bluuebunny/crossref_metadata_2025 huggingface dataset:
Labor Induction Rate Variation in Upstate New York: What Is the Difference?
Authors: Glantz J. Christopher
Published: August 2003

Abstract: Background: Labor induction rates in the United States rose from 9.0 percent in 1989 to 20.5 percent in 2001, but reasons for the increase are poorly defined. A birth database from a region of upstate New York, including 31,352 deliveries from 1998 through 1999, was used to determine the degree of variation of labor induction rates among hospitals and practitioners.

Methods: Total and elective labor induction rates were calculated for 16 hospitals and individual staff, and then evaluated using chi‐square testing and regression.

Results: Using all laboring women as the denominator, the regional labor induction rate was 20.8 percent; of these inductions, 25 percent had no apparent medical indication. Total induction rates and percent of elective inductions that were elective varied significantly among hospitals (10%–39% and 12%–55%, respectively, p < 0.0001) and among practitioners within hospitals (7%–48% and 3%–76%, respectively, p < 0.0001). Hospitals varied in size, risk status, and cesarean section rates, but these factors did not correlate with induction rates.

Conclusions: Labor induction rates are highly variable among and within hospitals. Delivery volume, population risk status, and differences in cesarean section rates did not explain this variation. (BIRTH 30:3 September 2003)
Salvage Therapy after Two or More Prior Helicobacter pylori Treatment Failures: the Super Salvage Regimen
Authors: Dore Maria Pina , Marras Lea , Maragkoudakis Emmanouil , Nieddu Salvatore , Manca Alessandra , Graham David Y. , Realdi Giuseppe
Published: August 2003

Background. Although effective therapies are available for curing Helicobacter pylori infection, the problem persists about what to do for patients who fail two or more treatment courses despite a good compliance.

Aim. To test a twice a day midday quadruple therapy as salvage therapy.

Methods. Dyspeptic H. pylori‐infected patients who failed two or more courses of anti‐H. pylori therapy received omeprazole 20 mg, tetracycline 500 mg, metronidazole 500 mg, and bismuth subcitrate caplets 240 mg twice a day (with the midday and evening meals) for 14 days. H. pylori status was evaluated by 13C‐urea breath test and histology 4–6 weeks after therapy. Eradication was defined as no positive test.

Results. Seventy‐one patients were enrolled and 68 completed the full 14 days of therapy (mean age 46 years; 28 men). Thirty‐three patients had failed prior treatment twice, 19 had failed three times, and 16 had failed four or more times.

The cure rates were: intention to treat = 93% (66/71); (95% CI = 84% to 98%), per protocol = 97% (66/68); (95% CI = 89%– 100%). Success was excellent irrespective of diagnosis, age, prior treatment protocols, or smoking status. Moderate side‐effects were experienced by only two patients.

Conclusion. Midday bismuth subcitrate based twice a day quadruple therapy was an excellent salvage therapy. BID midday quadruple regimen should be considered as the therapy of choice.
Characterization of Arginine Transport in Helicobacter pylori
Authors: Mendz George L. , Burns Brendan P.
Published: August 2003

Background. The amino acid L‐arginine is an essential requirement for growth of Helicobacter pylori. Several physiological roles of this amino acid have been identified in the bacterium, but very little is known about the transport of L‐arginine and of other amino acids into H. pylori.

Methods. Radioactive tracer techniques using L‐(U‐14C) arginine and the centrifugation through oil method were employed to measure the kinetic parameters, temperature dependence, substrate specificity, and effects of analogues and inhibitors on L‐arginine transport.

Results. The transport of arginine at millimolar concentrations was saturable with a Km of 2.4 ± 0.3 mM and Vmax of 1.3 ± 0.2 pmole min−1 (µl cell water)−1 or 31 ± 3 nmole per minute (mg protein)−1 at 20°C, depended on temperature between 4 and 40°C, and was susceptible to inhibitors. These characteristics suggested the presence of one or more arginine carriers. The substrate specificity of the transport system was studied by measuring the effects of L‐arginine analogues and amino acids on the rates of transport of L‐arginine. The absence of inhibition in competition experiments with L‐lysine and L‐ornithine indicated that the transport system was not of the Lysine‐Arginine‐Ornithine or Arginine‐Ornithine types. The presence of different monovalent cations did not affect the transport rates. Several properties of L‐arginine transport were elucidated by investigating the effects of potential inhibitors.

Conclusions. The results provided evidence that the transport of L‐arginine into H. pylori cells was carrier‐mediated transport with the driving force supplied by the chemical gradient of the amino acid.
Treatment of Helicobacter Pylori Infection Using a Novel Antiadhesion Compound (3′sialyllactose sodium salt). A Double blind, Placebo‐Controlled Clinical Study
Authors: Parente F. , Cucino C. , Anderloni A. , Grandinetti G. , Porro G. Bianchi
Published: August 2003

Background and Aim. 3′ sialyllactose sodium salt (3′SL) is an oligosaccharide that occurs naturally in human and bovine milk. It can inhibit the adhesion of H. pylori to human epithelial cells in vitro. The aim of this study was to test whether this oligosaccharide can suppress or cure H. pylori colonization in vivo and to determine its safety in humans.

Methods. Seventy‐one consecutive dyspeptic patients with H. pylori infection documented by histology and 13C‐Urea Breath Test (UBT) were initially recruited to this study. Patients with UBT values < 15 were excluded, thus reducing the enrolment to 65 patients. They were given two different dosages of 3′SL (10 g or 20 g/day) in three daily administrations before meals or placebo for 4 weeks, according to a randomised double‐blind protocol. A standardized 13C‐UBT (using 100 mg of 13C labelled urea) was repeated in all patients at fixed intervals during treatment (at the end of weeks 1, 2 and 4) and 4 weeks after treatment withdrawal. Patients compliance and side‐effects were evaluated at each weekly visit.

Results. Five patients were excluded from the PP analysis due to violation of the protocol (noncompliance, lost to follow‐up), whereas 61 patients completed correctly the study: 17 received 3′SL 10 g/day, 22 were treated with 3′SL 20 g/day and 21 were given placebo. The three treatment groups did not significantly differ in demographic or clinical patient characteristics. No serious adverse events were observed during therapy in any of the three groups. No patients became UBT negative (< 4) during or after treatment but UBT values decreased significantly during the study period in both treatment groups and placebo.

Conclusions. Antiadhesive therapy was safe and well tolerated but did not suppress or cure H. pylori colonization in humans. The observed decrease in UBT values could be explained by a regression towards the mean effect.
Surface localized Heat Shock Protein 20 (HslV) of Helicobacter pylori
Authors: Du Rui Juan , Ho Bow
Published: August 2003

Background. Heat Shock Protein (HSP) has been regarded as a pathogenic factor in Helicobacter pylori infection. Heat Shock Protein 20 (HSP20) of H. pylori is identified as Hs1V based on open reading frame predication of genome sequences. It is a homologue of HslV of E. coli, a peptidase involved in protein degradation.

Methods. The HSP20 gene was cloned and inserted into pET16b fused with His‐tag. Recombinant HSP20 protein (rHSP20) was expressed and purified by nickel column. Rabbit anti‐rHSP20 was purified by Protein A affinity chromatography and used as a probe to localize HSP20 in H. pylori by immuno‐gold labeling and Western blotting. rHSP20 was also used as antigen to test for antibody against HSP20 in patients with H. pylori infection by enzyme‐linked immunosorbant assay.

Results. Immuno‐gold labeled transmission electron microscopy shows that HSP20 is located on the cell surface of H. pylori. Western blotting of 2‐D gel shows that HSP20 has a pI of ∼5.5 and a molecular weight of ∼18 kDa. The ELISA result shows that there is no significant difference in antibody titre against rHSP20 in all sera tested.

Conclusion. The presence of IgG to rHSP20 may imply an earlier exposure of the patients and normal subjects to H. pylori. However, the mechanism has not been established. HSP20 has been shown to localize on the surface of H. pylori. Surface localization of H. pylori HSP20 may provide the path to a better understanding of the role and function of HSP20 in bacteria–host interaction.
A Coordinated Cytotoxic Effect of IFN‐γ and Cross‐Reactive Antibodies in the Pathogenesis of Helicobacter pylori Gastritis
Authors: Itoh Toshiyuki , Yoshida Masaru , Chiba Tsutomu , Kita Toru , Wakatsuki Yoshio
Published: August 2003

Background. Helicobacter pylori (H. pylori) infection is associated with chronic infiltration into the stomach by T cells and plasma cells producing IFN‐γ and antibodies of various specificities, respectively. It is unknown whether these lymphocyte‐products may play coordinated roles in the gastric pathology of this infection.

Aims. To know how IFN‐γ may relate to anti‐H. pylori antibodies in their roles in pathogenesis, we determined the isotype subclass of those antibodies as well as their cross‐reactivity and cytotoxicity to gastric epithelium.

Methods and Results. We infected BALB/c mice with H. pylori (SS1, Sydney Strain 1) and generated monoclonal antibodies, which were comprised of 240 independent clones secreting immunoglobulin and included 80 clones reactive to SS1. Ninety percent of the SS1‐reactive clones had IgG2a isotype. Two clones, 2B10 and 1A9, were cross reactive to cell surface antigens in H. pylori and to antigens of 28 KDa and 42 KDa, respectively, which were present on the cell surface of and shared by both mouse and human gastric epithelial cells. The antigens recognized by these monoclonal antibodies localized a distinctive area in the gastric glands. In the presence of complement, 2B10 showed cytotoxicity to gastric epithelial cells. The effect was dose dependant and augmented by IFN‐γ. Finally, administration of 2B10 to mice with SS1 infection aggravated gastritis by increasing cellular infiltration.

Conclusion. IFN‐γ by gastric T cells may participate in pathogenesis of the H. pylori infected stomach by directing an isotype‐switch of anti‐H. pylori antibodies to complement‐binding subclass and by augmenting cytotoxic activity of a certain autoantibody. This may explain a host‐dependent diversity in gastric pathology of the patients with H. pylori infection.
Active and Inactive Gastroesophageal Reflux Diseases Related to Helicobacter pylori Therapy
Authors: Nakajima Shigemi , Hattori Takanori
Published: August 2003

We systematically reviewed the literature on gastroesophageal reflux disease (GERD) related to Helicobacter pylori therapy, and classified the GERD according to various aspects. Preexisting GERD is active GERD before H. pylori therapy, and a substantial proportion of the GERD patients improve after successful H. pylori therapy. If the GERD does not persist or recur after cessation of acid‐suppressive therapy combined with H. pylori therapy, it may have been cured (cured GERD). If it recurs, it may have been masked by acid‐suppressive therapy and unmasked with cessation of the therapy (pharmacologically masked and unmasked GERD). Newly developed GERD after successful H. pylori therapy is a kind of unmasked GERD arising after cure of infection (de novo unmasked GERD). The possible mechanism of the improvement of cured GERD is normalized hyperacidity associated with an improved cytokine‐somatostatin‐gastrin system followed by normalized G‐cell activity and parietal cell mass. Preexisting GERD is not a reason to avoid eradication therapy. De novo unmasked GERD develops in a substantial proportion of patients with cured infection. The possible mechanism is increased acid exposure in the esophagus due to gastric acid increase, which is caused by a loss of neutralizing effect by ammonia, normalized cytokine‐acid suppression and improvement of corpus atrophy. De novo unmasked GERD is important because GERD is recurrent and may induce adenocarcinoma of the esophagus. However, it is expected that cure of infection lowers gastric cancer incidence. Eradication therapy is recommended irrespective of the possibility that de novo unmasked GERD may have a slight increase of the risk of esophageal adenocarcinoma.
Gastric Juice, Gastric Tissue and Blood Antibiotic Concentrations Following Omeprazole, Amoxicillin and Clarithromycin Triple Therapy
Authors: Nakamura Masahiko , Spiller Robin C. , Barrett David A. , Wibawa Judata I. D. , Kumagai Naoki , Tsuchimoto Kanji , Tanaka Takeshi
Published: August 2003

Background. Amoxicillin and clarithromycin are key antibiotics in proton pump inhibitor‐based Helicobacter pylori eradication therapies.

Aims. To study gastric mucus and tissue concentrations and collect basic data about optimal antibacterial doses.

Methods. Plasma, gastric mucosa and gastric juice antibiotic concentrations were measured following either low‐ or high‐dose amoxicillin (750 or 1000 mg bid) and clarithromycin (400 or 500 mg bid) given in combination with omeprazole 20 mg bid to 12 male volunteers in an open crossover design. Gastric juice and mucosal biopsy collection was performed either 2 (n = 6) or 6 hours (n = 6) after dosing.

Results. Amoxicillin concentrations 2 hours after high dosage were gastric juice > gastric body > antral mucosa > plasma. At 6 hours, plasma and gastric juice concentrations were still above the MIC for amoxicillin‐susceptible bacteria but no antibiotic was detectable in mucosa samples. Clarithromycin concentrations after high dosage were gastric juice > mucosa > serum; all above the MIC for clarithromycin‐susceptible bacteria at both 2 and 6 hours.

Conclusions. Both dosage regimens provided effective antibiotic concentrations in gastric juice at 2 hours. After dosing, both antibiotics demonstrated high gastric tissue concentrations via local diffusion while clarithromycin also provided sustained delivery (6 hours) via gastric mucosa penetration.
Intragastric Ascorbic But Not Uric Acid is Depleted in Relation with the Increased pH in Patients with Atrophic Body Gastritis and H. Pylori Gastritis
Authors: Capurso Gabriele , Ricci Riccardo , Panzuto Francesco , Baccini Flavia , Passi Siro , Di Giulio Emilio , Fave Gianfranco Delle , Annibale Bruno
Published: August 2003

Background. Helicobacter pylori gastritis induces reversible lowering of Ascorbic Acid (AA) intragastric concentrations. No studies have been aimed at determining the gastric juice AA concentration of atrophic body gastritis (ABG) patients. Uric Acid (UA), is another potent hydro‐soluble scavenger of ROS and its possible modification in the gastric juice of patients with H. pylori gastritis have never been investigated. This study was aimed at investigating the levels of AA and UA in the plasma and gastric juice of ABG patients, compared with H. pylori positive patients without corporal atrophy, and with healthy individuals.

Materials and Methods. Thirteen ABG patients (Group 1): 32 Chronic non‐atrophic H. pylori gastritis patients (Group 2); and 13 healthy stomach controls (Group 3) attending gastroscopy with gastric biopsies (antrum = 3, corpus = 3) had plasma and intragastric levels of AA and UA measured.

Results. Intragastric AA concentration was significantly lower in group 1 (median 0.21 µg/ml, range 0.1–24) compared both with groups 2 (median 5.5 µg/ml, range 0.1–33.2) (p = 0.043) and 3 (median 14.9 µg/ml, range 0.34–44.8) (p = 0.0028). Intragastric UA was not different between the three groups. Intragastric AA concentration resulted negatively correlated with the intragastric pH (Spearman r = −0.47, p = 0.0003). In patients with gastritis (groups 1 and 2) there was a significant negative correlation between the sum of the Sydney Score variables in the body mucosa, and AA in the gastric juice (Spearman r = −0.55; p = 0.0001).

Conclusion. The study shows that intragastric pH is the key factor for the depletion of gastric juice AA observed in patients with corporal atrophy and to a lower extent with nonatrophic H. pylori gastritis.
A Prospective, Randomized Study of Quadruple Therapy and High‐Dose Dual Therapy for Treatment of Helicobacter Pylori Resistant to Both Metronidazole and Clarithromycin
Authors: Miehlke Stephan , Kirsch Christian , Schneider‐Brachert Wulf , Haferland Christian , Neumeyer Michael , Bästlein Elke , Papke Jens , Jacobs Enno , Vieth Michael , Stolte Manfred , Lehn Norbert , Ekkehard Bayerdörffer
Published: August 2003

Background and Aim. Failure of primary anti‐H. pylori therapy results in a high rate of antimicrobial resistance. Here, we investigated the efficacy of high‐dose dual therapy and quadruple therapy as salvage treatments for eradication of H. pylori resistant to both metronidazole and clarithromycin.

Patients and Methods. Patients with at least one treatment failure and infected with H. pylori resistant to both metronidazole and clarithromycin, were randomized to receive either omeprazole 4 × 40 mg and amoxicillin 4 × 750 mg; or omeprazole 2 × 20 mg, bismuthcitrate 4 × 107 mg, metronidazole 4 × 500 mg and tetracycline 4 × 500 mg. Both regimens were given for 14 days. In cases of persistent infection, a cross‐over therapy was performed.

Results. Eighty‐four patients were randomized. Cure of H. pylori infection was achieved in 31 patients after dual therapy and in 35 patients after quadruple therapy (per protocol: 83.8% (95% CI, 67.9–93.8) and 92.1% (95% CI, 78.6–98.3), respectively (p = 0.71); intention to treat: 75.6% (95% CI: 59.7–87.6) and 81.4% (95% CI: 66.6–91.6), respectively (p = 0.60)). Cross‐over therapy was performed in six of nine patients, four of whom were cured of the infection.

Conclusion. Both high‐dose dual therapy and quadruple therapy are effective in curing H. pylori infection resistant to both metronidazole and clarithromycin in patients who experienced previous treatment failures.
Case Report of the First Severe Acute Respiratory Syndrome Patient in China: Successful Application of Extracorporeal Liver Support MARS Therapy in Multiorgan Failure Possibly Induced by Severe Acute Respiratory Syndrome
Authors: Luo Hong‐Tao , Wu Min , Wang Min‐Min
Published: August 2003

Abstract: A previously healthy patient was transferred to our infectious department with a 9‐day‐history of continued fever. The patient was placed on assisted respiration support in addition to anti‐viral medication. The diagnosis of SARS (Severe Acute Respiratory Syndrome) was made in view of the severe hypoxemia and the characteristic symptoms exhibited by the patient. Despite the best intensive therapy, he clinically deteriorated into multiorgan dysfunction syndrome (MODS) including additional dysfunction of kidney, liver, and heart. We initiated MARS therapy (extracorporeal liver support utilizing albumin dialysis) with intention to positively influence the organ functions in his MODS on the basis of recently published studies which suggested a positive impact of MARS in multiorgan failure secondary to respiratory illnesses and the possible influence on inflammatory mediators and cytokines. The application of 4 intermittent MARS treatments (8 h each, mean blood flow rate 180 ml/min) on 4 consecutive days resulted in an immediate improvement of clinical conditions within the treatment days. The further improvement of organ functions allowed withdrawing the patient from ventilatory support 13 days after start of MARS, and 44 days after admission he was discharged home with completely resolved organ functions and laboratory abnormalities. SARS is a severe form of the epidemic outbreak of atypical pneumonia which remains poorly defined regarding etiology and special therapy recommendations. However, the development and aggravation of this ARDS‐like severe acute respiratory syndrome is pathologically associated with the systemic inflammatory response syndrome (SIRS) which may then mediate or cause MODS. To our knowledge, this is the first report of an application of MARS therapy in MODS which was probably induced by SARS in a patient in China which improved the clinical condition of the patient in multi‐organ failure secondary to respiratory failure indicating that MARS might be an additional therapeutic option in multiorgan failure induced by SARS.
NTS Neuronal Response to Conversion from Pulsatile to Nonpulsatile Pressure in Isolated Carotid Sinus Baroreceptors
Authors: Tanaka Keizo , Yada Isao
Published: August 2003

Abstract: The purpose of this study was to demonstrate the effect of pulsatile pressure (PP) and nonpulsatile pressure (NP) on the carotid sinus baroreceptors and baroreceptor‐related neurons in the nucleus tractus solitarius (NTS), using an isolated carotid sinus preparation in anesthetized rats. The baroreceptor activities were recorded from the carotid sinus nerves (CSN). Fifteen baroreceptor‐related NTS neurons were recorded extracellularly. Conversion of PP to NP corresponded to a shift from phasic to irregular activity in the CSN and caused an increase in CSN activity at a mean pressure of 100 mm Hg. Under this condition, however, the discharge rate of baroreceptor‐related NTS neurons was decreased and the systemic blood pressure was elevated. These results indicate that the increasing baroreceptor afferent input resulting from depulsation was not faithfully transmitted in the NTS, and suggest that the NTS is an important site for modifying the arterial baroreflex under NP.
Magnesium Homeostasis in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Role of the Dialysate Magnesium Concentration
Authors: Katopodis Kostas P. , Koliousi Elli L. , Andrikos Emilios K. , Pappas Michael V. , Elisaf Moses S. , Siamopoulos Kostas C.
Published: August 2003

Abstract: We carried out this retrospective study to examine the magnesium status of our chronic ambulat‐ ory peritoneal dialysis (CAPD) patients dialyzed with 0.75 mmol/L (group I) or 0.50 mmol/L (group II) magnesium peritoneal dialysis solution. A total of 34 anuric patients on CAPD (age: 31–72 years; duration of CAPD: 7–74 months) were studied. None of them received magnesium‐containing phosphate binders or vitamin D. Biochemical parameters including magnesium, calcium, phosphate, parathormone, and albumin were measured in all patients. The corrected for hypoalbuminemia serum magnesium concentration in group I was significantly higher compared to that found in group II. However, there were no significant differences in the other measured parameters between the two groups of CAPD patients, though iPTH levels were somewhat increased in group II patients. Serum magnesium levels were weakly correlated with serum prealbumin levels in both groups of CAPD patients (r=0.16, P=0.08 and r=0.17, P=0.07). The incidence of hypermagnesemia was significantly higher in group I patients versus those in group II (13/19 68.4%] vs. 2/15 13.3%], P < 0.01). On the other hand, no patient developed hypomagnesemia (corrected total magnesium <0.65 mmol/L), despite the trend toward decreased magnesium levels in group II patients. Our results point out that serum iPTH levels and nutritional parameters, such as prealbumin levels, should be taken into account in the choice of the magnesium concentration of the peritoneal dialysis fluid.
Regurgitant Flow Field Characteristics of the St. Jude Bileaflet Mechanical Heart Valve under Physiologic Pulsatile Flow Using Particle Image Velocimetry
Authors: Manning Keefe B. , Kini Vinayak , Fontaine Arnold A. , Deutsch Steven , Tarbell John M.
Published: August 2003

Abstract: The regurgitant flow fields of clinically used mechanical heart valves have been traditionally studied in vitro using flow visualization, ultrasound techniques, and laser Doppler velocimetry under steady and pulsatile flow. Detailed investigation of the forward and regurgitant flow fields of these valves can elucidate a valve's propensity for blood element damage, thrombus formation, or cavitation. Advances in particle image velocimetry (PIV) have allowed its use in the study of the flow fields of prosthetic valves. Unlike other flow field diagnostic systems, recent work using PIV has been able to relate particular regurgitant flow field characteristics of the Bjork‐Shiley Monostrut valve to a propensity for cavitation. In this study, the regurgitant flow field of the St. Jude Medical bileaflet mechanical heart valve was assessed using PIV under physiologic pulsatile flow conditions. Data collected at selected time points prior to and after valve closure demonstrated the typical regurgitant jet flow patterns associated with the St. Jude valve, and indicated the formation of a strong regurgitant jet, in the B‐datum plane, along with twin vortices near the leaflets. Estimated ensemble‐average viscous shear rates suggested little potential for hemolysis when the hinge jets collided. However, the vortex motion near the occluder tips potentially provides a low‐pressure environment for cavitation.
Use of Near‐Infrared Spectroscopy to Monitor Regional Cerebral Oxygen Saturation during Infrarenal Aortic Crossclamping in Piglets
Authors: Ündar Akif , LeMaire Scott A. , Schmittling Zachary C. , Coselli Joseph S. , Köksoy Cüneyt , Deady Blake A. , Fraser Charles D.
Published: August 2003

Abstract: Purpose: The hemodynamic changes induced by infrarenal aortic crossclamping have been well documented, but the effects of such crossclamping on cerebral perfusion are unknown. To investigate these effects, we used near‐infrared spectroscopy (NIRS) to monitor regional cerebral oxygen saturation (rSO2) during infrarenal aortic crossclamping in a piglet model. Methods: The study involved 19 piglets, each weighing 7.8 ± 1 kg. The NIRS sensor was placed on each animal's forehead. General anesthesia was induced, and the infrarenal abdominal aorta was mobilized through a laparotomy. After heparin (1 mg/kg) was administered, crossclamps were applied proximally and distally. A 2 mm segment was resected from the proximal aortic stump, and an aorto‐aortic anastomosis was performed. Results: Crossclamping lasted for 30.6 ± 6.7 min. Between the time of baseline measurement and clamp application, the rSO2 did not decrease significantly (65.4%± 8.9% vs. 62.4%± 7.8%). However, significant decreases in the rSO2 occurred between baseline measurement and clamp removal (65.4%± 8.9% vs. 55.7%± 8.9%; P < 0.01), between baseline measurement and the end of surgery (65.4%± 8.9% vs. 57.7%± 7.5%; P < 0.01), and between clamp application and removal (62.4%± 7.8% vs. 55.7%± 8.9%; P < 0.01). At these same intervals, no intergroup differences occurred in the temperature, heart rate, or mean arterial pressure. Conclusion: Infrarenal aortic crossclamping significantly decreases the rSO2. NIRS, which has the advantages of being non‐ invasive and continuous, may be useful for monitoring this variable intraoperatively.
Use of Calcimimetics in Uremic Patients with Secondary Hyperparathyroidism: Review
Authors: Ureña Pablo
Published: August 2003

Abstract: Recognition of the role of the extracellular calcium sensing receptor (CaR) in mineral metabolism has greatly improved our understanding of calcium homeostasis. The activation of this receptor by small changes in extracellular ionized calcium (ec(Ca2+)) regulates PTH, calcitonin secretion, urinary calcium excretion, and ultimately, bone turnover. The cloning of this CaR and the discovery of mutations making the receptor less or more sensitive to calcium allowed a better understanding of several hereditary disorders characterized either by hyperparathyroidism or hypoparathyroidism. This CaR became an ideal target for the development of compounds, the calcimimetics, able to amplify the sensitivity of the CaR to ec(Ca2+) suppressing PTH levels with a resultant fall in blood Ca2+. The first clinical studies with first‐generation calcimimetic agents have demonstrated their efficacy lowering plasma intact PTH concentration in uremic patients with secondary hyperparathyroidism. However, the low bioavailability of these first calcimimetics predicts a difficult clinical utilization. The second‐generation calcimimetic AMG‐073, with a better pharmacokinetic profile, appears to be effective and safe for the treatment of secondary hyperparathyroidism, producing suppression of PTH levels with a simultaneous reduction in serum phosphorus levels and the calcium X phosphorus product. The advantage of controlling PTH secretion without the complications related to hypercalcemia, hyperphosphatemia, and increased calcium X phosphorus product is very promising.
The Artificial Organ Museum in Cleveland (1979–1999) Moved to Houston, Texas, and Named in 2002 as the ICMT Museum for Artificial Organs
Authors: Nosé Yukihiko
Published: August 2003

Abstract: The artificial organ museum established in Cleveland, Ohio, in 1979 organized by the International Center for Artificial Organs and Transplantation (ICAOT), was moved to Houston, Texas, in 1999. The museum with expanded and renewed artificial organ exhibits was officially opened on the 8th and 9th of November, 2002, at the Cullen Pavilion of the original Memorial Hermann Hospital. This building is the oldest in the Texas Medical Center, which was built in 1922.

The ICMT (International Center for Medical Technologies) Museum for Artificial Organs (Museum) was completed after phase I, II, and III expansions of the exhibit booths, which were made over the last two years. Approximately 250 historically important and currently widely used artificial organs are exhibited in the Museum. The official opening of the Museum was coordinated with the “Symposium on Artificial Organs: Past, Present, and Future” during two days in November. There were approximately 225 participants at these events, and approximately 40 pioneers and clinical experts in the development and practice of various types of artificial organs contributed. During these programs, a proposal to maintain human resources in addition to artificial organ hardware and software was made in addition to the Museum. This new organization would be called the International Academy of Artificial Organ Pioneers (Academy). All contributors to the symposium were invited to be members of the Academy. The attendants of the symposium accepted this proposal unanimously. An additional 40 individuals, who were recognized as contributors to artificial organ technologies, were later added to the original Academy members.

Later, the effective utilization of the Museum and Academy was encompassed in the International Faculty for Health and Medical Technologies (Faculty), a new addition to the activities of the ICMT. Dr. Michael DeBakey was elected as Dean of the Faculty. This is considered a “university without walls,” a “university linked to the world,” and a “university providing simultaneous teaching at multiple sites”—a completely new concept in teaching tools for medical technologies.

All of these subsidiary organizations of the ICMT were legally included as nonprofit, nontaxable charity organizations of the state of Texas.
Overview of Pediatric Renal Replacement Therapy in Acute Renal Failure
Authors: Goldstein Stuart L.
Published: August 2003

Abstract: The disease spectrum leading to pediatric renal replacement therapy (RRT) provision has broadened over the last decade. In the 1980s, intrinsic renal disease and burns constituted the most common pediatric acute renal failure etiologies. More recent data demonstrate that pediatric acute renal failure (ARF) most often results from complications of other systemic diseases, resulting from 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 ARF are sorely lacking. The aims of this article are to review the pediatric specific causes necessitating renal replacement therapy provision, with an emphasis on emerging practice patterns with respect to modality and the timing of treatment, and to focus upon the application of the different renal replacement therapy modalities and assessment of the outcome of children with ARF who receive renal replacement therapy.
Kinetic Comparison of Different Acute Dialysis Therapies
Authors: Liao Zhijie , Zhang Weiming , Hardy Peter A. , Poh Churn K. , Huang Zhongping , Kraus Michael A. , Clark William R. , Gao Dayong
Published: August 2003

Abstract: Recent clinical data indicate both ultrafiltration rate (Qf) and timing of treatment initiation in continuous renal replacement therapy (CRRT) and therapy frequency in intermittent hemodialysis (HD) influence survival in critically ill patients with acute renal failure (ARF). In this study, kinetic modeling is used to compare effective dose delivery by three acute dialysis therapies: continuous venovenous hemofiltration (CVVH), daily HD, and sustained low‐efficiency dialysis (SLED). A modified equivalent renal clearance (EKR) approach to account for the initial unsteady‐state stage during dialysis is employed. Effective small solute clearance in CVVH is found to be 8% and 60% higher than in SLED and daily HD, respectively. Differences are more pronounced for middle and large solute categories, and EKR in CVVH is approximately 2‐fold and 4‐fold greater than the corresponding values in daily HD and SLED, respectively. The superior middle and large solute removal for CVVH is due to the powerful combination of convection and continuous operation. In CVVH, a decrease in the initial BUN from 150 to 50 mg/dL is predicted to decrease TAC and, therefore, increase EKR by approximately 35%. After clinical validation, the quantification method presented in this article could be a useful tool to assist in the dialytic management of critically ill ARF patients.
Higher Renal Replacement Therapy Dose Delivery Influences on Drug Therapy
Authors: Mueller Bruce A. , Pasko Deborah A. , Sowinski Kevin M.
Published: August 2003

Abstract: Higher doses of renal replacement therapy have profound effects on pharmacotherapy, yet little research has been conducted in this area. High‐volume renal replacement therapies influence both the pharmacokinetic and the pharmacodynamic profiles of all drugs administered to these critically ill patients. Intermittent high‐dose “hybrid” hemodialysis therapies remove drugs to a much different degree than standard thrice‐weekly hemodialysis, yet pharmacokinetic studies have not been performed in patients receiving these therapies. High‐volume continuous renal replacement therapies offer dosing challenges not seen with standard low‐dose therapies. This article describes the pharmacokinetic and pharmacodynamic issues presented by high‐volume renal replacement therapies. Given the importance that pharmacotherapy has on optimal patient outcomes, a better understanding of the influence that high‐volume renal replacement therapy has on drugs is essential if these high volume therapies are to be used successfully in the intensive care unit.
Anemia in Acute Renal Failure: Role for Erythropoiesis‐Stimulating Proteins?
Authors: Liangos Orfeas , Pereira Brian J. , Jaber Bertrand L.
Published: August 2003

Abstract: The use of recombinant human erythropoietin (rHuEpo) has revolutionized anemia management of early and late stages of chronic kidney disease. Darbopoietin is also now available for the treatment of anemia of chronic kidney disease. In addition, rHuEpo has been used for the treatment of anemia observed in critical illness. Unfortunately, the existing clinical studies of anemia in critically ill patients do not distinguish between those with and without acute renal failure (ARF). This review summarizes the existing experimental and clinical studies supporting the use of rHuEpo in ARF due to ischemic/nephrotoxic injury and conclusions are drawn on the rationale for further research into the use of this drug in ARF.
Dose Determinants in Continuous Renal Replacement Therapy
Authors: Clark William R. , Turk Joseph E. , Kraus Michael A. , Gao Dayong
Published: August 2003

Abstract: Increasing attention is being paid to quantifying the dose of dialysis prescribed and delivered to critically ill patients with acute renal failure (ARF). Recent trials in both the intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) realms have suggested that a direct relationship between dose and survival exists for both of these therapies. The purpose of this review, first, is to analyze critically the above‐mentioned dose/outcome studies in acute dialysis. Subsequently, the factors influencing dose prescription and delivery are discussed, with the focus on continuous venovenous hemofiltration (CVVH). Specifically, differences between postdilution and predilution CVVH will be highlighted, and the importance of blood flow rate in dose delivery for these therapies will be discussed.
Interpreting the Mechanisms of Continuous Renal Replacement Therapy in Sepsis: The Peak Concentration Hypothesis
Authors: Ronco Claudio , Tetta Ciro , Mariano Filippo , Wratten Mary Lou , Bonello Monica , Bordoni Valeria , Cardona Ximena , Inguaggiato Paola , Pilotto Lidia , D’Intini Vince , Bellomo Rinaldo
Published: August 2003

Abstract: Severe sepsis and septic shock are the primary causes of multiple organ dysfunction syndrome (MODS), which is the most frequent cause of death in intensive care unit patients. Many water‐soluble mediators with pro‐ and anti‐inflammatory action such as TNF, IL‐6, IL‐8, and IL‐10 play a strategic role in septic syndrome. In intensive care medicine, blocking any one mediator has not led to a measurable outcome improvement in patients with sepsis. CRRT is a continuously acting therapy, which removes in a nonselective way pro‐ and anti‐inflammatory mediators; “the peak concentration hypothesis” is the concept of cutting peaks of soluble mediators through continuous hemofiltration. Furthermore, there is evidence of increased efficacy of high‐volume hemofiltration compared to conventional CVVH, and other blood purification techniques that utilize large‐pore membranes or sorbent plasmafiltration are conceptually interesting.
Approach to Intradialytic Hypotension in Intensive Care Unit Patients with Acute Renal Failure
Authors: Doshi Mona , Murray Patrick T.
Published: August 2003

Abstract: The increasing prevalence of acute renal failure (ARF) patients with hemodynamic intolerance of intermittent hemodialysis (HD), generally because of septic vasoparesis or severe cardiac dysfunction, has led to the development of several strategies to improve the delivery of renal replacement therapy (RRT) in ARF patients. Intradialytic hypotension (IDH) is caused by the interaction of dialysis‐dependent and dialysis‐independent factors. Dialysis‐dependent factors include the prescriptions for fluid removal, solute removal, and dialysate components such as sodium, buffer, and calcium. Dialysis‐ independent factors include hemodynamic compromise caused by hypovolemic, cardiogenic, vasodilatory, and mixed mechanisms. We propose an approach to the prevention and management of IDH in critically ill ARF patients, which minimizes hypovolemic, cardiogenic, and vasodilatory insults by optimizing fluid removal, cardiac function, and vascular contractility.
Artificial Organs versus Regenerative Medicine: Is It True?
Authors: Nosé Yukihiko , Okubo Hisashi
Published: August 2003

Abstract: Individuals engaged in the fields of artificial kidney and artificial heart have often mistakenly stated that “the era of artificial organs is over; regenerative medicine is the future.” Contrarily, we do not believe artificial organs and regenerative medicine are different medical technologies. As a matter of fact, artificial organs developed during the last 50 years have been used as a bridge to regeneration. The only difference between regenerative medicine and artificial organs is that artificial organs for the bridge to regeneration promote tissue regeneration in situ, instead of outside the body (for example, vascular prostheses, neuroprostheses, bladder substitutes, skin prostheses, bone prostheses, cartilage prostheses, ligament prostheses, etc.). All of these artificial organs are successful because tissue regeneration over a man‐made prosthesis is established inside the patient's body (artificial organs to support regeneration).

Another usage of the group of artificial organs for the bridge to regeneration is to sustain the functions of the patient's diseased organs during the regeneration process of the body's healthy tissues and/or organs. This particular group includes artificial kidney, hepatic assist, respiratory assist, and circulatory assist. Proof of regeneration of these healthy tissues and/or organs is demonstrated in the short‐term recovery of end‐stage organ failure patients (artificial organs for bridge to regeneration).

A third group of artificial organs for the bridge to regeneration accelerates the regenerating process of the patient's healthy tissues and organs. This group includes neurostimulators, artificial blood (red cells) blood oxygenators, and plasmapheresis devices, including hemodiafiltrators. So‐called “therapeutic artificial organs” fall into this category (artificial organs to accelerate regeneration).

Thus, almost all of today's artificial organs are useful in the bridge to regeneration of healthy natural tissues and organs. It does not matter whether these tissues are cultivated inside or outside the patient's body. Thus, we strongly believe in the need for joint development programs between artificial organ technologies and regenerative medicine technologies. In particular, the importance of using both man‐made substitute organ technologies and natural tissue‐derived substitute organ technologies is stressed for improved medical care in the future.
The influence of code‐oriented versus meaning‐oriented approaches to reading instruction on word recognition in the Spanish language
Authors: Jiménez Juan E. , Guzmán Remedios
Published: August 2003

This study was designed to examine the possible effect of instructional method and grade on the development of the competences used in reading isolated words in a transparent orthography (i.e., Spanish). A cross‐sectional design was used with a sample of 202 children who were learning to read by different instructional methods (code‐oriented vs. meaning‐oriented approaches). The effect of instructional method was analysed on reaction times, latency responses, and misreading on lexical decision and naming tasks. Words varied in frequency, length, and positional frequency of syllables (PFS) and the nonwords varied only in length and PFS. Our prediction was that the differences in reaction times and error performance as a function of the variables that allow us to test the routes—such as lexicality, word frequency, PFS, and word length—would be greater in the individuals who learn by a meaning‐oriented approach, which means that this group would be more affected by unfamiliar and longer words, low PFS, and nonwords in comparison to individuals who learn by a code‐oriented approach. This would support the view that individuals who learn by a meaning‐oriented approach have particular difficulties in naming words under conditions that require extensive phonological computation. Reliable effects of instructional method were found both in reaction times and latency responses and also on misreading in words and nonwords. The findings demonstrate superiority in the sublexical analysis in children who were learning by code‐oriented approaches. However, individuals who were learning by meaning‐oriented approaches had particular difficulties in naming words under conditions that require extensive phonological computation.
Managerial competency modelling and the development of organizational psychology: A Chinese approach
Authors: Wang Zhong‐Ming
Published: August 2003

In recent years, China has undergone rapid economic reform and dynamic organizational changes. Several major developments have given special momentum to those changes: China entering the WTO, opening the western regions of China, building up an information network, transforming new management systems nationwide, and encouraging innovations and entrepreneurship. These developments call for more comprehensive and adaptive competencies and new approaches to organizational psychology in China. This provides a national and cultural context of personnel assessment, selection, and development of organizational psychology. Organizational psychology is one of the most active fields for research and application in psychology in China. Three aspects of recent trends are described under a framework of managerial competency modelling. (1) Leadership competence assessment for personnel selection and development has become one of the key aspects of human resources (HR) management in China. Based upon the results from the structured interview and strategic hierarchical job analysis, a model of leadership competency with four dimensions of leadership characteristics and the managerial performance was proposed. The four dimensions are: psychological traits; leadership predispositions; managerial skills; and professional knowledge. (2) HR competency for person‐job‐organization fit. This includes competencies for compensation and motivational strategies, organizational commitment and career management competence, team competence, and group decision‐making skills. (3) Organizational competency for culture and change. This includes an integrative approach to link values with culture, and cross‐cultural leadership skills. On the basis of the recent practice and research developments, a Chinese approach to organizational psychology with important characteristics is summarized: active theoretical development and conceptualization; continuous methodological improvement; close link with HR and management practices; and systematic cross‐cultural socioeconomic perspective. This becomes a key framework for understanding organizational psychology. New directions for research and application in China are highlighted.
The relation of moral orientation and moral judgment to prosocial and antisocial behaviour of Chinese adolescents
Authors: Ma Hing Keung
Published: August 2003

The present study investigated the relation of moral orientation and moral judgment to prosocial and antisocial behaviour from a first‐person perspective. The major findings support the following four hypotheses. (la) The moral orientation of girls is higher than that of boys, and (1b) boys are more delinquent than girls; (2) the moral orientation of prosocial adolescents is higher than that of delinquent adolescents; (3) the moral judgment of prosocial adolescents is higher than that of delinquent adolescents; and (4) the moral development of prosocial adolescents is higher than that of delinquent adolescents. Few researchers have attempted to investigate how moral orientation and moral judgment relate to prosocial and antisocial behaviour in a single study. The present study fills this research gap. Moreover, the study of moral judgment from a first‐person perspective appears to be a meaningful and useful approach. Future studies should be conducted to investigate whether moral judgment from a first‐person perspective is more predictive of moral behaviour than moral judgment from a third‐person perspective. It would also be meaningful to conduct a cross‐cultural study to investigate the relation of moral orientation and moral judgment to prosocial and antisocial behaviour in different cultures. The use of a self‐report method in a study of prosocial and antisocial behaviour has certain limitations; for example, respondents may not give honest responses. However, this method has been found to be useful and acceptable, especially for researching the correlations among a large number of variables.