bluuebunny/crossref_metadata_2025 huggingface dataset:
Botulinum toxin type A injections can be an effective treatment for pain in children with hip spasms and cerebral palsy
Authors: LUNDY CLAIRE T , DOHERTY GARY M , FAIRHURST CHARLIE B
Published: April 2009

Aim  Botulinum toxin type A (BoNT‐A) injections were used in the treatment of lower‐limb spasticity in children with cerebral palsy (CP). Anecdotal evidence suggests a reduction in pain after this treatment in children who had pain localized to a displaced hip joint. We report on our current clinical practice.

Method  Twenty‐six children with non‐ambulant quadriplegic CP (Gross Motor Function Classification System level V) were assessed as having significant spasticity and pain at the hip level. Twelve were males and 14 females, with an age range of 2 to 19 years (mean age 11y 6mo, SD 4y 9mo). Ten had functional difficulties secondary to predominant spasticity and 16 had a mix of a high‐background peripheral tone with superimposed dystonia. Of the 26 children assessed, 10 had at least one hip which was dislocated and three had at least one hip which was subluxed. As part of their spasticity management programme they received targeted BoNT‐A injections to the adductor magnus, medial hamstrings and iliopsoas muscle groups. The Paediatric Pain Profile was used as the primary outcome measure.

Results  All had highly significant improvement in their recorded pain profile scores measured at 3 months after treatment (p<0.001). There was equal efficacy in response to treatment in the children with subluxed or dislocated hips. In addition, families commented on improved quality of life for the children across several areas, including sleep, postural management, and activities of daily living.

Interpretation  This report demonstrates that targeted BoNT‐A injections reduced pain in children with significant spasticity and pain at the hip level. They may also improve quality of life of non‐ambulant children with CP and a hip problem.
Validation of the Functional Status II questionnaire in the assessment of extremely‐low‐birthweight infants
Authors: COSTA DAVID DA , BANN CARLA M , HANSEN NELLIE I , SHANKARAN SEETHA , DELANEY‐BLACK VIRGINIA ,   FOR THE NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT NEONATAL RESEARCH NETWORK
Published: April 2009

Aim  The increased survival of infants born at extremely low birthweight (ELBW) has been associated with significant morbidity, including higher rates of neurodevelopmental disability. However, formalized testing to evaluate these problems is both time‐consuming and costly. The revised Functional Status questionnaire (FS‐II) was designed to assess caregivers’ perceptions of the functional status of children with chronic diseases.

Method  We evaluated the reliability and validity of the FS‐II for ELBW infants at 18 to 22 months corrected age using data from the US Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN). Exploratory factor analyses were conducted using data from the network’s first follow‐up study of 1080 children born in 1993 to 1994 (508 males, 572 females [53%]), and results were confirmed using data from the next network follow‐up of 4022 children born in 1995 to 2000 (1864 males, 2158 females [54%]).

Results  Results suggest that a two‐factor solution comprising measures of general health and independence is most appropriate for ELBW infants. These factors differed from those found among chronically ill children, and new, more appropriate scales are presented for screening ELBW survivors. Both scales demonstrated good internal consistency: Cronbach’s α=0.87 for general health and α=0.75 for independence. Construct validity of the scales was assessed by comparing mean scores on the scales according to scores on the Bayley Scales of Infant Development, second edition (BSID‐II), and medical conditions.

Interpretation  As hypothesized, infants with greater functional impairments according to their BSID‐II scores or medical conditions had lower scores on the general health and independence scales, supporting the validity of the scales.
The brain selenoproteome: priorities in the hierarchy and different levels of selenium homeostasis in the brain of selenium‐deficient rats
Authors: Kühbacher Markus , Bartel Jürgen , Hoppe Barbara , Alber Dorothea , Bukalis Gregor , Bräuer Anja U. , Behne Dietrich , Kyriakopoulos Antonios
Published: April 2009

The application of radionuclides for the localization of essential trace elements in vivo and the characterization of their binding proteins is a story of intermittently made improvements of the techniques used for their detection. In this study we present the use of neutron activation analysis and different autoradiographic imaging methods including real‐time digital autoradiography to reveal new insights in the hierarchy of selenium homeostasis. Selenoproteins containing the essential trace element selenium play important roles in the CNS. Although the CNS does not show the highest selenium concentration in the case of selenium‐sufficient supply in comparison with other organs, it shows a high priority for selenium uptake and retention in the case of dietary selenium deficiency. To characterize the hierarchy of selenium supply in the brain, in vivo radiotracer labeling with 75Se in rats with different selenium status was combined with autoradiographic detection of 75Se in brain tissue sections and 75Se‐labeled selenoproteins after protein separation by two‐dimensional gel electrophoresis. This study demonstrates significant differences in the uptake of 75Se into the brain of rats with different selenium status. A brain region‐specific uptake pattern of the radiotracer 75Se in selenium‐deficient rats could be revealed and the CSF was identified as a key part of the brain selenium homeostasis.
Are Feminists man Haters? Feminists' and Nonfeminists' Attitudes Toward Men
Authors: Anderson Kristin J. , Kanner Melinda , Elsayegh Nisreen
Published: April 2009

Despite the popular belief that feminists dislike men, few studies have actually examined the empirical accuracy of this stereotype. The present study examined self-identified feminists' and nonfeminists' attitudes toward men. An ethnically diverse sample ( N = 488) of college students responded to statements from the Ambivalence toward Men Inventory (AMI; Glick & Fiske, 1999 ). Contrary to popular beliefs, feminists reported lower levels of hostility toward men than did nonfeminists. The persistence of the myth of the man-hating feminist is explored.
Contributions of labile and resistant organic materials to the immobilization of inorganic soil N when used in the restoration of abandoned agricultural fields
Authors: Tilston E. L. , Szili‐Kovács T. , Hopkins D. W.
Published: April 2009

We have examined the contributions sucrose and sawdust make to the net immobilization of inorganic soil N and assimilation of both C and N into microbial biomass when they are used as part of a restoration plan to promote the establishment of indigenous vegetation on abandoned agricultural fields on the Central Hungarian Plain. Both amendments led to net N immobilization. Sucrose addition also led to mobilization of N from the soil organic N pool and its immobilization into microbial biomass, whereas sawdust addition apparently immobilized soil N into a non‐biomass compartment or a biomass component that was not detected by the conventional biomass N assay (CHCl3 fumigation and extraction). This suggests that the N was either cycled through the biomass, but not immobilized within it, or that it was immobilized in a protected biomass fraction different to the fraction into which N was immobilized in response to sucrose addition.
From preparedness to partnerships: case study research on humanitarian logistics
Authors: Tomasini Rolando M. , Van Wassenhove Luk N.
Published: April 2009

Disasters are on the rise, more complex, and donor support is increasingly unpredictable. In response to this trend humanitarian agencies are looking for more efficient and effective solutions. This paper discusses the evolution of supply chain management in disaster relief and the role of new players like the private sector. It is based on research conducted by the Humanitarian Research Group at INSEAD.
Using Wang's two‐dimensional cutting stock algorithm to optimally solve difficult problems
Authors: Vasko Francis J. , Bartkowski Christopher L.
Published: April 2009

P. Y. Wang's classic bottom‐up two‐dimensional cutting stock algorithm generates cutting patterns by building rectangles both horizontally and vertically. This algorithm uses a parameter β1 to tradeoff the number of rectangles generated by the algorithm and hence the quality of the cutting pattern solution obtained versus the amount of computer resources required. Several researchers have made relatively straightforward modifications to Wang's basic algorithm resulting in improved computational times. However, even with these modifications, Wang's approach tends to require large amounts of computer resources in order to optimally or near‐optimally solve difficult two‐dimensional guillotine cutting stock problems. In this paper, we present an iterative approach that judiciously uses Wang's basic algorithm (with some previously defined modifications) to obtain optimal cutting patterns to difficult two‐dimensional cutting stock problems in reasonable computer run times.
Moxidectin toxicosis in a puppy successfully treated with intravenous lipids
Authors: Crandell Dawn E. , Weinberg Guy L.
Published: April 2009

Objective –To describe successful treatment of canine moxidectin toxicosis with the novel therapy of IV lipid administration.

Case Summary –A 16‐week‐old female Jack Russell Terrier was presented with acute onset of seizures followed by paralysis and coma shortly following suspected exposure to an equine formulation of moxidectin. Moxidectin toxicity was later confirmed. Initial therapy consisted of diazepam, glycopyrrolate, and IV fluids. Mechanical ventilation and supportive nursing care were provided as needed. An emulsion of 20% soybean oil in water, commonly used as the fat component of parenteral nutrition, was administered intravenously as a bolus of 2 mL/kg followed by 4 mL/kg/h for 4 hours beginning 10 hours after exposure and was administered again at a rate of 0.5 mL/kg/min for 30 minutes beginning 25.5 hours post‐exposure. Mild improvement was seen after the first dose, and dramatic improvement was noted within 30 minutes of the second dose. The puppy's neurologic status returned to normal within 6 hours of the second administration, with no relapses.

Unique Information Provided –IV lipid therapy is a novel treatment approach for moxidectin toxicity. Its use is supported by recent research and case studies involving IV lipid administration for bupivacaine and other fat‐soluble toxins. Lipid administration appeared to reverse the signs of toxicity and may prove to be a highly effective therapy for moxidectin and other fat‐soluble toxins.
Use of human immunoglobulin in addition to glucocorticoids for the initial treatment of dogs with immune‐mediated hemolytic anemia
Authors: Whelan Megan F. , O'Toole Therese E. , Chan Daniel L. , Rozanski Elizabeth A. , DeLaforcade Armelle M. , Crawford Sybil L. , Cotter Susan M.
Published: April 2009

Objective –To determine the utility of human intravenous immunoglobulin (hIVIG) for the initial treatment of canine immune‐mediated hemolytic anemia (IMHA).

Design –Blinded, randomized, clinical trial.

Setting –Veterinary teaching hospital.

Animals –Twenty‐eight, client‐owned dogs with primary IMHA.

Interventions –At enrollment, after diagnosis of IMHA, dogs were randomly assigned to receive either hIVIG or placebo, in a blinded fashion. For the next 14 days, all dogs received glucocorticoids as the sole immunosuppressant agent. All dogs received low‐molecular‐weight heparin as an anticoagulant. D‐dimer concentrations were evaluated at the beginning and end of the study protocol to monitor for thromboembolic complications.

Measurements and Main Results –Twenty‐five of 28 dogs (89%) were discharged from the hospital. Thirteen of those received hIVIG and 12 received placebo. Twenty‐four dogs (86%) were alive 14 days after enrollment, and of these 13 received hIVIG and 11 received placebo. D‐dimer concentrations were elevated in 86% of all dogs at the time of diagnosis.

Conclusions –For initial treatment of dogs with IMHA, the addition of hIVIG to corticosteroid treatment did not improve initial response, nor did it shorten hospitalization.
Disseminated candidiasis secondary to fungal and bacterial peritonitis in a young dog
Authors: Rogers Catherine L. , Gibson Christopher , Mitchell Susan L. , Keating John H. , Rozanski Elizabeth A.
Published: April 2009

Objective
–
To describe a severe case of bacterial sepsis and disseminated candidiasis in a previously healthy dog.

Case Summary
–
Fungal sepsis was identified in a 2‐year‐old dog following intestinal dehiscence 4 days after abdominal surgery. Septic peritonitis was identified at admission and evidence of dehiscence at the previous enterotomy site was found during an exploratory laparotomy. Both gram‐positive cocci and Candida albicans were cultured from the abdominal cavity. Candida sp. was also subsequently cultured from a central venous catheter. Euthanasia was performed due to failure to respond to therapy. Fungal organisms, morphologically consistent with Candida spp., were found in the lungs and kidney on postmortem histopathologic examination indicating disseminated candidiasis.

New or Unique Information Provided
–
Candida peritonitis is a well‐recognized entity in humans and contributes to morbidity and mortality in critically ill patients. Abdominal surgery, intestinal perforation, presence of central venous catheters, and administration of broad‐spectrum antibiotics are all considered to be suspected risk factors. This report describes the first known case of systemic candidiasis occurring secondary to Candida peritonitis and bacterial sepsis in a critically ill dog.
The role of Ifng in alterations in liver gene expression in a mouse model of fulminant autoimmune hepatitis
Authors: Milks Michael W. , Cripps James G. , Lin Heping , Wang Jing , Robinson Richard T. , Sargent Jennifer L. , Whitfield Michael L. , Gorham James D.
Published: April 2009

Background/Aims: BALB/c mice with a homozygous deficiency in the Tgfb1 gene are a model of fulminant autoimmune hepatitis (AIH), spontaneously and rapidly developing Th1‐mediated IFN‐γ‐dependent necroinflammatory liver disease. We sought to understand the molecular basis for fulminant Th1 liver disease and the specific role of the Ifng gene.

Methods: Global gene expression in livers from BALB/c Tgfb1−/− mice with and without an intact Ifng gene was assessed by microarray analysis. Expression patterns were confirmed by quantitative reverse transcriptase‐polymerase chain reaction. Gene ontology clustering analysis was performed to identify altered pathways. The contributions of Ifng to altered expression pathways were quantified.

Results: Over 100 genes were strongly (>10‐fold) upregulated, most encoding proteins involved in immune function/response. Chemokines were the most prominently upregulated group, with eight chemokine genes upregulated >10‐fold. Ifng was necessary for the upregulation of CXC chemokines gene, but not of CC chemokine genes. By quantitative analysis, Ifng's role in liver gene upregulation varied greatly among overexpressed genes.

Conclusions: Gene expression changes indicate a particularly important and heretofore unappreciated role for chemokines in fulminant AIH. Ifng has an important role in expression of some but not all genes. Ifng is dichotomous in the regulation of distinct chemokine subfamilies: specifically, Ifng is critical for overexpression of specific CXCL genes but dispensable for overexpression of specific CCL genes. These results provide a clearer understanding of the role of Ifng in the molecular basis of necroinflammatory liver disease.
Liver cancer stem cells: implications for a new therapeutic target
Authors: Lee Terence Kin Wah , Castilho Antonia , Ma Stephanie , Ng Irene Oi Lin
Published: April 2009

Hepatocellular carcinoma (HCC) is an aggressive tumour with a poor prognosis. Current therapeutic strategies against this disease target mostly rapidly growing differentiated tumour cells. However, the result is often dismal due to the chemoresistant nature of this tumour type. Recent research efforts on stem cells and cancer biology have shed light on new directions for the eradication of cancer stem cells (CSCs) in HCC. The liver is a distinctive organ with the ability of tissue renewal in response to injury. Based on the hypothesis that cancer development is derived from the hierarchy of the stem cell system, we will briefly discuss the origin of liver stem cells and its relation to HCC development. We will also summarize the current CSC markers in HCC and discuss their relevance to the treatment of this deadly disease.
ASDIN: Autogenous Side‐to‐Side Brachial‐Basilic Fistulas Without Vein Transposition: A Valuable Option?
Authors: Lomonte Carlo , Casucci Francesco , Antonelli Maurizio , Losurdo Nicola , Marchio Giovanni , Teutonico Annalisa , Libutti Pasquale , Basile Carlo
Published: April 2009

An autogenous brachial‐basilic arteriovenous fistula (BBAVF) in the upper arm must be considered before placing prosthetic grafts in hemodialysis patients with multiple failures of forearm AVFs. The aim of this observational study was to compare technical and clinical outcomes of a new construction technique for BBAVF (n‐BBAVF) with that of the standard one‐stage side‐artery to end‐vein transposed BBAVF (t‐BBAVF). A n‐BBAVF is constructed in the following way: basilic vein and brachial artery are isolated. Patency of the proximal and distal vein is verified by injecting warmed (37°C) saline solution. A venotomy and an arterotomy of 4–5 mm are performed. The two vessels are prepared for a side‐to‐side anastomosis without transposition of the vein. The latter allows both an antegrade and retrograde flow along the basilic vein, both proximally and distally to the anastomosis with more sites available for the venipunctures of the dialysis. Thirty BBAVFs were constructed as the secondary or tertiary vascular access in 30 patients over a 4‐year period: 17 patients with adequate forearm basilic vein underwent the construction of a n‐BBAVF; 13 underwent the construction of a t‐BBAVF. The construction of a n‐BBAVF requires a significantly lesser surgical time (55.0 ± 9.0 minutes vs. 115.0 ± 18.0, p < 0.0001), has fewer surgical complications (5.9% vs. 46.2%, p < 0.0001), and a reduced time to first use (24.5 ± 6.3 vs. 37.7 ± 9.1 days, p < 0.0001) than that of a t‐BBAVF. n‐BBAVFs showed a relatively low rate of thrombosis per patient‐year at risk (0.067 at 1 year and 0.099 at 2 years). The latter was significantly lower at 1 year when compared with t‐BBAVFs (0.067 vs. 0.285; p < 0.004). Our policy of “all AVFs should be autogenous” led us to the construction of a vascular access which is based on a side‐to‐side anastomosis between the brachial artery and the basilic vein without transposition of the vein allowing both antegrade and retrograde flow into the basilic vein. The results of this surgical technique appear satisfactory.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Continuous Renal Replacement Therapies in Patients with Liver Disease
Authors: Davenport Andrew
Published: April 2009

Patients with acute and chronic liver disease are prone to hypotension, and mortality increases when acute kidney injury supervenes. Hypotension during renal replacement therapy compromises cerebral perfusion, which can exacerbate cerebral edema in cases of fulminant hepatic failure and those with encephalopathy due to chronic liver failure. As such, any renal replacement therapy utilized should have minimal adverse effects on cardiovascular and cerebrovascular stability. Continuous modes of renal replacement therapy have been shown to cause less cardiovascular and cerebrovascular instability compared to other modalities, and as such are the treatments of choice for this group of critically ill patients.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: The Use of Renal Replacement Therapy in Acute Decompensated Heart Failure
Authors: Udani Suneel M. , Murray Patrick T.
Published: April 2009

The worsening of renal function in the context of decompensated heart failure is an increasingly common clinical scenario, dubbed the cardiorenal syndrome. Its development is not completely understood; however, it results from the hemodynamic and neurohumoral alterations that occur in the setting of left ventricular pressure and volume overload with poor cardiac output. Diuretics have been the mainstay of treatment; however, they are often unsuccessful in reversing the vicious cycle of volume overload, worsening cardiac function, and azotemia. Renal replacement therapy (RRT) in the form of isolated or continuous ultrafiltration (UF) with or without a component of solute clearance (hemofiltration or hemodialysis) has been increasingly utilized as a therapeutic tool in this setting. Initial clinical trial data on the use of UF have demonstrated promising cardiac outcomes with regard to fluid removal and symptom relief without worsening renal function. The addition of a component of solute clearance may provide additional benefits in these patients with varying degrees of renal impairment. The exact clinical setting in which the various forms of RRT should be applied as initial or early therapy for acute decompensated heart failure (ADHF) remains unknown. More research examining the use of RRT in ADHF is necessary; however, it appears that the patients with the most severe clinical presentations have the best chance of benefiting from the early application of RRT.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Clinical Nursing for the Application of Continuous Renal Replacement Therapy in the Intensive Care Unit
Authors: Baldwin Ian , Fealy Nigel
Published: April 2009

Treatment of critically ill patients with continuous renal replacement therapy (CRRT) requires a set of new skills and knowledge base for the intensive care unit (ICU) nurse. After a decision to treat is made, nurses effectively manage the technique by following a series of steps in sequence. These sequential steps include patient and machine circuit preparation, connection of the extracorporeal circuit (EC) to the patient’s vascular access, and nursing management of a treatment in progress. During treatment, nurses prepare fluids, adjust fluid settings to provide fluid balance, prepare electrolyte additives, monitor acid base and electrolyte levels, monitor patient and machine “vital signs,” and, when necessary, diagnose circuit clotting and perform a disconnection of the EC from the patient. All of these aspects of CRRT nursing are essential for a successful CRRT nursing policy or protocol. This chapter provides a clinical review for this every day sequence when using CRRT in the ICU setting.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Overview of Pediatric Renal Replacement Therapy in Acute Kidney Injury
Authors: Goldstein Stuart L.
Published: April 2009

The disease spectrum leading to pediatric renal replacement therapy (RRT) provision has broadened over the last decade. In the 1980’s, intrinsic renal disease and burns comprised the most common pediatric acute kidney injury (AKI) etiologies. More recent data demonstrate that pediatric AKI most often results from complications of other systemic diseases resulting from the advancements in congenital heart surgery, neonatal care, and bone marrow and solid organ transplantation. In addition, RRT modality preferences to treat critically ill children have shifted from peritoneal dialysis to continuous renal replacement therapy (CRRT) as a result of improvements in CRRT technologies. Currently, multicenter prospective outcome studies for critically ill children with AKI are sorely lacking. The aims of this paper are to review the pediatric specific causes necessitating RRT provision with an emphasis on emerging practice patterns with respect to modality and the timing of treatment, and focus upon the application of the different RRT modalities and assessment of the outcome of children with AKI who receive RRT.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Continuous Renal Replacement Therapy in Sepsis and Multisystem Organ Failure
Authors: Joannidis Michael
Published: April 2009

This study reviews the role of continuous renal replacement therapy (CRRT) in sepsis with acute kidney injury (AKI) and septic shock with multiple organ failure. In addition to the conventional aim of replacing renal function in AKI, CRRT is often used with the concept of modulating immune response in sepsis. With the intention of influencing circulating levels of inflammatory mediators like cytokines and chemokines, the complement system, as well as factors of the coagulation system, several modifications of CRRT have been developed over the last years. These include high volume hemofiltration, high adsorption hemofiltration, use of high cut‐off membranes, and hybrid systems like coupled plasma filtration absorbance. One of the most promising concepts may be the development of renal assist devices using renal tubular cells for implementing renal tubular function into CRRT.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Vascular Access for Continuous Renal Replacement Therapy
Authors: Vijayan Anitha
Published: April 2009

A working vascular access is essential for performing continuous renal replacement therapy (CRRT) efficiently and without interruption. Dual‐lumen temporary hemodialysis catheters are the catheters of choice, although tunneled catheters can also be utilized if therapy is expected to be prolonged. Hemodialysis catheters have to be inserted under ultrasound guidance by trained personnel, using aseptic conditions. The right internal jugular vein is the preferred site. Catheter malfunction and catheter‐related infections can be reduced by adhering to preventive guidelines such as ultrasound guidance for placement, strict hand hygiene, gauze dressings, and sterile techniques during catheter handling. Antibiotic or antiseptic‐coated catheters and lock solutions may be beneficial in certain patients, but these are not widely used due to the concern for resistant organisms and allergic reactions.
Aging Adversely Impacts Biological Properties of Human Bone Marrow‐derived Mesenchymal Stem Cells: Implications for Tissue Engineering Heart Valve Construction
Authors: Xin Yuan , Wang Yu‐mei , Zhang Hao , Li Jun , Wang Wei , Wei Ying‐jie , Hu Sheng‐shou
Published: April 2009

Our aim was to study the aging effects on the in vitro biological properties of bone marrow‐derived mesenchymal stem cells (BMSCs) for construction of tissue‐engineered heart valves. BMSCs were taken from teenagers with congenital heart diseases, and middle‐aged and elderly patients with valvular diseases. Proliferative abilities were compared among the three groups by using colony‐forming unit counting and growth curves (5‐bromo‐2′‐deoxyuridine assay). Cell differentiation, vascular endothelial growth factor (VEGF) release under hypoxic condition, and migratory abilities were compared as well. Colony‐forming units in the teenage group were significantly greater than those in the other two groups (P < 0.05), and significantly higher counts were observed in the middle age group than in the aged group (P < 0.05). Growth curves presented similar trends in which cells' proliferative abilities in the aged group decreased significantly (P < 0.05), while no differences were noted between the two nonaged groups. The differentiation potential to endothelial cells, osteoblasts and adipocytes, VEGF releases, and migratory abilities differed significantly between the aged group and nonaged groups (P < 0.05). However, no differences were noted between the two nonaged groups. BMSCs from older patients with heart valve diseases could be harvested and expanded successfully, and the phenotype and morphology were uniform as nonaged groups. However, the proliferative and differentiation properties of aged cells, as well as cytokine release and migratory abilities, are significantly impaired.
Ethanol Teratogenesis in Five Inbred Strains of Mice
Authors: Downing Chris , Balderrama‐Durbin Christina , Broncucia Hali , Gilliam David , Johnson Thomas E.
Published: April 2009

Background: Previous studies have demonstrated individual differences in susceptibility to the detrimental effects of prenatal ethanol exposure. Many factors, including genetic differences, have been shown to play a role in susceptibility and resistance, but few studies have investigated the range of genetic variation in rodent models.

Methods: We examined ethanol teratogenesis in 5 inbred strains of mice: C57BL/6J (B6), Inbred Short‐Sleep, C3H/Ibg, A/Ibg, and 129S6/SvEvTac (129). Pregnant dams were intubated with either 5.8 g/kg ethanol (E) or an isocaloric amount of maltose–dextrin (MD) on day 9 of pregnancy. Dams were sacrificed on day 18 and fetuses were weighed, sexed, and examined for gross morphological malformations. Every other fetus within a litter was then either placed in Bouin’s fixative for subsequent soft‐tissue analyses or eviscerated and placed in ethanol for subsequent skeletal analyses.

Results: B6 mice exposed to ethanol in utero had fetal weight deficits and digit, kidney, brain ventricle, and vertebral malformations. In contrast, 129 mice showed no teratogenesis. The remaining strains showed varying degrees of teratogenesis.

Conclusions: Differences among inbred strains demonstrate genetic variation in the teratogenic effects of ethanol. Identifying susceptible and resistant strains allows future studies to elucidate the genetic architecture underlying prenatal alcohol phenotypes.
Altered White Matter Integrity in Adolescent Binge Drinkers
Authors: McQueeny Tim , Schweinsburg Brian C. , Schweinsburg Alecia D. , Jacobus Joanna , Bava Sunita , Frank Lawrence R. , Tapert Susan F.
Published: April 2009

Background:  White matter integrity has been found to be compromised in adult alcoholics, but it is unclear when in the course of alcohol exposure white matter abnormalities become apparent. This study assessed microstructural white matter integrity among adolescent binge drinkers with no history of an alcohol use disorder.

Methods:  We used diffusion tensor imaging to examine fractional anisotropy (FA), a measure of directional coherence of white matter tracts, among teens with (n = 14) and without (n = 14) histories of binge drinking but no history of alcohol use disorder, matched on age, gender, and education.

Results:  Binge drinkers had lower FA than controls in 18 white matter areas (clusters ≥27 contiguous voxels, each with p < 0.01) throughout the brain, including the corpus callosum, superior longitudinal fasciculus, corona radiata, internal and external capsules, and commissural, limbic, brainstem, and cortical projection fibers, while exhibiting no areas of higher FA. Among binge drinkers, lower FA in 6 of these regions was linked to significantly greater lifetime hangover symptoms and/or higher estimated peak blood alcohol concentrations.

Conclusions:  Binge drinking adolescents demonstrated widespread reductions of FA in major white matter pathways. Although preliminary, these results could indicate that infrequent exposure to large doses of alcohol during youth may compromise white matter fiber coherence.
Understanding and Treating Patients With Alcoholic Cirrhosis: An Update
Authors: Addolorato Giovanni , Russell Marcia , Albano Emanuele , Haber Paul S. , Wands Jack R. , Leggio Lorenzo
Published: April 2009

Alcoholic cirrhosis represents the terminal stage of alcoholic liver disease (ALD) and one of the main causes of death among alcohol abusers. The aim of this review was to provide an update on alcoholic cirrhosis, with an emphasis on recent findings. Increased alcohol consumption in developing countries is expected to increase cirrhosis mortality. There is a need, therefore, to develop new approaches to the prevention of ALD, including more attention to co‐factors that may increase risk of ALD (i.e., obesity and diabetes, chronic HCV infection, and smoking). Furthermore, a better understanding of the pathological mechanisms on the basis of alcohol cirrhosis represents a cornerstone in order to develop new pharmacological treatments. Inflammatory and immune responses along with oxidative stress and alterations in adipokine secretion might contribute in different ways to the evolution of alcohol‐induced fibrosis/cirrhosis. As of this date, patients with severe alcoholic hepatitis with a Maddrey Discriminant Factor (MDF) 32 should be offered pentoxifylline and/or corticosteroids unless contraindications exist. For ambulatory patients, S‐adenosylmethionine (SAMe) may be considered in a motivated patient with nutritional support. Current studies do not support use of anti‐tumor necrosis factor (TNF)‐alpha antibody. Finally, achieving total alcohol abstinence should represent the main aim in the management of patients affected by any stage of cirrhosis. In the last decades, several drugs able to increase abstinence and prevent alcohol relapse have been evaluated and some of them have obtained approval for alcohol dependence. Patients with alcoholic cirrhosis; however, are usually excluded from such treatments. A recent study demonstrated the efficacy and safety of baclofen in inducing and maintaining alcohol abstinence in cirrhotic alcohol‐dependent patients with cirrhosis. All together the information available suggests the need of a multimodal approach in the clinical management of these patients.
Clinical Interview Assessment of Financial Capacity in Older Adults with Mild Cognitive Impairment and Alzheimer's Disease
Authors: Marson Daniel C. , Martin Roy C. , Wadley Virginia , Griffith H. Randall , Snyder Scott , Goode Patricia S. , Kinney F. Cleveland , Nicholas Anthony P. , Steele Terri , Anderson Britt , Zamrini Edward , Raman Rema , Bartolucci Alfred , Harrell Lindy E.
Published: April 2009

OBJECTIVES: To investigate financial capacity in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) using a clinician interview approach.

DESIGN: Cross‐sectional.

SETTING: Tertiary care medical center.

PARTICIPANTS: Healthy older adults (n=75) and patients with amnestic MCI (n=58), mild AD (n=97), and moderate AD (n=31).

MEASUREMENTS: The investigators and five study physicians developed a conceptually based, semistructured clinical interview for evaluating seven core financial domains and overall financial capacity (Semi‐Structured Clinical Interview for Financial Capacity; SCIFC). For each participant, a physician made capacity judgments (capable, marginally capable, or incapable) for each financial domain and for overall capacity.

RESULTS: Study physicians made more than 11,000 capacity judgments across the study sample (N=261). Very good interrater agreement was obtained for the SCIFC judgments. Increasing proportions of marginal and incapable judgment ratings were associated with increasing disease severity across the four study groups. For overall financial capacity, 95% of physician judgments for older controls were rated as capable, compared with 82% for patients with MCI, 26% for patients with mild AD, and 4% for patients with moderate AD.

CONCLUSION: Physicians and other clinicians can reliably evaluate financial capacity in cognitively impaired older adults using a relatively brief, semistructured clinical interview. Patients with MCI have mild impairment in financial capacity, those with mild AD have emerging global impairment, and those with moderate AD have advanced global impairment. Patients with MCI and their families should proactively engage in financial and legal planning, given these patients' risk of developing AD and accelerated loss of financial abilities.
Pain and Disability in Older Mexican‐American Adults
Authors: Weaver Gayle D. , Kuo Yong‐Fang , Raji Mukaila A. , Al Snih Soham , Ray Laura , Torres Elizabeth , Ottenbacher Kenneth J.
Published: April 2009

OBJECTIVES: To examine an association between pain severity and functional disability in older Mexican Americans.

DESIGN: Cross‐sectional study (2005/06), a subsample of the Hispanic Established Population for Epidemiologic Study of the Elderly.

SETTING: Community.

PARTICIPANTS: One thousand thirteen Mexican American aged 74 to 100.

MEASUREMENTS: Bilingual interviewers administered structured questionnaires and assessed physical measures of mobility and frailty (exhaustion, weight loss, walking speed, grip strength, and self‐reported physical activity). Two items from the SF‐36 questionnaire assessed pain experiences in the previous 4 weeks.

RESULTS: Chi‐square one‐way analysis of variance and least square and negative binomial regressions were computed for 744 participants with complete data to investigate experience of pain and other dimensions of health and functioning. Close to two‐thirds (64.7%) reported pain within 4 weeks of the interview, and 49.7% reported that pain interfered with performance of daily activities. Female sex; low education; frailty; reduced mobility; disability; and high comorbidity, body mass index, and depressive symptomatology were significantly associated with pain severity and interference. Regression coefficients revealed that pain severity was significantly related to disability in activities of daily living (0.22, P<.001) and instrumental activities of daily living (0.23, P<.01) after controlling for sociodemographic and health status characteristics.

CONCLUSION: The findings expand the pain literature on older Mexican Americans. High pain rates were most prevalent in women and subjects with high comorbidity, high depressive symptomatology, poor mobility, and frailty. Pain also plays a significant role in disability status. In‐depth research is needed to understand the pain experiences of older Mexican Americans and their effect on health and well‐being.
Comparison of the Load at Fracture of Turkom‐Cera to Procera AllCeram and In‐Ceram All‐Ceramic Restorations
Authors: AL‐Makramani Bandar M. A. , Razak Abdul A. A. , Abu‐Hassan Mohamed I.
Published: April 2009

Purpose: This study investigated the occlusal fracture resistance of Turkom‐Cera‐fused alumina compared to Procera AllCeram and In‐Ceram all‐ceramic restorations.

Materials and Methods: Six master dies were duplicated from the prepared maxillary first premolar tooth using nonprecious metal alloy (Wiron 99). Ten copings of 0.6 mm thickness were fabricated from each type of ceramic, for a total of thirty copings. Two master dies were used for each group, and each of them was used to lute five copings. All groups were cemented with resin luting cement Panavia F according to manufacturer's instructions and received a static load of 5 kg during cementation. After 24 hours of distilled water storage at 37°C, the copings were vertically compressed using a universal testing machine at a crosshead speed of 1 mm/min.

Results: The results of the present study showed the following mean loads at fracture: Turkom‐Cera (2184 ± 164 N), In‐Ceram (2042 ± 200 N), and Procera AllCeram (1954 ± 211 N). ANOVA and Scheffe's post hoc test showed that the mean load at fracture of Turkom‐Cera was significantly different from Procera AllCeram (p < 0.05). Scheffe's post hoc test showed no significant difference between the mean load at fracture of Turkom‐Cera and In‐Ceram or between the mean load at fracture of In‐Ceram and Procera AllCeram.

Conclusion: Because Turkom‐Cera demonstrated equal to or higher loads at fracture than currently accepted all‐ceramic materials, it would seem to be acceptable for fabrication of anterior and posterior ceramic crowns.
Strength of Denture Base Resins Repaired with Auto‐ and Visible Light‐Polymerized Materials
Authors: Faot Fernanda , Da Silva Wander Jose , Da Rosa Rosena Santos , Del Bel Cury Altair A. , Garcia Renata Cunha Matheus Rodrigues
Published: April 2009

Purpose: Clinicians are still confused about the choice of repair method, which depends on factors such as the length of time required for processing, the mechanical strength of the repaired material, and the effect of stress concentration in the acrylic resins before the repair. The aim was to determine the impact and flexural strength characteristics, such as stress at yield, Young's modulus, and displacement at yield of denture base resins fractured and repaired by three methods using heat‐, auto‐, and visible light‐polymerized acrylic resins.

Material and Methods: For impact and flexural strength tests, 18 rectangular specimens measuring 50 × 6 × 4 mm3 and 64 × 10 × 3.3 mm3, respectively, were processed using Impact 2000, Lucitone 550, Impact 1500, and QC‐20 acrylic resins. Fracture tests were performed according to ISO1567:1999. Afterward, all fractured specimens were stored in distilled water at 37°C for 7 days, and then repaired with (1) the same acrylic resin used for specimen fabrication (n = 6), (2) an autopolymerized acrylic resin (TruRepair, n = 6), and (3) a visible light acrylic resin (Versyo.com, n = 6). The repaired specimens were again submitted to the same fracture tests, and the failures were classified as adhesive or cohesive. Data from all mechanical tests after repair by the different methods were submitted to two‐way ANOVA, and mean values were compared by the Tukey test.

Results: All acrylic resins showed adhesive fractures after impact and flexural strength tests. Differences (p < 0.05) were found among repair methods for all acrylic resins studied, with the exception of displacement at yield, which showed similar values for repairs with auto‐ and visible light‐polymerized acrylic resins. The highest values for impact strength, stress, and displacement at yield were obtained when the repair was made with the same resin the specimen was made of.

Conclusion: Denture base acrylic resins repaired with the same resin they were made of showed greater fracture strength.
Extracellular DNA in cord blood plasma and applications in cord blood banking for sample identification
Authors: Albano Maria S. , Scaradavou Andromachi , Stevens Cladd E. , Rubinstein Pablo
Published: April 2009

BACKGROUND: Human cord blood (CB) units donated for transplantation require testing for various markers in blood and plasma aliquots. Although the identity link between the CB unit and the labeled aliquots with the same identifiers can be confirmed by HLA‐DNA assays, these methods have not been used for CB plasma. We have previously reported that viral DNA sequences are present in the CB plasma of carrier babies and now hypothesize that human genomic DNA may also be present in CB plasma.

STUDY DESIGN AND METHODS: The aim of the study was to determine whether human genomic DNA is also present in CB plasma in quality and quantity able to support human genetic identification by short tandem repeat analysis (STR).

RESULTS: The presence of extracellular DNA (EC‐DNA) in CB and adult peripheral blood plasma was confirmed by HLA‐DR polymerase chain reaction (PCR) and real‐time PCR of Alu (SB2) genes. High concentrations were seen in CB plasma (0.131 ng/µL vs. adult 0.005 ng/µL; p < 0.001). EC‐DNA increased over time while CB was stored at room temperature; this increase was associated with decreasing cell viability. STR‐PCR of EC‐DNA showed good signal strength and accurate allele calling so that linkage between the infant donor, the collected CB unit, and CB plasma aliquots could be established.

CONCLUSION: This study demonstrates that infant‐derived EC‐DNA is present in CB plasma and provides a useful tool for the unambiguous confirmation of plasma aliquot identity, as routinely used in CB banking, by the use of a sensitive and highly accurate DNA assay.
A novel mouse model of red blood cell storage and posttransfusion in vivo survival
Authors: Gilson Christopher R. , Kraus Teresa S. , Hod Eldad A. , Hendrickson Jeanne E. , Spitalnik Steven L. , Hillyer Christopher D. , Shaz Beth H. , Zimring James C.
Published: April 2009

BACKGROUND: Storage of red blood cells (RBCs) is necessary for an adequate blood supply. However, reports have identified potential negative sequelae of transfusing stored RBCs. An animal model would be useful to investigate the pathophysiology of transfusing stored RBCs. However, it has been reported that storage of rat RBCs in CPDA‐1 resulted in an unexpected sudden decline in posttransfusion survival. A mouse model of RBC storage and transfusion was developed to assess survival kinetics of mouse RBCs.

STUDY DESIGN AND METHODS: RBCs expressing green fluorescent protein were collected in CPDA‐1, filter leukoreduced, adjusted to a 75% hematocrit, and stored at 4°C. At weekly intervals, stored RBCs were transfused into C57BL/6 recipients. RBC survival was measured by flow cytometry and chromium‐51 labeling. Phosphatidylserine externalization and CD47 expression was also evaluated.

RESULTS: Mean 24‐hour survivals of transfused RBCs were 99, 91, 64, 54, 30, and 18% after 0, 7, 14, 21, 28, and 35 days of storage, respectively. Stored RBCs showed an initial rapid clearance with subsequent extended survival. Increased surface phosphatidylserine and decreased CD47 expression were also observed.

CONCLUSIONS: Mouse RBCs showed a progressive decline in survival, as a function of storage time, unlike the precipitous loss of viability reported for rat RBCs. Moreover, changes in the measured surface markers were analogous to trends reported for human RBCs. Together, these findings provide an initial characterization of a novel mouse model of RBC storage with the potential to serve as an experimental platform for studying the pathophysiologic consequences of transfusing stored RBCs.
One‐year experience of nucleic acid technology testing for human immunodeficiency virus Type 1, hepatitis C virus, and hepatitis B virus in Thai blood donations
Authors: Phikulsod Soisaang , Oota Sineenart , Tirawatnapong Thaweesak , Sakuldamrongpanich Tasanee , Chalermchan Wilai , Louisirirotchanakul Suda , Tanprasert Srivilai , Chongkolwatana Viroje , Kitpoka Pimpun , Phanuphak Praphan , Wasi Chantapong , Nuchprayoon Chaivej ,   the Working Group for NAT Study in Thai Blood Donations
Published: April 2009

BACKGROUND: Blood donations collected at the National Blood Center, the Thai Red Cross Society, Bangkok, in 2007 were tested by nucleic acid amplification technology (NAT) using the Chiron TIGRIS/Procleix Ultrio test and the Roche cobas s 201/cobas TaqScreen multiplex (MPX) test.

STUDY DESIGN AND METHODS: The sensitivity, specificity, and robustness were determined by testing 486,676 seronegative blood donations. Samples from each day of collection were divided into two sets; the odd‐numbered samples were tested individually on the TIGRIS and the even‐numbered samples were tested in pools of 6 on the cobas s 201. The status of reactive samples was confirmed by duplicate testing of samples from the plasma bag to calculate the test specificity. Reactive samples were tested on the alternate system and followed up.

RESULTS: The analytical sensitivity of both systems met the 95% limits of detection claimed by the respective package inserts. No cross contamination was seen with either system. Test specificity was 99.93 and 99.90% for the Procleix Ultrio and cobas TaqScreen tests, respectively. The NAT yield rates for human immunodeficiency virus Type 1 (HIV‐1), hepatitis C virus (HCV), and hepatitis B virus (HBV) were 1:97,000, 1:490,000, and 1:2800, respectively. Several occult HBV donors, the majority of whom were detected by both tests, were also identified. The HIV‐1 and HCV window cases were detected with both tests.

CONCLUSION: The performances of the systems and tests indicated that both were acceptable for routine NAT by the National Blood Center, the Thai Red Cross Society. However, the Procleix Ultrio test appeared to be less sensitive than the cobas TaqScreen test for HBV.