Severe migraine was at least as common in prepubertal as in pubertal children. The severity of the pain and disability related to migraine attacks should be evaluated carefully and treated appropriately.
Influence of blood pressure and cardiac output on cerebral blood flow and autoregulation in acute stroke measured by TCD
Authors: Treib J. , Haass A. , Koch D. , Grauer M.T. , Stoll M. , Schimrigk K.
Published: January 2011

Although the dependence of cerebral perfusion on blood pressure has been well studied, little data is available about the effect cardiac output has on cerebral flow velocity and autoregulation, particularly during acute stroke. To improve cerebral perfusion, we treated 10 patients who suffered from an acute ischemic stroke of the middle cerebral artery with a hypervolemic hemodilution combined with dopamine‐dobutamine. The influence of blood pressure and cardiac output on the blood flow velocity in the middle cerebral artery was measured using transcranial doppler sonography (TCD). Under the therapy, a dosage‐dependent increase of 12% in blood pressure (BP) and 53% increase in cardiac output was observed. There was a significant (p > 0.01) correlation between TCD‐mean flow velocity (Vm) and cardiac output (r = 0.33) as well as between Vm and blood pressure (r = 0.52) on the affected side. The unaffected side showed no correlation between Vm and cardiac output (r = 0.01), or between Vm and blood pressure (r = 0.03). Systolic flow velocity increased significantly in both hemispheres. As an expression of increasing cerebral vascular resistance, the pulsating index (PI) increased significantly (p > 0.01) in the affected hemisphere as well as in the unaffected hemisphere. This suggests that during acute stroke blood flow velocity and autoregulation in the affected vascular region depend not only on cerebral perfusion pressure but also on CO levels.
Blood‐brain barrier impairment in acute optic neuritis evaluated by Gadolinium—DTPA enhanced MRI and CSF studies
Authors: Frederiksen J. L. , Larsson H. B. W. , Christiansen P. , Sellebjerg FT. , Olesen J.
Published: January 2011

We prospectively compared the brain magnetic resonance imagings (MRIs) following Gadolinium‐DTPA (Gd‐DTPA) injection with unenhanced T2‐weighted MRIs in a well‐defined population‐based group of 76 patients aged 20–57 years with acute optic neuritis (ON). We aimed to evaluate the blood‐brain barrier impairment in ON and the interrelationships of findings by CSF analyses and MRI. Lumbar puncture and MRI were performed within a median of 19 and 13 days from onset respectively. MRI showed unenhanced lesions in 22 of 54 patients with monosymptomatic ON (AMON) compared to 19 of 22 patients with ON as part of clinically definite MS (CDMS) (p = 0.0002). Enhanced lesions (sized 2–38 mm) were revealed in 10 out of 54 patients with AMON vs 8 of 22 patients with CDMS (p = 0.06). The number of enhancing lesions in proportion to the number of unenhancing lesions was higher in patients with AMON than in patients with CDMS (p > 0.05). Ten of altogether 30 enhancing lesions were situated periventricularly. An impaired blood‐brain barrier judged by increased albumin quotient was found in only five patients. The patients with AMON often had significantly less abnormal intrathecal IgG synthesis (p = 0.02), IgG‐index (p = 0.02) and oligoclonal bands (p = 0.04) than did the patients with CDMS. In AMON, the presence of oligoclonal bands was significantly related to abnormal unenhanced and enhanced MRI, p = 0.01 and p = 0.02, respectively. No other significant relationships were observed between the results of MRI and CSF findings, neither in AMON nor in CDMS.
The genetics of migraine
Authors: Russell M. B.
Published: January 2011

Clinical, pathophysiological and genetic studies indicate that migraine without aura (MO) and migraine with aura (MA) are distinct entities. Compared with the general population, first degree relatives of probands with MO have a two‐fold increased risk of MO. The mode of inheritance is most likely multifactorial inheritance without generational difference, but genetic heterogeneity can not be excluded. Compared with the general population, first degree relatives of probands with MA have a four‐fold increased risk of MA. The mode of inheritance is most likely multifactorial inheritance without generational differences. Familial hemiplegic migraine (FHM) is a rare autosomal dominant subtype of MA. A gene for FHM maps to chromosome 19. Some families with FHM do not link to this locus, indicating genetic heterogeneity of FHM. The gene for FHM is soon to be cloned. Loci for the more common types of migraine MO; and MA will problably be identified in the near future.
Changes in cerebral glucose metabolism with normal aging
Authors: Blesa R. , Mohr E. , Miletich R. S. , Randolph C. , Hildebrand K. , Sampson M. , Chase T. N.
Published: January 2011

The pattern of changes in cerebral glucose metabolism occurring with normal aging has been unclear. Advances in imaging technology, such as improved resolution and anatomical referencing, allow for more precise regional measurement than previously possible. This study explored cerebral glucose metabolism in 17 normal controls ranging in age from 20 to 74 years. High resolution PET scanning, with MRI‐based regions of interest correcting for partial volume and atrophy effects, revealed a linear association between advancing age and declining cerebral glucose metabolism. The decline averaged 8% per decade for the whole brain. Changes were most pronounced in limbic structures, and could be implicated in age‐associated memory loss.
Dutch normal pressure hydrocephalus study: baseline characteristics with emphasis on clinical findings
Authors: Boon A. J. W. , Tans J.Th. J. , Delwel E. J. , Egeler‐Peerdeman S. M. , Hanlo P. W. , Wurzer J. A. L. , Hermans J.
Published: January 2011

We present the baseline characteristics of 101 patients with normal pressure hydrocephalus (NPH), entering a study that evaluates the diagnostic reliability of CSF outflow resistance. Patients were assessed by a gait scale consisting of 10 features of walking and the number of steps and seconds necessary for 10 m, a dementia scale comprising the 10 word test, trail making, digit span and finger tapping, the modified Mini Mental State Examination (3MSE) and the modified Rankin scale (MRS). Inclusion criteria were a gait and dementia scale ≥ 12 (range 2–40), a MRS ≥ 2 and a communicating hydrocephalus on CT. Gait disorder and dementia varied from mild to severe leading to MRS 2 in 17%, MRS 3 in 34%, MRS 4 in 21%, MRS 5 in 16% and MRS 6, including akinetic mutism, in 12%. Only one patient showed both normal tandem walking and turning. Small steps, reduced foot floor clearance and wide base were also frequently seen in the 67 patients walking independently; 34 needed assistance or could not walk at all. Applying the 3MSE, 64% were demented; the remaining 36% exhibited a milder cognitive deficit. The 10 word test and trail making decreased with increasing dementia. Digit span and finger tapping declined in the most demented patients. This group of elderly patients with NPH, mostly of the idiopathic type, proved to be vulnerable because of considerable disability and comorbidity.
The neurological examination in the assessment of polyneuropathy in mechanically ventilated patients
Authors: Leijten F.S.S. , Poortvliet D.C.J. , de Weerd A.W.
Published: January 2011

Polyneuropathy has been implicated in critical illness as a cause of difficult weaning from artificial ventilation and of rehabilitation problems. We wanted to see which clinical parameters can be used to identify patients with polyneuropathy in the intensive care. In a prospective study during 18 months, mechanically ventilated patients underwent serial neurological and EMG investigations in the general intensive care unit of a large community hospital. Fifty patients under 75 years old were studied who were on the respirator for more than 7 days. Using simple criteria, both a provisional clinical and an EMG diagnosis were made with regard to polyneuropathy during the second and fourth week and the second month of mechanical ventilation. After the intensive care period, 34 surviving patients were also given a final clinical diagnosis which was compared to earlier EMG conclusions. Even with crude criteria, such as the presence of either paresis or areflexia, maximal sensitivity of the provisional clinical judgement was only 60% as compared to concurrent EMG diagnosed polyneuropathy. EMG investigations in the intensive care, however, did not identify two out of 10 patients with a final clinical diagnosis of polyneuropathy. Thus, neurological examination is an insufficient screening method for polyneuropathy in intensive care. EMG has a fair diagnostic yield but one should realize that it is not an infallible gold standard.
Titin antibody positive myasthenia gravis patients have a cellular immune response against the main immunogenic region of titin
Authors: Skeie G. O. , Aarli J. A. , Matre R. , Freiburg A. , Gilhus N. E.
Published: January 2011

Some myasthenia gravis (MG) patients have antibodies against non‐acetylcholine receptor (AChR) epitopes of skeletal muscle including titin. Peripheral blood lymphocytes from 11 MG patients and 13 blood‐donors were tested for lymphocyte proliferation after stimulation with the titin peptide MGT‐30, which represents the main immunogenic region. Four out of seven titin antibody positive patients had significant stimulation defined as a stimulation index (SI) above 2. Neither of the four titin antibody negative patients nor the 13 blood‐donors had SI above 2 (p = 0.001). Mean SI was significantly higher for T‐cells from titin antibody positive MG patients, SI = 2.2 ± 0.8, compared to titin antibody negative patients, SI = 0.9 ± 0.2 (p = 0.01), and blood‐donors, SI = 0.8 ±0.3 (p > 0.0005). After MGT‐30 stimulation, IL‐4 was detected in the blood lymphocyte culture supernatant from four of the five MG patients examined, but from none of the eight blood‐donors. Thus, MG patients with anti‐titin antibodies have a T‐cell mediated immune reaction against titin.
Event‐related brain potentials show changed attentional mechanisms in Gilles de la Tourette Syndrome
Authors: Johannes S. , Weber A. , Müller‐Vahl K. R. , Kolbe H. , Dengler R. , Münte T. F.
Published: January 2011

In many patients the Gilles de la Tourette Syndrome (TS) is associated with the childhood Attention Deficit Hyperactivity Disorder. To gain a general view of attentional processes in TS we recorded event‐related brain potentials (ERPs) in 12 TS patients and in a matched control group. Four visual attention experiments with different levels of complexity were done (oddball task, pop‐out experiment, figure extraction and figure conjunction task). The reaction times did not differ significantly between groups. The Tourette patients' event‐related brain potentials showed an increased amplitude of the N2 component to targets in the simple oddball and pop‐out experiments. While both groups had similar P3b latencies to targets in the figure extraction experiment, Tourette patients responded less accurately in the most complex figure conjunction task and had increased P3b latencies. This is interpreted as evidence for a stronger attentional effort of the Tourette patients to obtain behavioural results similar to control subjects in easy attentional tasks. Consequently, Tourette patients show a reduced performance in complex attentional tasks.
Psychiatric wandering behaviour in dementia patients correlated with increased striatal dopamine D2 receptor as shown by [11C]YM‐09151–2 and positron emission tomography
Authors: Meguro K. , Itoh M. , Yanai K. , Takase K. , Yamaguchi S. , Ido T. , Yamadori A.
Published: January 2011

It is known that some demented patients show psychiatric symptoms and behavioural abnormalities such as wandering. However, how such behavioural abnormalities are correlated with brain function is unclear. In this study, the relationship between the dopaminergic receptor and psychiatric wandering behaviour in dementia was examined. Nine probable Alzheimer's disease (AD) patients with the NINCDS–ADRDA criteria, nine vascular dementia (VD) patients with the NINDS–AIREN criteria and six age‐matched controls were studied. Four of each of the dementia group showed psychiatric wandering behaviour. The dopamine D2 receptor was assessed using the radiolabeled D2 antagonist [11C]YM‐09151–2, and positron emission tomography (PET). A three‐compartment analysis using the metabolite‐corrected (with HPLC) plasma radioactivity curve was performed for the calculation of receptor kinetics. Time–activity curves of the striatum were obtained. Two‐way analysis of variance showed that there was a significant difference in the k3/k4 value between the groups (normal, VD and AD) considering the effect of wandering behaviour (wanderers or not). Post hoc test indicated that the values for AD and VD were greater than those of the controls. Since the k3/k4 value was equal to the binding potential under the tracer condition, the result indicated that psychiatric wandering behaviour of dementia was correlated with increased dopamine D2 receptors.
Localized in vivo H‐MRS of traumatic brain injury
Authors: Zampolini M. , Tarducci R. , Gobbi G. , Franceschini M. , Todeschini E. , Presciutti O.
Published: January 2011

1H‐MRS examinations were carried out on 14 patients, recovering from traumatic brain injury (TBI), who were in a stabilized clinical status and showed a good clinical outcome. Magnetic resonance spectra were recorded in subcortical (SC) and mid‐brain (MB) areas where no detectable lesions appeared under magnetic resonance imaging. These two brain areas were selected because they are crucial sites of damage due to the physiopathologic mechanisms of TBI. A significant increase in inositol and choline peaks was found in MB compared to a control group of healthy individuals, whereas lower N‐acetyl‐aspartate peaks in the same area were detected. Reduced levels in the latter metabolite were also evident in the SC area. A significant correlation emerged between the inositol concentration in MB and the Glasgow Coma Scale Score measured just after the trauma. No correlation was found between the Glasgow Outcome Scale (GOS) at the time of the 1H‐MRS examination and the peaks of all the metabolites. Our study demonstrated that 1H‐MRS is a sensitive tool to evidentiate brain metabolic damage after TBI even in areas with lesions that are not detectable with current imaging techniques. The present research also shows an association between the alteration in one of the brain metabolites and the clinical parameters of TBI severity, but does not provide a clinical index of the patient's recovery. Further longitudinal studies on more conspicuous groups of patients with TBI could help to clarify whether metabolite modifications revealed by 1H‐MRS could be predictive of clinical outcome.
Cephalic postganglionic sympathetic involvement in cluster headache–as evidenced by the pupillary responses to phenylephrine and tyramine
Authors: Havelius U. , Milos P. , Hindfelt B.
Published: January 2011

Twenty‐six patients with episodic cluster headache were subjected to pupillometric examinations of the responses to bilateral conjunctival instillations of a single drop of a 1% phenylephrine and a 2% tyramine hydrochloride solution. Five patients had a Horner‐like syndrome on the symptomatic side, where they exhibited an increased pupillary response to phenylephrine and a decreased response to tyramine, i.e. a pattern compatible with postganglionic sympathetic dysfunction. It is suggested that these patients constitute a subgroup among the patients with cluster headache. The pupillary response to phenylephrine was frequently increased on the symptomatic side, while that to tyramine was reduced. This may indicate dysfunction of the sympathetic postganglionic fibers to the iris (and tentatively to the cephalic vasculature). Such an interpretation may be supported by the finding that a marked mydriatic response on the symptomatic side to tyramine was associated with an inactive cluster headache, frequently over many years.
A unilateral defect of short‐term visual memory in left hemineglect
Authors: D'Erme P. , Bartolomeo P.
Published: January 2011

Normal subjects and right‐ and left‐brain‐damaged patients with and without neglect performed a task of immediate visual memory and a task of same‐different judgment on visual items. In both tasks, stimull consisted in geometrical patterns, which differed either on the right or on the left side. Only right‐brain‐damaged patients with neglect showed an impaired performance in these tasks. They performed worse on items differing on the left side than on items differing on the right side. This impairment was more severe on the memory task than on the same‐different task, suggesting that a lateralized visual memory deficit contributes to the behavioural manifestations of left hemineglect.
Brain SPECT imaging in transcortical aphasias: the functional status of the left perisylvian language cortex*
Authors: Berthier M. L. , Posada A. , Puentes C. , Hinojosa J.
Published: January 2011

Single photon emission computerized tomography (SPECT) with 99mTc‐HMPAO was used to examine the functional status of the left perisylvian language cortex (PLC) in eight patients with transcortical aphasias (TAs) due to cerebrovascular accidents. According to the lesion location within the left hemisphere, the aphasic patients were divided into two groups: (a) patients with corticosubcortical lesions involving portions or the whole PLC (perisylvian group,n= 4); (b) patients with corticosubcortical lesions sparing the PLC (extraperisylvian group,n= 4). Results showed that, as expected, the perisylvian group had significant decrements in regional cerebral blood flow (rCBF) in structurally damaged regions of the left PLC, although some morphologically spared regions of the left PLC (Wernicke's area) also had perfusion defects in one patient. Among the extraperisylvian group, there was structural and functional damage to the posterior association areas, but two patients additionally had significant decrements of rCBF in morphologically spared regions of the PLC (Wernicke's area, sensorimotor cortex, Broca's area). These findings demonstrate not only that the left PLC may be structurally and functionally damaged among patients with TAs, but additionally suggest a major contribution of the right hemisphere in the mediation of residual language repetition.
The Skills Gap in Nursing Management in the South African Public Health Sector
Authors: Pillay Rubin
Published: January 2011

ABSTRACT
Objectives: Nurse managers are central to health delivery in South Africa. However, there is a paucity of research that analyzes their competence to successfully discharge their managerial role. To identify the competencies perceived to be important for effective nursing management in the South African public sector and the managers' self‐assessed proficiency in these.

Design and Sample: A cross‐sectional survey using a self‐administered questionnaire. 215 senior nursing managers at South African public sector hospitals.

Measures: Respondents rated the level of importance that 51 proposed competencies had in their job and indicated their proficiency in each.

Results: Public sector managers ranked controlling as the most important competency, followed by leading, organizing, and self‐management. Health/clinical skills, planning, and legal/ethical competencies were ranked as being relatively less important. They assessed themselves as being most competent in self‐management, followed by planning, controlling, leading, and specific health skills. The competency gap was the largest for legal/ethical issues, organizing, and controlling. The competency gap for planning and self‐management was relatively smaller.

Conclusions: This research confirms that there is a lack of management capacity within the public health sector and also identifies the areas in which the lack of knowledge or skills is most significant.
Dental Insurance and Dental Service Use by U.S. Women of Childbearing Age
Authors: Kaylor Mary Beth , Polivka Barbara J. , Chaudry Rosemary , Salsberry Pamela , Wee Alvin G.
Published: January 2011

ABSTRACT
Objectives: Oral health has a significant effect on health, and for women, poor oral health can lead to poor birth outcomes and can affect their child's health. Nursing interventions to improve the oral health of at‐risk women have the potential to increase maternal and child systemic and oral health. The identification of women at a high risk for poor oral health is a necessary to develop and evaluate these interventions.

Design and Sample: This study examined the factors related to dental insurance and dental service use for women of childbearing age in the United States. A secondary analysis of the 2003–2004 National Health and Nutrition Examination Survey was completed to examine the predisposing, enabling, and need variables associated with dental insurance status and dental service use in a representative random sample of 1,071 women.

Results: The results showed that over 40% of women had no dental insurance. Women with less education, lower income, and dental need were significantly less likely to have dental insurance. Dental utilization by the uninsured was low and a racial/ethnic disparity was noted.

Conclusion: A lack of dental insurance and dental service utilization is a significant concern. Nurses working with low‐income women should educate the population about oral health and advocate for policies to increase dental insurance coverage.
Public Health Nurse Perceptions of Empowerment and Advocacy in Child Health Surveillance in West Ireland
Authors: Cawley Teresa , Mannix McNamara Patricia
Published: January 2011

ABSTRACT
Objective: The objective of this study was to analyze public health nurses' perceptions of empowerment and advocacy within a child health screening and surveillance program in West Ireland.

Design and Sample: This study combined both qualitative and quantitative research methods. A purposive sample of 9 public health nurses (PHNs) (phase 1) participated in 2 focus groups and a purposive sample of 43 clients attending the child health screening service completed a questionnaire (phase 2).

Measures: Focus groups and Questionnaires were used.

Results: Thematic content analysis revealed that PHNs in the study did not perceive themselves to be empowered in their work. They attributed this to workload, lack of professional advocacy, and restricted access to power and opportunity, while also identifying the need for continued managerial support and feedback.

Conclusions: The results suggest that PHNs need to be empowered in order to facilitate client empowerment. PHNs struggled with empowerment and client advocacy. There is a need for professional development for PHNs in order to support them to more critically engage with empowerment and self‐efficacy in their work. This needs to be done within organizational structures that support PHNs to critically analyze the role of advocacy and empowerment in their practice.
Microcredit and the Social Determinants of Health: A Conceptual Approach
Authors: Salt Rebekah
Published: January 2011

ABSTRACTSocial determinants of health, such as human behavior, environment, and socioeconomics, contribute to health disparities at the individual and population levels. The association between socioeconomics and health is established, and it is acknowledged that people with a lower socioeconomic status experience poorer health. The impetus of microcredit programs is to provide financial alternatives for low‐income populations, the majority of whom are women with limited or no access to traditional lending, to start small businesses, generate income, and progress toward self‐sufficiency. The income‐health link within the context of microcredit has been internationally acknowledged; however, there is scarce research in this area in the United States. This article presents a review of the conceptual approach used to explore the microcredit and health link from a public health nursing perspective. Establishing conceptual foundations can enhance research focused on targeted interventions aimed at lasting change in social and health status. Exploring the link between microcredit and health can enrich research efforts and may offer innovative strategies and interventions to improve health‐promoting capacity in impoverished groups.
Contribution to safety of immunoglobulin and albumin from virus partitioning and inactivation by cold ethanol fractionation: a data collection from Plasma Protein Therapeutics Association member companies
Authors: Dichtelmüller Herbert O. , Biesert Lothar , Fabbrizzi Fabrizio , Falbo Anna , Flechsig Eckhard , Gröner Albrecht , von Hoegen Ilka , Kempf Christoph , Kreil Thomas R. , Lee Douglas C. , Pölsler Gerhard , Roth Nathan J.
Published: January 2011

BACKGROUND: Virus removal by partitioning into different fractions during cold ethanol fractionation has been described by several authors, demonstrating that cold ethanol fractionation can provide significant contribution to virus removal, even in those cases where virus removal is limited and must be supported by additional measures for virus inactivation during further processing.

STUDY DESIGN AND METHODS: Plasma Protein Therapeutics Association (PPTA) member companies collected and evaluated 615 studies on virus removal by the steps of the cold ethanol fractionation process. The studies describe the precipitation and separation of Fraction (F)III or FI/III in the immunoglobulin fractionation process and precipitation and separation of FII/III, FI/II/III, and FIV/IV in the albumin fractionation process.

RESULTS: The data indicate a significant contribution of cold ethanol fractionation to the overall clearance of a broad spectrum of viruses, at varied process variables such as pH, temperature, and alcohol concentration and demonstrate the robustness of virus removal by the cold ethanol fractionation process.

CONCLUSIONS: The data presented here support the importance of the partitioning steps for virus safety for immunoglobulins and albumin. However, virus removal by cold ethanol fractionation alone cannot provide viral safety of human albumin and immunoglobulins and therefore must be completed by other virus inactivation and removal procedures.
Rejuvenation capacity of red blood cells in additive solutions over long‐term storage
Authors: Meyer Erin K. , Dumont Deborah F. , Baker Sharry , Dumont Larry J.
Published: January 2011

BACKGROUND: Red blood cells (RBCs) are Food and Drug Administration (FDA)‐approved for 42‐day storage with the use of additive solutions (ASs). However, adenosine triphosphate (ATP) and 2,3‐diphosphoglycerate (2,3‐DPG) levels in the RBCs decline over this time. These constituents may be restored by treatment with rejuvenation (REJ) solutions. This study was done to assess the response capability of RBCs from 30 to 120 days of storage in three FDA‐licensed RBC storage solutions after incubation with a rejuvenating solution of pyruvate, inosine, phosphate, and adenine.

STUDY DESIGN AND METHODS: Three units each of RBCs in approved AS (AS‐1 [Adsol, Fenwal, Inc.], AS‐3 [Nutricel, Medsep Corp.], and AS‐5 [Optisol, Terumo Corp.]) were stored under standard conditions at 1 to 6°C for up to 120 days. Aliquots (4 mL) on Days 30, 42, 60, 80, 100, and 120 (±2 days) were REJ by incubating with Rejuvesol (Encyte Corp.). Control untreated and REJ aliquots were extracted using perchloric acid and stored at −80°C until assayed for 2,3‐DPG and ATP.

RESULTS: RBCs responded to REJ by increasing DPG and ATP contents. The response declined linearly at 0.070 ± 0.008 µmol DPG/g hemoglobin (Hb)/day and 0.035 ± 0.004 µmol ATP/g Hb/day with no differences between ASs.

CONCLUSION: We conclude that Rejuvesol is able to restore ATP and 2,3‐DPG levels in RBCs stored up to 120 days in AS. The response diminishes as storage time increases. This rejuvenation (REJ) capability does not seem useful for routine assessment of RBC anabolic capacity in research programs, but may be useful to the investigator when studying unique and novel treatment methods.
Current problems and future directions of transfusion‐induced alloimmunization: summary of an NHLBI working group
Authors: Zimring James C. , Welniak Lis , Semple John W. , Ness Paul M. , Slichter Sherrill J. , Spitalnik Steven L. ,   for the NHLBI Alloimmunization Working Group
Published: January 2011

In April 2010, a working group sponsored by the National Heart, Lung, and Blood Institute was assembled to identify research strategies to improve our understanding of alloimmunization caused by the transfusion of allogeneic blood components and to evaluate potential approaches to both reduce its occurrence and manage its effects. Significant sequelae of alloimmunization were discussed and identified, including difficulties in maintaining chronic transfusion of red blood cells and platelets, hemolytic disease of the newborn, neonatal alloimmune thrombocytopenia, and rejection of transplanted cells and tissues. The discussions resulted in a consensus that identified key areas of future research and developmental areas, including genetic and epigenetic recipient factors that regulate alloimmunization, biochemical specifics of transfused products that affect alloimmunization, and novel technologies for high‐throughput genotyping to facilitate extensive and efficient antigen matching between donor and recipient. Additional areas of importance included analysis of unappreciated medical sequelae of alloimmunization, such as cellular immunity and its effect upon transplant and autoimmunity. In addition, support for research infrastructure was discussed, with an emphasis on encouraging collaboration and synergy of animal models biology and human clinical research. Finally, training future investigators was identified as an area of importance. In aggregate, this communication provides a synopsis of the opinions of the working group on the above issues and presents both a list of suggested priorities and the rationale for the topics of focus. The areas of research identified in this report represent potential fertile ground for the medical advancement of preventing and managing alloimmunization in its different forms and mitigating the clinical problems it presents to multiple patient populations.
Examining the Impact of Pedagogy on Student Application of Learning: Acquiring, Sharing, and Using Knowledge for Organizational Decision Making
Authors: Stewart Alice C. , Williams Jacqueline , Smith‐Gratto Karen , Black Sylvia Sloan , Kane Betty Turner
Published: January 2011

In this pilot research we examine the impact of two leadership development training programs on the ability of students to acquire knowledge, share knowledge, and apply knowledge for organizational decision making. One program emphasized concepts and case‐based application based on a technical learning paradigm. The other program used a game‐based computer simulation, Virtual Leader, grounded in an experiential or situated learning paradigm. After training, students from both programs engaged in a complex in‐basket exercise to examine the quality of their leadership and managerial abilities. In this exercise, participants from each training intervention worked with their trained cohort to accomplish a day of managerial work. Participants were observed and their individual and collective actions and decisions on behalf of the organization were evaluated. Using qualitative research we compared the organizational decisions associated with each group to determine which pedagogical technique resulted in the most effective application of student learning. While technical learning pedagogy was associated with greater information acquisition, the game‐based computer simulation (an experiential, social‐interaction oriented pedagogy) was associated with better decision quality and more shared cognition. Evidence suggests that students taught with the game‐based computer simulation collectively demonstrated a greater ability to apply what they learned.
Applying Mass Customization Concepts to Core Courses: Increasing Student‐Centered Customization and Enabling Cross‐Functional Integration
Authors: Wilson Darryl D.
Published: January 2011

This conceptual paper suggests a methodology for increasing student satisfaction in core courses by applying the principle of mass customization to increase student satisfaction. It proposes that customization can be increased by increasing course flexibility along three dimensions: content flexibility, schedule flexibility, and course length flexibility. The increased flexibility provides opportunities for both student‐centered customization and the cross‐functional integration of the core course with other disciplines. Core courses were targeted because of their high volume of students specializing in something other than the core course being taught and the associated general disinterest of these types of students. There are two main sections. The first section provides an overview to the proposed course structure while the second provides suggestions about computer‐based technology that can be used to support the structure presented in the first section. Examples are presented that pertain to a core course in statistics, but the technology and course structure presented are easily adaptable to core courses in any discipline.
Ventricular Fibrillation Following Successful DC Cardioversion for Atrial Fibrillation
Authors: CALDWELL JANE C. , WOOLFSON PETER , CLARKE BERNARD , GARRATT CLIFFORD J.
Published: January 2011

Cardioversion remains an important therapy in the management of atrial fibrillation. Here, we report a case where direct current cardioversion resulted in a sudden dramatic change of heart rate that was associated with multiple ventricular fibrillation arrests in a manner akin to that previously observed post‐atrioventricular node ablation. (PACE 2012;35:e361–e364)
Morse taper connection implants supporting “planned” maxillary and mandibular bar‐retained overdentures: a 5‐year prospective multicenter study
Authors: Mangano Carlo , Mangano Francesco , Shibli Jamil Awad , Ricci Massimiliano , Sammons Rachel Lilian , Figliuzzi Michele
Published: January 2011

Objectives: In contrast to the excellent long‐term outcomes described for implant‐supported mandibular overdentures, less favorable long‐term survival and success rates have been reported for maxillary implants supporting overdentures. The aim of this study was to evaluate the treatment outcome of “planned” bar‐retained maxillary and mandibular overdentures supported by Morse taper connection implants, investigating implant survival, peri‐implant tissue health, marginal bone resorption and prosthetic complications.

Material and methods: Over a 2‐year period, 60 patients were enrolled in this study, in four different clinical centers. The overdentures (maxilla 38, mandible 34) were planned with support from four implants anchored on a bar. A total of 288 Morse taper connection implants (Leone Implant System®) were inserted (152 maxilla, 136 mandible). Implants were evaluated 5 years after insertion. Success criteria included the absence of pain, suppuration or clinical mobility, the distance between implant shoulder and first crestal bone–implant contact (DIB) <2 mm and no exudate history.

Results: The overall 5‐year implant survival rate was 98% (maxilla 97.4%, mandible 98.6%), with 282 implants still in function. Among these surviving implants, 278 (98.6%) were classified in the success group. At the 5‐year examination, the mean DIB was 0.7 mm (±0.53). Few prosthetic complications were reported.

Conclusions: With “planned” bar‐retained maxillary and mandibular overdentures supported by Morse taper connection implants, satisfactory survival and success rate can be achieved.

To cite this article:
 Mangano C, Mangano F, Shibli JA, Ricci M, Sammons R, Figliuzzi M. Morse taper connection implants supporting “planned” maxillary and mandibular bar‐retained overdentures: a 5‐year prospective multicenter study. Clin. Oral Impl. Res.22, 2011; 1117–1124 doi: 10.1111/j.1600‐0501.2010.02079.x
Titanium allergy: could it affect dental implant integration?
Authors: Siddiqi Allauddin , Payne Alan G. T. , De Silva Rohana Kumara , Duncan Warwick J.
Published: January 2011

Purpose: Degradation products of metallic biomaterials including titanium may result in metal hypersensitivity reaction. Hypersensitivity to biomaterials is often described in terms of vague pain, skin rashes, fatigue and malaise and in some cases implant loss. Recently, titanium hypersensitivity has been suggested as one of the factors responsible for implant failure. Although titanium hypersensitivity is a growing concern, epidemiological data on incidence of titanium‐related allergic reactions are still lacking.

Materials and methods: A computer search of electronic databases primarily MEDLINE and PUBMED was performed with the following key words: ‘titanium hypersensitivity’, ‘titanium allergy’, ‘titanium release’ without any language restriction. Manual searches of the bibliographies of all the retrieved articles were also performed. In addition, a complementary hand search was also conducted to identify recent articles and case reports.

Results: Most of the literature comprised case reports and prospective in vivo/in vitro trials. One hundred and twenty‐seven publications were selected for full text reading. The bulk of the literature originated from the orthopaedic discipline, reporting wear debris following knee/hip arthroplasties. The rest comprised osteosynthesis (plates/screws), oral implant/dental materials, dermatology/cardiac‐pacemaker, pathology/cancer, biomaterials and general reports.

Conclusion: This review of the literature indicates that titanium can induce hypersensitivity in susceptible patients and could play a critical role in implant failure. Furthermore, this review supports the need for long‐term clinical and radiographic follow‐up of all implant patients who are sensitive to metals. At present, we know little about titanium hypersensitivity, but it cannot be excluded as a reason for implant failure.

To cite this article:
 Siddiqi A, Payne AGT, De Silva RK, Duncan WJ. Titanium allergy: could it affect dental implant integration? Clin. Oral Impl. Res. 22, 2011; 673–680 doi: 10.1111/j.1600‐0501.2010.02081.x
The effect of zirconia and titanium implant abutments on light reflection of the supporting soft tissues
Authors: van Brakel Ralph , Noordmans Herke Jan , Frenken Joost , de Roode Rowland , de Wit Gerard C. , Cune Marco S.
Published: January 2011

Objectives: To determine the difference in light reflection of oral mucosa covering titanium (Ti) or zirconia (ZrO2) abutments as it relates to the thickness of the covering mucosa.

Material and methods: Fifteen anterior implants (Astra Osseo speed®) in 11 patients were fitted with a Ti or a ZrO2 abutment (cross‐over, within‐subject comparison). Hyper‐spectral images were taken with a camera fitted on a surgical microscope. High‐resolution images with 70 nm interval between 440 and 720 nm were obtained within 30 s (1392 × 1024 pixels). Black‐ and white‐point reference was used for spatial and spectral normalization as well as correction for motion during exposure. Reflection spectra were extracted from the image on a line mid‐buccal of the implant, starting 1 mm above the soft tissue continuing up to 3 mm apically.

Results: Median soft tissue height is 2.3 mm (min: 1.2 mm and max: 3.1 mm). The buccal mucosa rapidly increases in the thickness, when moving apically. At 2.2 mm, thickness is 3 mm. No perceivable difference between the Ti and ZrO2 abutment can be observed when the thickness of the mucosa is 2±0.1 mm (95% confidence interval) or more.

Conclusion: It is expected that the difference in light reflection of soft tissue covering Ti or ZrO2 abutments is no longer noticeable for the human eye when the mucosa thickness exceeds 2 mm. Haemoglobin peaks in the reflection spectrum can be observed and make hyper‐spectral imaging a practical and useful tool for measuring soft tissue health.

To cite this article:
 van Brakel R, Noordmans HJ, Frenken J, de Roode R, de Wit GC, Cune MS. The effect of zirconia and titanium implant abutments on light reflection of the supporting soft tissues. Clin. Oral Impl. Res. 22, 2011; 1172–1178 doi: 10.1111/j.1600‐0501.2010.02082.x
Retracted:Bone remodelling after regenerative procedures around implants placed in fresh extraction sockets: an experimental study in Beagle dogs
Authors: Barone A. , Ricci M. , Calvo‐Guirado J. L. , Covani U.
Published: January 2011

Introduction:After a tooth extraction, the height of the buccal wall tends to decrease. The literature indicates that regenerative techniques (guided bone regenerative [GBR] techniques) have succeeded in improving the bone levels. Therefore, this experiment set out to compare the physiological bone remodelling in Beagle dog models after implant placement in a fresh extraction socket, with and without the application of regenerative procedure.

Materials and methods:Five dogs were used in this study. Test and control sites were randomly selected. The experimental teeth (fourth pre‐molar and first molar) were hemi‐sected removing the distal roots and placing implants. Porcine bone was placed to fill the gap around the implant on the test sites and a reabsorbable membrane was used to cover the area. The dogs were put down at different times (2 weeks, 1 month and 3 months). The measurements were taken immediately and at 2, 4, 12 weeks after implant placement. Student's test for paired data was used to compare the means of the clinical measurements.

Results:At 2 weeks: On the control sites, few signs of resorption were detected at the first molar only, while at the test sites bone levels were placed at the implant shoulder or above.

At 4 weeks: On the control site, slight bone remodelling was observed, while on the test site minor signs of resorption or an increase of bone levels were detected.

At 12 weeks: The alveolar crest on the control sites showed various degrees of remodelling. On the test sites stable bone levels or an increase of bone crest was observed.

Conclusion:With the limits of this study, the findings showed that GBR techniques were able to limit resorption of the alveolar crest after tooth extraction. A pattern of bone remodelling after tooth extraction and implant placement was observed in the control sites (no GBR) as well as in test sites (GBR), and although the exact cause of this is unclear, surgical trauma could play a role. Further studies are necessary to confirm these results and to clarify the precise causes of bone remodelling in fresh extraction sockets.

To cite this article: Barone A, Ricci M, Calvo‐Guirado JL, Covani U. Bone remodelling after regenerative procedures around implants placed in fresh extraction sockets: an experimental study in the Beagle dogs. Clin. Oral Impl. Res.22, 2011; 1131–1137 doi: 10.1111/j.1600‐0501.2010.02084.x
X‐ray microtomography: 3‐dimensional imaging of teeth for computer‐assisted learning
Authors: Dowker Stephanie E. P. , Davis Graham R. , Elliott James C. , Wong Ferranti S. L.
Published: January 2011

X‐ray microtomography (XMT), a miniaturised form of computed tomography, has been used to generate 3‐dimensional volume data sets of the X‐ray absorption of human teeth in vitro, with a resolution of ∼40 μm (cubic voxel sidelength). Examples are presented of images relevant to dental morphology, cariology, and cavity preparation and restoration. Applications of XMT imaging to dental education are discussed in the context of new approaches to visual learning through computer‐assisted methods.