bluuebunny/crossref_metadata_2025 huggingface dataset:
Two‐stage repair with buccal mucosa for severe and complicated hypospadias in adults
Authors: Zhao Muxin , Li Yangqun , Tang Yong , Chen Wen , Yang Zhe , Li Qiang , Zhou Chuande , Li Fengyong , Zhou Yu
Published: January 2011

Objectives:  To report the outcomes of two‐stage repair for adult hypospadias using a buccal mucosa graft as a tube.

Methods:  A total of 57 adult patients who underwent surgery for severe urethral defect at our institution from January 2002 to March 2010 were included in this analysis. The urethroplasty procedure included penile urethra reconstruction with the buccal mucosa graft used as a tube in the first stage, anastomosis of the unobstructed urethra in the second stage and a scrotal fascio‐cutaneous flap transferred to resurface the reconstructed urethra for waterproofing.

Results:  No complications occurred after the first stage, whereas postoperative infections occurred in six cases and distal necrosis of the scrotal flap occurred in two cases after the second stage. All eight of these patients had the complication of urethrocutaneous fistula, which healed after 2–4 weeks by cleaning and changing dressings in six patients. Twelve patients complained of straining at voiding in the early postoperative period. However, nine of these patients had an obvious increase in maximum flow rate without any intervention 3 months after the operation. Follow up ranged from 6 to 62 months (mean 28 months) in 46 patients. Most of the patients presented terminal meatus, no chordee, no urethral stricture and normal voiding. The majority of patients achieved excellent cosmetic and functional results.

Conclusions:  A buccal mucosa graft as a tube is a reliable and durable method of two‐stage repair for severe and complicated hypospadias in adults. The use of scrotal flaps seems to contribute to a good vascularized waterproof cover.
Use of antibacterial prophylaxis for patients with neutropenia
Authors: Slavin M. A. , Lingaratnam S. , Mileshkin L. , Booth D. L. , Cain M. J. , Ritchie D. S. , Wei A. , Thursky K. A.
Published: January 2011

The use of oral prophylactic antibiotics in patients with neutropenia is controversial and not recommended by this group because of a lack of evidence showing a reduction in mortality and concerns that such practice promotes antimicrobial resistance. Recent evidence has demonstrated non‐significant but consistent, improvement in all‐cause mortality when fluoroquinolones (FQs) are used as primary prophylaxis. However, the consensus was that this evidence was not strong enough to recommend prophylaxis. The evidence base for FQ prophylaxis is presented alongside current consensus opinion to guide the appropriate and judicious use of these agents. Due consideration is given to patient risk, as it pertains to specific patient populations, as well as the net effect on selective pressure from antibiotics if FQ prophylaxis is routinely used in a target population. The potential costs and consequences of emerging FQ resistance, particularly among Escherichia coli, Clostridium difficile and Gram‐positive organisms, are considered. As FQ prophylaxis has been advocated in some chemotherapy protocols, specific regard is given to whether FQ prophylaxis should be used to support these regimens. The group also provides recommendations for monitoring and surveillance of emerging resistance in those centres that have adopted FQ prophylaxis.
An Australian survey of clinical practices in management of neutropenic fever in adult cancer patients 2009
Authors: Lingaratnam S. , Slavin M. A. , Mileshkin L. , Solomon B. , Burbury K. , Seymour J. F. , Sharma R. , Koczwara B. , Kirsa S. W. , Davis I. D. , Prince M. , Szer J. , Underhill C. , Morrissey O. , Thursky K. A.
Published: January 2011

Background:  An abundance of new evidence regarding treatment strategies for neutropenic fever is likely to contribute to variability in practice across institutions and clinicians alike.

Aims:  To describe current clinical practices in Australia, by surveying haematologists, oncologists and infectious diseases physicians involved in cancer care.

Methods:  Clinician members from Australian professional associations, accounting for the vast majority of Australian cancer specialists, were invited to participate in an electronic survey, comprising of a clinical case‐based questionnaire. Clinical practice areas explored were: use of risk‐assessment and empiric antibiotic strategies across various treatment settings; use of anti‐bacterial prophylaxis; and use of granulocyte‐colony stimulating factors for established neutropenic fever and for secondary prophylaxis.

Results:  A total of 252 clinicians returned responses (approximately 30% response rate). The majority (>70%) were representative of practices in public, major city, tertiary referral hospitals. Less than half of clinicians were aware of risk‐assessment tools and less than quarter currently used ambulatory care strategies. If adequate resources were made available, more than 80% were willing to use risk‐assessment tools and 60% more clinicians were likely to use ambulatory care strategies. Most clinicians prescribed dual therapy parenteral antibiotics, even for clinically stable patients (53% haematologists, 56% oncologists). Granulocyte‐colony stimulating factor was used frequently as secondary prophylaxis in the breast cancer case (91%), follicular lymphoma case (59%) and non‐small cell lung cancer case (31%). Fluoroquinolone prophylaxis was infrequently prescribed (19% oncologists, 30% haematologists).

Conclusions:  Evidence–practice gaps were identified around the use of risk‐assessment‐based empiric therapy, and help to inform better clinical guidance.
Central auditory processing in elderly with mild cognitive impairment
Authors: Rahman Tomader Taha Abdel , Mohamed Somaia Tawfeek , Albanouby Mohamed Hasan , Bekhet Hanaa Farag
Published: January 2011

Aim:  The aim of the present study was to assess if central auditory processing affected patients with mild cognitive impairment (MCI) or not and to assess sensitivity and specificity of central auditory processing tests in detection of MCI.

Methods:  This was a case–control study conducted at the Geriatrics Department and Audiology Unit, Ain Shams University Hospital. Participants were 150 elderly diagnosed as MCI compared with 150 normal subjects, based on a neuropsychological diagnostic test battery, the Cambridge Cognitive Examination (CAMCOG), and who were matched for age, sex and average threshold of hearing. Both cases and control groups were subjected to otological examination, immittancemetry, pure tone audiometry, speech audiometry and central auditory processing assessment by the use of a selective auditory attention test, dichotic digits test, auditory fusion test, pitch pattern sequences test and auditory memory battery of Goldman–Fristoe–Woodcock.

Results:  The MCI group scored significantly lower than the control group in central auditory processing tests (P < 0.05). Sensitivity of dichotic digit test, pitch pattern sequence test and recognition memory test were 76.6%, 71.7% and 70.4%, respectively, while specificity were 56.2%, 81.2% and 92.2%, respectively. When the previous three tests were used together the sensitivity and specificity were 82.8% and 93.2%, respectively.

Conclusion:  Central auditory processing was affected in MCI patients. The dichotic digit test, pitch pattern sequence test and recognition memory test can be used in detection of MCI with high sensitivity and specificity. Geriatr Gerontol Int 2011; 11: 304–308.
Dietary folate intakes and effects of folic acid supplementation on folate concentrations among Japanese pregnant women
Authors: Kondo Atsuo , Asada Yoshimasa , Shibata Kanemitsu , Kihira Masamichi , Ninomiya Keiu , Suzuki Masatoshi , Oguchi Hidenori , Hayashi Yoshihiko , Narita Osamu , Watanabe Junichiro , Shimosuka Yoichi
Published: January 2011

Aim:  To quantify the consumed amount of dietary folate and to evaluate effects of folic acid and balanced diets on serum folate concentrations.

Material & Methods:  Food records collected from 641 pregnant women were assessed to quantify the consumed amount of dietary folate for a 6‐year period from 2003 to 2008. Changes in serum folate concentrations were evaluated among 80 pregnant women who either took folic acid tablets or consumed balanced diets in 2008.

Results:  Though the dietary folate intake averaged 331 µg daily, 200 women in the 1st trimester consumed the least amount of dietary folate, 294 µg daily. It was observed that 42% of the 200 women either consumed at least 440 µg of dietary folate daily or took 400 µg folic acid supplements daily, but that 58% of them neither consumed dietary folate of 440 µg nor took folic acid supplements. Intakes of 400 µg folic acid supplements for 5 weeks resulted in a significant increase in serum folate concentrations but the consumption of balanced diets had no effect on increasing folate concentrations.

Conclusions:  The average intake of dietary folate did not fulfill the Recommended Dietary Allowance of 440 µg. Serum folate concentration significantly increased only among pregnant women who took folic acid supplements. Recommendations to consume balanced diets do not seem effective to decrease the incidence of neural tube defects.
Extensive uterovaginal prolapse during labor
Authors: Yousaf Shumaila , Haq Bushra , Rana Tabinda
Published: January 2011

Uterovaginal prolapse complicating pregnancy is an extremely rare event. Obstetricians should be familiar with the condition as early recognition and close follow up is essential in order to avoid possible fetomaternal risks.

We report a case of 35‐year‐old lady who presented to the emergency with complaints of labor pains, absent fetal movements and huge uterine cervical prolapse in active phase of labor. She was conservatively treated with bedrest, blood transfusions and irrigation of prolapsed cervix. A dead female fetus was delivered vaginally. Ring pessary was placed postnatally. We believe that an extensive uterovaginal prolapse needs close surveillance and can be managed conservatively.
Understanding congenital heart defects through abdominal fetal electrocardiography: Case reports and clinical implications
Authors: Velayo Clarissa , Sato Naoaki , Ito Takuya , Chisaka Hiroshi , Yaegashi Nobuo , Okamura Kunihiro , Kimura Yoshitaka
Published: January 2011

Aims:  Congenital heart defects are the most common fetal structural anomalies of which a significant number remain unrecognized during postnatal life. Fetal electrocardiography (FECG) is an ideal clinical tool to complement ultrasonography for the screening and management of these cases where early and accurate diagnoses would allow definite rather than palliative treatment. The objective of this report was to correlate the particular FECG results found with the different types of congenital heart defects involved and to further demonstrate the usefulness of FECG in clinical settings.

Material & Methods:  This is a report of four cases of prenatally diagnosed congenital heart defects seen at a university hospital in Sendai, Japan. Their complete and thorough evaluation included, among other tests, abdominal FECG analysis.

Results:  The presence of premature ventricular contractions, a prolonged pre‐ejection period (PEP > 75 msec), and prolonged QTc intervals (QTc > 440 msec) served as markers of hemodynamic alteration but were unlikely determinants of disease severity precluding further investigation.

Conclusions:  In practice, similar findings found on FECG should raise the index of suspicion for the presence of congenital heart disease and prompt a targeted ultrasound scan.
Microbial diversity associated with four functional groups of benthic reef algae and the reef‐building coral Montastraea annularis
Authors: Barott Katie L. , Rodriguez‐Brito Beltran , Janouškovec Jan , Marhaver Kristen L. , Smith Jennifer E. , Keeling Patrick , Rohwer Forest L.
Published: January 2011

The coral reef benthos is primarily colonized by corals and algae, which are often in direct competition with one another for space. Numerous studies have shown that coral‐associated Bacteria are different from the surrounding seawater and are at least partially species specific (i.e. the same bacterial species on the same coral species). Here we extend these microbial studies to four of the major ecological functional groups of algae found on coral reefs: upright and encrusting calcifying algae, fleshy algae, and turf algae, and compare the results to the communities found on the reef‐building coral Montastraea annularis. It was found using 16S rDNA tag pyrosequencing that the different algal genera harbour characteristic bacterial communities, and these communities were generally more diverse than those found on corals. While the majority of coral‐associated Bacteria were related to known heterotrophs, primarily consuming carbon‐rich coral mucus, algal‐associated communities harboured a high percentage of autotrophs. The majority of algal‐associated autotrophic Bacteria were Cyanobacteria and may be important for nitrogen cycling on the algae. There was also a rich diversity of photosynthetic eukaryotes associated with the algae, including protists, diatoms, and other groups of microalgae. Together, these observations support the hypothesis that coral reefs are a vast landscape of distinctive microbial communities and extend the holobiont concept to benthic algae.
Demethylation of methylarsonic acid by a microbial community
Authors: Yoshinaga Masafumi , Cai Yong , Rosen Barry P.
Published: January 2011

Arsenic is one of the most widespread environmental carcinogens and has created devastating human health problems worldwide, yet little is known about mechanisms of biotransformation in contaminated regions. Methylarsonic acid [MAs(V)], extensively utilized as an herbicide, is largely demethylated to more toxic inorganic arsenite, which causes environmental problems. To understand the process of demethylation of methylarsenicals, soil samples commonly used on Florida golf courses were studied. Several soil extracts were found to demethylate MAs(V) to inorganic arsenite [As(III)]. From these extracts, a bacterial isolate was capable of reducing MAs(V) to MAs(III) but not of demethylating to As(III). A second bacterial isolate was capable of demethylating MAs(III) to As(III) but not of reducing MAs(V). A mixed culture could carry out the complete process of reduction and demethylation, demonstrating that demethylation of MAs(V) to As(III) is a two‐step process. Analysis of the 16S ribosomal DNA sequences of the two organisms identified the MAs(V)‐reducing and the MAs(III)‐demethylating isolates as belong to Burkholderia and Streptomyces species respectively. This is the first report of a novel pathway of degradation of a methylarsenical herbicide by sequential reduction and demethylation in a microbial soil community, which we propose plays a significant role in the arsenic biogeocycle.
Exploring the City: Perceiving Istanbul through its Cultural Productions
Authors: SENOVA BASAK
Published: January 2011

This essay explores the role of Istanbul's ‘cultural productions’ as components of the city's structure and texture. Istanbul is a city of tensions, generated by its countless conflicting and divergent flows which are constantly influenced by socio‐economic, political and cultural fusions and confusions. It is constantly expanding, both horizontally and vertically, as evidenced by its central and peripheral settlements, illegal dwellings and squatted lands. With each and every new inhabitant, further cumulative cultural input is added to the city, which also blends social exclusion and transgression (together with axiomatic de facto regulations). The city ‘operates’ as a jumbled mode of excessive information; the repetitive collapse and replenishment of this information overload opens up diverse ‘realities’. Within this picture, ‘cultural productions’ of the city have emerged as indicators of inhabitants' reactions, exposing ways of coping with/surviving in the city. These cultural productions are locally, temporarily and spontaneously produced. Consequently, this essay investigates how such cultural productions have been processed by the inhabitants of the city since the 1980s, and specifically focuses on the latest research and project models, navigating through projects undertaken by academics, artists and architects who correspond and have connections with international institutions — most notably in the field of contemporary art.

Cet essai examine le rôle des ‘productions culturelles’ d'Istanbul en tant que composantes de la structure et de la texture urbaines. Cette ville est faite de tensions générées par un nombre infini de flux contradictoires et divergents, influencés en permanence par des fusions et confusions socio‐économiques, politiques et culturelles. Elle ne cesse de se développer tant au plan horizontal que vertical, comme le montrent ses implantations centrales et périphériques, ses habitats illégaux et ses terrains squattés. Chaque nouvel habitant apporte une contribution culturelle cumulative à la ville qui mélange également exclusion sociale et transgression (ainsi que des règles axiomatiques de fait). La ville ‘fonctionne’ comme un enchevêtrement d'informations excessives: l'effondrement et la reconstitution réitérés de cette surcharge d'informations révèlent diverses ‘réalités’. Dans cette représentation, les ‘productions culturelles’ de la ville sont apparues comme des indicateurs des réactions des habitants, traduisant leurs manières d'affronter la ville et d'y survivre. Les modalités de ces productions sont locales, temporaires et spontanées. L'étude s'intéresse donc au traitement de ces productions culturelles par les habitants depuis les années 1980, et porte en particulier sur les modèles de recherches et de projets les plus récents, en passant par des travaux d'universitaires, d'artistes ou d'architectes qui correspondent et ont des liens avec des institutions internationales, notamment dans le domaine de l'art contemporain.
The Market Effects of Breaking a String of Meeting or Beating Analysts’ Expectations: Downward Revision of Future Cash Flows or Increase in Cost of Equity Capital?
Authors: Xie Yuan
Published: January 2011

Abstract:  This paper parses the negative market reaction to breaking a string of consecutively meeting or beating analysts’ expectations (hereafter MBE). Using a set of firms that break a string of MBE relative to a control set of firms that do not, I show that, on average, breaking a string of MBE is associated with both decreases in expectations regarding future cash flows and increases in the cost of equity capital. Depending on the length of the string before a break, increases in the cost of equity capital are between 110 and 150 basis points over a three‐month period across the break. Overall, my evidence suggests that breaking a string of MBE increases the perceived uncertainty of firms’ future cash flows and investors’ required rate of return.
The ALS8‐associated mutant VAPBP56S is resistant to proteolysis in neurons
Authors: Gkogkas Christos , Wardrope Caroline , Hannah Matthew , Skehel Paul
Published: January 2011

J. Neurochem. (2011) 117, 286–294.

VAMP/synaptobrevin associated proteins A and B (VAPA and VAPB), are type IV membrane proteins enriched on ER and Golgi membranes. Both VAPA and B interact with cytoplasmic lipid transport proteins and cytoskeletal elements to maintain the structure and composition of ER and Golgi membranes. Truncated forms of both proteins are present in some tissues but the functional significance of this is not clear. In rodents processing of VAPA occurs in most tissues, however, truncated forms of VAPB have only been reported in brain tissue. It is demonstrated here that the extent of VAPB processing in rat increases during postnatal development and that it is restricted to neurons. The C‐terminal polypeptide generated by this cleavage reaction remains associated with cell membranes, but its subcellular distribution is distinct from the full‐length protein. A mutant form of VAPB is associated with a familial form of neurodegenerative disease, amyotrophic lateral sclerosis type 8. The mutant protein, VAPBP56S, is resistant to truncation in primary neuronal cultures, although remains sensitive to some form of proteolysis when over‐expressed in HEK293 cells. These data suggest that neuronal cells have a particular requirement for VAPB proteolysis and that reduced levels of processed polypeptides may contribute to the neurodegeneration associated with amyotrophic lateral sclerosis type 8.
Management of black Vertisols characterized by pot‐holes in the Chambal region, India
Authors: Somasundaram J. , Singh R. K. , Prasad S. N. , Sethy B. K. , Kumar A. , Ramesh K. , Lakaria B. L.
Published: January 2011

Crop yields in rainfed areas are primarily dependent on the rainfall pattern and stored soil moisture. High smectite clay causes the formation of cracks, which are a striking feature of black Vertisols which are also distinguished by the presence of pot‐holes. Soil water is recharged during the rainy season via these cracks, which also results in pot‐hole formation. This study was undertaken to evaluate the effect of different conservation measures on pot‐holes. Length, width and depth were measured during dry spells after the onset of the monsoon under various field treatments. The results indicate that uncultivated fields have a greater volume of pot‐holes (573 m3/ha) than cultivated ones due to unbroken gentle slopes, which would have caused silt‐laden runoff to travel longer distances to form pot‐holes. The results show that among the cultivated fields, a control plot had the maximum volume of pot‐holes (450 m3/ha), followed by a conservation bench terrace (CBT) (231 m3/ha), residue incorporated (RI) fields (142 m3/ha) and contour furrow areas (CF) (119 m3/ha). The CBT field treatment had a higher volume of pot‐holes despite a high percentage of micro‐aggregates and high total porosity.
Personality similarity, perceptual accuracy, and relationship satisfaction in dating and married couples
Authors: DECUYPER MIEKE , DE BOLLE MARLEEN , DE FRUYT FILIP
Published: January 2011

The association between actual and perceptual personality similarity and perceptual accuracy on relationship satisfaction is examined in 191 couples. Self‐ and partner ratings of personality were assessed using the Revised NEO Personality Inventory (P. T. Costa & R. R. McCrae, 1992) and relationship satisfaction using the Relationship Assessment Scale (S. S. Hendrick, A. Dicke, & C. Hendrick, 1998). Actual and perceptual similarity and perceptual accuracy were quantified using the index of profile agreement (R. R. McCrae, 1993) and L. J. Cronbach and G. C. Gleser's (1953) D‐indices. These indices showed large variability in personality profiles within couples and considerable perceptual accuracy between raters. Actual similarity was positively associated with female relationship satisfaction, controlling for personality traits of both partners. Moreover, partial support was obtained for the positive associations between perceptual similarity and accuracy and relationship satisfaction.
Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation‐volvulus: 84 dogs (2003–2007)
Authors: Green Tiffany I. , Tonozzi Caroline C. , Kirby Rebecca , Rudloff Elke
Published: January 2011

Objective –To test whether an initial plasma lactate≥6.0 mmol/L is associated with the presence of macroscopic gastric wall necrosis and overall survival in dogs presenting with gastric dilatation‐volvulus (GDV). Additionally, if no association was identified we sought to identify a different predictive initial plasma lactate concentration and to examine whether serial plasma lactate concentrations provide better prediction of survival.

Design –Retrospective study over a 5‐year period (2003–2007).

Setting –Urban private referral small animal teaching hospital.

Animals –Eighty‐four client‐owned dogs with a diagnosis of GDV and plasma lactate measurements.

Interventions –None.

Measurements and Main Results –There was no statistically significant relationship found between survival and the presence of macroscopic gastric wall necrosis with the initial plasma lactate≥6 mmol/L. There was a significant relationship between the initial plasma lactate >2.9 mmol/L for predicting necrosis and <4.1 mmol/L for predicting survival to discharge. Forty dogs that had an increased initial plasma lactate (>2.5 mmol/L) also had a subsequent plasma lactate measured within 12 hours of presentation, with 37/40 dogs surviving and 70% of these surviving dogs having the subsequent lactate decrease by≥50% within 12 hours. The 3/40 that died failed to decrease their plasma lactate by≥50% from the initial blood lactate.

Conclusion –The results of this study indicate that an initial presenting plasma lactate concentration≥6.0 mmol/L is not predictive of macroscopic gastric wall necrosis or survival in dogs presenting with GDV. A decrease in plasma lactate concentrations≥50% within 12 hours may be a good indicator for survival. Limitations to the study include its retrospective nature, the small number of patients, and the number of dogs that were euthanized rather than allowed to progress to a natural outcome.
A Case of Erythema Multiforme Associated with Primary Epstein–Barr Virus Infection
Authors: Nakai Hidetaka , Sugata Ken , Usui Chie , Asano Yoshizo , Yamakita Takashi , Matsunaga Kayoko , Mizokuchi Yoshikazu , Katano Harutaka , Iwatsuki Keiji , Yoshikawa Tetsushi
Published: January 2011

Abstract:  We present a case of primary Epstein–Barr virus (EBV) infection with erythema multiforme. A 1‐year‐old Japanese boy presented with skin eruptions, including typical target lesions and a low‐grade fever. Just before the skin biopsy, 95 copies/μg DNA of EBV genome was detected in peripheral blood mononuclear cells, which subsequently increased to 6,834 copies/μg DNA. Skin tissue collected from the skin lesion showed the typical pathologic findings of erythema multiforme. EBV‐encoded small nuclear RNA signals were not detected in the skin tissue by in situ hybridization.
Microcystic Adnexal Carcinoma: The First Reported Congenital Case
Authors: Smart David R. , Taintor Adam R. , Kelly Michael E. , Lyon Valerie B. , Segura Annette , Jensen John N. , Drolet Beth A.
Published: January 2011

Abstract:  Microcystic adenexal carcinoma is a rare, locally aggressive, malignant appendage tumor also known as sclerosing sweat duct carcinoma. Since widespread recognition of microcystic adenexal carcinoma as a distinct clinicopathologic entity, approximately 300 total cases have been reported in the literature, with only eight previous cases reported in children under the age of 18, with no reported cases in patients younger than 6 years old. Our patient is unique in that the lesion was present at birth, making this the youngest case of microcystic adenexal carcinoma reported.
Epidermolysis Bullosa Nevus‐Like Lesions in a Pediatric Patient with Pyoderma Gangrenosum
Authors: Mollet Todd , Henderson Frederick W. , Groben Pamela A. , Burkhart Craig N. , Morrell Dean S.
Published: January 2011

Abstract:  Epidermolysis bullosa‐associated nevi are recently described dysplastic nevi found in patients with epidermolysis bullosa. These lesions display clinical features of unusual nevi suggestive of malignancy but thus far cases with malignant transformation have not been reported. We describe a case of epidermolysis bullosa‐type nevi developing in a child with pyoderma gangrenosum. The nevi in our patient were found in areas previously affected by pyoderma gangrenosum and were clinically concerning for malignancy. However, they were only moderately atypical on light and confocal microscopy. This case demonstrates that pediatric patients with cutaneous inflammation, bullae formation, or both, are at risk for developing unusual nevi at previous sites of skin involvement. Considering the absence of malignant change in these nevi, we suggest that close observation can be employed in cases where this diagnosis can be confirmed both clinically and microscopically.
Clinical, Dermoscopic, and Histopathologic Features in a Case of Infantile Hemangioma without Proliferation
Authors: OISO NAOKI , KIMURA MASATOMO , KAWARA SHIGERU , KAWADA AKIRA
Published: January 2011

Abstract:  Infantile hemangioma precursors or those without a proliferative phase may mimic a port‐wine stain. We describe a case of infantile hemangioma precursor, which proved to be Glut‐1 positive in biopsy, with the dermoscopic features of red round globular vessels, red comma‐like vessels, and red linear vessels. These dermoscopic features should help to distinguish infantile hemangioma precursors or those with an absent or minimal growth phase from a port‐wine stain.
Intranasal versus intravenous lorazepam for control of acute seizures in children: A randomized open‐label study
Authors: Arya Ravindra , Gulati Sheffali , Kabra Madhulika , Sahu Jitendra K. , Kalra Veena
Published: January 2011

Purpose:  Intravenous lorazepam is considered the drug of first choice for control of acute convulsive seizures. However, resource or personnel constraints necessitate the study of alternative routes and medications. This study compared the efficacy and adverse effects of intranasal versus intravenous lorazepam in children aged 6–14 years who presented with acute seizures.

Methods:  This was a randomized open‐label study conducted at an Indian hospital from August 2008 to April 2009. One hundred forty‐one consecutive children aged 6–14 years who presented convulsing to the emergency room were included. After stabilization, the children were randomized to receive either intravenous or intranasal lorazepam (0.1 mg/kg, maximum 4 mg). The primary outcome measure was clinical seizure remission within 10 min of drug administration. The study was registered with clinicaltrials.gov (NCT00735527).

Key Findings:  Seventy patients were randomized to receive intravenous and 71 to receive intranasal lorazepam. The patients in the two groups were comparable at baseline. Clinical seizure remission within 10 min of drug administration was found in 80% of the intravenous group as compared to 83.1% of intranasal group. The lower limit of 95% confidence interval for effect size was approximately −9.7%, with an a priori cutoff for noninferiority of −10%.

Significance:  Intranasal administration of lorazepam is not found to be inferior to intravenous administration for termination of acute convulsive seizures in children.
Neuroimaging in identifying focal cortical dysplasia and prognostic factors in pediatric and adolescent epilepsy surgery
Authors: Kim Yoon Hee , Kang Hoon‐Chul , Kim Dong‐Seok , Kim Se Hoon , Shim Kyu‐Won , Kim Heung Dong , Lee Joon Soo
Published: January 2011

Purpose: The purpose of this study is to determine the sensibility of each imaging tool in identifying focal cortical dysplasia (FCD) in children and adolescents with epilepsy and to define the prognostic factors of pediatric and adolescent epilepsy surgery.

Methods: We identified 48 children with FCD who underwent resective surgery and analyzed their preoperative data. The results of various anatomic and functional neuroimaging studies were compared for accuracy in locating the lesion. We also investigated clinical factors that affected the outcome of surgical treatment.

Key Findings: Brain magnetic resonance imaging (MRI) was able to localize FCD in 30 patients and fluorodeoxyglucose positron emission tomography (FDG‐PET) and/or subtraction ictal single photon emission computed tomography (SPECT) coregistered with MRI provided additional information that helped to define the lesion in 13 patients. When comparing the pathologic results between a mild malformation of cortical development (MCD) and FCD type I and II, we noted a strong tendency for patients with FCD to have MRI abnormalities (p = 0.005). In addition, severe pathologic features (Palmini’s classification, FCD type II) (p = 0.025) showed significant correlation with a better surgical outcome. To define the primary epileptogenic area, various interictal epileptiform discharges and the results of multimodal neuroimaging studies were helpful, and younger age at the time of operation could aid in more favorable surgical outcomes (p = 0.048).

Significance: Our study showed a significant relationship between pathologic grade and the detectability of FCD by brain MRI. In addition, early surgery can be justified by showing that advanced neuroimaging studies in children with FCD and even with extensive epileptiform discharges have a higher rate of success.
In vivo viability of stored red blood cells derived from riboflavin plus ultraviolet light–treated whole blood
Authors: Cancelas Jose A. , Rugg Neeta , Fletcher Dana , Pratt P. Gayle , Worsham D. Nicole , Dunn Susan K. , Marschner Susanne , Reddy Heather L. , Goodrich Raymond P.
Published: January 2011

BACKGROUND: A novel system using ultraviolet (UV) light and riboflavin (Mirasol System, CaridianBCT Biotechnologies) to fragment nucleic acids has been developed to treat whole blood (WB), aiming at the reduction of potential pathogen load and white blood cell inactivation. We evaluated stored red blood cell (RBC) metabolic status and viability, in vitro and in vivo, of riboflavin/UV light–treated WB (IMPROVE study).

STUDY DESIGN AND METHODS: The study compared recovery and survival of RBCs obtained from nonleukoreduced WB treated using three different UV light energies (22, 33, or 44 J/mLRBC). After treatment, WB from 12 subjects was separated into components and tested at the beginning and end of component storage. After 42 days of storage, an aliquot of RBCs was radiolabeled and autologously reinfused into subjects for analysis of 24‐hour recovery and survival of RBCs.

RESULTS: Eleven subjects completed the in vivo study. No device‐related adverse events were observed. By Day 42 of storage, a significant change in the concentrations of sodium and potassium was observed. Five subjects had a 24‐hour RBC recovery of 75% or more with no significant differences among the energy groups. RBC t1/2 was 24 ± 9 days for the combined three groups. Significant correlations between 24‐hour RBC recovery and survival, hemolysis, adenosine triphosphate (ATP), and CO2 levels were observed.

CONCLUSIONS: This study shows that key RBC quality variables, hemolysis, and ATP concentration may be predictive of their 24‐hour recovery and t1/2 survival. These variables will now be used to assess modifications to the system including storage duration, storage temperature, and appropriate energy dose for treatment.
Short‐term deviations in temperature during storage of plasma at −40°C do not affect its quality
Authors: Cardigan Rebecca , Themessl Angelika , Garwood Margaret
Published: January 2011

BACKGROUND: Little data are available on the suitability of frozen plasma for transfusion when stored outside its normal temperature, which is the focus of investigation in this study.

STUDY DESIGN AND METHODS: Plasma was pooled and split to create 10 identical units on each of 24 occasions (12 Group A and O). Plasma was frozen and stored at −40°C for 2 weeks and then one of each of the 10 identical units was subjected to one of the following deviations in storage temperature: −18°C for 1 week, 1 month, or 2 months; −10°C for 1 week, 1 month, or 2 months; 4°C for 4, 24, or 72 hours; or stored at −40°C (control) before returning all units to −40°C.

RESULTS: Factor VIII was only significantly reduced when plasma was stored at 4°C for 24 hours or more or −10°C for 1 week. For all other arms of the study, the majority of units of plasma (>75%) remained above 0.70 IU/mL and more than 95% were above the lower limit of normal (0.50 IU/mL). The prothrombin time ratio only increased after storage at −10°C for 1 month or more, and the activated partial thromboplastin time ratio after storage at 4°C for 24 hours. None of the deviations in storage resulted in a decrease in fibrinogen activity.

CONCLUSION: These data suggest that plasma that has been stored at −40°C and exposed to storage temperatures and times of up to 4 hours at 4°C, 1 week at −10°C or 2 months at −18°C meets EU guidelines and is suitable for transfusion.
The influence of maintaining the correct whole blood‐to‐anticoagulant ratio during donation on the quality of leukoreduced whole blood
Authors: Karger Ralf , Lukow Christian , Kretschmer Volker
Published: January 2011

BACKGROUND: It is unclear whether maintaining the correct whole blood‐to‐anticoagulant (WB : AC) ratio during collection can improve the quality of red blood cell (RBC)‐containing blood products to a clinically relevant degree.

STUDY DESIGN AND METHODS: A total of 2 × 20 CPDA‐1 leukoreduced whole blood (WB) units suspended in CPDA‐1 were investigated. In one group, AC was continuously added to the donated blood, maintaining the correct WB : AC ratio during collection, using a new drawing device (MacoPharma ABC). In the other group, WB units were produced conventionally. Adenosine triphosphate (ATP), 2,3‐diphosphoglycerate, free hemoglobin (Hb), potassium, glucose, lactate, pH, and variables of coagulation were determined on Days 1, 7, 21, 35, 42, and 49 of storage. Variables of RBC deformability and aggregability were determined using a laser‐assisted optical rotational cell analyzer.

RESULTS: The ABC and conventional group showed comparable unit volumes of 525 (SD, 5.3) mL versus 524 (SD, 10.2) mL and Hb content of 65.9 (SD, 5.1) g/unit versus 67.5 (SD, 7.8) g/unit, but higher variation after conventional blood drawing (p = 0.006 and p = 0.07, respectively) was observed. During storage, none of the measured quality variables were significantly different between the groups. Mean (SD) ATP was 2.33 (0.41) µmol/g Hb versus 2.24 (0.39) µmol/g Hb after 42‐day storage. Deformability was not different (p = 0.44), whereas the extent of the aggregability was higher in the conventional group (p = 0.04).

CONCLUSION: The ABC device provided a better standardized blood product but did not improve RBC storage variables or plasma quality. It slightly reduced RBC aggregability during storage. Excess AC at the beginning of a donation appears not to significantly affect RBC storage in conventional blood drawing.
Balloon‐Facilitated Delivery of a Left Ventricular Pacing Lead
Authors: ELAYI CLAUDE S. , WHITBECK MATTHEW G. , MORALES GUSTAVO , GURLEY JOHN C.
Published: January 2011

While modern implant tools have contributed greatly to the success of cardiac resynchronization therapy, technical challenges remain. A common problem is the inability to advance left ventricular pacing leads into branch veins that are tortuous or arise at steep angles. In these cases, advancement of the lead causes it to buckle and prolapse into the coronary sinus or great cardiac vein. Lead prolapsed can be avoided by employing a balloon to temporarily obstruct the coronary sinus or great cardiac vein just upstream from the branch vein. The balloon redirects the force of advancement laterally into the branch vein, facilitating delivery. (PACE 2013; 36:e31–e34)
The QRS Narrowing Index Predicts Reverse Left Ventricular Remodeling Following Cardiac Resynchronization Therapy
Authors: RICKARD JOHN , POPOVIC ZORAN , VERHAERT DAVID , SRAOW DAN , BARANOWSKI BRYAN , MARTIN DAVID O. , LINDSAY BRUCE D. , VARMA NIRAJ , TCHOU PATRICK , GRIMM RICHARD A. , WILKOFF BRUCE L. , CHUNG MINA K.
Published: January 2011

Background:
 The relationship between QRS narrowing and response to cardiac resynchronization therapy (CRT) has been controversial.

Objective:
 We sought to analyze the relationship between QRS narrowing and reverse remodeling in patients undergoing CRT, taking into account potential confounders including pre‐CRT QRS duration and underlying QRS morphology.

Methods:
 We reviewed pre‐ and postimplant electrocardiograms and echocardiograms in a cohort of 233 patients undergoing the new implantation of a CRT device between December 2001 and September 2006. For inclusion in the final cohort, patients had New York Heart Association classes II–IV heart failure, left ventricular ejection fraction (LVEF) ≤ 40%, and QRS duration ≥120 ms. Response to CRT was defined as a reduction in left ventricular end‐systolic volume (LVESV) of ≥10%. A multivariate model was constructed to determine the relationship between QRS change and response to CRT.

Results:
 Patients with QRS narrowing had significantly greater reductions in left ventricular end‐diastolic volume (LVEDV) (mL) (−26.5 ± 52.5 vs −4.8 ± 44.0, P = 0.002) and LVESV (mL) (−34.0 ± 55.5 vs −9.9 ± 45.8, P = 0.002) and improvement in LVEF (%) (8.9 ± 12.8 vs 4.5 ± 9.0, P = 0.007) than patients without narrowing. In univariate analysis, female gender (P = 0.0002), percent QRS narrowing from baseline (P = 0.008), lack of nitrate (P≤0.0001) and antiarrhythmic medication use (P = 0.01), lack of a nonspecific intraventricular conduction delay (=0.02), nonischemic cardiomyopathy (P = 0.003), and lower pre‐CRT LVEDV (P = 0.006) and LVESV [P = 0.01]) were associated with responders. In a multivariate model, QRS narrowing, indexed to the baseline QRS duration, remained strongly associated with response (odds ratio 0.08 [0.01–0.56], P = 0.01).

Conclusions:
 After adjusting for potential confounders, QRS narrowing, indexed to baseline QRS duration, is associated with enhanced reverse ventricular remodeling following CRT. (PACE 2011; 34:604–611)
The Relationship between Heart Rate Variability and Serum Cytokines in Chronic Chagasic Patients with Persistent Parasitemia
Authors: LLAGUNO MAURICIO , PERTILI LUIZ ANTONIO RODRIGUES de RESENDE , SILVA MARCOS VINICIUS da , BUNAZAR PABLO , REGES ARIANE MARTIM , FALEIROS ANA CAROLINA GUIMARÃES , LAGES‐SILVA ELIANE , RODRIGUES JUNIOR VIRMONDES , SILVA VALDO JOSÉ DIAS da , FILHO DALMO CORREIA
Published: January 2011

Background:
 Persistent parasitemia, immunological, and autonomic nervous system impairments may play an important role in the evolution and clinical outcome of the chronic phase of Chagas’ disease by triggering functional cardiovascular changes.

Methods:
 Three groups were evaluated: 17 chronic chagasic patients with the indeterminate form (IChD), 12 chronic chagasic patients with cardiac forms (ChHD), and 29 individuals as a healthy control group. Parasitemia was assessed by polymerase chain reaction; hemoculture, heart rate variability by linear and nonlinear methods, and interleukin (IL)‐1β, IL‐4, IL‐6, IL‐10, IL‐12, IL‐13, IL‐17, and tumor necrosis factor‐α, and interferon (IFN)‐γ serum cytokines were assessed by enzyme‐linked immune assay.

Results:
 Twenty‐nine chronic chagasic patients were positive for parasitemia (17 IChD and 12 ChHD). Heart rate variability parameters in baseline condition and after cold face test were significantly decreased in chagasic patients compared to controls. Tilt tests showed no alteration. However, using nonlinear indices, ChHD patients presented lower values compared to IChD and controls. Differences in the expression of serum cytokines were observed between chagasic patients and controls. However, among the groups, ChHD presented higher median values of IL‐10 and lower of IFN‐γ compared to IChD.

Conclusion:
 Both chagasic groups present an autonomic impairment using linear methods. The nonlinear methods revealed that the ChHD group had a higher cardiovascular risk. Serum cytokine concentrations between chagasic patients were similar. However, ChHD showed higher concentrations of IL‐10 and lower of IFN‐γ, suggesting some established process of immune regulation. (PACE 2011; 724–735)
Investigation of hair shaft in seborrheic dermatitis using atomic force microscopy
Authors: Kim Kyung Sook , Shin Min Kyung , Ahn Jae‐Jun , Haw Choong‐Rim , Park Hun‐Kuk
Published: January 2011

Background/purpose: We have investigated the changes of seborrheic dermatitis (SD) on the hair shaft in the morphological and physical properties using atomic force microscopy (AFM).

Methods: Hair samples were obtained from the lesional and perilesional regions in 15 patients with SD. Fifteen healthy adults were included as the control group. From the topography of hair obtained by AFM, the height of the scale, step height, roughness, diameter, and pit were determined.

Results: The scale thickness of the SD‐affected hair was sevenfold more than in the control hair showing statistically significance. The lesional hair showed greater roughness parameters of Sa, Sq, and Sz than the perilesional and the control hair, but this difference was not significant. The cuticle of the lesional hair was significantly damaged while perilesional hair showed a very distinct cuticle structure with smooth edges and a regular interval between the cuticles. The diameter of the lesional hair was significantly lesser by 10–35% than that of the perilesional hair. The pit was rarely observed in the SD‐affected hair collected from both the lesional and perilesional regions.

Conclusion: The changes in the hair shaft affected SD was measured using AFM non‐invasively. AFM could be a useful tool in monitoring the treatment response and the severity of SD.
The Economic Benefits of Wetland Retention and Restoration in Manitoba
Authors: Pattison John , Boxall Peter C. , Adamowicz Wiktor L.
Published: January 2011

This study examines the willingness to pay of Manitobans for wetland retention and restoration using stated preference methods applied to a sample of 1,980 respondents from the provincial population. The approach employed an iterated series of binary choice scenarios framed as referenda and utilized both cheap talk and certainty approaches in the design as well as tests of sensitivity to scope of the environmental improvement. The results suggest that over a five‐year period Manitobans would be willing to pay $296–$326/household/year depending on the level of the wetland program improvement. Using 5% (10%) discount rates these estimates result in present value aggregate payments of $504 ($550) million for retaining wetlands at current levels and about a further $106($110) million (for a total of $611 [$666] million) for restoring wetlands to estimated 1968 levels. Comparison of these benefits with current land values and restoration costs suggests that full restoration may not be economically efficient, but that retention in concert with some restoration may be.

La présente étude, fondée sur la méthode des préférences déclarées d'un échantillon de 1 980 répondants du Manitoba, a examiné le consentement à payer des Manitobains pour conserver et pour restaurer les milieux humides. La méthode comprenait une série itérée de scénarios à choix binaires intégrés dans des enquêtes, des propos gratuits (cheap talk), des estimateurs d'équivalent‐certains et des tests de sensitivité pour évaluer l'étendue de l'amélioration de l'environnement. Nos résultats permettent de croire que, au cours d'une période de cinq ans, les Manitobains consentiraient à payer de 296 à 326$/par ménage/par année selon le niveau d'amélioration des milieux humides prévu dans le programme. À des taux d'actualisation de 5% (10%), ces estimations engendrent des paiements agrégés dont la valeur actualisée s'élève à 504 (550) millions de dollars pour conserver les milieux humides aux niveaux actuels et à 106 (110) millions de dollars supplémentaires pour restaurer les milieux humides aux niveaux de 1968. Une comparaison de ces avantages avec la valeur actuelle des terres et les coûts de restauration autorise à penser que la restauration complète pourrait ne pas être économiquement efficace et que la conservation combinée à un certain degré de restauration pourrait l'être.