bluuebunny/crossref_metadata_2025 huggingface dataset:
Protective anti-tumour immune responses by murine dendritic cells pulsed with recombinant Tat-carcinoembryonic antigen derived from Escherichia coli
Authors: Bae M-Y , Cho N-H , Seong S-Y
Published: April 2009

Carcinoembryonic antigen (CEA) is over-expressed on various human cancer cells and has been the target of immunotherapies using dendritic cells (DCs) pulsed with CEA-specific RNA or peptides, or transduced by CEA-expressing adenovirus or vaccinia virus. Because activated DCs do not phagocytose soluble protein antigens efficiently and pure immature DCs are not obtained easily ex vivo, an efficacious whole CEA protein-loaded DC vaccine has not been reported. To improve the antigen delivery into DCs, we utilized CEA conjugated to a protein-transduction domain, human immunodeficiency virus transactivating Tat. Furthermore, we purified the truncated non-glycosylated CEA from Escherichia coli to overcome the safety concerns and immunosuppressive functions associated with the native CEA protein. Using confocal microscopy and fluorescence activating cell sorter analysis, we demonstrated that the Tat-CEA protein entered the cytoplasm of DCs efficiently within 10 min of co-culture, compared with the negligible amount of CEA into DCs 30 min later. CEA-specific T cell proliferation and cytotoxic T cell responses were enhanced significantly in mice immunized with Tat-CEA-pulsed DCs [DC (Tat-CEA)] compared with those immunized with CEA-pulsed DCs [DC (CEA)]. T helper type 1 responses were more prominent in the DC (Tat-CEA) immunized mice whose splenocytes secreted more interferon-γ and less interleukin-4 than those from DC (CEA) immunized mice. In vivo, the DC (Tat-CEA) vaccine delayed tumour growth significantly and prolonged survival of tumour-bearing mice. These results suggest that protective epitopes are well preserved on bacteria-derived recombinant Tat-CEA. This strategy may provide a basic platform for DC-based anti-CEA vaccines that could be utilized in combination with advanced immune-enhancing therapeutics.
3D finite‐difference synthetic acoustic logging in cylindrical coordinates
Authors: Pissarenko D. , Reshetova G.V. , Tcheverda V.A.
Published: April 2009

On the basis of the application of a finite‐difference approximation of an initial boundary value problem for elastic wave equations (velocity/stress formulation), a numerical method and its algorithmic implementation have been developed in order to perform a computer simulation of sonic logging. A very general statement is dealt with – the surrounding medium is allowed to be 3D heterogeneous and the source can be located at any point inside or outside the well. To provide the most precise description of the sharpest interface of the problem – the interface of the well, we formulate the problem in cylindrical coordinates with a z axis directed along the well. In order to avoid excessive azimuth inflation of grid cells with radius increase, we perform periodical refinement of the grid step in the azimuth direction. This guarantees the quasi‐uniform size of the grid cells throughout the area of computation.

In order to truncate area of computation, a classical version of a perfectly matched layer is developed and implemented for cylindrical coordinates. Its main advantage in comparison with other approaches is an extremely low level of artificial reflections and it is not necessary to perform splitting of variables in the azimuth direction.

Implementation of parallel computations is performed via domain decomposition: the area of computation is sliced into a number of adjoining discs and each disc is assigned to its own processor unit. Data exchange between processor units is performed with the help of a message‐passing interface library. Results of numerical experiments for an elastic medium with a circular crack are presented and discussed.
A systematic review of the effect of diet in prostate cancer prevention and treatment
Authors: Ma R. W.‐L. , Chapman K.
Published: April 2009

Dietary therapy has been proposed as a cost effective and noninvasive means of reducing the risk of prostate cancer (PC) and its progression. There is a large volume of published studies describing the role of diet in the prevention and treatment of PC. This article systematically reviews the data for dietary‐based therapy in the prevention of PC, as well as in the management of patients with PC, aiming to provide clarity surrounding the role of diet in preventing and treating PC. Although conclusive evidence is limited, the current data are indicative that a diet low in fat, high in vegetables and fruits, and avoiding high energy intake, excessive meat, excessive dairy products and calcium intake, is possibly effective in preventing PC. However, caution must be taken to ensure that members of the public do not take excessive amounts of dietary supplements because there may be adverse affects associated with their over consumption. The dietary recommendations for patients diagnosed with PC are similar to those aiming to reduce their risk of PC.
The impact of visual media to encourage low protein cooking in inherited metabolic disorders
Authors: Evans S. , Daly A. , Hopkins V. , Davies P. , MacDonald A.
Published: April 2009

Background:  The use of educational visual aids is one way to help children with inherited metabolic disorders (IMD) understand and develop a positive attitude towards their low protein diet. However, it is difficult to establish their effectiveness in the clinical setting. The present study aimed to evaluate the impact of a low protein recipe book and accompanying DVD for children with IMD.

Methods:  One hundred and five children (53% female; median age = 6–8 years) with IMD on low protein diets were each given a low protein recipe book and DVD. After 6 months, children and carers were posted a questionnaire asking whether they used these resources; identifying any change in frequency of low protein cooking; and the outcome when preparing recipes.

Results:  One hundred and two questionnaires were returned, representing 105 patients. Seventy percent (n = 71) of questionnaires were from carers. Ninety‐three percent (n = 66) of carers acknowledged receipt of the resource; one‐third (n = 22) had not watched the DVD and 23% (n = 15) had not opened the recipe book; 55% (n = 36) had tried the recipes; and 71% (n = 47) said the recipe book and/or DVD motivated them to try new recipes. Children were more likely to have watched the DVD (75%; n = 21/28) and read the recipe book (86%; n = 24/28) than carers.

Conclusions:  Although a helpful educational tool, just over one‐half of respondents had used the resource. Identifying visual media that, by itself, will motivate most families of children with IMD to prepare low protein recipes may be unrealistic. The combined approach of visual aids and ‘hands‐on’ practical experience, such as low protein cooking workshops and individual counselling, may be more beneficial.
Molecular and Conventional Identification and Pathogenicity of Rhizoctonia solani Isolates from Tobacco (Nicotiana tabacum L.) in Samsun, Turkey
Authors: Gurkanli Cem Tolga , Ozkoc Ibrahim , Gunduz Islam
Published: April 2009

A total of 101 fungal samples were isolated from tobacco (Nicotiana tabacum L.) plants in Samsun, Turkey and identified as Rhizoctonia solani. Of these samples, three were identified as belonging to Anastomosis Group (AG) ‐1‐IB, 6 to AG‐2‐1, 25 to AG‐4‐HG‐I and 67 to AG‐4‐HG‐II, using ITS1‐5.8S‐ITS2 rDNA RFLP analysis, base sequence phylogenies and conventional characters, such as anastomosis reactions, morphology and thiamine requirement. For five isolates from both the AG‐4‐HG‐I and AG‐4‐HG‐II groups and for all isolates of the AG‐1‐IB and AG‐2‐1 groups, molecular analysis and pathogenicity tests were performed. All selected Rhizoctonia solani isolates were highly virulent to tobacco plants, causing symptoms resembling damping‐off, except for isolate 55TkTB63, which was only moderately virulent.
Nonlocal Symmetries for Bilinear Equations and Their Applications
Authors: Hu Xing‐Biao , Lou Sen‐Yue , Qian Xian‐Min
Published: April 2009

In this paper, nonlocal symmetries for the bilinear KP and bilinear BKP equations are re‐studied. Two arbitrary parameters are introduced in these nonlocal symmetries by considering gauge invariance of the bilinear KP and bilinear BKP equations under the transformation . By expanding these nonlocal symmetries in power series of each of two parameters, we have derived two types of bilinear NKP hierarchies and two types of bilinear NBKP hierarchies. An impressive observation is that bilinear positive and negative KP (NKP) and BKP hierarchies may be derived from the same nonlocal symmetries for the KP and BKP equations. Besides, as two concrete examples, we have derived bilinear Bäcklund transformations for t−2‐flow of the NKP hierarchy and t−1‐flow of the NBKP hierarchy. All these results have made it clear that more nice integrable properties would be found for these obtained NKP hierarchies and NBKP hierarchies. Because KP and BKP hierarchies have played an essential role in soliton theory, we believe that the bilinear NKP and NBKP hierarchies will have their right place in this field.
Inhibiting Shear Instability Induced by Large Amplitude Internal Solitary Waves in Two‐Layer Flows with a Free Surface
Authors: Barros Ricardo , Choi Wooyoung
Published: April 2009

We consider a strongly nonlinear long wave model for large amplitude internal waves in two‐layer flows with the top free surface. It is shown that the model suffers from the Kelvin–Helmholtz (KH) instability so that any given shear (even if arbitrarily small) between the layers makes short waves unstable. Because a jump in tangential velocity is induced when the interface is deformed, the applicability of the model to describe the dynamics of internal waves is expected to remain rather limited. To overcome this major difficulty, the model is written in terms of the horizontal velocities at the bottom and the interface, instead of the depth‐averaged velocities, which makes the system linearly stable for perturbations of arbitrary wavelengths as long as the shear does not exceed a certain critical value.
INTERNATIONAL VARIATIONS IN LIFE EXPECTANCY: A SPATIO‐TEMPORAL ANALYSIS
Authors: JEN MIN HUA , JOHNSTON RON , JONES KELVYN , HARRIS RICHARD , GANDY AXEL
Published: April 2009

Life expectancy at birth has increased substantially at the global scale over recent decades, but the improvements have not been experienced equally across all countries – in large part reflecting changes in economic and social situations. To identify the spatial variations in life expectancy at birth across a large number of countries over a 33‐year period, this paper provides an expository account of a developing modelling methodology for the analysis of spatio‐temporal trajectories. It identifies broad patterns of change and simultaneously examines between‐ and within‐country variation to assess the degree to which patterns of life expectancy are becoming more or less similar at national and sub‐national scales.
Did Vasco da Gama matter for European markets?1
Authors: O'ROURKE KEVIN H. , WILLIAMSON JEFFREY G.
Published: April 2009

This article explores the impact of the ‘Voyages of Discovery’ on European spice markets, asking whether the exploits of Vasco da Gama and others brought European and Asian spice markets closer together. To this end we compare trends in pepper and fine spice prices before and after 1503, the year when da Gama returned from his financially successful second voyage. Other authors have examined trends in nominal spice prices, but this article uses relative spice prices, that is, accounting for inflation. We find that the Voyages of Discovery had a major impact on European spice markets, and provide a simple model of monopoly and oligopoly to decompose the sources of the Cape route's impact on European markets. Finally, we offer some speculations regarding the impact of the Cape route on intra‐European market integration.
Coping with a two‐dimensional political space: Party mobilisation in referendums on European integration
Authors: SHU MIN
Published: April 2009

European Union referendums invite national electorates to vote on transnational cooperation and regional integration, thereby creating tension between transnational ballot issues and domestic electoral mobilisation. Because of the tension, domestic political parties are forced to confront a two‐dimensional political space in EU referendums. In the referendum‐generated political space, unless integration issues are more salient than domestic concerns, intra‐divided and inter‐converged mainstream parties tend strategically to abstain from the campaigns. Yet, explicit inter‐party collusion may allow the pro‐integration mainstream to form a party cartel in EU referendums. Suggestive evidence is drawn from a case study of the two Irish referendums on the Nice Treaty. Based on a party‐candidate survey, Irish parties are mapped onto a latent two‐dimensional political space. The findings shed new light on the initial abstention of Irish mainstream parties in the first Nice campaign and their subsequent mobilisation in the second referendum.
Commentary: Knowles RE, Tarrier N (2009). Evaluation of the effect of prospective patient diaries on emotional well‐being in intensive care unit survivors: a randomized control trial
Authors: Jones Christina
Published: April 2009

Objective:  To evaluate the effect of a prospective diary intervention on levels of anxiety and depression in a group of intensive care unit (ICU) survivors.

Design:  Pragmatic randomized controlled trial.

Setting:  Adult ICU, medical/surgical wards of a district general hospital and community bases.

Patients:  A total of 36 patients who were admitted to the ICU between March 2006 and March 2007 for a minimum of 48 h.

Interventions:  Prospective diary kept by nursing staff for the duration of the patient’s stay on ICU, containing daily information about their physical condition, procedures and treatments, events occurring on the unit, and significant events from outside the unit.

Measurement and main results:  At initial assessment, almost half of patients fell into the ‘disorder likely’ category on the Hospital Anxiety and Depression Scale (44% for anxiety and 47·2% for depression). Paired samples Student’s t‐tests to compare the Hospital Anxiety and Depression Scale scores at time 1 and time 2 in the two participant groups revealed that the experimental group displayed statistically significant decreases in both anxiety [t(1, 17) = 2·65, p < 0·05) and depression [t (1, 17) = 3·33, p < 0·005] scores, while the control group did not, a difference attributed to the diary intervention.

Conclusions:  Survivors of critical illnesses are likely to experience clinically significant symptoms of anxiety and depression following their discharge from hospital. The prospective diary intervention was designed to help patients understand what happened to them in intensive care, and it has a significant positive impact on anxiety and depression scores almost 2 months after patients’ discharge from ICU. Attempts to replicate these results using larger samples are therefore encouraged, with the aim of informing best practice guidelines.

Abstract reprinted from the Critical Care Medicine, volume 37, Knowles and Tarrier, ‘(2009) Evaluation of the effect of prospective patient diaries on emotional well‐being in intensive care unit survivors: A randomized control trial’, pages 184–191. © 2009, reproduced with permission from Lippincott Williams & Wilkins.
Experimental Study of Bone Lengthening in Dogs by Means of Backscattered Scanning Electron Microscopy
Authors: LAFUENTE PILAR , FRANCH JORDI , DURALL IGNACIO , MANZANARES CRISTINA
Published: April 2009

Objective— To describe the morphology of calcified tissues involved in distraction osteogenesis (DO) by means of backscattered scanning electron microscopy (BS‐SEM).

Study Design— Experimental study.

Animals— Adult female Beagle dogs (n=12).

Methods— Nonsimultaneous and bilateral transverse mid‐diaphyseal osteotomies performed in tibiae were stabilized and distracted by a Type Ia external skeletal fixation device. After a latency period of 5 days, distraction was applied at a rate of 0.5 mm every 12 hours for 10 days. Then, the external fixator was maintained in a static mode during the consolidation period until bone healing or euthanasia at 1, 2, 3, 4, 6, 8, 10, 12, 14, and 18 weeks after operations, whichever came first. Distracted regions were isolated and their structure was examined by BS‐SEM.

Results— Calcified chondroid tissue was prominent during distraction and calcified cartilaginous tissue during consolidation; both tissues were successively replaced by woven, lamellar, and osteonal bone.

Conclusions— In osteotomized tibia, chondroid tissue is the main component of the mineralization front during distraction, calcified cartilaginous tissue during consolidation, and then both tissues are replaced by woven, lamellar, and osteonal bone. The ossification mechanism of distraction callus is transchondroidal.

Clinical Relevance— BS‐SEM is an effective technique for studying progression of bone healing during DO. The presence of chondroid tissue during DO explains why callus mineralization occurs more rapidly during distraction than during static stabilization.
Long‐Term Clinical Effects and Side Effects of Mexiletine in Patients with Ventricular Arrhythmias
Authors: JOHANSSON BENGT W. , STAVENOW LARS
Published: April 2009

In an investigation designed to study the nature and prevalence of side effects during long‐term therapy and the degree of correlation between side effects and the drug serum level, starting in 1975, mexiletine was given to 12 patients for 4 to 128 months with a mean of 56.2 months. The patients were followed according to a strict protocol for the first 18 months of treatment and then returned to routine care. In August 1983, 5 patients had been taking mexiletine for 74 and 96 months (mean 85 months). At the latest follow‐up in April 1986, two patients were still on mexiletine therapy after 117 and 128 months of medication, respectively. A third patient died of probable digitalis intoxication just prior to follow‐up, having then been on mexiletine for 118 months, Mexiletine was well tolerated and no serious side effects were seen. In particular, there was no rise in antinuclear factor titer. The serum level of mexiletine was easily maintained within the therapeutic range. The cerebral side effects correlated closely with the drug level; the gastrointestinal with the amount of mexiletine per dose. It is concluded that mexiletine can be administered for a long time as a safe alternative to other anti arrhythmic drugs.
Telemetry of Intracardiac Electrograms: Applications in Spontaneous and Induced Arrhythmias
Authors: LUCERI RICHARD M. , CASTELLANOS AGUSTIN , THURER RICHARD J.
Published: April 2009

In order to demonstrate the feasibility of dysrhythmia analysis by means of noninvasive intracardiac telemetry, a custom‐modified AFP DDD pulse generator was attached to temporary pacing electrodes in 15 patients undergoing electrophysiology studies for a variety oftacliy‐ or bradyarrhythmias. Intracardiac atrial and ventricular electrograms were obtained during induction, termination, and drug intervention in patients with these arrhythmias. The telemetered computer‐generated hardcopy tracings compared favorably to those obtained through a standard multichannel physiological recorder, and thus confirmed the accuracy of the technique. Therefore, microprocessor‐based telemetry ofintracardiac electrograms may have a prominent role in the design of multifunction devices for both bradycardias and tachycardias
Drug Interactions with Propafenone
Authors: STOHLER JANE L. , KOWEY PETER R. , MARINCHAK ROGER A. , FRIEHLING TED D.
Published: April 2009

Propafenone is a Class IC antiarrhythmic drug that has been under investigation for over 10 years and is on the threshold of release for general use. Clinical trials have been completed that present compelling evidence of the safety and efficacy of the drug for the treatment of malignant ventricular arrhythmias. As with other potent antiarrhythmic agents, propafenone has the propensity to interact with a variety of other drugs, and these interactions are of critical importance to physicians who will prescribe the drug to patients with cardiac arrhythmias. A particularly detailed knowledge of the interactions between propafenone and such commonly used drugs as anticoagulants, digoxin, cimetidine, other antiarrhythmics, and even food is essential to its safe administration. This paper reviews current information regarding the drug interactions of propafenone so that, once released and available, it will be used appropriately and safely.
Parasystolic Accelerated Idioventricular Rhythms Producing Bidirectional Tachycardia Patterns
Authors: CASTELLANOS AGUSTIN , SHIN EAK‐KYUN , LUCERI RICHARD M. , MYERBURG ROBERT J.
Published: April 2009

Two patients with digitalis toxicity had markedly irregular accelerated idioventricular rhythms that were parasystolic in nature. The relatively abrupt appearance of extrasystoles with different morphologies resulted in patterns of the so‐called rapid and “slow” bidirectional ventricular tachycardias.The parasystolic rhythms seemed to have been classic rather than modulated since nonparasystolic beats occurring in different moments of the cycle failed to affect the latter in the expected, predictable manner. It is possible for the existence of marked, spontaneous variations of the degree of automatic activity to interfere with the diagnosis of parasystolic modulation.
Production of Chronic First Degree Atrioventricular Block in Dogs, Using Closed‐Chest Electrode Catheter with Radiofrequency Energy
Authors: MARCUS FRANK I. , BLOUIN LEONARD T. , BHARATI SAROJA , LEV MAURICE , WHARTON KEITH
Published: April 2009

Atrioventricuiar (AV) ablation to yield chronic first degree block was attempted in six mongrel dogs. Radio frequency energy (RFE) at 750 KHz, ranging from 3.4 to 4.5 W, was delivered from the distal pole of a USCI 6F quadripolar electrode catheter to a site near the AV node. RFE delivery times ranged from 5 to 60 sec and were repeated in each animal tintil the PR interval was prolonged by 25% or more, if possible. Immediately after ablation, during autouomic blockade, 5 of the 6 dogs had PR‐interval prolongation of 25% or more, averaging 36%. The mean PR prolongation in 4 of these dogs was +41% at 1 week, +50% at 1 month ami +50% at 4 months after ablation in the absence of autonomic blocking agents and +54%, +42%, and +44%, respectively, for the same periods after autonomic blockade. The fifth dog had less than 20% increase in PR during subsequent measurements and the sixth dog experienced permanent third degree block after multiple KFE shocks. In the 4 dogs with chronic PR prolongation, the maximum damage was found in the approaches to and in the AV node, less in the His bundle, and least in the bundle branches. It is concluded that chronic modification of AV conduction can be produced in a majority of dogs with RFE with lesions located in the approaches to the AV node and at the AV node, with minimal or moderate involvement of surrounding tissues.
Effects of Sustained Ventricular Pacing During Cardioplegic Arrest on Global and Regional Postischemic Left Ventricular Performance
Authors: LAZAR HAROLD L. , WILCOX KENNETH , LEVINE PAUL A.
Published: April 2009

Although coronary artery bypass graft surgery is frequently performed in patiejits with permanent ventricular pacemakers, the effects of pacemaker generator stimuli during cardioplegic arrest are unknown. This study was undertaken to detennine whether, during cardioplegic arrest in the presentee of a coronary occlusion, pacemaker stimuli accentuate postischemic LV damage.

Twelve pigs were placed on cardiopulmonary bypass and subjected to 80 min ofischemic arrest with multiple doses of crystalloid potassium crystalloid caidioplegia supplemented with topical and systemic (28C) hypothermia. During arrest, the mid LAD was occluded with a snare that was released upon reperfusion. In all animals, epicardial ventricular pacing wires were placed and capture was confirmed. In 6 pigs, pacing was instituted prior to ischemic arrest and continued throughout the ischemic and postischemic periods. Six other pigs were not paced and served as controls.

Pacemaker stimuli during arrest had no effect on LV temperature. There was no difference in postischemic Lt mass, compliance curves, wall‐motion scores, or stroke xvork itidex between the paced and nonpaced hearts.

We conclude that sustained pacemaker stimuli during cardioplegic arrest does not impair global and regional postischemic LV function.
Computer Modelling of Cardiac Recovery Processes and Repolarization Sequences
Authors: MALIK MAREK , CAMM A. JOHN
Published: April 2009

A computer model has been developed which simulates both excitation and recovery processes within a block of heart muscle tissue. The model emphasizes the electro physiologic features of repolarization processes. It is comprised of artificial images of myocardial tissue consisting of several thousand elements and introduces phenomena that are omitted or seriously simplified in most of the existing computer models of cardiac electrophysiology. These phetiomeria include the abnormal shapes of action‐potential curves corresponding to premature excitation of cells that have not fully recovered, different durations of the repolarization phase in endoepicardial layers of tissue, and the tissue anisotropy of excitation transmission and electric resistivity.

The model has been used in several experiments. Results of simulation studies are presented in the form of modelled 3‐lead electrocardiographic records. In spite of simple assumptions used at model construction, the results of simulation experiments reproduce natural phenomena. The experimental series include: simulation of regular activation sequences, models of ischemia and infarction, models of pnemature beats, simulation of effects due to fast sequential excitation, and simulation of reentry mechanisms with special reference to the initiation of ventricular fibrillation.

The future development of more realistic models of cardiac recovery processes is also discussed.
Defibrillation Energy Requirements Differ Between Anesthetic Agents
Authors: WANG MICHELE , DORIAN PAUL
Published: April 2009

We examined the effect of anesthesia on the energy requirements for internal defibrillation (DF) in dogs anesthetized with pentobarbital (30 mg/kg IV followed by 2–3 mg/kg/hr constant infusion) (n = 20), fentanyl (25 μg/kg/hour) (n = 25), and enflurane (0.5%–1.5%) (n = 8). Multiple shocks of varying energies were applied through left and right ventricular epicardial patch electrodes to relate delivered energy to percent success in DF. The energies required for 50% success (E50) and 80% success (E80) in DF were estimated using logistic regression. E50 in fentanyl anesthetized animals (3.8 ± 2.3 J) was significantly lower than in those given pentobarbital (6.9 ± 3.0 J) (P < 0.01), and lawer than those given enflurane (5.7 ± 2.8 J) (NS). E80 with fentanyl (6.5 ± 4.0 J) was also lower than that of pentobarbital (10.4 ± 4.9 J) (P < 0.01) and enflurane (7.6 ± 4.3 J) (NS) animals. lawer defibrillation energy requirements (DER) with fentanyl anesthesia, when compared with pentobarbital, were associated with significantly longer ventricular effective refractory periods (VERP) (171 ± 20 versus 142 ± 15 msec: P < 0.01), lower mean arterial pressures (114 ± 20 vs 136 ± 25 mmHg: P < 0.01), and Iower heart rates (90 ± 37 versus 164 ± 19 b/m; P < 0.01).

Anesthetic agents may modify DER; their effects need to be taken into account in the assessment of DER in patients receiving implanted defibrillators and in the evaluation of the results of defibrillation research in anesthetized animals.
Potassium and Magnesium Changes Associated with Programmed Electrical Stimulation
Authors: BLESKE BARRY E. , KLUGER JEFFREY , COLUCCI ROBERT , CHOW MOSES S.S.
Published: April 2009

Serum potassium and magnesium concentrations decrease secondary to an increase in catecholamine concentrations. We hypothesized that during programmed electrical stimulation (PES), where stress of the procedure may elevate catecholamine levels, potassium and magnesium concentrations would decrease. To test this hypothesis, potassium and magnesium concentrations were measured at baseline, during, and after PES in 16 patients. Potassium concentrations (mean ± standard deviation) decreased from 4.5 ± 0.3 (mEq/L) at baseline to 3.9 ± 0.2 during PES (P < 0.05). At 2 hours post‐PES, serum potassium concentrations returned to baseline values (mean 4.2 ± 0.5 mEq/L, P > 0.05 compared to baseline). Mean magnesium concentrations (mmol/L) decreased from 0.84 ± 0.07 at baseline to 0.81 ± 0.07 at the end of PES (P < 0.05) but did not decrease significantly during PES.

In conclusion, potassium concentrations decreased significantly during PES, whereas magnesium concentrations decreased slightly but significantly at the end of PES. These changes in electrolyte concentrations may be due to catecholamine influence secondary to the PES procedure. In light of these observations, serum concentrations of potassium and magnesium should be normalized prior to PES procedure in order to prevent hypokalemia and hypomagnesemia.
Masquerading Bundle‐Branch Block—Electrophysiological Correlation
Authors: KOWEY PETER R. , KOSLOW MICHAEL , MARINCHAK ROGER A. , FRIEHLING TED D.
Published: April 2009

The term masquerading bundle‐branch block has been used to describe a peculiar electrocardiographic abnormality in which the standard leads exhibit a left bundle‐branch block pattern while the precordial leads manifest a right bundle‐branch configuration. Autopsy studies of patients who have had this electrocardiographic pattern in life have shown diffuse conduction system disease, but direct recordings of conduction system function have never been reported. We recently cared for a man with masquerading bundle‐branch block, and in this report we summarize the results of invasive electrophysiological testing. Our findings confirm that masquerading bundle‐branch block can be associated with severe and diffuse conduction system disease, and that patients with this finding may require permanent pacemaker implantation, especially if they are symptomatic.
Hemodynamics of AV Synchrony and Rate
Authors: WISH MARC , FLETCHER ROSS D. , COHEN ANDREW
Published: April 2009

Dual‐chamber pacing was developed to overcome the symptomatic and hemodynamic deficiencies of single‐chamber ventricular pacing. It was later suggested that the benefit of dual‐chamber pacing with activity was not because ofAV synchrony but because of the ability to increase rate. It is suggested that the benefit of dual‐chamber pacing has been underestimated by lack of an appropriately programmed AV delay.
Sudden Death Late After Doxorubicin Administration: Use of Electrophysiological Study and Treatment by Automatic Implantable Cardioverter Defibrillator
Authors: EPSTEIN ANDREW E. , MCGIFFIN DAVID C. , KAY G. NEAL , PLUMB VANCE J. , SHEPARD RICHARD B.
Published: April 2009

Two patients who survived cardiac arrest late after doxorubicin administration are described. Both patients had nonischemic, dilated cardiomyopathies and underwent electrophysiological studies during which no ventricular arrhythmias were induced. Their negative electrophysiological studies despite well documented cardiac arrests and subsequent clinical courses suggest that patients with cardiomyopathies after doxorubicin administra tion and dilated cardiomyopathies of other etiologies have similar natural histories. Treatment with an automatic implantable cardioverter defibrillator appears to be a reasonable therapeutic option for patients with anthracyline associated cardiac disease who have survived their malignancy but at the price of developing life‐threatening arrhythmias.
Multimedia Emergency Bedside Ultrasound Quality Assurance Feedback
Authors: Leech Stephen , Daugharty Jennifer
Published: April 2009

Clear feedback is important for teaching the technical and interpretive skills of emergency bedside ultrasound. Using screen capture software (Snapz Pro X, Ambrosia Software Inc.), we create multimedia feedback videos for our users still in the training phase. These self‐contained videos with voice‐over instruction are made using either the still images or digital video that users submit for quality assurance. The videos are simple to make and allow for clear, focused feedback and personalized instruction with each study. Users see their images and visual feedback, and hear real‐time audio instruction. This allows us to easily reinforce positive technique and interpretation, provide constructive comments, and review areas for improvement. The feedback videos are posted on a server, and links are emailed to users when new studies are reviewed. Users can review studies at their convenience with a minimal time commitment. Since switching from written to multimedia feedback, we have seen a marked improvement in our users’ ultrasound skills and enthusiasm toward ultrasound. The following are examples of reviewed studies: http://www.emedsonar.com/qa/video_review/ziggy_fast_091408.mov. http://www.emedsonar.com/qa/video_review/110308/ziggy_jd_gb_nm_092408.mov. http://www.emedsonar.com/qa/video_review/110308/wiepert_thundiyil_ao_cp_092508.mov.
The E.R. Game
Authors: Dilena Michael
Published: April 2009

This is a digital board game designed as an entertaining educational tool. Adapted from “MONOPOLY,” the board appears on the computer screen and the players roll digital dice and their game piece moves appropriately. The space landed on will have a category assigned and produce a question from that category. Correctly answering the question gives ownership of the space and awarding of points. Players subsequently landing on the space must answer another question from the category or lose equivalent points. The game proceeds until one player has circled the board three times or any player reaches preset point total. The game is designed to import questions from a digital question bank that the end‐user can edit. The game provides referenced explanation of erroneous choices.
Competency Testing Using a Novel Eye Tracking Device
Authors: Wetzel Paul , Christiansen Gregory , Ward Kevin
Published: April 2009

Assessment and evaluation metrics currently rely upon interpretation of observed performance or end points by an ‘expert’ observer. Such metrics are subject to bias since they rely upon the traditional medical education model of ‘see one, do one, teach one’. The Institute of Medicine's Report and the Flexner Report have demanded improvements in education metrics as a means to improve patient safety. Additionally, advancements in adult learning methods are challenging traditional medical education measures. Educators are faced with the daunting task of developing rubrics for competency testing that are currently limited by judgment and interpretation bias. Medical education is demanding learner‐centered metrics to reflect quantitative and qualitative measures to document competency. Using a novel eye tracking system, educators now have the ability to know how their learners think. The system can track the focus of the learner during task performance. The eye tracking system demonstrates a learner‐centered measuring tool capable of identifying deficiencies in task performance. The device achieves the goal of timely and direct feedback of performance metrics based on the learner's perspective. Employment of the eye tracking system in simulation education may identify mastery and retention deficits before compliance and quality improvement issues develop into patient safety concerns.
A Model for Ultrasound‐Assisted Lumbar Puncture
Authors: Herron Matthew , Aloi Mara , Korvek Scott
Published: April 2009

Clinicians may find traditional lumbar puncture (LP) attempts fail due to indistinct landmarks in morbidly obese patients necessitating ultrasound localization or fluoroscopy. We believe a readily available teaching model is needed because many emergency physicians may be unfamiliar with ultrasound‐assisted LP. Review of current literature shows that there are few commercially available LP models suitable for use with ultrasound. Those on the market are expensive and have limited reusability. We have succeeded in creating a low‐cost reusable model for training health care professionals to perform ultrasound‐assisted LP. We believe there will be many benefits to using this model including: increase in emergency department (ED) LP success rates, decrease in number of radiology consults for fluoroscopy, increase in patient satisfaction, decreased waiting time in the ED, and fewer complications due to fewer needle passes. This model effectively reproduces the sonographic appearance of the lumbar spine and overlying soft tissue and aids in teaching bedside ultrasound‐assisted LP. The model has an opaque “skin” overlying a gel wax mold containing a lumbar spine. A catheter containing water is imbedded in the spine to simulate the spinal canal and cerebrospinal fluid. The skin allows for a more realistic procedure and can be removed for visual confirmation of a successful LP. In addition, successful needle placement will result in return of clear fluid. Construction of the model requires a commercially available lumbar spine and items found in craft stores with a total cost of approximately $100.
Use of Simulation Technology in Forensic Medical Education
Authors: Rozzi Heather , Bohrn Michael , Kepner Andrew
Published: April 2009

Although the emergency department often provides the first and only opportunity to collect forensic evidence, very few emergency medicine residencies have a forensic medicine curriculum in place. Most of the existing curricula are composed only of traditional didactics. However, as with any lecture‐based education, there may be a significant delay between the didactic session and clinical application. In addition, traditional curricula lack the opportunity for residents to practice skills including evidence collection, documentation, and use of a colposcope. At York Hospital, we have developed a forensic curriculum which consists of both traditional lectures and practical experience in our Medical Simulation Center. As part of their educational conference series, residents receive presentations on domestic violence, child abuse, elder abuse, evidence collection, sexual assault, ballistics, pattern injuries, documentation, forensic photography, and court testimony. Following these presentations, residents have the opportunity to apply their knowledge of forensic medicine in the Simulation Center. First, they interview a standardized patient. They then utilize the mannequins in the Simulation Center to practice evidence collection, photo documentation, and use of our specialized forensic medicine charts. After evidence collection and documentation, the residents provide safety planning for the standardized patients. Each portion is videotaped, and each resident is debriefed by victim advocates, experienced sexual assault nurse examiners, and emergency department faculty. The use of simulation technology in resident education provides the opportunity to practice the skills of forensic medicine, ultimately benefiting patients, residents, and law enforcement, and permitting teaching and evaluation in all six core competency areas.
The Emergency Informatics Transition Course: A Flexible, Online Course in Health Informatics for Emergency Medicine Clinicians and Trainees
Authors: Wadman Michael , Hersh William , Nielson Jeffrey , McClay James
Published: April 2009

Increasing emphasis on health information technology (HIT) as a mechanism to control costs and increase quality in health care is accelerating the diffusion of more advanced health information systems into emergency medicine. This has created an increased demand for informatics‐trained emergency physicians to provide clinical input. In response to this need we partnered with the American College of Emergency Physicians (ACEP) to adapt an existing informatics educational program to emergency medicine. The American Medical Informatics Association (AMIA) 10X10 program is an effort to provide formal informatics training to 10,000 clinicians by 2010. Our first AMIA‐ACEP 10X10 Emergency Informatics Transition Course matriculated 37 emergency physicians this fall. This 12 week online course is an adaption of the Oregon Health & Science University (OHSU) introductory informatics 10X10 course where students complete weekly assignments and participate in online discussions. At the end of the course they meet face‐to‐face at the ACEP Scientific Assembly where they present their projects and discuss common themes. The online design of the course proved adaptable for a widely varied enrollment. The first class contained students from the United States and four other countries, both large urban and small rural hospitals, and both new and experienced clinicians. Extensive input from the students will assist us in further refining this annual course to better meet the needs of emergency clinicians. We will demonstrate the design of this course, which we believe offers interested residents and fellows in emergency medicine a flexible opportunity to advance their informatics training.
Mast‐producing trees and the geographical ecology of western scrub‐jays
Authors: Koenig Walter D. , Krakauer Alan H. , Monahan William B. , Haydock Joseph , Knops Johannes M. H. , Carmen William J.
Published: April 2009

We analyzed the relationship between population abundance and variability of western scrub‐jays Aphelocoma californica based on 48 yr of Audubon Christmas Bird Counts and the resources on which they depend as indexed by the diversity and abundance of mast‐producing oaks and pines and, for California, estimates of acorn production based on a statewide survey. In general, populations of A. c. californica along the Pacific coast were related to oaks, with populations being more abundant and more stable in areas with more oak species and greater oak abundance. In contrast, populations of A. c. woodhouseii in the Great Basin were correlated with pines/conifers, again with higher abundance and greater stability with increased number of pine species and greater abundance of pines/conifers. The presumed driver of these patterns is increased resource abundance with greater habitat abundance and increased resource stability with increasing species diversity due to asynchrony in seed production among different species of trees. Asynchrony in acorn production is particularly high among oaks that require different number of years to produce acorns, but we failed to confirm that populations with access to both types were more stable than those with access to only one type after controlling for oak diversity. However, we did find a strong positive correlation between overall mean scrub‐jay abundance in California and overall acorn production one year earlier, suggesting that acorns benefit scrub‐jay populations primarily by increasing reproductive success the following year. These patterns demonstrate the strong dependence between population dynamics and resource stability as well as how different these relationships can be within closely related taxa.
ORIGINAL ARTICLE: Functional Changes of Human Peripheral B‐Lymphocytes in Pre‐Eclampsia
Authors: Liao Ai‐Hua , Liu Li‐Ping , Ding Wen‐Ping , Zhang Ling
Published: April 2009

Problem  The aim of our study was to investigate the functional changes of human peripheral B‐lymphocytes in healthy and pre‐eclamptic pregnancies.

Method of study  Twenty patients with pre‐eclampsia and 15 healthy third‐trimester pregnant women were recruited in this study. Peripheral blood mononuclear cells (PBMCs) were isolated and directly stained with fluorescein isothiocyanate (FITC)‐labeled anti‐CD27 monoclonal antibody (mAb) and phycoerythrin (PE)‐labeled anti‐CD38 mAb. The percentages of the individual B‐cell subsets were estimated out of total lymphocytes by flow cytometric analysis. Additionally, the enriched PBMCs were cultured with or without the stimulation of pokeweed mitogen (PWM) for 5 days. Then morphologic observation of plasma cells was analysed by Wright‐Giemsa stain, and antibody‐producing cells were detected by enzyme‐linked immunospot assay.

Results  The percentage of CD27−CD38− naïve B‐cells and CD27−CD38+ plasma cells did not differ between study groups (P > 0.05). The percentage of CD27+CD38− memory B‐cells and CD27+CD38+ plasma cell pre‐cursors increased in pre‐eclamptic women compared with the controls (P < 0.05). Irrespective of whether the PBMCs were stimulated with or w/o PWM in vitro, the mean percentages of generated plasma cells were significantly higher in pre‐eclamptic group than in the controls (P < 0.05). There were more antibody‐producing cells in pre‐eclamptic women following the activation of PWM than those in the controls (P < 0.01).

Conclusion  Our findings implicate that the functional changes of human circulating B‐cells might contribute to the etiology of pre‐eclampsia.
ORIGINAL ARTICLE: Allergic Women have Reduced sHLA‐G Plasma Levels at Delivery
Authors: Rizzo Roberta , Stignani Marina , Amoudruz Petra , Nilsson Caroline , Melchiorri Loredana , Baricordi Olavio , Sverremark‐Ekström Eva
Published: April 2009

Problem  HLA‐G antigen maintains a tolerogenic condition at the foeto‐maternal interface, counteracts inflammation in autoimmune diseases and soluble HLA‐G (sHLA‐G) levels decrease in allergic‐asthmatics. Taking into consideration these findings, we analyzed if sHLA‐G and interleukin‐10 (IL‐10) could be influenced by pregnancy and labour in allergic and non‐allergic women.

Method of study  sHLA‐G isoforms and IL‐10 levels were determined in the plasma samples of 43 women (15 non‐allergic, 28 allergic) during third trimester, at delivery and 2 years after pregnancy by immunoenzymatic assays.

Results  A significant increase in sHLA‐G and IL‐10 levels was documented at delivery in both allergic and non‐allergic women. Allergic women showed lower sHLA‐G concentrations. sHLA‐G1 was evidenced as the predominant plasma isoform.

Conclusion  The data showed increased sHLA‐G and IL‐10 concentrations at delivery, regardless of the allergic status. The sHLA‐G1 isoform is mainly responsible for the increased sHLA‐G levels at delivery.
Psoriasis – a systemic inflammatory disorder: clinic, pathogenesis and therapeutic perspectives
Authors: Boehncke Wolf‐Henning , Sterry Wolfram
Published: April 2009

Psoriasis has seen a dramatic change in its perception by dermatologists as well as other medical specialties. Its well‐recognized association with several other diseases makes a complete switch in its management necessary. This review summarizes current epidemiological data on the comorbidities of psoriasis. Subsequently, the evidence for insulin resistance as a cause for endothelial cell dysfunction with its relevant pathogenetic link to the development of cardiovascular comorbidity is discussed. Based on these novel insights, we propose a possible state‐of‐the‐art approach towards comprehensive psoriasis management.