bluuebunny/crossref_metadata_2025 huggingface dataset:
Preemptive Dexamethasone and Etoricoxib for Pain and Discomfort Prevention After Periodontal Surgery: A Double‐Masked, Crossover, Controlled Clinical Trial
Authors: Steffens Joao Paulo , Santos Fábio André , Sartori Rafael , Pilatti Gibson Luiz
Published: April 2010

Background: Several anti‐inflammatory drugs have been used to reduce pain and discomfort after periodontal surgeries. This study evaluates the efficacy of using etoricoxib and dexamethasone for pain prevention after open‐flap debridement surgery.

Methods: For this prospective, double‐masked, crossover, placebo‐controlled, randomized clinical trial, open‐flap debridement surgeries were performed on 15 patients (eight males and seven females, age range 20 to 56 years: mean age ± SD: 40 ± 9.7 years) who presented with chronic periodontitis after non‐surgical periodontal therapy at three quadrants. Each patient underwent three surgical procedures at intervals of 30 days and received one of the following premedication protocols 1‐hour before surgery: group 1 = placebo, group 2 = 8 mg dexamethasone, and group 3 = 120 mg etoricoxib. Rescue medication (750 mg acetaminophen) was given to each patient who was instructed to take it when necessary. Pain intensity and discomfort were evaluated by a 101‐point numeric rate scale and a four‐point verbal rate scale, respectively, hourly for the first 8 hours after surgery and three times a day on the following 3 days.

Results: The results demonstrate that groups 2 and 3 present reduced postoperative pain‐intensity levels compared to group 1. There were statistically significant differences at the 4, 5, 6, 7, and 8 hour‐periods after surgery (Friedman test; P <0.05). Furthermore, rescue‐medication intake was significantly lower for groups 2 and 3 than for group 1 (analysis of variance; P <0.02).

Conclusion: The adoption of a preemptive medication protocol using etoricoxib or dexamethasone may be considered effective for pain and discomfort prevention after open‐flap debridement surgeries.
Use of Ash from Sewage Sludge in the Preparation of Desulfurant Sorbents
Authors: Fernández Ferreras Josefa , García Posadas Hipolito , Rico Gutierrez Jose Luis , Renedo Omaechevarría Josefina
Published: April 2010

This work aims to develop new uses for sewage sludge, which is a byproduct of municipal wastewater treatment plants, by examining the calcination of this waste, the characterization of ashes is obtained, and its use to prepare desulfurant sorbents. Samples of sewage sludge were obtained from a local municipal wastewater treatment plant. This plant applies a pre-treatment followed by a biological treatment, where anaerobic digestion and centrifugation reduces the sludge. Three samples were characterized (in humidity, volatile and fixed solids content), dried, and ignited at two temperatures, 550 and 750°C. The composition of the ash obtained at both ignition temperatures was studied by x-ray fluorescent spectroscopy and the BET specific surface area of the two ashes and of the prepared sorbents was measured. Ash composition was similar for the two temperatures tested, where the components were Si, Ca, Al, Fe, P, S, Mg, K, Cl, Zn and Ti. BET specific surface area values indicate that the lower temperature of calcination produces ash with the highest SSA values (18 m2/g against near 10 m2/g). Preparation of desulfurant sorbents was carried out by mixing the ash with CaO or Ca(OH)2 at room temperature and different experimental conditions. The BET SSA of the prepared desulfurant sorbents showed higher values for the sorbents prepared with the ashes obtained at the lowest temperature. The behaviour of the ash and the prepared sorbents was tested in a fixed bed reactor at 58°C with a flue gas containing 5000 ppm of SO2 with a relative humidity of 55%. Results in the desulfurization process show that the calcium from the sludge seems more efficient than the calcium added as CaO or Ca(OH)2 to prepare the sorbents.
Liquid-Phase Esterification of Methacrylic Acid with Methanol Catalyzed by Heteropolyacid
Authors: Witczak Teresa , Grzesik Miroslaw , Skrzypek Jerzy , Witczak Mariusz
Published: April 2010

The esterification kinetics of methacrylic acid with methanol in the presence of H3PW12O40 or H3MoW12O40 as a catalyst was studied with isothermal batch experimental. The catalyst concentration was varied between 14.4 and 57.7 mol/m3. The experiences were carried out at temperatures from 316 to 333 K and initial molar ratios of the reactants from 3 to 10. The non-ideality of the liquid phase was accounted for by using activities instead of molar. The activity coefficients were determined using the UNIFAC method. The kinetic equations developed had a non-elementary form, and the order of the reaction was a fraction.
A Survey of Improved Gari Frying Methods
Authors: Samuel Taiwo Moses , Igbeka J. C. , Kolawole Oladele Peter
Published: April 2010

Processing cassava to gari is a storage method. Gari frying is the last operation and is still largely done manually in Nigeria. The women processors usually adopt various postures during production as appeared comfortable to them. This paper reports the survey carried out in 50 gari factories across five states (Ekiti, Ondo, Ogun, Osun and Oyo) of southwestern Nigeria and the versions of Improved Traditional Garification Methods (ITGMs) in use. These were grouped into eight (ITGM I-VIII) based on operator's and workplace's characteristics, heating process and estimated output. Their modes of operation were explained and estimation of their outputs and common working postures were determined. Four working postures were identified namely, sitting beside (SB), sitting in front (SF), alternating between sitting and standing (ASS) and standing (S). ITGM VIII with operator in standing posture using both hands had the highest output, having efficient use of both hands and indicating an ergonomic balance of right and left arms as well as overcoming certain asymmetric symptoms in the workers. ITGM VIII is, therefore, recommended based on output.
Experimental Study on Drying High Moisture Paddy by Heat Pump Dryer with Heat Recovery
Authors: Jinjiang Zhang , Yaosen Wu
Published: April 2010

In this study, a heat pump dryer with heat recovery (HPHR) was employed to dry the paddy with high moisture content. The paddy (w. b.) was about 30% initial moisture content and 1200kg in each batch. After drying process, the final moisture content was 14%, and the average energy consumption of HPHR was 10.5kwh/100kg (based on the weight of final paddy). The total drying time, drying cost and energy consumption were 88%, 64% and 58% of those using diesel-powered low-temperature heated air drying.
Subsidies for the Production of Cleaner Energy: When Do They Cause Emissions to Rise?
Authors: Hutchinson Emma , Kennedy Peter W , Martinez Cristina
Published: April 2010

We show that a production subsidy to low-carbon energy can have a perverse effect on emissions. The subsidy causes a shift in the composition of production towards the cleaner energy, but it also causes an offsetting consumption effect: energy consumption rises because the subsidy causes the equilibrium price of energy to fall. The net effect on emissions can be positive if the low-carbon energy is not significantly cleaner than the high-carbon energy it displaces. We derive a necessary and sufficient condition for this perverse effect in the context of a competitive energy market. We calibrate an example for an ethanol subsidy in the U.S. and find that this policy is likely to cause an increase in carbon emissions for most plausible parameter values.
Functional Gait Assessment: Concurrent, Discriminative, and Predictive Validity in Community-Dwelling Older Adults
Authors: Wrisley Diane M. , Kumar Neeraj A.
Published: April 2010

Background

The Functional Gait Assessment (FGA) is a reliable and valid measure of gait-related activities.

Objective

The purpose of this study was to determine the concurrent, discriminative, and predictive validity of the FGA in community-dwelling older adults.

Design

This was a prospective cohort study.

Methods

Thirty-five older adults aged 60 to 90 years completed the Activities-specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Timed “Up & Go” Test (TUG), and Functional Gait Assessment (FGA) during one session. Falls were tracked by having participants complete a monthly fall calendar for 6 months. Spearman correlation coefficients were used to determine concurrent validity among the ABC, BBS, TUG, DGI, and FGA. To determine the optimum scores to classify fall risk, sensitivity (Sn), specificity (Sp), and positive and negative likelihood ratios (LR+ and LR−) were calculated for the FGA in classifying fall risk based on the published criterion scores of the DGI and TUG and for the FGA, TUG, and DGI in identifying prospective falls. Receiver operator curves with area under the curve were used to determine the effectiveness of the FGA in classifying fall risk and of the DGI, TUG, and FGA in identifying prospective falls.

Results

The FGA correlated with the ABC (r=.053, P<.001), BBS (r=.84, P<.001), and TUG (r=−.84, P<.001). An FGA score of ≤22/30 provides both discriminative and predictive validity. The FGA (scores ≤22/30) provided 100% Sn, 72% Sp, LR+ of 3.6, and LR− of 0 to predict prospective falls.

Limitations

The study was limited by the length of time of follow-up and the small sample size that did not allow for evaluation of criterion scores by decade.

Conclusions

The FGA with a cutoff score of 22/30 is effective in classifying fall risk in older adults and predicting unexplained falls in community-dwelling older adults.
Patterns of tobacco exposure before and during pregnancy
Authors: ANDERKA MARLENE , ROMITTI PAUL A. , SUN LIXIAN , DRUSCHEL CHARLOTTE , CARMICHAEL SUZAN , SHAW GARY ,   the National Birth Defects Prevention Study
Published: April 2010

Objectives. To describe maternal exposure to tobacco in the three months before conception and throughout pregnancy, examine risk factors associated with tobacco exposure in pregnancy and smoking cessation, assess use of pharmacotherapy for smoking cessation and evaluate birth outcomes by smoking status. Design. A cohort of women from a multi‐site United States study were asked retrospectively about their exposure to tobacco. Population. The study population was comprised of 4,667 mothers of non‐malformed control infants who participated in the National Birth Defects Prevention Study from 1997 to 2003. Methods. Using computer‐assisted telephone interview responses from this population‐based sample, we assessed patterns of maternal smoking and exposure to environmental tobacco smoke (ETS) as well as use of pharmacotherapy for quitting smoking during pregnancy. Results. Overall, 961 (20.6%) mothers reported any smoking and 1,401 (30.0%) reported any exposure to ETS at home or work during the three months before conception through pregnancy. Of the 961 smokers, 512 (53.3%) reportedly quit smoking before or during pregnancy, including 379 (74% of quitters) in the first trimester, and 420 (43.7%) continued to smoke throughout the pregnancy. Only 2.1% of smokers reportedly used pharmacotherapy to quit smoking anytime from three months before conception through pregnancy. Low birthweight and preterm delivery rates were lowest among offspring of non‐smokers and highest in offspring of those who continued to smoke throughout pregnancy. Conclusions. About one‐half of mothers who reported preconceptional smoking quit before or during pregnancy. Use of pharmacotherapy to quit smoking during pregnancy was not common.
Exposure to secondhand smoke and associated factors among non‐smoking pregnant women with smoking husbands in Sichuan province, China
Authors: YANG LIAN , TONG ELISA K. , MAO ZHENGZHONG , HU TEH‐WEI
Published: April 2010

Background. Secondhand smoke (SHS) exposure harms pregnant women and the fetus. China has the world's largest number of smokers and a high male smoking prevalence rate. Objective. To compare exposure to SHS among rural and urban Chinese non‐smoking pregnant women with smoking husbands, and analyze factors associated with the level of SHS exposure and hair nicotine concentration Setting. Sichuan province, China. Population. In all 1,181 non‐smoking pregnant women with smoking husbands recruited from eight district/county Women and Children's hospitals. Methods. The women completed a questionnaire in April and May 2008. Based on systematic sampling, 186 pregnant women were selected for sampling the nicotine concentration in their hair. Ordinal logistic regression analysis was conducted to examine correlates with self‐reported SHS exposure (total and at home); linear regression was conducted for the sub‐sample of hair nicotine concentrations. Main outcome measures. Secondhand smoking exposure rates, hair nicotine levels. Results. About 75.1% of the non‐smoking pregnant women with smoking husbands reported regular SHS exposure. The major source of exposure was through their husband. In the multivariate analysis, the risk of greater SHS exposure (total and at home) and hair nicotine concentration was increased for women who were rural, had a husband with greater cigarette consumption, less knowledge about SHS, less negative attitudes about SHS, and no smoke‐free home rules. Conclusions. The high prevalence rate of SHS exposure suggests that it is important for non‐smoking pregnant women, especially rural women, to establish smoke‐free home rules and increase knowledge and negative attitudes towards SHS.
An integrated brief intervention to address smoking in pregnancy
Authors: BOWDEN JACQUELINE A. , OAG DEBRA A. , SMITH KATE L. , MILLER CAROLINE L.
Published: April 2010

Objective. Evaluate the impact of an integrated brief intervention to assist antenatal staff in addressing smoking with pregnant women. Design. Three studies were conducted: (a) antenatal staff surveys pre‐ and post‐training to deliver the brief intervention; (b) retrospective audit of pregnancy records; (c) post‐intervention follow‐up interviews with a cohort of pregnant women who smoked at baseline. Setting. South Australia. Sample. (a) Antenatal health professionals at two major birthing hospitals (n = 117 pre‐survey and n = 62 post‐survey); (b) 1,024 pregnancy records; (c) follow‐up interviews with women at one month (n = 58), 6 months (n = 40) and 12 months (n = 31) post‐intervention. Methods. (a) Staff surveys about current practice prior to training (via written questionnaire) and 12 months post‐training (by telephone); (b) pregnancy record audit for presence and use of the Smoke‐Free Assessment & Intervention Form (SFA&IF) conducted at 12 months; (c) telephone surveys assessing smoking behavior. Main Outcome Measures. Staff practice change and compliance with the intervention. Cessation rates among pregnant women. Results. At 12 months, 89% of staff reported that the intervention integrated well into their work; The SFA&IF was physically present in 80% of pregnancy records and 89% had been completed. Over 65% of current smokers were offered advice about the benefits of quitting; quit rates were highest at 6 months (18, 13% conservative estimate), but women tended to relapse after the birth of their baby. Conclusions. The intervention was well‐received and staff compliance was high. Quit rates exceeded spontaneous quit rates in the community. This project has been expanded nationally.
Physician counseling of pregnant women about active and secondhand smoking in Argentina
Authors: MEJIA RAUL , MARTINEZ VALERIA GUIL , GREGORICH STEVEN E , PÉREZ‐STABLE ELISEO J
Published: April 2010

Objective. Describe physicians' practices of smoking cessation and secondhand smoke (SHS) exposure counseling during prenatal visits. Design. Cross‐sectional survey. Setting. A total of 13 public and private hospitals from three cities in Argentina. Population. A total of 300 obstetrician/gynecologists. Methods. Self‐administered survey included knowledge and attitudes about tobacco use during pregnancy, frequency, type and duration of smoking cessation counseling, barriers to counseling, communication skills, level of understanding and personal smoking history. Main outcome measures. Composite outcomes of four items, each representative of counseling on smoking cessation and SHS exposure. Results. A total of 235 (78.3%) questionnaires were completed; 54.5% men, mean age 45, 35% current smokers. Only 22% had received training in smoking cessation counseling and 48.5% reported insufficient knowledge to provide smoking cessation advice. Although 88.9% always or almost always advised women to stop smoking, 75% believed it was acceptable for pregnant women to smoke up to 6 cigarettes per day. The risk of SHS exposure was ‘always or almost always discussed’ by only 34.5% of physicians. Multivariate logistic regression showed that lack of training was associated with less counseling about smoking cessation (OR 0.18; 95% CI 0.04–0.82) and SHS exposure (OR 0.27; 95% CI 0.12–0.59). Current compared to never smokers had lower odds of smoking cessation counseling (OR 0.39; 95% CI 0.05–0.82). Current smokers were less likely than former smokers to counsel about SHS (OR 0.25; 95% CI 0.11–0.62). Conclusions. Smoking cessation counseling during pregnancy in Argentina occurs infrequently, interventions are needed to assist physicians motivate and counsel women to quit smoking and avoid SHS exposure. Physicians taking care of pregnant women also need to quit smoking.
Cannula placement for effective convection-enhanced delivery in the nonhuman primate thalamus and brainstem: implications for clinical delivery of therapeutics
Authors: Yin Dali , Richardson R. Mark , Fiandaca Massimo S. , Bringas John , Forsayeth John , Berger Mitchel S. , Bankiewicz Krystof S.
Published: April 2010

Object

The purpose of this study was to optimize stereotactic coordinates for delivery of therapeutic agents into the thalamus and brainstem, using convection-enhanced delivery (CED) to avoid leakage into surrounding anatomical structures while maximizing CED of therapeutics within the target volume.

Methods

The authors recently published targeting data for the nonhuman primate putamen in which they defined infusion parameters, referred to as “red,” “blue,” and “green” zones, that describe cannula placements resulting in poor, suboptimal, and optimal volumes of distribution, respectively. In the present study, the authors retrospectively analyzed 22 MR images with gadoteridol as a contrast reagent, which were obtained during CED infusions into the thalamus (14 cases) and brainstem (8 cases) of nonhuman primates.

Results

Excellent distribution of gadoteridol within the thalamus was obtained in 8 cases and these were used to define an optimal target locus (or green zone). Good distribution in the thalamus, with variable leakage into adjacent anatomical structures, was noted in 6 cases, defining a blue zone. Quantitative containment (99.7 ± 0.2%) of gadoteridol within the thalamus was obtained when the cannula was placed in the green zone, and less containment (85.4 ± 3.8%) was achieved with cannula placement in the blue zone. Similarly, a green zone was also defined in the brainstem, and quantitative containment of infused gadoteridol within the brainstem was 99.4 ± 0.6% when the cannula was placed in the green zone. These results were used to determine a set of 3D stereotactic coordinates that define an optimal site for infusions intended to cover the thalamus and brainstem of nonhuman primates.

Conclusions

The present study provides quantitative analysis of cannula placement and infusate distribution using real-time MR imaging and defines an optimal zone for infusion in the nonhuman primate thalamus and brainstem. Cannula placement recommendations developed from such translational nonhuman primate studies have significant implications for the design of anticipated clinical trials featuring CED therapy into the thalamus and brainstem for CNS diseases.
Mechanical stress-induced reactive gliosis in the auditory nerve and cochlear nucleus
Authors: Sekiya Tetsuji , Matsumoto Masahiro , Kojima Ken , Ono Kazuya , Kikkawa Yayoi S. , Kada Shinpei , Ogita Hideaki , Horie Rie T. , Viola Arpad , Holley Matthew C. , Ito Juichi
Published: April 2010

Object

Hearing levels following microsurgical treatment gradually deteriorate in a number of patients treated for vestibular schwannoma (VS), especially in the subacute postoperative stage. The cause of this late-onset deterioration of hearing is not completely understood. The aim of this study was to investigate the possibility that reactive gliosis is a contributory factor.

Methods

Mechanical damage to nerve tissue is a feature of complex surgical procedures. To explore this aspect of VS treatment, the authors compressed rat auditory nerves with 2 different degrees of injury while monitoring the compound action potentials of the auditory nerve and the auditory brainstem responses. In this experimental model, the axons of the auditory nerve were quantitatively and highly selectively damaged in the cerebellopontine angle without permanent compromise of the blood supply to the cochlea. The temporal bones were processed for immunohistochemical analysis at 1 week and at 8 weeks after compression.

Results

Reactive gliosis was induced not only in the auditory nerve but also in the cochlear nucleus following mechanical trauma in which the general shape of the auditory brainstem response was maintained. There was a substantial outgrowth of astrocytic processes from the transitional zone into the peripheral portion of the auditory nerve, leading to an invasion of dense gliotic tissue in the auditory nerve. The elongated astrocytic processes ran in parallel with the residual auditory neurons and entered much further into the cochlea. Confocal images disclosed fragments of neurons scattered in the gliotic tissue. In the cochlear nucleus, hypertrophic astrocytic processes were abundant around the soma of the neurons. The transverse diameter of the auditory nerve at and proximal to the compression site was considerably reduced, indicating atrophy, especially in rats in which the auditory nerve was profoundly compressed.

Conclusions

The authors found for the first time that mechanical stress to the auditory nerve causes substantial reactive gliosis in both the peripheral and central auditory pathways within 1–8 weeks. Progressive reactive gliosis following surgical stress may cause dysfunction in the auditory pathways and may be a primary cause of progressive hearing loss following microsurgical treatment for VS.
Predictors of long-term shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage
Authors: Rincon Fred , Gordon Errol , Starke Robert M. , Buitrago Manuel M. , Fernandez Andres , Schmidt J. Michael , Claassen Jan , Wartenberg Katja E. , Frontera Jennifer , Seder David B. , Palestrant David , Connolly E. Sander , Lee Kiwon , Mayer Stephan A. , Badjatia Neeraj
Published: April 2010

Object

The purpose of this study was to identify predictors of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH).

Methods

The authors evaluated the incidence of shunt-dependent hydrocephalus in a consecutive cohort of 580 patients with SAH who were admitted to the Neurological Intensive Care Unit of Columbia University Medical Center between July 1996 and September 2002. Patient demographics, 24-hour admission variables, initial CT scan characteristics, daily transcranial Doppler variables, and development of in-hospital complications were analyzed. Odds ratios and 95% CIs for candidate predictors were calculated using multivariate nominal logistic regression.

Results

Admission glucose of at least 126 mg/dl (adjusted OR 1.6; 95% CI 1.0–2.6), admission brain CT scan with a bicaudate index of at least 0.20 (adjusted OR 1.43; 95% CI 1.0–2.0), Fisher Grade 4 (adjusted OR 2.71; 95% CI 1.2–5.7), fourth ventricle hemorrhage (adjusted OR 1.78; 95% CI 1.1–2.7), and development of nosocomial meningitis (adjusted OR 2.2; 95% CI 1.4–3.7) were independently associated with shunt dependency.

Conclusions

These data suggest that permanent CSF diversion after aneurysmal SAH may be independently predicted by hyperglycemia at admission, findings on the admission CT scan (Fisher Grade 4, fourth ventricle intraventricular hemorrhage, and bicaudate index ≥ 0.20), and development of nosocomial meningitis. Future research is needed to assess if tight glycemic control, reduction of fourth ventricle clot burden, and prevention of nosocomial meningitis may reduce the need for permanent CSF diversion after aneurysmal SAH.
Absence of an association between glucose levels and surgical site infections in patients undergoing craniotomies for brain tumors
Authors: Hardy Sara J. , Nowacki Amy S. , Bertin Mary , Weil Robert J.
Published: April 2010

Object

In select patient populations, hyperglycemia has been shown to increase the risk of surgical site infection (SSI), whereas stringent glucose control has improved outcomes. To date, no study has focused on whether SSIs in patients with brain tumors undergoing resection are associated with hyperglycemia.

Methods

The authors performed a retrospective chart review of patients who underwent a craniotomy after receiving a diagnosis of brain tumor. From 2001 to 2008, 2485 patients underwent a craniotomy for tumor resection at the Brain Tumor & Neuro-Oncology Center at the Cleveland Clinic. Fifty-seven of these patients (2.3%) developed SSIs postoperatively. A matched case-control study design was used, with 57 patients who developed SSIs after craniotomy (cases) matched with 57 patients who did not develop SSIs (controls). The results were analyzed using both univariate and multivariate conditional logistic regression.

Results

Glucose level was not a significant factor in postoperative SSI (p = 0.83) after adjusting for duration of surgery and adherence to antibiotic prophylaxis. However, duration of surgery was significantly associated with postoperative SSI (p = 0.047).

Conclusions

For patients who undergo craniotomy for definitive resection of a brain tumor, duration of surgery described more variation in the model to predict SSI than blood glucose levels.
Anatomy of the palmar branch of the ulnar nerve: application to ulnar and median nerve decompressive surgery
Authors: Tubbs R. Shane , Rogers Jason M. , Loukas Marios , Cömert Ayhan , Shoja Mohammadali M. , Cohen-Gadol Aaron A.
Published: April 2010

Object

The palmar cutaneous branch of the ulnar nerve (PCUN) has received little attention in the literature, and to the authors' knowledge, has received no attention in the neurosurgical literature. The present study was performed to help the surgeon minimize postoperative complications of nerve decompression at the wrist.

Methods

Forty cadaveric upper limbs underwent dissection of the ulnar nerve in the forearm, at the wrist, and in the palm. The PCUN was investigated and when identified, measurements were made and relationships documented between this cutaneous branch and the ulnar artery. The length and width of the PCUN were measured, as was the distance from the medial epicondyle of the humerus to the origin of the PCUN from the ulnar nerve.

Results

A PCUN was found on 90% of sides. The origin of the PCUN from the ulnar nerve was found to lay a mean of 14.3 cm distal to the medial epicondyle. The mean length and width of this branch were 13 and 0.08 cm, respectively. In the forearm, the PCUN traveled lateral to the ulnar artery on 75% of sides and on the medial side of this vessel on the remaining sides. The PCUN perforated the fascia of the anterior forearm just proximal to the distal wrist crease. In the palm, the PCUN traveled superficial to the superficial palmar arch on all but 5 sides, where it traveled deep to this vascular structure's distal extent. On 2 sides each, the PCUN communicated with the superficial and deep ulnar nerves. On 2 sides, the PCUN communicated with the palmar cutaneous branch of the median nerve. The majority of the terminal fibers of the PCUN were found on the ulnar side of a hypothetical line drawn longitudinally through the fourth digit and supplied an area roughly 3 × 3 cm over the proximal medial palm.

Conclusions

The authors hope that the present data may be useful to the surgeon during decompressive procedures at the wrist, such as carpal tunnel and the Guyon canal. Based on this study, skin incisions of the palm made longitudinally along a line through the middle of the fourth digit would minimize injury to the PCUN.
Predictors of mortality following treatment of intracranial hemangiopericytoma
Authors: Rutkowski Martin J. , Sughrue Michael E. , Kane Ari J. , Aranda Derick , Mills Steven A. , Barani Igor J. , Parsa Andrew T.
Published: April 2010

Object

Intracranial hemangiopericytoma (HPC) is a rare and malignant extraaxial tumor with a high proclivity toward recurrence and metastasis. Given this lesion's rarity, little information exists on prognostic factors influencing mortality rates following treatment with surgery or radiation or both. A systematic review of the published literature was performed to ascertain predictors of death following treatment for intracranial HPC.

Methods

The authors identified 563 patients with intracranial HPC in the published literature, 277 of whom had information on the duration of follow-up. Statistical analysis of survival was performed using Kaplan-Meier and Cox regression analysis.

Results

Hemangiopericytoma was diagnosed in 246 males and 204 females, ranging in age from 1 month to 80 years. Among patients treated for HPC, overall median survival was 13 years, with 1-, 5-, 10-, and 20-year survival rates of 95%, 82%, 60%, and 23%, respectively. Gross-total resection alone (105 patients) was associated with superior survival rates overall, with a median survival of 13 years, whereas subtotal resection alone (23 patients) resulted in a median survival of 9.75 years. Subtotal resection plus adjuvant radiotherapy led to a median survival of 6 years. Gross-total resection was associated with a superior survival benefit to patients regardless of the addition or absence of radiation, and patients receiving > 50 Gy of radiation had worse survival outcomes (median survival 4 vs 18.6 years, p < 0.01, log-rank test). Patients with tumors of the posterior fossa had a median survival of 10.75 versus 15.6 years for those with non–posterior fossa tumors (p < 0.05, log-rank test).

Conclusions

Treatment with gross-total resection provides the greatest survival advantage and should be pursued aggressively as an initial therapy. The addition of postoperative adjuvant radiation does not seem to confer a survival benefit.
Isolation and characterization of 20 microsatellite loci for laurel species (Laurus, Lauraceae)
Authors: Arroyo Juan M. , Rigueiro Cristina , Rodríguez Rocío , Hampe Arndt , Valido Alfredo , Rodríguez‐Sánchez Francisco , Jordano Pedro
Published: April 2010

• Premise of the study: Microsatellite primers were developed for the evergreen tree Laurus to investigate population genetic structure and patterns of gene flow via animal‐dispersed pollen and seeds.

• Methods and Results: Twenty polymorphic nuclear microsatellite markers were developed using CA, GA, AAC, and ATG n‐enriched genomic libraries. Given the tetraploidy of the sampled populations, we analyzed our data both as dominant loci and as codominant genotypic data to calculate allele frequencies and genetic diversity. A total of 196 and 222 alleles were found in 37 Mediterranean (L. nobilis) and 26 Macaronesian islands (L. azorica) individuals, respectively.

• Conclusions: Levels of polymorphism of the reported markers are adequate for studies of diversity and parentage in natural populations of this Tertiary relict tree.
Using Magnetic Resonance Angiography to Measure Abnormal Synovial Blood Vessels in Early Inflammatory Arthritis: A New Imaging Biomarker?
Authors: VASANTH LISA C. , FOO LI FOONG , POTTER HOLLIS G. , ADLER RONALD S. , FINZEL KATHLEEN C. , PAVLOV HELENE , MANDL LISA A.
Published: April 2010

Objective.

To ascertain whether magnetic resonance angiography (MRA) can reliably detect synovial neovascularization in subjects with early inflammatory arthritis.

Methods.

Subjects with 6 weeks to 6 months of clinical evidence of inflammatory hand arthritis had a radiograph, power Doppler ultrasound (PDU) scan, magnetic resonance imaging (MRI), and contrast enhanced MRA performed on the more symptomatic hand. Ultrasound examination of the wrist and 2nd–5th metacarpophalangeal (MCP) joints was scored for erosions, synovial thickening, and synovial blood flow. MRI were assessed using the OMERACT Rheumatoid Arthritis MRI Score (RAMRIS). MRA was used to assess the number of abnormal vessels in the 2nd–5th MCP and in the wrist.

Results.

Of 30 subjects, 66.7% showed abnormal vasculature on MRA in the MCP and/or wrist; mean number of abnormal vessels was 5.24 (range 0–22). Number of abnormal vessels on MRA was strongly correlated with degree of blood flow seen in the corresponding area on PDU (r = 0.79, p ≤ 0.0001). The number of abnormal vessels was highly correlated with MRI MCP synovitis scores (r = 0.69, p ≤ 0.0001), MRI wrist synovitis scores (r = 0.73, p ≤ 0.0001), and ultrasound synovitis scores (r = 0.68, p ≤ 0.0001).

Conclusion.

In this cross-sectional pilot study, MRA identified abnormal vessels in patients with early inflammatory arthritis. This is the first report of MRA visualizing abnormal vessels in this patient population. If the degree of neovascularization in early inflammatory arthritis predicts disease course, MRA evidence of abnormal vessels could be a new imaging biomarker.
Outcomes of Children Treated for Lyme Arthritis: Results of a Large Pediatric Cohort
Authors: TORY HEATHER O. , ZURAKOWSKI DAVID , SUNDEL ROBERT P.
Published: April 2010

Objective.

Children often develop arthritis secondary to Lyme disease; however, optimal treatment of Lyme arthritis in pediatric patients remains ill-defined. We sought to characterize the outcomes of a large cohort of children with Lyme arthritis treated using the approach recommended by the American Academy of Pediatrics and the Infectious Diseases Society of America.

Methods.

Medical records of patients with Lyme arthritis seen by rheumatologists at a tertiary care children’s hospital from 1997 to 2007 were reviewed. Patients were classified with antibiotic responsive or refractory arthritis based on absence or presence of persisting joint involvement 3 months after antibiotic initiation. Treatment regimens and outcomes in patients with refractory arthritis were analyzed.

Results.

Of 99 children with Lyme arthritis, 76 had arthritis that responded fully to antibiotics, while 23 developed refractory arthritis. Most patients with refractory arthritis were successfully treated with nonsteroidal antiinflammatory drugs (6 patients), intraarticular steroid injections (4), or disease-modifying antirheumatic drugs (DMARD) (2). Five were lost to followup. Six patients with refractory arthritis were initially treated elsewhere and received additional antibiotic therapy, with no apparent benefit. Three subsequently required DMARD, while 3 had gradual resolution of arthritis without further therapy. Antibiotic responsiveness could not be predicted from our clinical or laboratory data.

Conclusion.

Lyme arthritis in children has an excellent prognosis. More than 75% of referred cases resolved with antibiotic therapy. Of patients with antibiotic refractory arthritis, none in whom followup data were available developed chronic arthritis, joint deformities, or recurrence of infection, supporting current treatment guidelines.
Reproducibility of Joint Swelling Assessments in Long-lasting Rheumatoid Arthritis: Influence on Disease Activity Score-28 Values (SEA-Repro Study Part I)
Authors: MARHADOUR THIERRY , JOUSSE-JOULIN SANDRINE , CHALÈS GÉRARD , GRANGE LAURENT , HACQUARD CÉCILE , LOEUILLE DAMIEN , SELLAM JÉRÉMIE , ALBERT JEAN-DAVID , BENTIN JACQUES , CHARY VALCKENAERE ISABELLE , d’AGOSTINO MARIA-ANTONIETTA , ETCHEPARE FABIEN , GAUDIN PHILIPPE , HUDRY CHRISTOPHE , DOUGADOS MAXIME , SARAUX ALAIN
Published: April 2010

Objectives.

To evaluate the reproducibility of clinical synovitis assessments in rheumatoid arthritis and the effect of variability on the Disease Activity Score-28 (DAS28).

Methods.

Seven healthcare professionals from different cities examined the same patients with active non-early rheumatoid arthritis (RA; duration > 4 yrs), for whom a treatment change was being considered. There was no training session and the examination was to be performed as quickly as possible. The healthcare professionals assessed the 28 joints of the DAS28 in 7 patients (196 joints), then reexamined the same 28 joints in 4 of these 7 patients (112 joints), who had been rendered unrecognizable. Then 7 sonographers examined each of the 7 patients twice, using B-mode and power Doppler ultrasound (PD). The reference standards were presence of synovitis according to at least 50% of clinical examiners and 50% of sonographers. Agreement was assessed by Cohen’s kappa statistic.

Results.

Intraobserver reliability ranged from 0.31 (least experienced research technician) to 0.77 (most experienced physician). Interobserver reliability ranged from 0.18 to 0.62. The largest difference between the lowest and the highest swollen joint counts in the same patient was 15, and the greatest variation in the DAS28 score was 0.92. Agreement between clinical and sonographic reference standards was 0.46, 0.37, and 0.36 for B-mode, PD, and both, respectively.

Conclusion.

Clinical inter- and intraobserver reliability is highly dependent on the examiner. Consequences on the DAS28 score can be substantial. Agreement with sonography is poor when both B-mode and PD are used but seems better, although low, when B-mode is used alone.
Adverse Effects of Topical Nonsteroidal Antiinflammatory Drugs in Older Adults with Osteoarthritis: A Systematic Literature Review
Authors: MAKRIS UNA E. , KOHLER MINNA J. , FRAENKEL LIANA
Published: April 2010

Objective.

To systematically review the literature on reported adverse effects (AE) associated with use of topical nonsteroidal antiinflammatory drugs (NSAID) in older adults with osteoarthritis (OA).

Methods.

A systematic search of Medline (1950 to November 2009), Scopus, Embase, Web of Science, Cochrane databases, Dissertation and American College of Rheumatology meeting abstracts was performed to identify original randomized controlled trials, case reports, observational studies, editorials, or dissertations reporting AE from topical NSAID in older adults with OA. Information was sought on study and participant characteristics, detailed recording of application site, and systemic AE as well as withdrawals due to AE.

Results.

The initial search yielded 953 articles of which 19 met eligibility criteria. Subjects receiving topical NSAID reported up to 39.3% application site AE, and up to 17.5% systemic AE. Five cases of warfarin potentiation with topical agents were reported, 1 resulting in gastrointestinal bleeding. In formal trials, the withdrawal rate from AE ranged from 0 to 21% in the topical agents, 0 to 25% in the oral NSAID, and 0 to 16% in the placebo group.

Conclusion.

Although topical NSAID are safer than oral NSAID (fewer severe gastrointestinal AE), a substantial proportion of older adults report systemic AE with topical agents. The withdrawal rate due to AE with topical agents is comparable to that of oral NSAID. Given the safety profile and withdrawal rates described in this study, further data are needed to determine the incremental benefits of topical NSAID compared to other treatment modalities in older adults with OA.
Comorbidities in Patients with Primary Sjögren’s Syndrome: A Registry-based Case-control Study
Authors: KANG JIUNN-HORNG , LIN HERNG-CHING
Published: April 2010

Objective.

Although multiple diseases associated with primary Sjögren’s syndrome (pSS) have been reported, reliable data regarding the prevalence of specific medical comorbidities among patients with pSS remain sparse. We investigated the prevalence and risk for a broad spectrum of medical conditions among patients with pSS in Taiwan.

Methods.

A total of 1974 patients with pSS were eligible for inclusion in the study group. We randomly selected 9870 enrollees matched with the study subjects, using the Taiwan National Health Insurance Research Dataset for 2006 and 2007, inclusive. Conditional logistic regression analyses conditioned on sex, age, monthly income, and level of urbanization of the patient’s community were used to calculate the odds ratios (OR) of various comorbid conditions.

Results.

Pearson chi-square tests revealed that patients with pSS had significantly higher prevalence of hyperlipidemia, cardiac arrhythmias, headaches, migraines, fibromyalgia (FM), asthma, pulmonary circulation disorders, hypothyroidism, liver disease, peptic ulcers, hepatitis B, deficiency anemias, depression, and psychoses. Conditional regression analyses showed that, compared to patients without the condition, patients with pSS were more likely to have hyperlipidemia (OR 1.42), cardiac arrhythmias (OR 1.32), headaches (OR 1.47), migraines (OR 1.86), FM (OR 1.71), asthma (OR 1.54), pulmonary circulation disorders (OR 1.42), hypothyroidism (OR 2.37), liver disease (OR 1.89), peptic ulcers (OR 1.88), hepatitis B (OR 2.34), deficiency anemias (OR 1.33), depression (OR 2.57), and psychoses (OR 2.15).

Conclusion.

The prevalence of several comorbidities was increased among the patients with pSS. Our study provides epidemiological data for comorbidities among pSS patients in an ethnic Chinese population.
Socioeconomic Burden of Psoriatic Arthritis in Hong Kong: Direct and Indirect Costs and the Influence of Disease Pattern
Authors: ZHU TRACY Y. , TAM LAI-SHAN , LEUNG YING-YING , KWOK LAI-WA , WONG KONG-CHIU , YU TRACY , KUN EMILY W. , LI EDMUND K.
Published: April 2010

Objective.

To estimate the direct costs and indirect costs of patients with psoriatic arthritis (PsA) in Hong Kong.

Methods.

A retrospective cost-of-illness study was performed on 125 patients with PsA. Participants completed questionnaires on demographics, employment status, and out of pocket expenses. Health resources consumption was recorded by chart review and patient self-report questionnaire. Patients were grouped according to disease pattern, i.e., peripheral and axial disease. Multiple regression was used to determine the predictors of the costs.

Results.

The average annual direct costs were $4,141 (2006 US dollars) per patient. Costs of inpatient care accounted for 27% of direct costs, followed by costs of visits to healthcare providers (25%). The estimated average indirect costs were $3,127 per patient-year. Forty-eight (42%) patients had no indirect costs. Sixty percent of patients with peripheral disease were still employed, compared to 39% of patients with axial disease. Patients with axial disease had almost twice the indirect costs compared to those with peripheral disease (p = 0.005). Increased pain and poor function were independently associated with increased direct costs. Worse physical health status, determined by indirect costs borne by the patient, and poor function and old age predicted high costs.

Conclusion.

PsA imposes substantial economic burden. Pain and function are significantly associated with costs. Improvements in treatments to reduce pain and restore function are likely to reduce the costs incurred by these patients.
Influence of STAT4 Polymorphism in Primary Sjögren’s Syndrome
Authors: PALOMINO-MORALES ROGELIO J. , DIAZ-GALLO LINA-MARCELA , WITTE TORSTEN , ANAYA JUAN-MANUEL , MARTÍN JAVIER
Published: April 2010

Objective.

To examine the influence ofSTAT4rs7574865 gene polymorphism on patients with primary Sjögren’s syndrome (SS).

Methods.

Two different cohorts were studied: 69 patients with primary SS and 296 controls from Colombia and 108 patients with primary SS and 227 controls from Germany. Samples were genotyped for theSTAT4rs7574865 single-nucleotide polymorphism with a predesigned TaqMan single-nucleotide polymorphism genotyping assay. We carried out a metaanalysis of our results combined with data published to date.

Results.

Although no significant differences were observed in the allele frequencies ofSTAT4rs7574865 gene polymorphism between patients and controls in Colombians (p = 0.28, OR 1.24, 95% CI 0.82–1.87) and Germans (p = 0.08, OR 1.40, 95% CI 0.96–2.02), the metaanalysis disclosed a significant effect of the T allele on disease (p = 4.7 × 10−6, OR 1.40, 95% CI 1.21–1.62).

Conclusion.

These data reinforce the influence ofSTAT4gene on primary SS and as a general autoimmune gene.
Observational Studies of Infections in Rheumatoid Arthritis: A Metaanalysis of Tumor Necrosis Factor Antagonists
Authors: BERNATSKY SASHA , HABEL YOUSSEF , RAHME ELHAM
Published: April 2010

Objective.

Published metaanalyses of tumor necrosis factor (TNF) antagonists and infection have focused on randomized controlled trials, which tend to have short duration, relatively small size, and stringent inclusion/exclusion criteria that may limit enrollment to patients at low risk of infection. We performed a systematic review and synthesis of observational studies of TNF antagonists and infection risk.

Methods.

We conducted a systematic literature search of studies estimating overall risk of serious infection after anti-TNF exposure in rheumatoid arthritis (RA). We estimated a pooled relative risk (RR) for the relevant observational studies, using a random-effects model.

Results.

Five cohort studies and 2 nested case-control studies were included in the metaanalysis. Anti-TNF therapy appeared to significantly increase risk of serious infection (pooled adjusted RR 1.37, 95% CI 1.18, 1.60).

Conclusion.

Our metaanalysis of observational data demonstrated an increased risk of serious infection in subjects with RA receiving anti-TNF therapy, versus those not receiving these agents.
Untargeted Metabolomics
Authors: Vinayavekhin Nawaporn , Saghatelian Alan
Published: April 2010

Along with genes and proteins, metabolites play important roles in sustaining life. Their functions include “primary” functions in metabolism and energy storage, as well as “secondary” functions in cell‐to‐cell signaling, metal acquisition, and virulence. There remains much to be learned about the in vivo roles of metabolites. Approaches that accelerate measurement of metabolite levels directly from cells and tissues should increase our understanding of the diverse roles of metabolites and potentially lead to discovery of novel metabolites and metabolic pathways. Metabolomics is an important comparative tool to study global metabolite levels in samples under various conditions. In this unit, the steps needed to perform a mass spectrometry (MS)–based untargeted metabolomics experiment using bacterial supernatants are detailed. In contrast to a targeted metabolomics experiment, which measures ions from known metabolites, an untargeted metabolomics experiment registers all ions within a certain mass range, including ions belonging to structurally novel metabolites. The protocols in this unit describe the conditions necessary for analyzing hydrophobic metabolites and provide an example of how to structurally characterize a novel metabolite. Curr. Protoc. Mol. Biol. 90:30.1.1‐30.1.24. © 2010 by John Wiley & Sons, Inc.
Click‐iT Proliferation Assay with Improved DNA Histograms
Authors: Krishan Awtar , Hamelik Ronald M.
Published: April 2010

The Click‐iT EdU cell proliferation assay (Invitrogen) for detection of replicating cells is based on incorporation of EdU into newly synthesized DNA and its recognition by azide dyes via a copper mediated “click” reaction. In the protocol provided by Invitrogen, cells are fixed with paraformaldehyde and stained with 7‐aminoactinomycin D (7‐AAD) for DNA content analysis. Both of these procedures result in DNA histograms with a broad coefficient of variation. We have modified this protocol and show that after EdU incorporation, nuclei isolated by hypotonic lysis of cells can be directly labeled using the Click‐iT Alexa Fluor 488 Assay kit and stained with propidium iodide. This modified procedure using isolated nuclei and propidium iodide staining results in DNA histograms with better resolution (lower coefficient of variation of the G1 peak) and shorter processing time by eliminating the fixation and permeabilization steps. Curr. Protoc. Cytom. 52:7.36.1‐7.36.7. © 2010 by John Wiley & Sons, Inc.