bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of Introducing a Rapid Recovery Program for Total Abdominal Hysterectomy
Authors: Dickson Elizabeth , Argenta Peter A. , Reichert John A.
Published: December 2011

Objective: To review the impact of implementing a rapid recovery protocol (RRP) for patients undergoing abdominal hysterectomy. Setting: Metropolitan teaching hospital. Population: Women undergoing abdominal hysterectomy for non-malignant indications. Methods: We conducted a retrospective review of consecutive cases performed during study periods before and after the introduction of an elective rapid recovery program emphasizing regional anesthesia. To control for universal improvements in medical practice, charts from a comparable local hospital without an RRP were also reviewed. Results: 400 charts were reviewed and 366 cases met inclusion criteria and had sufficient information. Patients were well matched for demographic and medical variables between the study periods and between the institutions. The median length of stay (LOS) fell dramatically from 3 (range 1–12) days prior to RRP introduction to 1 (range 1–17) day after RRP (p < 0.001). LOS among patients at the ‘control’ institution remained unchanged at 3 days during the same time frame, indicating that external pressures contributed minimally to the observed changes. There were no significant differences in estimated blood loss, duration of surgery, or complication rate between the groups in either time period. Conclusions: Introducing a rapid recovery program was associated with shorter hospitalization and did not appear to compromise surgical outcome.
Insights into Caspase-Mediated Apoptotic Pathways Induced by Amyloid-β in Cerebral Microvascular Endothelial Cells
Authors: Fossati Silvia , Ghiso Jorge , Rostagno Agueda
Published: December 2011

Background: The vascular deposition of amyloid known as cerebral amyloid angiopathy (CAA) – an age-associated condition and a common finding in Alzheimer’s disease – compromises cerebral blood flow, causing macro/microhemorrhages and/or cognitive impairment. Very little is known about the mechanisms causing CAA-related degeneration of cerebral vascular cells. The Dutch E22Q familial amyloid-β (Aβ) variant is primarily associated with CAA, and manifests clinically with severe cerebral hemorrhages. Objective: We aimed to determine the molecular mechanisms causing apoptosis of cerebral endothelial cells in the presence of wild-type Aβ40 or its vasculotropic E22Q variant. Methods: We challenged human brain microvascular endothelial cells with both Aβ variants, and studied the apoptotic pathways triggered by these peptides. Results: Caspase-mediated apoptotic pathways were elicited by both peptides within time frames correlating with their aggregation properties and formation of oligomeric/protofibrillar assemblies. Our data revealed a primary activation of caspase-8 (typically triggered by death receptors) with secondary engagement of caspase-9, with cytochrome C and apoptosis-inducing factor release from the mitochondria, suggesting the independent or synergistic engagement of extrinsic and intrinsic apoptotic mechanisms. Conclusion: Our data demonstrate the induction of caspase-8- and caspase-9-dependent mitochondrial-mediated apoptotic pathways by Aβ oligomers/protofibrils in vascular cells, likely implicating a primary activation of death receptors.
Should Central Serous Chorioretinopathy Be Added to the List of Ocular Side Effects of Phosphodiesterase 5 Inhibitors?
Authors: Aliferis K. , Petropoulos I.K. , Farpour B. , Matter M.A. , Safran A.B.
Published: December 2011

Introduction: Rare cases of central serous chorioretinopathy (CSC) associated with the intake of sildenafil citrate have been reported, although CSC is not included in the list of phosphodiesterase 5 (PDE5) inhibitor side effects. Materials and Methods: We present a review of the literature and 2 cases of CSC in 2 men taking PDE5 inhibitors (vardenafil and tadalafil) for erectile dysfunction. In both cases chorioretinopathy appeared after intake of the inhibitor, resolved once the latter was discontinued, reappeared when the inhibitor was restarted and resolved once again after the inhibitor had been discontinued for the second time. Discussion: PDE5 inhibitors used for male erectile dysfunction have been associated with ocular side effects including lid edema, hyposphagma, photophobia, mydriasis, dyschromatopsia, and nonarteritic anterior ischemic optic neuropathy. CSC was previously described in patients taking sildenafil citrate. Very recently, a case of CSC after tadalafil intake was reported. The relevant literature is reviewed and possible pathophysiologic mechanisms are discussed. Conclusion: The 2 presented cases of CSC after intake of vardenafil or tadalafil with positive dechallenge, rechallenge and second dechallenge reactions provide important arguments for considering CSC as a rare PDE5 inhibitor class-specific side effect.
Vitamin D-Mentia: Randomized Clinical Trials Should Be the Next Step
Authors: Annweiler Cédric , Beauchet Olivier
Published: December 2011

Hypovitaminosis D is highly prevalent in the elderly. Its possible role in the pathogenesis of Alzheimer’s disease (AD) is particularly important, as AD remains a public health concern with no current efficient treatment. Vitamin D administration could be a multitarget stabilizing treatment for AD since vitamin D simultaneously targets several factors leading to neurodegeneration through immunoregulatory, antioxidant and anti-ischemic actions, as well as the regulation of neurotrophic factors, acetylcholine neurotransmitter and clearance of amyloid beta peptide, and the avoidance of hyperparathyroidism. By preventing neuronal loss, the question is whether correcting hypovitaminosis D among older adults could also prevent AD-related cognitive decline. The cross-sectional associations between the vitamin D intakes – whether from diet, sun exposure or drug supplements – and cognition strengthened this hypothesis, but prevented the finding of a cause and effect link. Pre-post studies showed an improvement of cognition concomitant with the increase in 25-hydroxyvitamin D concentrations. One randomized trial found that supraphysiological doses of vitamin D were not better than physiological doses at improving cognition in AD. At this stage, only clinical trials testing vitamin D supplements versus placebo can further determine the impact of vitamin D administration on cognition and AD with higher levels of evidence.
Catheter Ablation of Right Atrial Ganglionated Plexi in Patients With Vagal Paroxysmal Atrial Fibrillation
Authors: Calò Leonardo , Rebecchi Marco , Sciarra Luigi , De Luca Lucia , Fagagnini Alessandro , Zuccaro Lorenzo Maria , Pitrone Pietro , Dottori Serena , Porfirio Maurizio , de Ruvo Ermenegildo , Lioy Ernesto
Published: December 2011

Background—

Catheter ablation of ganglionated plexi (GP) in the left atrium has been proposed in different subgroup of patients with atrial fibrillation (AF). Anatomic studies found a high prevalence of GP in the posterior surface of the right atrium (RA). Experimental data suggested the potential role of right atrial GP in the AF initiation and maintenance. The aim of our study was to assess the efficacy of GP ablation in RA in patients with vagal AF.

Methods and Results—

Thirty-four patients without structural heart diseases were randomly assigned for a selective ablation procedure targeted on the elimination of vagal reflex evoked by high frequency stimulation or an extensive approach at anatomic sites of GP. All patients underwent Holter ECG and heart rate variability evaluation at baseline and at 3, 6, 12, and 18 months of follow-up. At a mean follow-up of 19.7±5.2 months, AF recurred in 5 of 17 patients with anatomic ablation and in 13 of 17 patients with a selective approach (
P
=0.01). No patient had major complications. After ablation, heart rate variability parameters showed a significant parasympathetic (and sympathetic) denervation in the first 6 months, which was more prominent in patients with anatomic GP ablation and in those without AF recurrence.

Conclusions—

This study demonstrates that in a selected population of vagal paroxysmal AF, the anatomic ablation of GPs in the RA is effective in about 70% of patients. These results confirm that atrial vagal denervation can abolish AF, as suggested by experimental and clinical data.
Retrospective Description and Analysis of Consecutive Catheterization Laboratory ST-Segment Elevation Myocardial Infarction Activations With Proposal, Rationale, and Use of a New Classification Scheme
Authors: Mixon Timothy A. , Suhr Eunice , Caldwell Gerald , Greenberg Robert D. , Colato Fernando , Blackwell Jeffry , Jo Chan-Hee , Dehmer Gregory J.
Published: December 2011

Background—

Rapid activation of a cardiac catheterization laboratory (CCL) has reduced door-to-balloon times in ST-segment elevation myocardial infarction (STEMI), leading to lower mortality. This process is accelerated with prehospital electrocardiography and notification. False activations of the CCL occur at an unknown rate and have been poorly described.

Methods and Results—

We analyzed 345 consecutive CCL activations for suspected STEMI over 18 months (March 2009–August 2010). We retrospectively reviewed the ECGs that prompted activation, as well as the clinical course and final diagnoses. Among all CCL activations, STEMI was not confirmed in 28%. On review, 301 (87.2%) had appropriate ECG criteria for activation. However, even among the ECG-appropriate patients, only 247 (82%) had a final diagnosis of STEMI. The inclusion of clinical characteristics did not improve the ability to identify patients with STEMI. Activations were modestly more accurate when made by emergency department physicians than by emergency medical service personnel, but door-to-balloon time was noticeably shorter when emergency medical service personnel requested prehospital activation.

Conclusions—

If all CCL activations are considered, the occurrence of false activations is surprisingly high. Although still the gold standard for diagnosis, these data reveal the inherent limitations of clinical evaluation and the ECG in identifying patients with STEMI. Within our retrospective review, we used a 2-tiered classification for STEMI activations based on ECG appropriateness and final clinical diagnosis to give a complete picture of false activations and assist in quality improvement.
A Percutaneous Coronary Intervention Lab in Every Hospital?
Authors: Concannon Thomas W. , Nelson Jason , Goetz Jessica , Griffith John L.
Published: December 2011

Background—

In 2001, 1176 US hospitals were capable of performing primary percutaneous coronary intervention (PCI), and 79% of the population lived within 60-minute ground transport of these hospitals. We compared these estimates with data from 2006 to explore how hospital PCI capability and population access have changed over time.

Methods and Results—

We estimated the proportion of the population 18 years of age or older, living in 2006 within a 60-minute drive of a PCI-capable hospital, and we compared our estimate with a previously published report on 2001 data. Over the 5-year period, the number of PCI-capable hospitals grew from 1176 to 1695 hospitals, a relative increase of 44%; access to the procedure grew from 79.0% to 79.9% of the population, a relative increase of 1%.

Conclusions—

Our data indicate a large increase in the number of hospitals capable of performing PCI from 2001 to 2006, but this increase was not associated with an appreciable change in the proportion of the population with access to the procedure. In the future, more attention is needed on changes in PCI capacity over time and on the effects of these changes on outcomes of interest such as service utilization, expenditures, patient outcomes, and population health.
Comprehensive Use of Cardiopulmonary Exercise Testing Identifies Adults With Congenital Heart Disease at Increased Mortality Risk in the Medium Term
Authors: Inuzuka Ryo , Diller Gerhard-Paul , Borgia Francesco , Benson Leah , Tay Edgar L.W. , Alonso-Gonzalez Rafael , Silva Margarida , Charalambides Menelaos , Swan Lorna , Dimopoulos Konstantinos , Gatzoulis Michael A.
Published: December 2011

Background—

Parameters of cardiopulmonary exercise testing were recently identified as strong predictors of mortality in adults with congenital heart disease. We hypothesized that combinations of cardiopulmonary exercise testing parameters may provide optimal prognostic information on midterm survival in this population.

Methods and Results—

A total of 1375 consecutive adult patients with congenital heart disease (age, 33±13 years) underwent cardiopulmonary exercise testing at a single center over a period of 10 years. Peak oxygen consumption (peak V̇
o
2
), ventilation per unit of carbon dioxide production (V̇
e
/V̇
co
2
slope), and heart rate reserve were measured. During a median follow-up of 5.8 years, 117 patients died. Peak V̇
o
2
, heart rate reserve, and V̇
e
/V̇
co
2
slope were related to midterm survival in adult patients with congenital heart disease. Risk of death increased with lower peak V̇
o
2
and heart rate reserve. A higher V̇
e
/V̇
co
2
slope was also related to increased risk of death in noncyanotic patients, whereas the V̇
e
/V̇
co
2
slope was not predictive of mortality in cyanotic patients. The combination of peak V̇
o
2
and heart rate reserve provided the greatest predictive information after adjustment for clinical parameters such as negative chronotropic agents, age, and presence of cyanosis. However, the incremental value of these exercise parameters was reduced in patients with peak respiratory exchange ratio <1.0.

Conclusions—

Cardiopulmonary exercise testing provides strong prognostic information in adult patients with congenital heart disease. Prognostication should be approached differently, depending on the presence of cyanosis, use of rate-lowering medications, and achieved level of exercise. We provide 5-year survival prospects based on cardiopulmonary exercise testing parameters in this growing population.
China in Bollywood
Authors: Uberoi Patricia
Published: December 2011

This article engages sociologically with three different academic discourses. The first pertains to the field of international relations, referring specifically to an enduring aspect of India-China bilateral relations over the last half-century or more that is known in shorthand as the ‘trust deficit’. The second has reference to the field of cinema studies, in particular to the generic characteristics of the Hollywood/Bollywood ‘war film’. The third reflects on issues of territoriality in the modern world of nation-states: on national borders and the ‘borderlanders’ of the contact zones, and on sacred and secular carto-graphies. In attempting to understand the nature and mode of production and reproduction of the Indian public’s mistrust of China, the article takes up Chetan Anand’s iconic ‘war film’, Haqeeqat, released in 1964 very shortly after the disastrous 1962 India-China border war which formed its subject matter. Unlike many films of the last two decades on India-Pakistan and Hindu-Muslim relations, briefly referred to by way of comparison and con-trast, Haqeeqat’s stereotypes of Indians, Chinese, and borderlanders have yet to be over-written or complicated by countervailing images. They remain effectively frozen in time, leaving the dominant public perception of China as it was in the early 1960s––an image of both menace and duplicity.
Fever epidemics and fever clinics
Authors: George Mathew
Published: December 2011

During the mid-1990s, the state of Kerala witnessed a wave of ‘fever epidemics’, which the government tackled by establishing fever clinics. Based on an ethnography of these clinics, this article examines how, from being a symptom of the body’s defensive response, fever has itself become institutionalised as a disease. It argues that the institutionalisation of fever as a disease has occurred through two sets of practices: first, discursively at the societal level by interactions among health professionals, the media, organisations repre-senting various systems of medicine, and ordinary people; and second, curatively at the clinic while rendering fever care, including diagnosis and treatment. The article shows that, despite the discursive prevalence of a dominant system of allopathic medicine, the practices at the fever clinic are not consistently based on an allopathic understanding of physiology and pathology but rely on skilled trial-and-error which incorporates plural medical traditions. The article critically evaluates the effects of institutionalisation in terms of narrowing how fever is understood and how it may be treated.
The Impacts of “Growing Our Own”
Authors: Kahn Linda S. , Tumiel-Berhalter Laurene , D’Aniello Rona , Danzo Andy , Fox Chester H. , Taylor John , Holland Shannon , Glaser Kathryn , Patel Vinod , Glick Myron
Published: December 2011

Purpose

The purpose of the study was to examine the impact of incorporating certified diabetes educator trainees into medical practices on patient diabetes outcomes.

Methods

This was a mixed methods practice-based evaluation study undertaken in 2 primary care practices in high-poverty neighborhoods in Buffalo, New York. The evaluation entailed a physician-referred patient cohort with pre- and postanalysis of chart review data corresponding to the American Diabetes Association’s diabetes indicators. Patient charts were reviewed at baseline and 12 months. A brief survey was administered to the providers and staff to ascertain the extent to which the certified diabetes educator trainees were perceived as useful as part of the medical practice team.

Results

Among 74 patients enrolled in diabetes classes, A1C levels decreased from a mean of 8.8% to 8.3%. Among a subset of patients (35%) with poorly controlled diabetes at baseline (A1C ≥ 9), there was a 15% decrease in A1C levels. Overall improvement in A1C was observed among 219 patients seen by a diabetes educator, in either a diabetes education class or a one-on-one visit.

Conclusions

Results suggest that having a certified diabetes educator trainee as part of the primary care practice team may advance diabetes care, as evidenced by improvements in glucose control. Responses from providers and staff suggest that the certified diabetes educator trainees were well integrated into the practices and were perceived as instrumental in educating patients to better manage their diabetes.
Migrant narratives of health and well-being: Challenging ‘othering’ processes through photo-elicitation interviews
Authors: Ortega-Alcázar Iliana , Dyck Isabel
Published: December 2011

This paper concerns the use of photo-elicitation interviews in constructing migrant narratives of health and well-being. It argues that photo-elicitation can be particularly effective in producing nuanced understandings about relationships among culture, place and health. It explores how, through this method, subject-centred understandings of health and well-being are able to challenge dominant discursive constructions that tend to ‘other’ and potentially stereotype minority groups in explanations of health behaviour. The paper includes discussion of issues of power and representation in research with marginalized populations, which further elaborates the value of photo-elicitation in developing a non-essentializing view of minority groups. The paper concludes with comment on the potential value of this method in the formulation of health and social policies aiming to incorporate the views and needs of marginalized or minority groups.
A Theater-Based Approach to Primary Prevention of Sexual Behavior for Early Adolescents
Authors: Lieberman Lisa D. , Berlin Cydelle , Palen Lori-Ann , Ashley Olivia Silber
Published: December 2011

Early adolescence is a crucial period for preventing teen pregnancy and sexually transmitted infections. This study evaluated STAR LO, a theater-based intervention designed to affect antecedents of sexual activity among urban early adolescents ( N = 1,143). Public elementary/middle schools received the intervention or served as a wait-listed comparison group in a quasi-experimental study. Students completed pretest and posttest questionnaires. Multivariate regression models were used to examine treatment effects. Comparison students showed significantly greater increases in sexual intentions and decreases in pro-abstinence attitudes and intended age of first sex than treatment group adolescents. Comparison girls showed significantly greater increases in desire to be a teen parent than STAR LO girls. Treatment group adolescents exhibited greater increases in sexual knowledge than comparison group adolescents, with stronger effects for boys than girls. The results suggest that this theater-based prevention program can help early adolescents develop knowledge, attitudes, and intentions that may prevent future sexual risk behavior.
3-Dimensional Imaging Modalities for Phenotyping Genetically Engineered Mice
Authors: Powell K. A. , Wilson D.
Published: December 2011

A variety of 3-dimensional (3D) digital imaging modalities are available for whole-body assessment of genetically engineered mice: magnetic resonance microscopy (MRM), X-ray microcomputed tomography (microCT), optical projection tomography (OPT), episcopic and cryoimaging, and ultrasound biomicroscopy (UBM). Embryo and adult mouse phenotyping can be accomplished at microscopy or near microscopy spatial resolutions using these modalities. MRM and microCT are particularly well-suited for evaluating structural information at the organ level, whereas episcopic and OPT imaging provide structural and functional information from molecular fluorescence imaging at the cellular level. UBM can be used to monitor embryonic development longitudinally in utero. Specimens are not significantly altered during preparation, and structures can be viewed in their native orientations. Technologies for rapid automated data acquisition and high-throughput phenotyping have been developed and continually improve as this exciting field evolves.
Rapid detection of Betacoronavirus 1 from clinical fecal specimens by a novel reverse transcription loop-mediated isothermal amplification assay
Authors: Qiao Jun , Meng Qingling , Cai Xuepeng , Chen Chuangfu , Zhang Zaichao , Tian Zhenzhong
Published: December 2011

Betacoronavirus 1 (BCoV-1) is an important pathogen causing diarrhea in calves. In the current study, a novel reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay for rapid detection of BCoV-1 was successfully developed. The primers were designed to target the highly conserved fragment of BCoV-1 nucleocapsid gene. The assay displayed high specificity detecting only BCoV-1 with no cross reaction with other viruses. When 418 clinical samples from 6 different geographical areas of Xinjiang province were tested by the RT-LAMP method, the results indicated that this test is a simple, rapid, accurate, and sensitive method for the detection of BCoV-1.
Diagnostic investigation of porcine periweaning failure-to-thrive syndrome
Authors: Huang Yanyun , Gauvreau Henry , Harding John
Published: December 2011

Porcine periweaning failure-to-thrive syndrome (PFTS), an increasingly recognized syndrome in the swine industry of North America, is characterized by the anorexia of nursery pigs noticeable within 1 week of weaning, and progressive loss of body condition and lethargy during the next 1–2 weeks. Morbidity caused by PFTS is moderate, but case fatality is high. The etiology of PFTS is presently unknown and may include infectious agent(s), noninfectious factors, or both. PFTS was identified in a high health status farm with good management in early 2007. A diagnostic investigation was undertaken to identify the pathological lesions of, and infectious agents associated with, pigs demonstrating typical clinical signs. Affected (PFTS-SICK) and unaffected (PFTS-HLTHY) pigs from an affected farm, and unaffected pigs from 2 unaffected farms, were examined. The most prevalent lesions in PFTS-SICK pigs were superficial lymphocytic fundic gastritis, atrophic enteritis, superficial colitis, lymphocytic and neutrophilic rhinitis, mild nonsuppurative meningoencephalitis, and thymic atrophy. Rotavirus A and Betacoronavirus 1 (Porcine hemagglutinating encephalomyelitis virus) were identified only in PFTS-SICK pigs, but the significance of the viruses is uncertain because PFTS is not consistent with the typical presentation following infection by these pathogens. Porcine reproductive and respiratory syndrome virus, Porcine circovirus-2, Influenza A virus, Alphacoronavirus 1 (Transmissible gastroenteritis virus), Torque teno virus 1, Brachyspira hyodysenteriae, and Brachyspira pilosicoli were not identified in PFTS-SICK pigs. Suid herpesvirus 2 (Porcine cytomegalovirus), Porcine enteric calicivirus, Torque teno virus 2, pathogenic Escherichia coli, and coccidia were detected in both PFTS-SICK and PFTS-HLTHY pigs. It was concluded that there is a lack of compelling evidence that PFTS is caused by any of these pathogens.
c-KIT messenger RNA and protein expression and mutations in canine cutaneous mast cell tumors
Authors: Giantin Mery , Vascellari Marta , Morello Emanuela Maria , Capello Katia , Vercelli Antonella , Granato Anna , Lopparelli Rosa Maria , Nassuato Chiara , Carminato Antonio , Martano Marina , Mutinelli Franco , Dacasto Mauro
Published: December 2011

Cutaneous mast cell tumors (MCTs) are among the most common neoplasms in dogs and show a highly variable biologic behavior. Histological grading, cell proliferation markers, and KIT immunohistochemistry are typically used to predict post-surgical prognosis. In the present study, c-KIT messenger RNA (mRNA) expression was measured in canine MCTs and its relationship with tumor grade, immunohistochemical staining pattern, post-surgical prognosis, and mutations was investigated. A significant increase of c-KIT mRNA was observed in MCTs versus healthy skin and surgical margins. Mutations were observed in 8.3% of cases. The KIT staining pattern was investigated for both grading systems. In particular, staining pattern III was associated with grade II (G2) and G3 MCTs, while staining patterns I and II were associated with G1 and G2 MCTs. Considering the 2-tier histological grading, the high grade was mainly associated with pattern III (71%) while the low grade was associated with patterns II (70%) and I (28%). A weak association between the KIT staining pattern and outcome was also observed. The results obtained suggest that c-KIT mRNA is overexpressed in canine MCT, although the fold variations were not associated with the protein localization or complementary DNA mutations. These observations suggested that the 3 events were independent. The histological grading and the KIT staining pattern have prognostic value as previously published. Staining pattern I could be especially helpful in predicting a good prognosis of G2 MCTs. Sequence mutations were not necessarily suggestive of a worse prognosis, but might be useful in choosing a chemotherapy protocol.
Generation and diagnostic application of monoclonal antibodies against Seneca Valley virus
Authors: Yang Ming , van Bruggen Rebekah , Xu Wanhong
Published: December 2011

Seneca Valley virus (SVV), a member of the Picornaviridae family, was implicated in a suspicious vesicular disease discovered in pigs from Canada in 2007. Because any outbreak of vesicular disease in pigs is assumed to be foot-and-mouth disease (FMD) until confirmed otherwise, a test for diagnosing the presence of SVV would be a very useful tool. To develop the diagnostic tests for SVV infection, 5 monoclonal antibodies (mAbs) were produced from mice immunized with binary ethylenimine (BEI)-inactivated SVV. Using a dot blot assay, the reactivity of the mAbs was confirmed to be specific for SVV, not reacting with any of the other vesicular disease viruses tested. The mAbs demonstrated reactivity with SVV antigen in infected cells by an immunohistochemistry assay. An SVV-specific competitive enzyme-linked immunosorbent assay (cELISA) was developed using BEI-inactivated SVV antigen and a mAb for serodiagnosis. The cELISA results were compared to the indirect isotype (immunoglobulin [Ig]M and IgG) ELISA and the virus neutralization test. All SVV experimentally inoculated pigs exhibited a positive SVV-specific antibody response at 6 days postinoculation, and the sera remained positive until the end of the experiment on day 57 (>40% inhibition) using the cELISA. The cELISA reflected the profile of the indirect ELISA for both IgM and IgG. This panel of SVV-specific mAbs is valuable for the identification of SVV antigen and the serological detection of SVV-specific antibodies.
Comparison of a TaqMan real-time polymerase chain reaction assay with a loop-mediated isothermal amplification assay for detection of Gallid herpesvirus 1
Authors: Ou Shan-Chia , Giambrone Joseph J. , Macklin Kenneth S.
Published: December 2011

A TaqMan real-time polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP) assay were developed to detect Gallid herpesvirus 1 (GaHV-1, formerly Infectious laryngotracheitis virus). The standard curve of real-time PCR was established, and the sensitivity reached 10 copies/μl. In the current study, the conversion between viral titer and GaHV-1 genomic copy number was constructed. Six primers for LAMP assay amplified target gene at 65°C within 45 min, and the detection limit was 60 copies/μl. The 6 primers were highly specific, sensitive, and reproducible for detection of GaHV-1. Although the sensitivity of LAMP was lower than that of real-time PCR, LAMP was faster, less expensive, and did not require a thermocycler. The LAMP assay would be a viable alternative assay in diagnostic laboratories that do not employ real-time PCR technology.
Mean Platelet Volume Has a Prognostic Value in Patients With Coronary Artery Ectasia
Authors: Varol Ercan , Uysal Bayram Ali , Dogan Abdullah , Ozaydin Mehmet , Erdogan Dogan
Published: December 2011

The aim of this study was to investigate the prognostic role of mean platelet volume (MPV) in patients with coronary artery ectasia (CAE). The baseline MPV values of 258 patients with CAE were screened. The mean time of follow-up was 49 ± 21 months for major adverse cardiac events (MACEs) defined as the combination of cardiac death, nonfatal myocardial infarction (MI), rehospitalization due to cardiac disorders, and readmission due to chest pain. During follow-up period, 63 (24%) MACEs developed. There were 4 (2%) cardiovascular deaths, 0 nonfatal MI, 14 (5%) rehospitalization, and 45 (17%) readmission. Mean platelet volume values were significantly higher in patients with CAE with MACEs than in patients with CAE without MACEs (9.5 ± 1.2 fL vs 8.9 ± 1.1 fL, respectively, P = .002). The rate of MACE was higher in CAE patients with MPV of >9 fL than those with MVP of ≤9 fL (33% vs. 15%, P = .001). Mean platelet volume has a prognostic value for MACEs in patients with CAE.
The interaction between tea polyphenols and rice starch during gelatinization
Authors: Wu Yue , Lin Qinlu , Chen Zhengxing , Xiao HuaXi
Published: December 2011

The interaction between tea polyphenols (TPLs) and rice starch (RS) during gelatinization has been studied. In the RVA analysis, TPLs-fortified RS exhibited no clearly defined peak viscosity and hot paste viscosity. After excluding other factors, irregular viscosity changes were attributed to the strong interactions between RS and TPLs during pasting/gelatinization. Subsequently, the coupling constants of samples A (the gelatinized sample of the blend of 16% TPLs and RS) and B (the blend of 16% TPLs and gelatinized RS sample) in 1H-NMR measurements were found to be the difference. Sample A had two coupling constants, 26h JHH = 82.08, 100.77 Hz and 6h JHH = 35.57 Hz, whereas Sample B had one larger coupling constant, 9h JHH = 140.24 Hz. This implied that these two samples differed in H–H interaction and interaction strength of sample A may be stronger than that of sample B. More important is, sample A had clearly broadened O–H stretching and frequency red-shifts of C–O–H bending as compared with sample B in quantitative FT–IR analysis. The overall results indicate that TPLs and RS can have hydrogen bonding interaction during gelatinization.
Consensus statement: evaluation of new and existing therapeutics for pediatric multiple sclerosis
Authors: Chitnis T , Tenembaum S , Banwell B , Krupp L , Pohl D , Rostasy K , Yeh E A , Bykova O , Wassmer E , Tardieu M , Kornberg A , Ghezzi A ,   and for the International Pediatric Multiple Sclerosis Study Group
Published: December 2011

New therapies are being evaluated by clinical trials and, if efficacious, introduced for the treatment of adult MS. The role of these new and existing agents in the management of pediatric MS has yet to be defined. Pediatric investigation plans are now required by the Food and Drug Administration and European Medicines Agency for approval of new biological agents, providing an important opportunity to gather much-needed data for clinicians caring for children and adolescents with MS. However, challenges include the small number of patients, and the need for efficient yet comprehensive study designs incorporating factors necessary to inform the clinical care of children with MS. The elected Steering committee of the International Pediatric MS Study Group (IPMSSG) conducted a structured review of existing data on the disease-modifying therapies in pediatric MS and developed a consensus statement, which was further modified by the IPMSSG general membership, using an online survey tool. Fifty-one IPMSSG members from 21 countries responded to the survey, and 50 approved the final statement. Consensus recommendations regarding use of existing first- and second-line therapies, as well as a proposed definition for inadequate treatment response, are presented. Recommendations for the use and evaluation of emerging therapies (currently in phase III clinical trials or recently approved for adult MS) are discussed. The IPMSSG endorses the inclusion of pediatric MS patients in trials evaluating appropriate new and emerging therapies. Mechanisms for conducting high-impact, multicenter studies, including long-term follow-up in pediatric MS, are required to ensure that all MS patients, irrespective of age, benefit from advances in MS therapeutics.
The time course and phenotype of Uhthoff phenomenon following optic neuritis
Authors: Fraser Clare L , Davagnanam Indran , Radon Mark , Plant Gordon T
Published: December 2011

As there is little information regarding the recovery from Uhthoff phenomenon (UP) in the multiple sclerosis (MS) literature, the objective of this study was to assess the phenotypes of UP. A one-page questionnaire was sent to 80 consecutive optic neuritis (ON) patients seen in a tertiary neuro-ophthalmology clinic. Of the 48 responders to the questionnaire, 52% reported experiencing UP, with a range of follow-up from 1 to 20 years. Only 16% had resolution of UP, all this occurred within 8 weeks of the onset of ON. Of the MS patients with UP, 88% experienced non-visual heat-related phenomenon compared with 30% without UP. The presence of UP may have a more general phenotypic significance. If full recovery from UP has not occurred within the first 2 months from the onset of ON, then recovery appears to be uncommon and may therefore be a surrogate marker of remyelination in future drug trials.
The Multiple Sclerosis Work Difficulties Questionnaire
Authors: Honan Cynthia A , Brown Rhonda F , Hine Donald W , Vowels Lindsay , Wollin Judy A , Simmons Rex D , Pollard John D
Published: December 2011

Background: A better understanding of the workplace difficulties experienced by people with multiple sclerosis (PwMS) may be critical to developing appropriate vocational and rehabilitative programs.

Objective: We aimed to assess the factor structure, internal consistency and validity of the new Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ).

Methods: Work difficulty items were developed and reviewed by a panel of experts. Using the MSWDQ, cross-sectional self-report data of work difficulties were obtained in addition to employment status and MS disease information, in a community-based sample of 189 PwMS.

Results: Exploratory Maximum Likelihood Factor Analysis on the draft questionnaire yielded 50 items measuring 12 factors. Subscale internal consistencies ranged from 0.74 to 0.92, indicating adequate to excellent internal consistency reliability. The MSWDQ explained 40% of the variance in reduced work hours since diagnosis, 40% of the variance in expectations about withdrawing from work, 34% of the variance in expectations about reducing work hours, and 39% of the variance in expectations about changing type of work due to MS.

Conclusion: The MSWDQ is a valid and internally reliable measure of workplace difficulties in PwMS. Physical difficulties, as well as cognitive and psychological difficulties were important predictors of workplace outcomes and expectations about future employment.
The Extraction of a Bacillus anthracis Surrogate from HVAC Filters
Authors: Solon Ian , Gurian Patrick L. , Perez Hernando
Published: December 2011

Developing a quick and inexpensive method to extract bacteria from HVAC filters can provide valuable information on the extent of contamination of a building after a release of pathogenic microorganisms. In order to identify the preferred extraction procedure of Bacillus thuringiensis HD1011 from a pleated filter with a minimum efficiency reporting value of 7, different agitation methods were varied systematically. This study shows that the vortex–shake extraction procedure was found to be significantly more efficient when preceded by sonication; the vortex–shake sequence had a mean of 0.49 (0.3–0.77) CFUs (colony forming units) compared to 1.3 (0.8–2.1) CFUs for sonicate–vortex–shake agitation. The control data suggested that growth was occurring when the filter was present in the bacterial solution, and this was investigated further. The data with no filter ever present produced a mean of 0.37 (0.14–0.47) CFU compared to the means of 0.85 (0.52–1.35) CFU and 1.07 (0.65–1.74) CFUs, respectively, for when the filter was present for agitation and when it was present for 24 h prior to agitation, indicating significant growth. Because these results suggest that germination could occur during the extraction procedure, all the results were quantified based on presence versus absence using a most probable number method.
Angiogenesis: A Target in Solid Tumors, Also in Leukemia?
Authors: Schmidt Thomas , Carmeliet Peter
Published: December 2011

Targeting angiogenesis has become an established therapeutic approach to fighting solid tumor growth in cancer patients. Even though increased angiogenesis has long been recognized in various types of hematologic malignancies, the molecular basis underlying this angiogenic switch in leukemias remains poorly understood. The BM stroma is gaining increasing attention for its role in promoting leukemia growth and resistance against current treatments with tyrosine kinase inhibitors. This article provides a brief overview of the role of angiogenesis in leukemias, discusses recent insights into the role of placenta growth factor (PlGF), a VEGF family member, as a novel disease candidate in chronic myeloid leukemia (CML), and highlights the therapeutic potential of PlGF blockade for imatinib-resistant CML.
How I Diagnose and Manage HIT
Authors: Warkentin Theodore E.
Published: December 2011

Heparin-induced thrombocytopenia (HIT) is a prothrombotic drug reaction caused by platelet-activating IgG antibodies that recognize platelet factor 4 (PF4)/polyanion complexes. Platelet activation assays, such as the serotonin-release assay, are superior to PF4-dependent immunoassays in discerning which heparin-induced antibodies are clinically relevant. When HIT is strongly suspected, standard practice includes substituting heparin with an alternative anticoagulant; the 2 US-approved agents are the direct thrombin inhibitors (DTIs) lepirudin and argatroban, which are “niche” agents used only to manage HIT. However, only ∼ 10% of patients who undergo serological investigation for HIT actually have this diagnosis. Indeed, depending on the clinical setting, only 10%-50% of patients with positive PF4-dependent immunoassays have platelet-activating antibodies. Therefore, overdiagnosis of HIT can be minimized by insisting that a positive platelet activation assay be required for definitive diagnosis of HIT. For these reasons, a management strategy that considers the real possibility of non-HIT thrombocytopenia is warranted. One approach that I suggest is to administer an indirect, antithrombin (AT)–dependent factor Xa inhibitor (danaparoid or fondaparinux) based upon the following rationale: (1) effectiveness in treating and preventing HIT-associated thrombosis; (2) effectiveness in treating and preventing thrombosis in diverse non-HIT situations; (3) both prophylactic- and therapeutic-dose protocols exist, permitting dosing appropriate for the clinical situation; (4) body weight–adjusted dosing protocols and availability of specific anti-factor Xa monitoring reduce risk of under- or overdosing (as can occur with partial thromboplastin time [PTT]–adjusted DTI therapy); (5) their long half-lives reduce risk of rebound hypercoagulability; (6) easy coumarin overlap; and (7) relatively low cost.
Atypical Hemolytic Uremic Syndrome, Genetic Basis, and Clinical Manifestations
Authors: Kavanagh David , Goodship Timothy H. J.
Published: December 2011

Atypical hemolytic uremic syndrome (aHUS) is now well recognized to be a disease characterized by excessive complement activation in the microvasculature. In both the familial and sporadic forms, inherited and acquired abnormalities affecting components of the alternative complement pathway are found in ∼ 60% of patients. These include mutations in the genes encoding both complement regulators (factor H, factor I, membrane cofactor protein, and thrombomodulin) and activators (factors B and C3) and autoantibodies against factor H. Multiple hits are necessary for the disease to manifest, including a trigger, mutations, and at-risk haplotypes in complement genes. The prognosis for aHUS is poor, with most patients developing end-stage renal failure. Renal transplantation in most patients also has a poor prognosis, with frequent loss of the allograft to recurrent disease. However, improving results with combined liver-kidney transplantation and the advent of complement inhibitors such as eculizumab offer hope that the prognosis for aHUS will improve in future years.
Genetic and Epigenetic Complexity in Myeloproliferative Neoplasms
Authors: Cross Nicholas C. P.
Published: December 2011

The past 7 years have witnessed remarkable progress in our understanding of the genetics of BCR-ABL–negative myeloproliferative neoplasms (MPNs) and has revealed layers of unexpected complexity. Deregulation of JAK2 signaling has emerged as a central feature, but despite having biological activities that recapitulate the cardinal features MPNs in model systems, JAK2 mutations are often secondary events. Several other mutated genes have been identified with a common theme of involvement in the epigenetic control of gene expression. Remarkably, the somatic mutations identified to date do not seem to be acquired in any preferred order, and it is possible that the disease-initiating events remain to be identified. The finding of complex clonal hierarchies in many cases suggests genetic instability that, in principle, may be inherited or acquired. A common haplotype has been identified that is strongly associated with the acquisition of JAK2 mutations, but the cause of relatively high-penetrance familial predisposition to MPNs remains elusive. This review summarizes the established facts relating to the genetics of MPNs, but highlights recent findings and areas of controversy.
Late Effects of Acute Lymphoblastic Leukemia Therapy in Patients Diagnosed at 0-20 Years of Age
Authors: Robison Leslie L.
Published: December 2011

Survival rates for children with acute lymphoblastic leukemia (ALL) have increased dramatically over the past 4 decades, with 5-year survival rates of > 90% in recent trials. With the increasing number of children and adolescents cured of ALL, identifying and characterizing the occurrence of long-term adverse late effects has become increasingly important. In this young population, successful treatment of ALL is associated with increased risk of adverse outcomes such as late mortality, second neoplasms, chronic health conditions, endocrine dysfunction, and psychological function. Research efforts conducted through large survivor cohorts, such as the Childhood Cancer Survivor Study, are providing new and important insights into the very long-term consequences of ALL therapy, while providing direction for screening recommendations and intervention-based approaches for reducing late morbidity and mortality.
World Health Organization Classification, Evaluation, and Genetics of the Myeloproliferative Neoplasm Variants
Authors: Vardiman James , Hyjek Elizabeth
Published: December 2011

There is no single category in the fourth edition (2008) of the World Health Organization (WHO) classification of myeloid neoplasms that encompasses all of the diseases referred to by some authors as the myeloproliferative neoplasm (MPN) “variants.” Instead, they are considered as distinct entities and are distributed among various subgroups of myeloid neoplasms in the classification scheme. These relatively uncommon neoplasms do not meet the criteria for any so-called “classical” MPN (chronic myelogenous leukemia, polycythemia vera, primary myelofibrosis, or essential thrombocythemia) and, although some exhibit myelodysplasia, none meets the criteria for any myelodysplastic syndrome (MDS). They are a diverse group of neoplasms ranging from fairly well-characterized disorders such as chronic myelomonocytic leukemia to rare and thus poorly characterized disorders such as chronic neutrophilic leukemia. Recently, however, there has been a surge of information regarding the genetic infrastructure of neoplastic cells in the MPN variants, allowing some to be molecularly defined. Nevertheless, in most cases, correlation of clinical, genetic, and morphologic findings is required for diagnosis and classification. The fourth edition of the WHO classification provides a framework to incorporate those neoplasms in which a genetic abnormality is a major defining criterion of the disease, such as those associated with eosinophilia and abnormalities of PDGFRA, PDGFRB, and FGFR1, as well as for those in which no specific genetic defect has yet been discovered and which remain clinically and pathologically defined. An understanding of the clinical, morphologic, and genetic features of the MPN variants will facilitate their diagnosis.
Eosinophilic Myeloproliferative Disorders
Authors: Klion Amy D.
Published: December 2011

Despite recent attempts to define and classify patients with marked eosinophilia and features consistent with myeloproliferative disease, areas of controversy remain. These are particularly apparent in situations in which multiple lineages are involved in a clonal process and clinical manifestations are overlapping. Although the introduction of new molecular diagnostics and targeted therapies has begun to clarify the boundaries between some of these disorders, several questions remain with respect to the classification of patients with myeloproliferative hypereosinophilic syndrome (HES) of unknown etiology.