bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Postoperative Peritoneal Lavage in Standing Horses for Prevention of Experimentally Induced Abdominal Adhesions
Authors: HAGUE BRENT A. , HONNAS CLIFFORD M. , BERRIDGE BRIAN R. , EASTER J. LANE
Published: February 2008

Objective—To evaluate the postoperative use of peritoneal lavage for prevention of experimentally induced intraabdominal adhesions in horses.

Study Design—Areas of serosal abrasion were created on the jejunum of 12 horses. Postoperatively, six horses had peritoneal lavage, and six horses did not (controls). The number of adhesions was determined at necropsy 2 weeks after surgery.

Animals or Sample Population—12 horses.

Methods—Five sites of jejunal serosal abrasion were created in each horse. A 32 French thoracic catheter was placed into the right ventral aspect of the abdomen before closure of the abdominal incision. Treated horses had abdominal lavage with 10 L of lactated Ringer's solution on four occasions, then catheters were removed from all horses 34 hours after celiotomy. Horses were necropsied at 2 weeks to quantify the number of intraabdominal adhesions.

Results—All control horses and one treated horse developed intraabdominal adhesions. The number of adhesions was significantly less (P<.0293) in treated horses. No adverse inflammatory reactions appeared to be associated with repeated peritoneal lavage using lactated Ringer's solution or use of an abdominal drain.

Conclusions—Peritoneal lavage reduced the frequency of intraabdominal adhesions.

Clinical Relevance—When postoperative adhesions are likely to develop, postoperative peritoneal lavage may decrease the frequency of adhesion formation.
In VitroPullout Strength of Screws Inserted in Adult Equine Third Metacarpal Bone After Overdrilling a 4.5‐mm Threaded Insertion Hole
Authors: SEDRISH STEVEN A. , MOORE RUSTIN M. , KELLY KEVIN , MARTIN GEORGE S. , BURBA DANIEL J.
Published: February 2008

Objective—To determine and compare thein vitropullout strength of 5.5‐mm cortical versus 6.5‐mm cancellous bone screws inserted in the diaphysis and metaphysis of adult equine third metacarpal (MCIII) bones, in threaded 4.5‐mm cortical bone screw insertion holes that were then overdrilled with a 4.5‐mm drill bit to provide information relevant to the selection of a replacement screw if a 4.5‐mm cortical screw is stripped.

Study Design—In vitropullout tests of 5.5‐mm cortical and 6.5‐mm cancellous screws in equine MCIII bones.

Sample Population—Two independent cadaver studies each consisting of 14 adult equine MCIII bones.

Methods—Two 4.5‐mm cortical screws were placed either in the middiaphysis (study 1) or distal metaphysis (study 2) of MCIII bones. The holes were then overdrilled with a 4.5‐mm drill bit and had either a 5.5‐mm cortical or a 6.5‐mm cancellous screw inserted; screw pullout tests were performed at a rate of 0.04 mm/second until screw or bone failure occurred.

Results—In diaphyseal bone, the screws failed in all tests. Tensile breaking strength for 5.5‐mm cortical screws (997.5 ± 49.3 kg) and 6.5‐mm cancellous screws (931.6 ± 19.5 kg) was not significantly different. In metaphyseal bone, the bone failed in all tests. The holding power for 6.5‐mm cancellous screws (39.1 ± 4.9 kg/mm) was significantly greater than 5.5‐mm cortical screws (23.5 ± 3.5 kg/mm) in the metaphysis. There was no difference in the tensile breaking strength of screws in the diaphysis between proximal and distal screw holes; however, the holding power was significantly greater in the distal, compared with the proximal, metaphyseal holes.

Conclusions—Although tensile breaking strength was not different between 5.5‐mm cortical and 6.5‐mm cancellous screws in middiaphyseal cortical bone, holding power of 6.5‐mm cancellous screws was greater than 5.5‐mm cortical screws in metaphyseal bone of adult horses.

Clinical Relevance—If a 4.5‐mm cortical bone screw strips in MCIII diaphyseal bone of adult horses, either a 5.5‐mm cortical or 6.5‐mm cancellous screw, however, would have equivalent pullout strengths. A 6.5‐mm cancellous screw, however, would provide greater holding power than a 5.5‐mm cortical screw in metaphyseal bone.
Short‐Term Hemodynamic Evaluation of Circumferential Mitral Annuloplasty for Correction of Mitral Valve Regurgitation in Dogs
Authors: KERSTETTER KYLE K. , SACKMAN JILL E. , BUCHANAN JAMES W. , BRIGHT JANICE M. , KRAHWINKEL D.J. , BRIGHT RONALD M. , LORINSON DRAGAN , GOMPF REBECCA E.
Published: February 2008

Objective—To determine the short‐term hemodynamic effects associated with circumferential mitral annuloplasty (CMA) in dogs with mitral regurgitation.

Study Design—Prospective experimental study.

Animals—Seven healthy adult mongrel dogs.

Methods—Mitral regurgitation was surgically induced, and annular dilation occurred. Echocardiography and cardiac catheterization were used to determine forward ejection fraction (FEF), regurgitant fraction (RF), pulmonary capillary wedge pressure (PCWP), and annular diameter before and immediately after CMA in five dogs. FEF and RF were also evaluated 7 days after annuloplasty.

Results—Mean annular diameter and PCWP were significantly reduced immediately after CMA. Significant increases in FEF of 19% and 22% were shown immediately and 7 days after CMA. Significant reductions in RF of 19% and 22% were also shown immediately and 7 days after annuloplasty.

Conclusions—Sustained hemodynamic benefits and a reduction in annular diameter were achieved by CMA in a canine model of mitral regurgitation.

Clinical Implications—CMA may be a suitable treatment for heart failure because of mitral regurgitation when early signs of cardiovascular decompensation persist despite appropriate medical management.
Ventral Abdominal Approach for Laparoscopic Ovariectomy in Llamas
Authors: RODGERSON D. H. , BAIRD A. N. , PUGH D. G.
Published: February 2008

Objective—To evaluate a technique for laparoscopic ovariectomy by a ventral abdominal approach in the llama.

Study Design—Prospective evaluation.

Animal Population—Six healthy adult female llamas, aged 2 to 6 years.

Methods—Laparoscopic ovariectomy was performed with the llamas in a 30‐degree Trendelenburg position. The mesovarium and proper ligament of the ovary were isolated, and two Hulka clips were placed in opposite directions across each mesovarium and proper ligament of the ovary. Ovaries were removed through either the instrument cannula or instrument portal.

Results—The ovaries, mesovarium, and proper ligaments of the ovaries were easily identified using laparoscopy by a ventral abdominal approach. The Hulka Clip Applicator was easy to use, and the Hulka Clips provided secure hemostasis of the vessels within the mesovarium. Mean duration of surgery was 35 minutes (range, 17 to 85 minutes). Two llamas were depressed after surgery but improved within 24 hours. No other complications occurred during an 18‐month follow‐up period.

Conclusions—Laparoscopic ovariectomy in the llama was facilitated by the use of Hulka Clips placed across the mesovarium and proper ligament of the ovary.

Clinical Relevance—Laparoscopic ovariectomy in the llama can be accomplished easily with few complications.
A Comparison of Indirect Blood Pressure Monitoring Techniques in the Anesthetized Cat
Authors: CAULKETT NIGEL A. , CANTWELL SHAUNA L. , HOUSTON DOREEN M.
Published: February 2008

Objective—To determine the accuracy of three indirect blood pressure monitoring techniques (oscillometric technique [OS], Doppler [DOP], and optical plethysmography [OP] [blood pressure determined with a pulse oximeter waveform]) when compared with direct arterial pressure measurement in cats.

Study Design—Prospective study.

Animal Population—Eight healthy (five female, three male), domestic short‐hair cats, weighing 3.5 ± 0.8 kg

Methods—Cats were anesthetized with isoflurane. The inspired concentration of isoflurane was adjusted to produce mild hypotension (80 to 100 mm Hg direct systolic), moderate hypotension (60 to 80 mm Hg direct systolic), and severe hypotension (<60 mm Hg direct systolic). Indirect pressure measurements were obtained from the thoracic limb and compared with concurrent direct measurement using regression analysis and a modification of Bland and Altman's technique.

Results—All three techniques underestimated systolic pressure. OS produced the best prediction of systolic pressure with a bias ± precision of ‐15.9 ± 8.1 mm Hg. DOP and OP were relatively inaccurate with a bias ± precision of ‐25 ± 7.4 mm Hg and ‐25 ± 7.5 mm Hg. All three techniques correlated well with direct pressure with r values of 0.81, 0.88, and 0.88 for OS, DOP, and OP. DOP and OP provided an accurate prediction of direct mean arterial pressure with a bias ± precision of ‐0.8 ± 6 mm Hg and 0.6 ± 5.5 mm Hg. Correlation was good between DOP and mean arterial pressure with r = 0.89. Correlation was also good between OP and mean arterial pressure with r = 0.90.

Conclusions—OS provided the most accurate prediction of direct systolic pressure. DOP and OP provided a good prediction of mean arterial pressure in the cat.

Clinical Relevance—All three of these techniques are useful for detecting trends. Direct monitoring of blood pressure should be considered if accurate blood pressure measurement is required.
Respiratory Depressant and Skeletal Muscle Relaxant Effects of Low‐Dose Pancuronium Bromide in Spontaneously Breathing, Isoflurane‐Anesthetized Dogs
Authors: LEE D. DAVID , MEYER ROBERT E. , SULLIVAN THOMAS C. , DAVIDSON MICHAEL G. , SWANSON CLIFFORD R. , HELLYER PETER W.
Published: February 2008

Objective—To assess and compare the respiratory depressant and skeletal muscle relaxant effects of two low doses of a nondepolarizing neuromuscular blocker, pancuronium bromide. To determine if a “low dose” of pancuronium bromide can produce selective skeletal muscle relaxation in extraocular muscles sufficient to perform intraocular surgery while sparing or minimizing depression of muscles of ventilation.

Study Design—Blinded, randomized crossover, placebo controlled study. Animals—Six healthy, adult mongrel dogs weighing 20.8 ±1.9 kg.

Methods—Spontaneously breathing, isoflurane‐anesthetized dogs received 0.02 mg/kg pancuronium bromide, intravenously (IV), (high dose [HD]), 0.01 mg/kg pancuronium bromide, IV, (low dose [LD]), or saline placebo IV in a blinded, randomized crossover study. Indices of patient ventilation including tidal volume (Vt), respiratory rate (RR), and minute ventilation (VE) were recorded throughout the study period. Serial arterial blood gas analyses were performed at timed intervals. Neuromuscular blockade of skeletal muscle was assessed at timed intervals with train‐of‐four stimulus/response ratios. Eye position scores, based on the degree of ocular rotation from a neutral gaze axis, were assigned by an ophthalmologist who was blinded to the treatment given.

Results—Vt and VE in HD dogs decreased by 82% from baseline after administration of pancuronium bromide. Similarly, Vt and VE in LD dogs decreased 40% and 55%, respectively. Decreased ventilation in HD dogs corresponded with significant (P< .05) neuromuscular blockade, as indicated by train‐of‐four ratio less than 75% between 0 and 60 minutes. Eye position scores in HD and LD dogs were suitable for intraocular surgery between 0 and 60 minutes. Eye position scores in five of six control dogs were unsuitable for intraocular surgery at any time period.

Conclusions—LD dogs experienced only transient, mild to moderate respiratory depression compared with HD dogs, which experienced prolonged, moderate to severe respiratory depression. Both LD and HD dogs acquired and maintained eye position scores suitable for intraocular surgery between 0 to 60 minutes. A “low dose” of pancuronium bromide, which would provide adequate extraocular muscle relaxation while minimizing ventilatory depression, was not identified.

Clinical Relevance—All patients receiving any dose of neuromuscular blocking agents should be closely monitored and receive ventilatory assistance as needed.
Biomechanical Evaluation of a Crimp Clamp System for Loop Fixation of Monofilament Nylon Leader Material Used for Stabilization of the Canine Stifle Joint
Authors: ANDERSON C. COLLINS , TOMLINSON JAMES L. , DALY WILLIAM R. , CARSON WILLIAM L. , PAYNE JOHN T. , WAGNER‐MANN COLETTE C.
Published: February 2008

Objective—To test a crimp clamp system designed to secure monofilament nylon leader (MNL) material commonly used as lateral fabellotibial sutures (LFS) in extra‐articular stabilization of the canine stifle joint.

Study Design—In vitro biomechanical tests of MNL loops secured with either the crimp clamp system or knots were performed. Suture loops (n = 94) were created from 27.3 kg tensile strength MNL and fastened with knots or crimp clamps. Tests were conducted on steam‐sterilized, ethylene‐oxide‐sterilized, and nonsterilized MNL sutures. Loops were evaluated in single load tests and cycled tests. Values for load to failure, initial loop tension, loop elongation, mode of failure, and point of failure were determined.

Results—Crimp‐clamped loops were superior to knotted loops in all parameters tested in both cycled and noncycled tests. Loop failure generally occurred by breaking within 3 mm of the fixation in both clamped and knotted tests. Loop elongation after cycling was greater in the knotted loops compared with clamped loops (P < .001). Load to failure was greater in clamped tests than in knotted tests (P < .001), regardless of sterilization technique used. Significantly higher initial loop tension could be achieved with the clamp system compared with knot fixation (P < .001).

Conclusions—The crimp clamp system provides superior in vitro loop fixation characteristics compared with knot fixation in 27.3 kg test MNL.

Clinical Relevance—Based on the results of biomechanical testing and the known biocompatibility of the system's implant components, clinical trials using the crimp clamp system are warranted.
A Comparison of the Synthes 4.5‐mm Cannulated Screw and the Synthes 4.5‐mm Standard Cortex Screw Systems in Equine Bone
Authors: COLGAN SALLY A. , HECKER AARON T. , KIRKER‐HEAD A. , HAYES WILSON C.
Published: February 2008

Objective—To determine risk of failure of the Synthes 4.5‐mm cannulated screw system instrumentation in equine bone and to compare its application with the Synthes 4.5‐mm standard cortex screw system.

Study Design—The maximum insertion torque of the cannulated and standard cortex screw systems were compared with the ultimate torsional strengths of the equipment. Pullout strength and ultimate tensile load of cannulated and standard cortex screws were also determined.

Sample Population—Paired equine cadaver third metacarpal and third carpal bones.

Methods—Maximum insertion torque and ultimate torsional strengths were determined by using an axial‐torsional, servohydraulic materials testing system and a hand‐held torquometer. Pullout tests were performed by using a servohydraulic materials testing system.

Results—Maximum insertion torque of all cannulated instrumentation was less than ultimate torsional strength at all locations (P< .05). Maximum insertion torques of cannulated taps and screws were greater than for standard taps and screws in the third carpal bone (P< .002). Pullout strength of the cannulated screws was less than the standard cortex screws at all sites (P< .001). Cannulated screws broke before bone failure in all but one bone specimen. Conclusions—The risk of cannulated instrument or screw failure during insertion into bone is theoretically low. The relatively low pullout strength of the cannulated screws implies that the interfragmentary compression achievable is likely to be less than with standard cortex screws. Clinical Relevance—The relatively low pullout strength of the cannulated screw suggests that its risk of failure during fracture repair is greater than with the standard cortex screw.
Use of Drug‐Eluting Stents in Saphenous Vein Aortocoronary Bypass Graft Lesions: A Critical Appraisal
Authors: BRILAKIS EMMANOUIL S. , SAEED BILAL , BANERJEE SUBHASH
Published: February 2008

The use of drug‐eluting stents (DES) in aortocoronary saphenous vein bypass grafts (SVGs) remains controversial. We reviewed 14 published studies that examined the outcomes after DES implantation in SVG lesions. All studies, except two, were retrospective, and reported follow‐up for approximately 1 year or less. Ten of the 14 studies were single‐center. Six studies (5 retrospective and 1 prospective), including a total of 711 patients, compared DES with bare metal stents: 2 studies included paclitaxel‐eluting stents, 2 studies included sirolimus‐eluting stents, and 2 studies included both. Four of five retrospective comparative studies showed lower incidence of major adverse cardiac events in the DES group during short‐term follow‐up (6–12 months), mainly due to a reduction in target vessel revascularization (TVR) (3 of 4 studies had high rates of follow‐up angiography). In the only published prospective, randomized controlled study, patients receiving DES had lower incidence of TVR at 6 months, but during longer follow‐up (median 32 months), they had similar incidence of TVR and higher mortality. A large, multicenter, randomized controlled clinical trial is needed to clarify the role of DES in the percutaneous treatment of SVG lesions.
Effect of Clopidogrel on Neointimal Formation and Inflammation in Balloon‐Denuded and Radiated Hypercholesterolemic Rabbit Iliac Arteries
Authors: WAKSMAN RON , PAKALA RAJBABU , ROY PROBAL , BAFFOUR RICHARD , HELLINGA DAVID , SEABRON RUFUS , CHAN ROSANNA , SCHEINOWITZ MICKEY , KOLODGIE FRANK , VIRMANI RENU
Published: February 2008

Background: Platelet‐derived peptide and nonpeptide growth factors are known to play pivotal roles in neointimal proliferation. Along with its antiplatelet activity of reducing P‐selectin and hs‐CRP, clopidogrel has also been shown to have anti‐inflammatory properties. The aim of this study is to find out by modulating inflammation if clopidogrel can affect neointima formation in balloon‐denuded iliac arteries of hypercholesterolemic rabbits.

Methods and Results: Rabbits were fed with 1% cholesterol diet with (n = 20) or without (n = 20) clopidogrel (10 mg/kg body weight) for 7 days followed by balloon‐denudation of endothelial layer in both the iliac arteries and continued on 0.15% cholesterol diet with or without clopidogrel. Four weeks later, the denuded area in both iliac arteries was radiated (n = 11, cholesterol‐only group; n = 9, clopidogrel group) or sham treated (n = 10 from each group). Four weeks after radiation, animals were sacrificed and arterial segments were processed for morphometry. In the sham‐treated clopidogrel group, neointimal area, percent stenosis, and macrophage score were 39% (P = 0.01), 32% (P = 0.02), and 50% (P = 0.02) smaller, respectively, when compared to the cholesterol‐only group (0.48 ± 0.18, 32.42 ± 13.04, and 1.5 ± 0.83). There were no differences in the radiated group (0.89 ± 0.32, 50.34 ± 13.00, and 1.88 ± 1.27 vs. 0.93 ± 0.38, 59.41 ± 11.41, and 2.00 ± 0.74, respectively).

Conclusion: This study demonstrates that clopidogrel reduces inflammation and neointimal formation in balloon‐denuded iliac arteries of hypercholesterolemic rabbits.
Impact of Wearable Alcohol Gel Dispensers on Hand Hygiene in an Emergency Department
Authors: Haas Janet P. , Larson Elaine L.
Published: February 2008

Objectives:  Compliance with hand hygiene (HH) by health care workers is widely recognized as the most effective way to decrease transmission of infection among patients. However, compliance remains poor, averaging about 40%. A potential barrier to compliance is convenience and accessibility of sinks or alcohol hand sanitizer dispensers. The purpose of this study was to assess the use of a personal alcohol gel dispensing system, compared with the traditional wall‐mounted alcohol gel dispenser and sinks in an urban hospital’s emergency department (ED).

Methods:  This was a quasi‐experimental trial of a personal wearable alcohol hand sanitizer dispenser. Observations of ED staff HH were performed in the month before intervention and during three intervention phases over a 2.5‐month period.

Results:  A total of 757 HH opportunities were observed: 112 before and 432 after patient contact, 72 after contact with the patient’s environment, 24 before invasive procedures, and 117 after body fluid contact. HH compliance improved during the first intervention period, but improvement was not sustained. There was no significant improvement in HH from baseline to the final intervention period. The wearable alcohol gel dispenser was used for 9% of HH episodes.

Conclusions:  Availability of a wearable dispenser was not associated with a significant improvement in use of alcohol products for HH. These results support other studies in which only transient success was reported with a single intervention; greater success in sustaining increased HH compliance has been reported with use of multimodal approaches in which increased availability of products may be a part of the intervention.
Noninvasive Ventilation Outcomes in 2,430 Acute Decompensated Heart Failure Patients: An ADHERE Registry Analysis
Authors: Tallman Thomas A. , Peacock W. Frank , Emerman Charles L. , Lopatin Margarita , Blicker Jamie Z. , Weber James , Yancy Clyde W. ,   for the ADHERE Registry
Published: February 2008

Objectives:  Continuous or bilevel positive airway pressure ventilation, called noninvasive ventilation (NIV), is a controversial therapy for acute decompensated heart failure (ADHF). While NIV is considered safe and effective in patients with chronic obstructive pulmonary disease (COPD), clinical trial data that have addressed safety in ADHF patients are limited, with some suggestion of increased mortality. The objective of this study was to assess mortality outcomes associated with NIV and to determine if a failed trial of NIV followed by endotracheal intubation (ETI) (NIV failure) is associated with worse outcomes, compared to immediate ETI.

Methods:  This was a retrospective analysis of the Acute Decompensated Heart Failure National Registry (ADHERE), which enrolls patients with treatment for, or with a primary discharge diagnosis of, ADHF. The authors compared characteristics and outcomes in four groups: no ventilation, NIV success, NIV failure, and ETI. One‐way analysis of variance or Wilcoxon testing was performed for continuous data, and chi‐square tests were used for categorical data. In addition, multivariable logistic regression was used to adjust mortality comparisons for risk factors.

Results:  Entry criteria were met by 37,372 patients, of which 2,430 had ventilation assistance. Of the ventilation group, 1,688 (69.5%) were deemed NIV success, 72 (3.0%) were NIV failures, and 670 (27.6%) required ETI. The NIV failure group had the lowest O2 saturation (SaO2) (84 ± 16%), compared to either NIV success (89.6 ± 10%) or ETI (88 ± 13%; p = 0.017). ETI patients were more likely to receive vasoactive medications (p < 0.001) than the NIV success cohort. When comparing NIV failures to ETI, there were no differences in treatment during hospitalization (p > 0.05); other than that the NIV failure group more often received vasodilators (68.1% vs. 54.3%; p = 0.026). In‐hospital mortality was 7.9% with NIV, 13.9% with NIV failure, and 15.4% with ETI. After risk adjustment, the mortality odds ratio for NIV failure versus ETI increased to 1.43, although this endpoint was not statistically significant.

Conclusions:  In this analysis of ADHF patients receiving NIV to date, patients placed on NIV for ADHF fared better than patients requiring immediate ETI. Patients who failed NIV and required ETI still experienced lower mortality than those initially placed on ETI. Thus, while the ETI group may be more severely ill, starting therapy with NIV instead of immediate ETI will likely not harm the patient. When ETI is required, mortality and length of stay may be adversely affected. Since a successful trial of NIV is associated with improved outcomes in patients with ADHF, application of this therapy may be a reasonable treatment option.
Nodal melanocytic nevus with balloon‐cell change (nodal balloon‐cell nevus)
Authors: Urso Carmelo
Published: February 2008

Most nodal nevi are intracapsular and present the morphology of conventional nevi; less frequently, they show the appearance of common and cellular blue nevi. We report a case of an nodal capsular, trabecular and intraparenchymal melanocytic nevus with balloon‐cell change in a patient with a malignant melanoma which arose in a pre‐existing cutaneous giant congenital nevus, showing balloon‐cell degeneration.
Immunohistological study of involucrin expression in Darier's disease skin
Authors: Kassar Selma , Charfeddine Cherine , Zribi Hela , Tounsi‐Kettiti Haifa , Bchetnia Mbarka. , Jerbi Emna , Cassio Doris , Mokni Mourad , Abdelhak Sonia , Ben Osman Amel , Boubaker Samir
Published: February 2008

Background:  Darier’s disease (DD) is an autosomal dominant skin disorder characterized by acantholysis and abnormal keratinization. The gene responsible for DD, ATP2A2 encodes for the sarco/endoplasmic reticulum (ER) Ca2+‐ATPase isoform 2 protein. Involucrin, considered as a marker of terminal epidermal differentiation, could be altered in some keratinization disorders including DD.

Patients and methods:  An immunohistochemical staining using anti‐involucrin antibody was carried out on 16 DD patients epidermis. Involucrin staining was compared with biopsies from cutaneous lesions of three healthy individuals and of patients with Hailey‐Hailey disease (five cases) and Mal de Meleda (four cases). A semi‐quantitative analysis was performed in order to evaluate involucrin immunostaining on the basis of intensity, extension and epidermal distribution. The involucrin expression was examined afterward with confocal laser scanning microscopy.

Results:  In contrast to normal skin, all DD cases showed premature expression of involucrin in the lower epidermal layers in four cases with a strong labeling in both keratinocytes cell membrane and cytoplasm. Other keratinization disorders share premature expression of involucrin but displayed differences in cytoplasm/cell membrane labeling.

Conclusions:  DD skin displayed a constant immunohistochemical involucrin pattern characterized by both premature expression and a particular cytoplasmic/cell membrane localization distribution.
Facets of lupus erythematosus: panniculitis responding to thalidomide
Authors: Wienert Simone , Gadola Stephan , Hunziker Thomas
Published: February 2008

Lupus erythematosus profundus or lupus panniculitis is a rare clinical variant of lupus erythematosus, which involves the deep dermis and subcutaneous fat. Diagnosis may be difficult in cases with isolated involvement. Further manifestations of lupus erythematosus may thus be essential for diagnosis, which depends on the clinical picture, histopathology and a positive lesional lupus band test. We report a severe, mutilating case of lupus panniculitis, which responded well to thalidomide.
Sentinel lymph node status is the most important prognostic factor for thick (≥ 4 mm) melanomas
Authors: Gutzmer Ralf , Satzger Imke , Thoms Kai‐Martin , Völker Bernward , Mitteldorf Christina , Kapp Alexander , Bertsch Hans Peter , Kretschmer Lutz
Published: February 2008

Background: The value of the status of the sentinel lymph node (SLN) in patients with thick melanomas (Breslow thickness ≥ 4 mm) is controversial.

Patients and Methods: Using Kaplan‐Meier estimates and Cox regression models, we studied 152 patients with primary melanomas ≥ 4 mm thickness who underwent sentinel lymph node excision (SLNE) at the university hospitals of Hannover and Göttingen, Germany, between 1998 and 2006.

Results: The median tumor thickness was 5.2 (4–18) mm; 58.5% of primary melanomas were ulcerated. Micrometastasis to a SLN was found in 48.7%. The patients with positive SLNs were significantly younger than those with negative SLN (p = 0.01). Of the complete lymph node dissections, 32% contained positive non‐SLN. The estimated 5 year recurrence‐free survival was 42.5 ± 5% (± standard error) (26.3 ± 6.6% after positive SLNE, 58.7 ± 7.1% after negative SLNE). The 5 year overall survival rate was 53.2 ± 5.4% (37.5 ± 8.1% after positive SLNE, 67.6 ± 6.7% after negative SLNE). By multivariate analysis, the SLN was a highly significant predictor for overall survival (p = 0.007, relative risk 2.3, 95%, confidence interval 1.2–4.2). The overall survival was significantly associated with penetration of nodal metastases into the SLN > 0.3 mm (p = 0.001). Other parameters such as tumor thickness, ulceration, age and sex were not significant. In the subgroup of patients with negative SLN, neither tumor thickness nor ulceration was significant.

Conclusions: The status of the SLN represents the most important prognostic parameter in patients with thick melanomas, whereas other parameters such as tumor thickness and ulceration loose their prognostic value.
Crystal structure of a cold‐adapted class C β‐lactamase
Authors: Michaux Catherine , Massant Jan , Kerff Frédéric , Frère Jean‐Marie , Docquier Jean‐Denis , Vandenberghe Isabel , Samyn Bart , Pierrard Annick , Feller Georges , Charlier Paulette , Van Beeumen Jozef , Wouters Johan
Published: February 2008

In this study, the crystal structure of a class C β‐lactamase from a psychrophilic organism, Pseudomonas fluorescens, has been refined to 2.2 Å resolution. It is one of the few solved crystal structures of psychrophilic proteins. The structure was compared with those of homologous mesophilic enzymes and of another, modeled, psychrophilic protein. The elucidation of the 3D structure of this enzyme provides additional insights into the features involved in cold adaptation. Structure comparison of the psychrophilic and mesophilic β‐lactamases shows that electrostatics seems to play a major role in low‐temperature adaptation, with a lower total number of ionic interactions for cold enzymes. The psychrophilic enzymes are also characterized by a decreased number of hydrogen bonds, a lower content of prolines, and a lower percentage of arginines in comparison with lysines. All these features make the structure more flexible so that the enzyme can behave as an efficient catalyst at low temperatures.
Taurine Prevents Tamoxifen‐Induced Mitochondrial Oxidative Damage in Mice
Authors: Parvez Suhel , Tabassum Heena , Banerjee Basu Dev , Raisuddin Sheikh
Published: February 2008

Abstract:  Tamoxifen is a selective oestrogen receptor modulator widely used in the treatment of breast cancer. Tamoxifen potentially affects mitochondrial functions as it acts as an uncoupling agent and a powerful inhibitor of mitochondrial electron transport chain. There is concern for the deleterious effects of tamoxifen. Taurine is known to have membrane stabilizing and antioxidant properties. We studied effect of taurine pre‐treatment on the toxicity of tamoxifen in mouse liver mitochondria focusing specifically on the redox cycle biomarkers. Tamoxifen caused a significant rise in the mitochondrial lipid peroxidation, protein carbonyl content and superoxide radical generation. There was a significant change in the mitochondrial thiol profile in the tamoxifen‐treated animals. Pre‐treatment of mice with taurine (100 mg/kg) markedly lowered mitochondrial lipid peroxidation, protein carbonyl content and superoxide radical generation. It also restored decreased enzymatic and non‐enzymatic antioxidants of mitochondria. It is suggested that taurine has a potential role in ameliorating tamoxifen‐induced mitochondrial toxicity, and the protection is afforded either by reversing the decline of antioxidants or by the direct free radical‐scavenging activity.
Developing an Adverse Drug Reaction Reporting System at a Teaching Hospital
Authors: Baniasadi Shadi , Fahimi Fanak , Shalviri Gloria
Published: February 2008

Abstract:  Adverse drug reactions (ADRs) are a frequent cause for hospitalization and occur often in hospitalized patients. The objective of this study was to establish an ADR reporting and monitoring system at a teaching hospital. The pharmacovigilance unit of Masih Daneshvari hospital was established by a clinical pharmacist and a clinical pharmacologist. Healthcare professionals were encouraged to report any suspected ADRs encountered in in‐patients. The incidence, pattern, seriousness, severity and preventability of the reported ADRs were analysed. During the period of 12 months, for 6840 patients, 112 spontaneous reports were received. The most frequently reported reactions were due to anti‐infective agents (58.2%). Ceftriaxone accounted for the highest number of the reported ADRs among anti‐infective agents. The skin and appendages system was the most frequently affected system (32.5% of all reactions). Seventeen per cent of the ADRs were reported as serious reactions. Although the incidence of ADRs reported by physicians and nurses was found to be low, this programme was useful as a preliminary programme in initiating a culture of ADR reporting among healthcare professionals. Improved communication between the physicians and nurses with the pharmacovigilance centre in the hospital is suggested.
Preparation and Properties of Self‐Healing Coating for C/SiC Brake Materials
Authors: Fan Shangwu , Zhang Litong , Cheng Laifei , Xu Yongdong , Yao Ningna
Published: February 2008

An oxidation‐protective coating of C/SiC brake materials was prepared by the sol–gel method using tetraethoxysilane and triethylborate. The coating was characterized by Fourier transform‐infrared spectroscopy, X‐ray diffraction, and scanning electron microscopy. The oxidation resistance was also investigated. The results indicated that a dense and homogeneous borosilicate glass coating was formed on C/SiC. At 800°C, the normal service temperature of the brake disks, the as‐received borosilicate glass coating effectively protected C/SiC brake materials from oxidizing in air. Moreover, the coating showed excellent thermal shock resistance, excellent seawater corrosion resistance, and excellent self‐healing ability.
Pulsed Laser Micromachining of Yttria‐Stabilized Zirconia Dental Ceramic for Manufacturing
Authors: Dear Fraser C. , Shephard Jonathan D. , Wang Xin , Jones Julian D. C. , Hand Duncan P.
Published: February 2008

We describe the machining of a zirconia ceramic with millisecond pulses at 1064 nm (Nd:YAG) and present techniques that allow this material to be processed effectively. We show experimentally that due to the thermal expansion rate and absorption of the material, laser machining processes such as drilling and milling can critically fail in the millisecond regime. Results are also presented indicating that the phase structure of the bulk material postmillisecond‐processing remains largely unmodified. Furthermore, we show that the addition of a nanosecond system to the process confers not only flexibility but the capability of precision machining at 1064 nm.
Why Assessment Centers Do Not Work the Way They Are Supposed To
Authors: Lance Charles E.
Published: February 2008

Assessment centers (ACs) are often designed with the intent of measuring a number of dimensions as they are assessed in various exercises, but after 25 years of research, it is now clear that AC ratings that are completed at the end of each exercise (commonly known as postexercise dimension ratings) substantially reflect the effects of the exercises in which they were completed and not the dimensions they were designed to reflect. This is the crux of the long-standing “construct validity problem” for AC ratings. I review the existing research on AC construct validity and conclude that (a) contrary to previous notions, AC candidate behavior is inherently cross-situationally (i.e., cross-exercise) specific, not cross-situationally consistent as was once thought, (b) assessors rather accurately assess candidate behavior, and (c) these facts should be recognized in the redesign of ACs toward task- or role-based ACs and away from traditional dimension-based ACs.
Increased mast cell numbers in human patellar tendinosis: correlation with symptom duration and vascular hyperplasia
Authors: Scott A , Lian Ø , Bahr R , Hart D A , Duronio V , Khan K M
Published: February 2008

Objectives:

The cellular basis of painful tendon overuse pathology (tendinosis) is poorly understood. It has been suggested that because of the close anatomical associations between mast cells and vessels in connective tissues, mast cells may mediate the development of tendon hypervascularity or oedema.

Objectives:

To examine the distribution of mast cells in men and women with patellar tendinopathy.

Design:

Case–control study.

Methods:

Tendinopathic tissue was collected at open debridement of the patellar tendon and a control tendon from patients undergoing intramedullary nailing of the tibia. The tendon was assessed immunohistochemically by evaluating the distribution of mast cells (AA1), and markers for T lymphocytes (CD3) and macrophages (CD68). The vessel-area fraction was quantified using computer-assisted digital image analysis.

Results:

The prevalence of mast cells per mm2(mean 3.3 (SD 3.0)) was greater in tendinosis tissue than in controls (1.1 (1.5); p = 0.036). In patients with tendinosis, mast cell density was moderately correlated with the vessel-area fraction (r2 = 0.49) and with symptom duration (r2 = 0.52).

Conclusion:

Mast-cell prevalence in patellar tendinopathy was increased and was predominantly associated with vascular hyperplasia, particularly in patients with longstanding symptoms. Future research should investigate whether mast cells play direct or indirect modulatory roles in the development and progression of human tendinosis.
Effect of glucocorticosteroid injections in tennis elbow verified on colour Doppler ultrasonography: evidence of inflammation
Authors: Torp-Pedersen T E , Torp-Pedersen S T , Qvistgaard E , Bliddal H
Published: February 2008

Objectives:

It has previously been reported that lateral epicondylitis may be diagnosed with colour Doppler ultrasonography (US) by detecting hyperaemia inside the common extensor origin (CEO).This study reports on the association between Doppler US findings and the short-term response of US-guided corticosteroid injection in patients with LE.

Design:

Case-only, blinded intervention study.

Setting:

Secondary care at a government hospital.

Patients:

62 patients with LE verified by colour Doppler US.

Intervention:

One US-guided corticosteroid injection was given into the CEO.

Main outcome measures:

Patients were evaluated at baseline before the injection and at 2 weeks of follow-up. Outcome measures were changes in pain score and US parameters (resistive index (RI) and the amount of colour within the CEO). Prognosticators for outcome were: use of computer mouse, symptom duration, elbow strain, RI, colour fraction, Likert pain score, pain at rest, pain during activity, age, height, weight, disease in dominant versus nondominant arm.

Results:

All but one patient experienced improvement of general elbow pain perception at follow-up at 2 weeks. In parallel, Doppler US showed significant reduction in colour fraction (mean (standard deviation) with 95% confidence limits: baseline 0.14 (0.10), at follow-up 0.02 (0.02), p<0.0001). All but five patients showed a decrease in colour fraction; 74% decreased to 0. No clinical or US parameter could distinguish responders from non-responders.

Conclusion:

Corticosteroid injection has a marked short-term effect on pain and Doppler parameters. The reduction in hyperaemia mediated by an anti-inflammatory drug can be interpreted as evidence of an inflammatory component in LE.
Heart rate-based protocols for exercise challenge testing do not ensure sufficient exercise intensity for inducing exercise-induced bronchial obstruction
Authors: Trümper C , Mäueler S , Vobejda C , Zimmermann E
Published: February 2008

Objective:

To determine if a heart rate-based protocol for bronchial provocation testing ensures sufficient exercise intensity for inducing exercise-induced bronchial obstruction.

Participants:

100 clinically healthy non-asthmatic sports students.

Design:

Subjects underwent an exercise challenge test (ECT) on a treadmill ergometer for bronchial provocation according to the guidelines of the American Thoracic Society (ATS). Heart rate (HR), forced expiratory volume in 1 second (FEV1), pH (pH) and lactate concentration were measured before and after exercise.

Results:

After exercise in 56% of the examined subjects lactate concentrations were <6 mmol/l. A highly significant decrease in FEV1(mean −4.41 (SD 1.5%)) was found at concentrations of >6 mmol/l, whereas at concentrations <6.48 mmol/l, no participant showed an impairment of lung function (FEV1values ⩽90%). In five subjects, a bronchial obstruction was found, as shown by decreases in FEV1of −10 to −47% after exercise. The lactate concentrations in these individuals were between 6.48 and 11.7 mmol/l, indicating a predominantly anaerobic metabolic response to exercise.

Conclusion:

These results show that the ATS standard protocol, using a heart rate formula for assessing the exercise intensity, is not sufficient to cause predominantly anaerobic lactate metabolism and hence exercise-induced hyperventilation. Therefore, a potential bronchial obstruction could not be induced in 56% of the subjects. For a sensitive study design, exercise intensities demanding anaerobic lactate metabolism should always be ensured. A more precise protocol is required.
Is heart rate a convenient tool to monitor over-reaching? A systematic review of the literature
Authors: Bosquet L , Merkari S , Arvisais D , Aubert A E
Published: February 2008

Objective:

A meta-analysis was conducted on the effect of overload training on resting HR, submaximal and maximal exercise HR (HR), and heart rate variability (HRV), to determine whether these measures can be used as valid markers of over-reaching.

Methods:

Six databases were searched using relevant terms and strategies. Criteria for study inclusion were: participants had to be competitive athletes, an increased training load intervention had to be used, and all necessary data to calculate effect sizes had to be available. An arbitrary limit of 2 weeks was chosen to make the distinction between short-term and long-term interventions. Dependent variables were HR and HRV (during supine rest). Standardised mean differences (SMD) in HR or HRV before and after interventions were calculated, and weighted according to the within-group heterogeneity to develop an overall effect.

Results:

In these competitive athletes, short-term interventions resulted in a moderate increase in both resting HR (SMD = 0.55; p = 0.01) and low frequency/high frequency ratio (SMD = 0.52; p = 0.02), and a moderate decrease in maximal HR (SMD = −0.75; p = 0.01). Long-term interventions resulted in a small decrease in HR during submaximal (SMD = −0.38; p = 0.006) and maximal exercise (SMD = −0.33; p = 0.007), without alteration of resting values.

Conclusion:

The small to moderate amplitude of these alterations limits their clinical usefulness, as expected differences may fall within the day-to-day variability of these markers. Consequently, correct interpretation of HR or HRV fluctuations during the training process requires the comparison with other signs and symptoms of over-reaching to be meaningful.
The practice of primary care sports medicine in the USA
Authors: Diehl J J , Pirozzolo J J , Best T M
Published: February 2008

Objective:

To investigate and to characterise the practice patterns, academic rank, and income variables that exist in order to better understand the career of a sports medicine physician in the USA.

Design:

A cross-sectional survey of family physicians holding a Certificate of Added Qualifications in Sports Medicine through the American Board of Family Medicine as of January 2006.

Results:

The survey was completed by 325 of 862 physicians (a return rate of 38%). Of all respondents, 212 (65%) reported completing a Primary Care Sports Medicine Fellowship, 276 (85%) were male and 49 (15%) were female, and 300 (92%) reported having a MD, while 25 (8%) had a DO. Clinical duties represented the largest proportion of the physicians’ schedules (7.94 half days/week), and the majority of physicians performed routine athletic event coverage. The average salary for all physicians was $166 000 US. Higher-income groups included: men ($172 000 vs $132 000 for women); regions including Central, South East, and South West; full professors; and non-student health or urgent care clinical work. With control for all other variables, four groups demonstrated significantly higher odds of being high income earners (annual gross salary > $200 000 US). These groups included age over 40, male sex, practice owner, and seeing over 10 patients per half day.

Conclusions:

Salary can be related to age, gender, number of patients seen, and practice ownership. No statistical difference among salaries was found between MDs and DOs, osteopathic manipulative therapy (OMT) practice, region of the country, or how practices are marketed.
Does the presence of proximal humerus growth plate changes in young baseball pitchers happen only in symptomatic athletes? Anxray evaluation of 21 young baseball pitchers
Authors: Murachovsky J , Ikemoto R Y , Nascimento L G P , Serpone Bueno R , Strose E , Almeida L H
Published: February 2008

Objective

To evaluate the presence ofxray changes in the proximal humerus growth plate of 21 young pitchers.

Design

Case series.

Setting

This study was conducted at the Orthopaedic and Traumatology Department of the ABC College of Medicine, Santo Andre, São Paulo, Brazil, tertiary institution.

Patients

21 male adolescent baseball pitchers, with a mean age of 14.5 years and selected from the Brazilian National Team, were studied.

Interventions

The patients underwentxray examinations of the shoulders.

Main outcome measurements

Thexrays of the pitchers’ shoulders were studied to determine any changes in the proximal humeral growth plate and correlate them with clinical findings.

Results

Fourteen athletes (66%) had radiographic changes in the humerus growth plate but only 5 (36%) had pain complaints. Nine of these 14 cases (64%) whom the observers found radiographic changes did not complain of pain. It was also observed that there was a correlation in only 11 cases between clinical and radiographic evaluations.

Conclusion

Radiographic changes in the proximal humerus growth plate were found in 66% of the cases, but 64% were asymptomatic. These changes indicate possible evolution, in the future, to a greater degree of retroversion in pitchers’ dominant shoulders.